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Huang H, Zhang L, Tu L, Zhang X, Zhong H, Liu Q, Liu Y, Chen H. The Impact of Stigma on Self-Management Behavior Among People with HIV in China: The Role of Social Support and Self-Esteem. AIDS Patient Care STDS 2024; 38:453-462. [PMID: 39126267 DOI: 10.1089/apc.2024.0104] [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: 08/12/2024] Open
Abstract
Understanding the psychosocial factors influencing self-management behaviors among people with HIV (PWH) is crucial for effective medical interventions and improving their quality of life. However, there has been limited research exploring the psychosocial mechanisms influencing self-management behaviors among PWH in China. Our study examined the relationship between stigma, social support, self-esteem, and self-management behaviors among PWH, as well as whether social support and self-esteem mediate these relationships. Cross-sectional data were collected from 282 PWH in Sichuan Province, China. Data were collected using four validated self-report measures (HIV Stigma Scale, HIV/AIDS Patient Self-Management Scale, Social Support Rating Scale, and Self-Esteem Scale). Structural equation modeling was used to examine the different pathways influencing self-management behaviors. All the impacts on self-management behavior outcomes were found to be significant. The final mediation model indicated that social support and self-esteem significantly mediated the relationship between stigma and self-management behaviors. These findings underscore the importance of addressing stigma and enhancing social support and self-esteem in interventions aimed at promoting self-management behaviors among PWH.
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Affiliation(s)
- Haitao Huang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Liao Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Tu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaona Zhang
- School of Public Administration, Sichuan University, Chengdu, China
| | - Hua Zhong
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qianwen Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Hong Chen
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Xie Z, Duan Z. Evolving Challenges in the Implementation of China's "Four Frees and One Care" Policy for HIV/AIDS. Risk Manag Healthc Policy 2024; 17:1315-1321. [PMID: 38778921 PMCID: PMC11108755 DOI: 10.2147/rmhp.s459173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
In response to the HIV/AIDS epidemic, China initiated the "Four Frees and One Care" policy in late 2003. This policy provided free counseling, testing, and antiretroviral treatment for people living with HIV, while also offering support to affected families. While instrumental in advancing HIV/AIDS prevention, the policy faces evolving challenges. This study aims to analyze this challenge from multiple dimensions and, based on this analysis, provide effective recommendations for the Chinese government to address it, promoting the sustainable development of the "Four Frees and One Care" policy. The research found that reduced government funding has led to the decline of grassroots organizations, creating a disconnect between administrative and treatment systems. Additionally, advancements in medical technology introduce new antiretroviral drugs, complicating their integration into the healthcare system. In the current healthcare reform, updating the list of free antiretroviral drugs proves challenging. Adapting the policy to contemporary HIV/AIDS prevention should be a priority for the Chinese government. Balancing financial constraints, organizational sustainability, and evolving medical technologies will be pivotal for the ongoing transformation of the "Four Frees and One Care" initiative.
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Affiliation(s)
- Ziyi Xie
- Faculty of Humanities and Social Science, Macao Polytechnic University, Macao, People’s Republic of China
| | - Zhizhuang Duan
- Xingzhi College, Zhejiang Normal University, Jinhua, People’s Republic of China
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Warner S, Cheung D, Condon A, Cunningham J, Bailie J, Minc A, Herbert S, Edmiston N. Communication and coordination of care for people living with HIV: a qualitative study of the patient perspective. BMC PRIMARY CARE 2024; 25:19. [PMID: 38200444 PMCID: PMC10777490 DOI: 10.1186/s12875-023-02243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND There is growing consensus that primary health care (PHC) providers have an important role in providing holistic, preventative care for people living with human immunodeficiency virus (PLHIV). In regional Australia, HIV care is primarily delivered through specialist services, thus adequate coordination and communication between specialist and PHC professionals is crucial. This study aimed to explore patient experiences of the coordination of care and health care professional communication for PLHIV in regional Australia. METHODS Semi-structured interviews with PLHIV in a regional area of Australia were conducted in March to April 2022. Interviews were conducted via video conferencing, face-to-face, or via telephone call. Interviews were audio-recorded and manually transcribed. Transcripts were coded inductively and thematic analysis was conducted to explore perspectives on communication and coordination. RESULTS Thirteen participants were interviewed. Most participants were male, aged 50-70, were diagnosed with HIV more than ten years ago, and had been living in regional Australia long-term. Through qualitative analysis, themes emerged in the following areas: (1) Patient perception of care coordination; (2) Patient understanding of modality of communication; (3) Positive attitudes towards communication between healthcare professionals; and (4) Concerns for information sharing between healthcare professionals. Many participants highlighted lack of clarity around care coordination as a key issue in their healthcare, with some citing themselves as the primary care coordinator. Participants identified that coordination and communication between PHC professionals and specialist services are essential in the delivery of their health care, but some were hesitant for this to occur. Hesitancy was entrenched in some patients' distrust of healthcare due to previous experiences of confidentiality breaches and stigma. CONCLUSION This study identifies the need for clarity in coordination between health care professionals to deliver safe and effective HIV care, which may occur through care plans. Patient support for communication between healthcare providers may be strengthened by ensuring trust in the people and systems involved. Eliminating stigma in healthcare as well as building more trustworthy electronic-based communication technologies are essential components to trust-building between PLHIV and healthcare systems.
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Affiliation(s)
- Sherridan Warner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Daniel Cheung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashleigh Condon
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juliet Cunningham
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW, 2480, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Ariane Minc
- North Coast Sexual Health Service, Mid North Coast New South Wales Local Health District, Lismore, Australia
| | - Simone Herbert
- North Coast Sexual Health Service, Mid North Coast New South Wales Local Health District, Lismore, Australia
| | - Natalie Edmiston
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW, 2480, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
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Dawe J, Cassano D, Keane R, Ruth S, Wilkinson AL, Elsum I, Gunn J, Brown G, West M, Hoy J, Power J, Stoové M. Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing. HIV Med 2023; 24:1253-1267. [PMID: 37990812 DOI: 10.1111/hiv.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions. METHODS In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services. RESULTS Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β -0.49; 95% CI -0.74 to -0.24), stigma (β -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (β -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (β -0.50; 95% CI -0.71 to -0.30). CONCLUSIONS Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.
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Affiliation(s)
- Joshua Dawe
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Dean Cassano
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Richard Keane
- Living Positive Victoria, Melbourne, Victoria, Australia
| | - Simon Ruth
- Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Anna Lee Wilkinson
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- University of Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Imogen Elsum
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Jack Gunn
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Michael West
- Department of Health, Melbourne, Victoria, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Mark Stoové
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
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5
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Wells N, Murphy D, Ellard J, Philpot S, Prestage G. Experiences of, and motivations for, disclosing HIV to social and familial networks: considering the social and relational domains of HIV disclosure. CULTURE, HEALTH & SEXUALITY 2023; 25:1483-1497. [PMID: 36639148 DOI: 10.1080/13691058.2022.2161638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
For people living with HIV, decisions about when, how and who to tell about their HIV status can involve navigating complex social, legal and health domains. With a focus on disclosure to broader social and familial networks, we explored the experiences of, and motivations for, HIV (non-)disclosure among recently diagnosed people living with HIV in Australia. Semi-structured interviews were conducted with 35 people diagnosed with HIV from 2016 onwards, of whom 25 completed follow-up interviews. Participants commonly reported anticipating negative responses and rejection from others when considering whether to disclose their HIV status. Some participants also took on the role of ensuring others' wellbeing when disclosing (or not), even as they themselves needed emotional support. Finally, some participants felt it important to be open about their HIV status to raise awareness of HIV and challenge HIV-related stigma. Our findings highlight the complex relational and social contexts that shape HIV disclosure. In addition to supporting individual people living with HIV when disclosing, we argue that educational programmes that target the broader, HIV-negative population are needed to shift the social landscape in which people living with HIV disclose.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Dean Murphy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Steven Philpot
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
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6
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Wells N, Murphy D, Ellard J, Philpot SP, Prestage G. HIV Diagnosis as Both Biographical Disruption and Biographical Reinforcement: Experiences of HIV Diagnoses Among Recently Diagnosed People Living With HIV. QUALITATIVE HEALTH RESEARCH 2023; 33:165-175. [PMID: 36633974 DOI: 10.1177/10497323221146467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the potential for HIV treatments to transform the health needs of people living with HIV, receiving a positive HIV diagnosis can be a difficult experience and feelings of shock, distress and concerns for the future are commonly reported. Drawing on Michael Bury's conceptualisation of 'biographical disruption', we utilised semi-structured interviews to explore experiences of HIV diagnoses among 34 people diagnosed with HIV between 2016 and 2020 and living in Australia. Interviews were conducted between January 2018 and August 2021. Despite significant advances in biomedical HIV treatments and prevention, participants commonly experienced HIV diagnosis as emotionally challenging. For those with limited HIV awareness, HIV was commonly understood as a likely fatal condition. For some participants, receiving a positive diagnosis also engendered a degree of uncertainty as to their anticipated life trajectory, particularly its impact on future sexual and romantic relationships, options for starting a family and migration opportunities. For some gay and bisexual male participants, receiving a positive diagnosis almost confirmed a life trajectory that they had worked to avoid and their own sometimes-negative attitudes toward people living with HIV were internalised, making adjusting to diagnosis more complex. While all participants reported challenges in adjusting to an HIV diagnosis, some ultimately came to experience living with HIV as bringing about unexpected and welcome changes to their lives. Our findings highlight the complex and intersecting medical, social and emotional needs of people living with HIV when receiving and adjusting to a positive HIV diagnosis.
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Affiliation(s)
- Nathanael Wells
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Dean Murphy
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Jeanne Ellard
- 110434Australian Research Centre in Sex, Health, and Society, Melbourne, VIC, Australia
| | - Steven P Philpot
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Garrett Prestage
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
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Feldman MB, Tran TT, Boucher LM, Abdelqader F, Raker AR, Hile SJ. A process and impact evaluation of a peer-led HIV self-management program. EVALUATION AND PROGRAM PLANNING 2023; 96:102175. [PMID: 36459775 DOI: 10.1016/j.evalprogplan.2022.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/24/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
There is evidence that people with HIV (PWH) receive health-related benefits from having peer support and learning self-management skills. This evaluation assessed the effect of The Positive Life Workshop (TPLW)-a 7-session peer-led HIV self-management program-on psychosocial and HIV treatment outcomes. The overall sample included 1360 PWH who completed TPLW during 3/2015-2/2019. Surveys were administered before and after the program, and three months following program completion. Analyses examined changes in outcomes from pre-test to both post-test and 3-month follow-up using non-parametric tests. Subgroup analyses were conducted for 406 participants with ≥ 1 characteristic of the priority population for TPLW (i.e., recent HIV diagnosis, not taking antiretroviral therapy (ART), suboptimal ART adherence, unsuppressed viral load). In the overall sample, there were statistically significant improvements in HIV-related knowledge, social support, patient self-advocacy, and confidence in self-management between pre-test and post-test/3-month follow-up assessment. Analyses for the priority population showed significant increases from pre-test to 3-month follow-up in the proportion of participants who were ≥ 90 % adherent to ART (59-83 %, p < 0.01) and virally suppressed (42 % to 66 %, p < 0.01). The findings suggest the importance of ensuring HIV self-management interventions reach vulnerable populations of PWH who struggle with initiating and maintaining HIV-related health-promoting behaviors.
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Affiliation(s)
- Matthew B Feldman
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States.
| | - Trang T Tran
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Lisa M Boucher
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent Ottawa, Ontario K1G 5Z3, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
| | - Faisal Abdelqader
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Amanda R Raker
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Stephen J Hile
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
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Boucher LM, Shoemaker ES, Liddy CE, Leonard L, MacPherson PA, Presseau J, Martin A, Pineau D, Lalonde C, Diliso N, Lafleche T, Fitzgerald M, Kendall CE. “They’re all struggling as well”: social and economic barriers and facilitators to self-managing chronic illness among marginalized people who use drugs. Int J Qual Stud Health Well-being 2022; 17:2082111. [PMID: 35652801 PMCID: PMC9176359 DOI: 10.1080/17482631.2022.2082111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Self-management is recommended for addressing chronic conditions, and self-management programmes improve health behaviours and outcomes. However, social and economic factors have been neglected in self-management research, despite their relevance for marginalized groups. Thus, we aimed to explore barriers and facilitators that influence self-management among socioeconomically marginalized people who use drugs (PWUD). Methods Using community-based participatory methods, we developed a qualitative interview guide and conducted peer-led recruitment. Participants were admitted into the study after self-identifying as using non-prescribed drugs, having a chronic health issue, and experiencing socioeconomic marginalization. Data were analysed using reflexive thematic analysis, taking a relational autonomy lens. Results Participants highlighted substantial barriers to managing their health issues, mostly stemming from their social and economic environments, such as unstable housing, low income, lack of supportive social networks, and negative healthcare experiences. Participants also described how their ability to self-manage their chronic conditions benefited from specific aspects of social interactions, including close relationships, community connectedness, and engaging in peer support. Conclusions Our findings suggest that structural interventions are needed to support self-management among marginalized PWUD, especially stable housing. Self-management supports for PWUD would benefit from including a range of low-barrier community-based options, peer work opportunities, and advocacy for needs.
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Affiliation(s)
- Lisa M. Boucher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Esther S. Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Clare E. Liddy
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lynne Leonard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul A. MacPherson
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, ON, Canada
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Dave Pineau
- The CDSM among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Lalonde
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Nic Diliso
- The CDSM among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Terry Lafleche
- The CDSM among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
- Sandy Hill Community Health Centre, Ottawa, ON, Canada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E. Kendall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Developing an app-based self-management program for people living with HIV: a randomized controlled pilot study during the COVID-19 pandemic. Sci Rep 2022; 12:19401. [PMID: 36371442 PMCID: PMC9653395 DOI: 10.1038/s41598-022-19238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
People living with human immunodeficiency virus (PLWH) in Korea demonstrate insufficient self-management behaviors. Especially during pandemics such as COVID-19, technology-based self-management programs are needed to overcome time and space limitations. The purpose of this study was to evaluate the effects of a self-management program using a mobile app (Health Manager) on self-management outcomes among PLWH in Korea. A randomized controlled pilot trial was performed and participants were enrolled in the infectious outpatient clinic of a single hospital. The intervention group used the mobile app for 4 weeks, while the control group received self-management education materials in a portable document format. The online self-report questionnaire assessed primary outcomes including self-efficacy for self-management, self-management behaviors, and medication adherence, and secondary outcomes including perceived health status, depression, and perceived stigma. Thirty-three participants were randomly assigned to the intervention (n = 17) or the control group (n = 16). In the intention-to-treat analysis, self-efficacy for self-management and self-management behaviors increased, while perceived stigma decreased. The app-based self-management program could be considered a helpful strategy to improve self-management outcomes among PLWH and reduce their perceived stigma during the pandemic. Further studies with larger samples and longer follow-ups are needed.Trial registration: Clinical Research Information Service, KCT0004696 [04/02/2020].
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Hosseini Z, Ebadi A, Aghamolaei T, Nedjat S. A model for explaining adherence to antiretroviral therapy in patients with HIV/AIDS: A grounded theory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5735-e5744. [PMID: 36102307 DOI: 10.1111/hsc.14004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in-depth interviews and a focus-group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long-term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long-term use of antiretroviral medications and, hence, become more resilient.
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Affiliation(s)
- Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abbas Ebadi
- School of Nursing and Midwifery, Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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11
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Khalpey Z, Fitzgerald L, Howard C, Istiko SN, Dean J, Mutch A. Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1353-1362. [PMID: 34101291 DOI: 10.1111/hsc.13465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.
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Affiliation(s)
- Zoyah Khalpey
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Queensland, Australia
| | - Satrio Nindyo Istiko
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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12
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Alford K, Daley S, Banerjee S, Hamlyn E, Trotman D, Vera JH. "A fog that impacts everything": a qualitative study of health-related quality of life in people living with HIV who have cognitive impairment. Qual Life Res 2022; 31:3019-3030. [PMID: 35579729 PMCID: PMC9470604 DOI: 10.1007/s11136-022-03150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
Background Cognitive impairment (CI) in people living with HIV (PLWH) is an important health concern in the context of an ageing HIV population. Impacting 14–28% of PLWH, CI is associated with lower health-related quality of life (HRQoL), however, evaluation of the illness-specific factors comprising HRQoL in PLWH with CI have not been assessed. Objective We sought to contribute evidence toward an understanding of HRQoL and identify domains of HRQoL in PLWH with CI. Methods Qualitative interviews with 25 PLWH with objective CI related to HIV disease were conducted with participants attending HIV clinics in the UK. Clinically significant CI was defined based on The European AIDS Clinical Society guidelines, requiring: (i) subjective reporting of cognitive symptoms; (ii) symptoms to be related to HIV (e.g. potentially confounding non-HIV related conditions have been excluded or are being optimally managed) and; (iii) formal neuropsychological assessment confirming CI. Median age was 56 years (range 35–80); 18 participants were men (72%); 11 (44%) were white British and 8 (32%) were Black African; 14 (56%) were men that have sex with men and 10 (40%) were heterosexual; median number of years living with HIV was 17 (range 1–34); and all participants were on combination antiretroviral therapy. Analyses employed techniques from grounded theory, underpinned by an inductive, collaborative team-based approach. Results Findings revealed seven interrelated domains comprising HRQoL experiences were identified: Physical function, Cognition, Social connectedness, Physical and mental health, Stigma, Self-concept, and Control and acceptance, and each was defined by specific descriptive components. Conclusion This study provides valuable insights on the factors that drive HRQoL in PLWH with CI and contribute to a body of evidence which provides targets for the development of targeted interventions to maintain or improve quality of life.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Daniel Trotman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex, Sussex, UK
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Hollingdrake O, Dean J, Mutch A, Lui CW, Howard C, Fitzgerald L. Understanding the Social and Emotional Dimensions of HIV Self-Management: A Qualitative Study of Newly Diagnosed People Living With HIV in Queensland, Australia. J Assoc Nurses AIDS Care 2022; 33:106-117. [PMID: 33989243 DOI: 10.1097/jnc.0000000000000272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Understanding of HIV self-management increasingly focuses on treatment adherence and associated health-related behaviors, yet people living with HIV (PLWH) seldom perform these actions in a social vacuum. Thus, delivering comprehensive self-management support programs for PLWH requires an understanding of the social and emotional dimensions of HIV self-management. Through thematic analysis of in-depth interviews with 35 newly diagnosed PLWH, this descriptive qualitative study highlights these dimensions and their effect on experiences of HIV diagnosis and care. HIV self-management involves interpersonal interactions that affect efforts to seek support and reimagine one's personal identity in a changed reality. Managing disclosures and navigating stigma constitute everyday work for many PLWH. Because stigma continues to impede care engagement and well-being for PLWH, health practitioners must extend focus beyond viral suppression and prioritize support for emotional and social self-management. Nurses can create safe, nonstigmatizing spaces for conversations about HIV, uphold the rights of PLWH around disclosure, and ensure that PLWH are connected to peer support services.
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Affiliation(s)
- Olivia Hollingdrake
- Olivia Hollingdrake, PhD, MPH, GCert (Onc Nursing), BN, RN, is a Lecturer, School of Nursing, Queensland University of Technology, Brisbane, Australia. Judith Dean, PhD, MPHTM, BN, RN, Midwife, Centaur Fellow, is a Senior Research Fellow, School of Public Health, The University of Queensland, Brisbane, Australia. Allyson Mutch, PhD, GCert (Higher Ed), BA (Hons), Senior Fellow HEA, is an Associate Professor, School of Public Health, The University of Queensland, Brisbane, Australia. Chi-Wai Lui, PhD, MA, GCert (Higher Ed), BA, is a Research Associate, Queensland Bioethics Centre, Australian Catholic University, Brisbane, Australia. Chris Howard is the Executive Programs Manager, Queensland Positive People, Brisbane, Australia. Lisa Fitzgerald, PhD, GCert (Higher Ed), DPH, MA (dis), BA (Hons), is an Associate Professor, School of Public Health, The University of Queensland, Brisbane, Australia
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14
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Fracso D, Bourrel G, Jorgensen C, Fanton H, Raat H, Pilotto A, Baker G, Pisano MM, Ferreira R, Valsecchi V, Pers YM, Engberink AO. The chronic disease Self-Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project. Health Expect 2022; 25:947-958. [PMID: 35014112 PMCID: PMC9122418 DOI: 10.1111/hex.13430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The Chronic Disease Self‐Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles. Aim This study aimed to understand the effects of the CDSMP on the lived experience of vulnerable patients included in the EFFICHRONIC project in France, based on their needs and expectations before and after participation. Methods We conducted a qualitative phenomenological semio‐pragmatic study based on 37 in‐depth interviews with 20 patients (20 before/17 after CDSMP). Results By transforming existential dimensions (identity, relationship with others and bodily experience), chronic illness generates new needs in the vulnerable person. By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers. It has enabled the participants to become actors of their own health until empowerment. Although some limitations are reported, the programme has awakened a desire in the participants to take better care of their health and to develop personal skills with, for some, a desire to become involved in health education. Conclusion Our phenomenological approach highlighted the resonance between the programme (its design and implementation) and the lived experience of patients, as an effective element of empowerment. This necessitates training the facilitators to elicit the lived experience of patients. Furthermore, as a patient‐centred approach is required, the facilitators need to learn how to adapt the design of the programme to the singularity of the patient. Patient or Public Contribution Patients provided the data that were collected through in‐depth interviews, and their experiences before and after the programme were analysed.
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Affiliation(s)
- Dallal Fracso
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Gérard Bourrel
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Hélène Fanton
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Graham Baker
- Quality Institute for Self Management Education and Training, Portsmouth, UK
| | - Marta M Pisano
- General Direction of Care, Humanization and Social and Health Care, Ministry of Health, Biosanitary Research Institute of the Principality of Asturias, Asturias, Spain
| | - Rosanna Ferreira
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Agnes Oude Engberink
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
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15
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Stutzin Donoso F. Understanding the problem of long-term treatment adherence: a phenomenological framework. MEDICAL HUMANITIES 2021; 47:466-474. [PMID: 32753548 DOI: 10.1136/medhum-2019-011836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
In light of the large burden of chronic disease and the low rates of long-term treatment adherence contributing to high rates of morbidity and mortality worldwide, this paper contributes to better understanding the particular kind of challenge that living with chronic illness and adhering to long-term treatment can imply. Both literature on the concept of chronic disease and the experience of illness suggest going outside specific diagnostic categories to better understand the problem of adherence. After introducing the distinction of a thin understanding of chronicity-merely as long duration-and a thick one-chronicity in a phenomenological sense, this paper analyses academic literature on the experience of illness and specifies it to the case of chronic diseases, introducing an original conceptual framework describing some main challenges arising from the experience of chronic disease. The framework is organised in three dimensions: failing to recover as a failure to belong, being at a loss and breaking-up with oneself. This work suggests a particular subjective state in which struggling to follow long-term treatment may seem understandable and reasonable, offering a phenomenological perspective that feeds into the ethical problems arising in chronic diseases, and shedding light on how to increase adherence without reproducing patterns of disadvantage.
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Affiliation(s)
- Francisca Stutzin Donoso
- Centre for Multidisciplinary and Intercultural Inquiry, Health Humanities, University College London, London, UK
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16
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Sultan N, Swinglehurst D. Self-Management in Older Pakistanis Living With Multimorbidity in East London. QUALITATIVE HEALTH RESEARCH 2021; 31:2111-2122. [PMID: 34110228 PMCID: PMC8552379 DOI: 10.1177/10497323211019355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of "managing" in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.
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Affiliation(s)
- Najia Sultan
- Queen Mary University of London, London, United Kingdom
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17
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Armstead AB, Wilkerson JM, Gemeinhardt G, Nyitray A, Collins DM. Antiretroviral Therapy Adherence, Functional Independence, and Falls among People with HIV. Occup Ther Health Care 2021; 35:318-335. [PMID: 34137654 DOI: 10.1080/07380577.2021.1938337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic disease management coupled with education may improve outcomes for those with chronic disease. As Human Immunodeficiency Virus (HIV) is now a chronic disease, addressing the needs of as people living with HIV (PLWH) is essential as they experience an accelerated aging process due to the mechanisms of the disease and medications taken. Although studies exist on the management of chronic HIV, few discuss the implications of medication adherence and activities of daily living related to falls among PLWH. To inform occupational therapy services for PLWH, this case-control study used extracted data from the electronic medical records of PLWH who had received occupational therapy (OT) at a large academic hospital. Two-hundred-and-four subjects were included in the final dataset; sixty-eight were cases that reported a fall within the last 12 months, while 136 were controls which were PLWH who had not sustained a fall. The association between falls and antiretroviral therapy adherence indicated males who were ART non-adherent and had balance deficits were more likely to fall. The association between ADL dysfunction and falls among PLWH showed those more likely to fall had moderate ADL dysfunction and balance deficits. The findings suggest further examination of the person factors of PLWH who are categorized clinically as non-adherent with antiretroviral therapy and have ADL dysfunction may improve health outcomes and reduce falls when paired with occupation-based interventions.
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Affiliation(s)
- Amber B Armstead
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.,Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - J Michael Wilkerson
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Gretchen Gemeinhardt
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Alan Nyitray
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Diane M Collins
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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18
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Areri H, Marshall A, Harvey G. Exploring Self-Management of Adults Living with HIV on Antiretroviral Therapy in North-West Ethiopia: Qualitative Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:809-820. [PMID: 33312002 PMCID: PMC7725142 DOI: 10.2147/hiv.s287562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022]
Abstract
Background The changing nature of HIV from an acute to chronic illness requires adults living with HIV to self-manage. Self-management enables individuals with HIV to maintain physical health, medication adherence and live with HIV-related conditions. This study aimed to explore self-management experiences of adults living with HIV on antiretroviral therapy in Ethiopia. Methods A qualitative descriptive study framed by the Individual and Family Self-Management Theory was carried out to explore the self-management experience of adults living with HIV in Northwest Ethiopia. Eleven semi-structured, in-depth interviews were conducted. The recruitment involved participants who volunteered to be contacted during a preceding quantitative study. The interview data were coded inductively and subject to thematic analysis. Results The main themes identified, each with a number of sub-themes, related to perceptions and experience of self-management, barriers and facilitators of self-management. Factors influencing self-management behaviour were inter-connected and particularly influenced by spiritual practices, low levels of income and experiences of stigma and discrimination. Conclusion The study highlights barriers to self-management among individuals living with HIV on antiretroviral therapy in a resource-constrained country. Interventions to address modifiable barriers and build on identified facilitators of self-management include working with the broader community to minimise HIV-related stigma and discrimination and engaging with religious leaders to tackle the observed conflict between spiritual practice and effective self-management behaviour.
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Affiliation(s)
- Habtamu Areri
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.,School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa 4412, Ethiopia
| | - Amy Marshall
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Gillian Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
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19
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Klassen KM, Millard T, Stout J, McDonald K, Dodson S, Osborne RH, Battersby MW, Fairley CK, Kidd MR, McMahon J, Baker D, Elliott JH. Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators. Sex Health 2020; 16:340-347. [PMID: 31234962 DOI: 10.1071/sh18130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
Background Recruitment of people to randomised trials of online interventions presents particular challenges and opportunities. The aim of this study was to evaluate factors associated with the recruitment of people with HIV (PWHIV) and their doctors to the HealthMap trial, a cluster randomised trial of an online self-management program. METHODS Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. RESULTS Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9; 95% CI -2.55, 114.25; P = 0.06). CONCLUSION Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.
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Affiliation(s)
- Karen M Klassen
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Tanya Millard
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Julia Stout
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Karalyn McDonald
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Sarity Dodson
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Vic. 3125, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Vic. 3125, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA 5001, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre and Department of Medicine, Central Clinical School, Monash University, Melbourne, Vic. 3000, Australia
| | - Michael R Kidd
- Department of Family and Community Medicine, University of Toronto, Toronto M5G 1V7, Canada
| | - James McMahon
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - David Baker
- East Sydney Doctors, 102 Burton Street, Darlinghurst, NSW 2010, Australia
| | - Julian H Elliott
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia; and Cochrane Australia, School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia
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Restall G, Simms A, Etcheverry E, Roger K, James D, Roddy P, Porch W, Potts J, Skitch D, Yates T. Supporting choices about HIV disclosure in the workplace: A cross-Canada survey of strategies. Work 2020; 64:731-741. [PMID: 31815713 PMCID: PMC7029371 DOI: 10.3233/wor-193035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: People living with human immunodeficiency virus (HIV) often make highly personal decisions about whether or not to disclose their HIV status in the workplace. OBJECTIVE: We aimed to determine current practices that support people living with HIV to make workplace disclosure decisions and to understand factors that affect disclosure decision-making. METHODS: Ninety-four people who provide health, social and peer-based services responded to an on-line survey about their experiences supporting workplace disclosure decisions of employees living with HIV. RESULTS: Respondents identified a range of strategies to support workplace disclosure decision-making. One-third of respondents were only a little or not confident in their abilities to support people in making disclosure decisions and 32% expressed little or no confidence in the resources available. Respondents working at HIV-specific organizations, as compared to respondents not working at those organizations, were more confident supporting people with disclosure decisions and in available resources, p < .05. Perceived barriers to disclosure decisions included stigma, lack of knowledge, and personal factors. Supports for decision-making resided within personal, workplace and societal contexts. CONCLUSIONS: The study provides important understanding about the complexity of disclosure decision-making and strategies that people living with HIV can use to address this complex issue.
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alexandria Simms
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Emily Etcheverry
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kerstin Roger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dawn James
- Nine Circles Community Health Centre, Winnipeg, MB, Canada (at the time of the study)
| | - Pumulo Roddy
- Sexuality Education Resource Centre, Winnipeg, MB, Canada
| | | | - Jeff Potts
- Canadian Positive People Network, Ottawa, ON, Canada (at the time of the study)
| | - Dave Skitch
- Toronto HIV/AIDS Network, Toronto, ON, Canada (at the time of the study)
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21
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Stroumpouki T, Perrett S, Kasdovasilis P, Papatheodorou P, Paparizos V, Stavropoulou A. "A journey towards acceptance": The process of adapting to life with HIV in Greece. A Qualitative study. Appl Nurs Res 2020; 53:151249. [PMID: 32451004 DOI: 10.1016/j.apnr.2020.151249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Aim To identify the experiences related to adaptation for people living with HIV in Greece and to explore different adaptation stages as well as their individual reactions. BACKGROUND Receiving an HIV positive diagnosis leads to major changes in an individual's life and it can trigger an array of emotions including fear, despair and loss of control. As the profile of the disease has changed due to its transition into a chronic disease and extended life expectancy, adaptation to life and coping with uncertain events is of paramount importance. METHOD Interpretative phenomenological research design was used to guide data collection and analysis. A purposive sampling technique was used. Ethical procedures were taken into account and nine individuals who were diagnosed with HIV took part in the study using semi-structured interviews. RESULTS Data analysis revealed the different stages of adaptation that the participants experienced after an HIV positive diagnosis. A superordinate theme identified as 'a journey towards acceptance' while five subthemes were formed, namely, 'Communicating the bad news, Conscious loneliness, Getting information, Receiving Support, and Moving on with hope'. CONCLUSION An HIV positive diagnosis can affect the very core of the individual as the essence of -self- is targeted and in need of reform. Education, empathy, family and social support can help the individual make small steps towards a greater journey, that of acceptance.
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Affiliation(s)
- Theodora Stroumpouki
- Acute Adult Nursing, Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, Kingston Hill Campus, Kingston upon Thames KT2 7LB, United Kingdom.
| | - Stephanie Perrett
- Health and Justice, Health Protection Team, Public Health Wales, 4th Floor, Number 2 Capital Quarter, Tyndall Way, Cardiff CF10 4BZ, United Kingdom.
| | - Pavlos Kasdovasilis
- Health Psychology, Business Improvement and Research Manager, Rehability UK, 25 Hatton Place, 118 Midland Rd, Luton, LU2 0FB, United Kingdom
| | | | - Vasilios Paparizos
- HIV/AIDS Unit, 'A. Syggros' Hospital, 5 I. Dragoumi Str., Kessariani 161 21, Athens, Greece
| | - Areti Stavropoulou
- Department of Nursing, University of West Attica, Ag. Spiridonos 28, 12243 Aegaleo, Greece.
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22
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Mehraeen E, Safdari R, SeyedAlinaghi S, Mohammadzadeh N. Exploring and Prioritization of Mobile-Based Self-Management Strategies for HIV Care. Infect Disord Drug Targets 2020; 19:288-296. [PMID: 30345930 DOI: 10.2174/1871526518666181022113900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/20/2018] [Accepted: 10/12/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Appropriate mobile-based self-management strategies can be as new approaches to decelerate the HIV infection progression and improve the quality of life. This study aims at (i) identifying in the literature mobile-based self-management strategies for HIV care and (ii) prioritizing those from the point of view of infectious diseases specialists. This study provides some clues to design useful mobile-based self-management tools for HIV patients, from the point of view of practitioners. METHODS This mixed methods study was done in two main phases. In the first phase, a review was conducted in: PubMed, Web of Science, Science Direct, Scopus, and Ovid. In this manner, related studies published between 2010 and 2017 and in the English language were reviewed. In the second phase, identified mobile-based self-management strategies were scored and prioritized by 23 participants. Frequency distribution and mean reports were calculated using SPSS statistical software. RESULTS By detailed reviewing of 24 related articles, the HIV mobile-based self-management strategies were identified in 47 categories and subcategories. According to the findings, "enhance the quality of life" was the main self-management strategy addressed by reviewed studies. However, "antiretroviral therapy and medication adherence" was reported at a higher rate to be a more helpful strategy than "enhance the quality of life". CONCLUSION In this study, helpful HIV mobile-based self-management strategies were identified that can be used to guide self-management interventions which have the potential to improve the healthcare services for people living with HIV.
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Affiliation(s)
- Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Reza Safdari
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
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Boucher LM, O'Brien KK, Baxter LN, Fitzgerald ML, Liddy CE, Kendall CE. Healthy aging with HIV: The role of self-management support. PATIENT EDUCATION AND COUNSELING 2019; 102:1565-1569. [PMID: 30827568 DOI: 10.1016/j.pec.2019.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/19/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
People living with HIV on antiretroviral treatment have significantly improved longevity, but as a result may also face increasing multimorbidity due to aging and long-term medication use. Thus, care needs for this population have evolved to require a chronic disease management approach in which self-management plays a central role. Here we highlight the importance of expanding self-management support options for people living with HIV, and discuss strategies for implementing and evaluating self-management interventions, outlining potential opportunities, challenges and solutions. We contend that standardized programs such as those offered through the Self-Management Resource Centre provide a rich opportunity to build the evidence base regarding the potential effectiveness of self-management support among people living with HIV. Thus we recommend enhancing self-management support through meaningful community-level collaboration with people with lived experience, careful assessment of process and outcome factors including who does not participate and why, attention to stigma and the specific needs of HIV priority groups, and consideration of how to extend engagement with services to address social and material needs beyond self-management program participation. We hope this reflection will serve as an aide for researchers and program managers to improve the array of evidence-based self-management support options available to people living with HIV.
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Affiliation(s)
- Lisa M Boucher
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | | | - Michael L Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Clare E Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; Institute of Clinical and Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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24
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Zhang Y, Liu S, Sheng X, Lou J, Fu H, Sun X. Evaluation of a community-based hypertension self-management model with general practitioners. Int J Health Plann Manage 2019; 34:960-974. [PMID: 31368128 DOI: 10.1002/hpm.2867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventive interventions of hypertension and health care activities are often performed in the community and at home. Studies have shown that self-management plays an indispensable role in the management of chronic diseases. This study aimed to explore an innovative community-based hypertension self-management model and to evaluate its effects. METHODS The study involved qualitative and quantitative research methods. A community-based hypertension self-management model was developed using consultation with experts and qualitative interviews. The intervention was executed in the communities of Pudong New Area in Shanghai, China. We enrolled 1080 patients with hypertension in the intervention group and 588 similar patients in the control group. A questionnaire was administered before and after the intervention to collect information on patients' health status, self-management skills, and disease management abilities. Analyses were conducted to evaluate changes in the health-related outcomes. RESULTS There was a significant difference in general health and health literacy after the intervention for the intervention patients group (P < .05). Furthermore, the proportion of health literacy was higher in the intervention group than in the control group (71.6% vs 59.6%). The significant differences were demonstrated in the comparison of the disease management ability data between the intervention and control group, especially in drug compliance, physical activity, regulate diet, and smoking. In addition, there is other evidence of the successful applicability and effectiveness of the community-based hypertension self-management program in 2007-2013, such as self-management teams formation and blood pressure control rate. CONCLUSIONS The community-based self-management hypertension model, which involved the participation of general practitioners, is suitable for the management of hypertension disease in Pudong of Shanghai and could provide a reference for its large-scale promotion and application.
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Affiliation(s)
- Yimin Zhang
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Shanshan Liu
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Xinchun Sheng
- General Office, Pudong New Area Center for Patriotic Sanitation Campaign and Health Promotion Counsel, Shanghai, China
| | - Jiquan Lou
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaoming Sun
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China.,School of Public Health, Fudan University, Shanghai, China
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25
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Zhang P, Gao J, Wang Y, Sun Q, Sun X. Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China. Int J Health Plann Manage 2019; 34:1055-1064. [PMID: 31364209 DOI: 10.1002/hpm.2874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM). METHODS We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires. RESULTS The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%. CONCLUSION MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.
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Affiliation(s)
- Peng Zhang
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jing Gao
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yanmei Wang
- Department of Nursing, Shanghai Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Qiao Sun
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoming Sun
- School of Public Health, Fudan University, Shanghai, China.,Pudong Institute for Health Development, Shanghai, China
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26
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Mannes ZL, Bryant VE, Burrell LE, Lu H, Ferguson EG, Zhou Z, Cook RL, Ennis N. The prevalence and patterns of substance use by birth cohort among HIV-positive adults in Florida. Aging Ment Health 2019; 23:515-523. [PMID: 29436844 PMCID: PMC6286223 DOI: 10.1080/13607863.2018.1430740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida. METHODS PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use. RESULTS The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group. CONCLUSION The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH.
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Affiliation(s)
- Zachary L. Mannes
- Corresponding Author: Zachary L. Mannes, NIDA Predoctoral Fellow, Department of Clinical & Health Psychology College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, Phone: +1-(352)-273-6617,
| | - Vaughn E. Bryant
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Huiyin Lu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 117450, 2004 Mowry Road, 5th Floor CTRB, Gainesville, Florida, 32611-7450, United States, , (352)-294-5770
| | - Erin G. Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 294-5949
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 273-5869
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, , +1-(352)-273-6617
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A descriptive, cross-sectional study examining treatment burden in people living with HIV. Appl Nurs Res 2019; 46:31-36. [PMID: 30853073 DOI: 10.1016/j.apnr.2019.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/28/2018] [Accepted: 02/10/2019] [Indexed: 12/20/2022]
Abstract
AIM (1) describe the percentage of people living with HIV (PLWH) experiencing high levels of treatment burden who are at risk for self-management non-adherence, and (2) examine the relationship between known antecedent correlates (the number of chronic conditions, social capital, and age) of self-management and treatment burden while controlling for sample socio-demographics. BACKGROUND Chronic condition self-management is key to maintaining optimal health in the aging population of PLWH. Despite the efforts of providers, patients, and caregivers, self-management non-adherence is still a factor contributing to poor chronic condition self-management and subsequent poor health outcomes. Recent research has identified treatment burden as a risk factor of poor chronic disease self-management adherence. METHOD Cross-sectional, secondary analysis of a sub-sample of 103 community dwelling, men and women diagnosed with HIV/AIDS derived from a larger parent study examining physical activity patterns in PLWH. RESULTS Participants reported an overall low level of treatment burden (M = 22.84; SD = 24.57), although 16% (n = 16) of the sample indicated experiencing high treatment burden. The number of chronic conditions (r = 0.25; p ≤ .01) and social capital (r = -0.19; p = .03) were significantly correlated with treatment burden. Multivariate analysis testing known antecedent correlates of treatment burden was statistically significant (p < .05), but only explained 8% of treatment burden's variance. CONCLUSION Findings have implications for nursing care of PLWH demonstrating a subset of PLWH experience high treatment burden related to chronic condition self-management. Findings also identify characteristics of PLWH who may be at high risk for treatment burden and subsequent self-management non-adherence.
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Millard T, Dodson S, McDonald K, Klassen KM, Osborne RH, Battersby MW, Fairley CK, Elliott JH. The systematic development of a complex intervention: HealthMap, an online self-management support program for people with HIV. BMC Infect Dis 2018; 18:615. [PMID: 30509195 PMCID: PMC6278155 DOI: 10.1186/s12879-018-3518-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
Background Despite persistent calls for HIV care to adopt a chronic care approach, few HIV treatment services have been able to establish service arrangements that prioritise self-management. To prevent cardiovascular and other chronic disease outcomes, the HealthMap program aims to enhance routine HIV care with opportunities for self-management support. This paper outlines the systematic process that was used to design and develop the HealthMap program, prior to its evaluation in a cluster-randomised trial. Methods Program development, planning and evaluation was informed by the PRECEDE-PROCOEDE Model and an Intervention Mapping approach and involved four steps: (1) a multifaceted needs assessment; (2) the identification of intervention priorities; (3) exploration and identification of the antecedents and reinforcing factors required to initiate and sustain desired change of risk behaviours; and finally (4) the development of intervention goals, strategies and methods and integrating them into a comprehensive description of the intervention components. Results The logic model incorporated the program’s guiding principles, program elements, hypothesised causal processes, and intended program outcomes. Grounding the development of HealthMap on a clear conceptual base, informed by the research literature and stakeholder’s perspectives, has ensured that the HealthMap program is targeted, relevant, provides transparency, and enables effective program evaluation. Conclusions The use of a systematic process for intervention development facilitated the development of an intervention that is patient centred, accessible, and focuses on the key determinants of health-related outcomes for people with HIV in Australia. The techniques used here may offer a useful methodology for those involved in the development and implementation of complex interventions.
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Affiliation(s)
- Tanya Millard
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia. .,Cochrane Australia, School of Public Health and Preventative Medicine, Melbourne, Australia.
| | | | - Karalyn McDonald
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Karen M Klassen
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre and Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Julian H Elliott
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia.,Cochrane Australia, School of Public Health and Preventative Medicine, Melbourne, Australia
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29
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Stutzin Donoso F. Chronic disease as risk multiplier for disadvantage. JOURNAL OF MEDICAL ETHICS 2018; 44:371-375. [PMID: 29511042 DOI: 10.1136/medethics-2017-104321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 12/29/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease health policy. The paper develops the argument that certain disadvantages which may predispose to illness might overlap with disadvantages that may hinder self-management, potentially becoming disadvantageous in handling chronic disease. If so, chronic diseases may be seen as disadvantages in themselves, describing a reproduction of disadvantage among the chronically ill and a vicious circle of disadvantage that could both predict and shed light on the catastrophic health outcomes among disadvantaged groups-or individuals-dealing with chronic disease.
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Affiliation(s)
- Francisca Stutzin Donoso
- Programa de Estudios Sociales en Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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30
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Terpstra AR, Worthington C, Ibáñez-Carrasco F, O'Brien KK, Yamamoto A, Chan Carusone S, Baltzer Turje R, McDougall P, Granger W, Thompson V, DeSousa M, Creal L, Rae A, Medina C, Morley E, Rourke SB. "I'm Just Forgetting and I Don't Know Why": Exploring How People Living With HIV-Associated Neurocognitive Disorder View, Manage, and Obtain Support for Their Cognitive Difficulties. QUALITATIVE HEALTH RESEARCH 2018; 28:859-872. [PMID: 29676675 DOI: 10.1177/1049732318761364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.
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Affiliation(s)
| | | | | | | | - Aiko Yamamoto
- 5 St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - William Granger
- 7 Dr. Peter AIDS Foundation, Vancouver, British Columbia, Canada
| | - Victor Thompson
- 7 Dr. Peter AIDS Foundation, Vancouver, British Columbia, Canada
| | - Maureen DeSousa
- 7 Dr. Peter AIDS Foundation, Vancouver, British Columbia, Canada
| | - Liz Creal
- 6 Casey House, Toronto, Ontario, Canada
| | - Allan Rae
- 8 Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Claudia Medina
- 8 Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | - Sean B Rourke
- 3 St. Michael's Hospital, Toronto, Ontario, Canada
- 4 University of Toronto, Ontario, Canada
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Mehraeen E, Safdari R, SeyedAlinaghi S, Mohammadzadeh N, Mohraz M. Common elements and features of a mobile-based self-management system for people living with HIV. Electron Physician 2018; 10:6655-6662. [PMID: 29881528 PMCID: PMC5984020 DOI: 10.19082/6655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, mobile-based applications have become important technologies to the delivery of healthcare around the world. Mobile-based self-management systems with standard features for providing, evaluating, and improving HIV care are significantly required in developing countries. Objective To determine the common elements of a mobile-based self-management system for people living with HIV (PLWH). Methods This cross-sectional study was done in two main phases in 2017. In the first phase, a review was conducted in relevant databases such as; PubMed, Scopus, Up To Date, and Web of Science. The keywords used to search for resources were as follows; Self-care, Self-management, Data elements, Minimum data set, Mobile application, Mobile health, and HIV/AIDS. In the second phase, the infectious diseases specialists and health information managers affiliated with Tehran University of Medical Sciences were consulted to score identified elements by a questionnaire. Frequency and mean of collected data were calculated using SPSS software (version 19). Results By full-text reviewing of 9 related articles, the identified elements were justified in 3 main categories and 37 subcategories including: clinical data elements (17), technical capabilities (12) and demographic data elements (8). According to the findings, among the clinical category, 11 data elements were selected by the statistical population. Among the identified technical capabilities, 11 features were selected. Moreover, 6 data elements were selected as the demographic category. Conclusion We obtained data elements and technical capabilities of a mobile-based self-management system for people living with HIV. Using these elements and features, designing of self-management system architecture will be possible. Self-management skills of PLWH and their communication with healthcare providers will improve by using this system.
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Affiliation(s)
- Esmaeil Mehraeen
- Ph.D. Candidate of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Ph.D. of Health Information Management, Professor, Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Assistant Professor, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Ph.D. of Health Information Management, Assistant Professor, Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Professor, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
This article uses social practice theory to examine the role of information-seeking in the maintenance of existing lifestyle and illness-related adjustments in the context of chronic illnesses. The research findings are derived from a thematic analysis of 16 semi-structured in-depth interviews with Estonian Parkinson's disease patients. The coding scheme bases on the four practice elements outlined by Schatzki (practical understandings, rules, teleological structures and general understandings) and other categories related to chronic illness self-management skills, bodily movements, daily routines and information-seeking practices. The findings reveal that people with chronic illness value maintaining their existing lifestyles as long as possible and the willingness to seek out illness-related information is related to the severity and duration of the disease. These findings suggest that effective illness-related communication that supports self-management should provide patients with possibilities to adjust and switch between practices in a time and a pace that is natural and acceptable to them.
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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Nelson KM, Gamarel KE, Pantalone DW, Carey MP, Simoni JM. Sexual Debut and HIV-Related Sexual Risk-Taking by Birth Cohort Among Men Who Have Sex with Men in the United States. AIDS Behav 2016; 20:2286-2295. [PMID: 26860630 DOI: 10.1007/s10461-016-1330-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Age-discordant and earlier sexual debut are risk factors for HIV among men who have sex with men (MSM). Despite differences in the sociopolitical landscape over time, there are no studies sampling participants from the United States that have examined the role of birth cohort in relations between sexual debut characteristics and sexual risk among MSM. We assessed sexual debut patterns and associations with sexual risk-taking in 812 adult MSM stratified by ten-year birth cohorts (i.e., before 1970, 1970-1979, 1980-1989, after 1990). Sexual debut characteristics differed by birth cohort. In multivariate models controlling for birth cohort, both younger age of sexual debut and younger age of anal sex debut were associated with an increased likelihood of condomless sex. Men born in the 1990s had increased odds of engaging in sexual risk regardless of sexual debut characteristics. Sexual risk reduction interventions tailored to the unique needs of young MSM are encouraged.
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Affiliation(s)
- Kimberly M Nelson
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Coro West, Suite 309 164 Summit Ave, Providence, RI, 02906, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Kristi E Gamarel
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Coro West, Suite 309 164 Summit Ave, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
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