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Tekeste R, Grant M, Newton P, Davis NL, Tekeste M, Carter R. Prevalence of Medical Mistrust and Its Impact on Patient Satisfaction in Pediatric Caregivers. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02165-z. [PMID: 39240453 DOI: 10.1007/s40615-024-02165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/18/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024]
Abstract
Racial minorities report lower perceived quality of care received compared to non-Hispanic White Americans, resulting in racial disparities in patient satisfaction. Medical mistrust, defined as a lack of confidence in the medical establishment and the intentions of medical personnel, is more prevalent among racial minority groups and is associated with poorer health outcomes. This study examines the prevalence and racial differences of patient/caregiver medical mistrust and its relationship to patient satisfaction among the pediatric patient population at a large urban academic medical center. A cross-sectional anonymous survey was conducted for caregivers of pediatric families seen at an urban tertiary care facility, including demographic information, the Patient Satisfaction Questionnaire (PSQ), and the Group-Based Medical Mistrust Scale (GBMMS). Linear regressions and mediation analyses were performed, examining race-based medical mistrust and associations with patient satisfaction. Sixty-seven surveys (67% Black/African American, 24% White) were completed. Black/African American participants reported higher levels of medical mistrust (M = 2.29, SD = 0.88 vs. M = 1.37, SD = 0.50; p < .001), which was associated with lower patient satisfaction (p < .001). In a parallel mediation analysis, disaggregating the GBMMS into three subscales, a significant indirect relationship emerged between race and patient satisfaction via the subscale lack of support from healthcare providers (95% CI [- 1.52, - .02], p < .05). Black/African American participants were more likely to have medical mistrust, and greater medical mistrust was significantly associated with lower patient satisfaction. Black/African American participants were significantly more likely to perceive lower support from healthcare providers which, in turn, was associated with lower patient satisfaction. These findings identify potential areas for intervention to improve Black/African American patients' experience with healthcare.
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Affiliation(s)
- R Tekeste
- Mercy Medical Center, Baltimore, MD, USA
| | - M Grant
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - P Newton
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - N L Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - R Carter
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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Karashiali C, Konstantinou P, Kasinopoulos O, Michael C, Papageorgiou A, Kadianaki I, Karekla M, Kassianos AP. Tensions in caring for chronic patients' medication adherence: A qualitative study in Cyprus. J Health Psychol 2024; 29:1088-1100. [PMID: 38282383 PMCID: PMC11344954 DOI: 10.1177/13591053241227003] [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] [Indexed: 01/30/2024] Open
Abstract
Medication adherence (MA) to recommended treatment is a multi-faceted problem and an ongoing challenge for healthcare providers (HCPs) to monitor. This qualitative study with 10 HCPs in Cyprus aims to explore HCPs' perceptions and strategies used on addressing medication non-adherence (MNA) in patients with chronic conditions. Two main themes emerged from the analysis reflecting the ways that HCPs described their reactions to MNA of their patients: (1) "Relying on information provision to improve MA" and (2) "Trying to understand patients' perspective." HCPs reported empathizing with patients and engaging in discussions to understand patients' perspective and reasons for MNA, so as to explore alternative solutions. Simultaneously, some HCPs reflected that the techniques used to improve MA are solely centered around information on medication and side-effects. HCPs experienced an internal conflict between providing patient-centered care versus using directive approaches to improve MA. Findings suggest how HCPs could thoroughly address patients' individual barriers.
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West BS, Krasnova A, Philbin MM, Diaz JE, Kane JC, Mauro PM. HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015-2019: Implications for healthcare service provision and integration. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209440. [PMID: 38880303 DOI: 10.1016/j.josat.2024.209440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Substance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status. METHODS We included participants from the 2015-2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income. RESULTS Overall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08-3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07-4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20-0.77). CONCLUSIONS Despite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, New York, NY, United States of America.
| | - Anna Krasnova
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Morgan M Philbin
- Division of Vulnerable Populations, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - José E Diaz
- SUNY Downstate, New York, NY, United States of America
| | - Jeremy C Kane
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Pia M Mauro
- Department of Epidemiology, Columbia University, New York, NY, United States of America
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Padi A, Pericot-Valverde I, Heo M, Dotherow JE, Niu J, Martin M, Norton BL, Akiyama MJ, Arnsten JH, Litwin AH. Distrust in the Health Care System and Adherence to Direct-Acting Antiviral Therapy among People with Hepatitis C Virus Who Inject Drugs. Viruses 2024; 16:1304. [PMID: 39205278 PMCID: PMC11359142 DOI: 10.3390/v16081304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
This study is a secondary analysis of a randomized clinical trial (October 2013-April 2017) involving 150 People Who Inject Drugs (PWIDs) with hepatitis C virus (HCV) seen in opioid agonist treatment programs in the Bronx, New York, and investigates the impact of distrust in the healthcare system on adherence to Direct-Acting Antivirals (DAAs) HCV treatment therapy among PWIDs. The distrust was scaled on a 9-item instrument and the adherence to DAA medications was measured using electronic blister packs. This study demonstrated a significant inverse relationship between levels of distrust and medication adherence: 71.8 ± 2.2% (se) vs. 77.9 ± 1.8%, p = 0.024 between participants with higher and lower distrust levels. Despite the absence of significant association of distrust with sociodemographic or substance use characteristics, these findings suggest that building trust within the healthcare system is paramount for improving adherence to DAAs among PWIDs. The results call for a healthcare approach that emphasizes trust-building through patient-centered care, sensitivity training, peer support, and health system reform to effectively address the treatment needs of this marginalized population.
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Affiliation(s)
- Akhila Padi
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Irene Pericot-Valverde
- Department of Psychology, Clemson University, Clemson, SC 29634, USA;
- Addiction Medicine Center, Department of Medicine, Prisma Health, Greenville, SC 29605, USA
| | - Moonseong Heo
- Department of Public Health Science, Clemson University, Clemson, SC 29634, USA; (M.H.); (J.E.D.)
| | - James Edward Dotherow
- Department of Public Health Science, Clemson University, Clemson, SC 29634, USA; (M.H.); (J.E.D.)
| | - Jiajing Niu
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA;
| | - Madhuri Martin
- Department of Medicine, University of South Carolina School of Medicine, Greenville, SC 29615, USA;
| | - Brianna L. Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; (B.L.N.); (J.H.A.)
| | - Matthew J. Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; (B.L.N.); (J.H.A.)
| | - Julia H. Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; (B.L.N.); (J.H.A.)
| | - Alain H. Litwin
- Department of Psychology, Clemson University, Clemson, SC 29634, USA;
- Addiction Medicine Center, Department of Medicine, Prisma Health, Greenville, SC 29605, USA
- Department of Medicine, University of South Carolina School of Medicine, Greenville, SC 29615, USA;
- Department of Medicine, Prisma Health, 605 Grove Road, Suite 205, Greenville, SC 29605, USA
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Voisin DR, Takahashi L, Walsh JL, DiFranceisco W, Johnson A, Dakin A, Bouacha N, Brown K, Quinn KG. An exploratory study of community violence and HIV care engagement among Black gay and bisexual men. AIDS Care 2024; 36:1111-1118. [PMID: 38648523 DOI: 10.1080/09540121.2024.2331221] [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: 08/14/2023] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
Abstract
This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.
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Affiliation(s)
- Dexter R Voisin
- Jack Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | | | | | - Khalil Brown
- Jack Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Quinn KG, Hunt BR, Jacobs J, Valencia J, Voisin D, Walsh JL. Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination. Behav Med 2024; 50:250-259. [PMID: 37578320 PMCID: PMC10864675 DOI: 10.1080/08964289.2023.2244626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 08/15/2023]
Abstract
In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center
| | | | | | - Dexter Voisin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin
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7
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Costa-Font J, Sato A. Cultural persistence and the 'herbal medicine paradox': Evidence from European data. J Health Psychol 2024:13591053241237031. [PMID: 38566399 DOI: 10.1177/13591053241237031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
The use of herbal or traditional medicines has survived the proliferation of modern medicine. The phenomenon has been labeled as the 'herbal medicines paradox' (HMP). We study whether such HMP hypothesis can be explained by the persistence of attitudes across cultural boundaries. We undertake a secondary analysis of individual-level migration data to test the persistence of the use of herbal medicines in relation to norms in the person's country of birth (or home country). We study the association between attitudes towards herbal medicine treatments of both first (N = 3630) and second-generation (N = 1618) immigrants in 30 European countries, and the average attitudes of their sending country origins. We find robust evidence of an association that is stronger for the second-generation migrants. We document a stronger effect among maternal than paternal lineages, as well as significant heterogeneity based on migrants' country of origin. Our estimates are robust to different sample analysis. Our estimates are consistent with a cultural explanation for the HMP.
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YIGIT I, TURAN B, KURT G, WEISER SD, JOHNSON MO, MUGAVERO MJ, TURAN JM. Longitudinal Associations of Experienced and Perceived Community Stigma With Antiretroviral Therapy Adherence and Viral Suppression in New-to-Care People With HIV: Mediating Roles of Internalized Stigma and Depression Symptoms. J Acquir Immune Defic Syndr 2024; 95:231-237. [PMID: 38180894 PMCID: PMC10922854 DOI: 10.1097/qai.0000000000003360] [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: 07/01/2023] [Accepted: 11/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States. SETTING/METHODS Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit. RESULTS Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms. CONCLUSIONS These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.
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Affiliation(s)
- Ibrahim YIGIT
- Department of Psychology, TED University, Ankara, Turkey
| | - Bulent TURAN
- Department of Psychology, Koc University, Istanbul, Turkey; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gülşah KURT
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
| | - Sheri D. WEISER
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mallory O. JOHNSON
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael J. MUGAVERO
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M. TURAN
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, Department of Public Health, Koc University, Istanbul, Turkey
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Jordan H, Jeremiah R, Watson K, Corte C, Steffen A, Matthews AK. Exploring Preventive Health Care Utilization Among Black/African American Men. Am J Mens Health 2024; 18:15579883231225548. [PMID: 38243644 PMCID: PMC10799604 DOI: 10.1177/15579883231225548] [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: 05/19/2023] [Revised: 09/21/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.
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Affiliation(s)
- Harrell Jordan
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Rohan Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Karriem Watson
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Colleen Corte
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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10
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El-Krab R, Brousseau N, Kalichman SC. Medical mistrust as a barrier to HIV prevention and care. J Behav Med 2023; 46:897-911. [PMID: 37698802 DOI: 10.1007/s10865-023-00417-7] [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: 10/22/2022] [Accepted: 05/03/2023] [Indexed: 09/13/2023]
Abstract
Medical mistrust is fueled by conspiracy theories and histories of healthcare systems abuse and is a known determinant of health outcomes in minority populations. Plagued by multiple and pervasive conspiracy theories, HIV/AIDS has proven to be particularly hampered by medical mistrust. The current paper systematically reviews the literature on medical mistrust among people at risk for or living with HIV infection. The bulk of evidence from 17 studies supports medical mistrust as a barrier to HIV testing, engagement in prevention and care services, treatment uptake and adherence, and clinical outcomes. While findings mostly indicate that medical mistrust is a barrier to HIV prevention and care, some studies report null results and others suggest that medical mistrust may actually improve some HIV-related outcomes. Additionally, most of the reviewed literature was cross-sectional. Thus longitudinal, theory-driven research is needed to reconcile inconsistent findings and determine long term outcomes of medical mistrust. Interventions may then be developed to reduce the negative consequences associated with medical mistrust.
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Affiliation(s)
- Renee El-Krab
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States.
| | - Natalie Brousseau
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
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11
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Small LA, Godoy SM, Lau C. Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA. CULTURE, HEALTH & SEXUALITY 2023; 25:1295-1309. [PMID: 36571392 PMCID: PMC10558086 DOI: 10.1080/13691058.2022.2155706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.
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Affiliation(s)
- Latoya A. Small
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Sarah M. Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Lau
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
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12
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Dale SK, Etienne K, Hall S, Lazarus K, Nunnally K, Gibson G, Bolden R, Gardner N, Sanders J, Reid R, Phillips A. Five point initiative: a community-informed bundled implementation strategy to address HIV in Black communities. BMC Public Health 2023; 23:1625. [PMID: 37626315 PMCID: PMC10463742 DOI: 10.1186/s12889-023-16525-7] [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: 05/19/2022] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Black individuals in the U.S. remain the most disproportionately impacted by new HIV diagnoses, represent the highest portion of individuals living with HIV, and have the highest morbidity rates. Structural inequities and historical oppression are the primary drivers. Such drivers limit access to HIV prevention tools that need to be delivered with culturally congruent and community-informed approaches. METHODS The Five Point Initiative (FPI) is a community-informed bundled implementation strategy developed and piloted between September 2019 and March 2020 in Miami, Florida in communities heavily impacted by HIV. Key components of the strategy included community consultants/experts, five categories (hence the "Five Point") of community businesses (e.g., corner stores, beauty supply stores, laundromats, mechanics, barbershops), local health organizations, an academic research program engrossed in community engaged research, and community residents who provided ongoing feedback throughout. Outcomes of FPI included (a) survey information (e.g., knowledge of and access to PrEP, barriers to care) and pilot data (acceptability and feasibility), (b) expansion of reach to Black individuals in HIV high impact zip codes in Miami, (c) insights on our bundled implementation strategy, (d) condom distribution, and (e) HIV testing. RESULTS Over the course of six months FPI carried out 10 outreach events, partnered with 13 community businesses and 5 health organizations, engaged 677 community residents, collected health information via a survey, distributed 12,434 condoms, provided information on PrEP, and offered voluntary HIV testing (131 completed). FPI's ability to reach residents who are not being reached (e.g., 68.8% never heard of PrEP, 8% no HIV testing ever, 65.9% no primary care provider), positive feedback from residents (e.g., 70% very satisfied, 21% satisfied; 62% strongly agree and 25% agree they would participate again) and qualitative interviews with businesses provide evidence of acceptability and feasibility. Further, survey data provided insights on factors such as socio-demographics, discrimination experiences, barriers to care, social-structural factors, physical and sexual health, and mental health and substance use. CONCLUSIONS The FPI bundled implementation strategy shows promise to deliver health prevention/intervention for HIV and other health conditions to communities facing health inequities and for whom the current system for delivering care is insufficient.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Kayla Etienne
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sidny Hall
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- New College of Florida, Sarasota, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | | | | | - Roxana Bolden
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- A Sister with A Testimony, Miami, FL, USA
| | - Nadine Gardner
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
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13
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Sauceda JA, Campbell CK, Ndukwe SO, Dubé K, Saberi P. Medical mistrust of health systems as a moderator of resilience and self-reported HIV care engagement in Black and Latinx young adults living with HIV. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2023:2023-99078-001. [PMID: 37589681 PMCID: PMC10873476 DOI: 10.1037/cdp0000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To study resilience and its association with HIV care engagement in a sample of young adult Black and Latinx people living with HIV (PLWH) in the United States and to test if a systems-level barrier, medical mistrust, would moderate the resilience-engagement association. METHOD Between April and August 2021, we recruited participants through social media and dating apps (N = 212) and verified age and HIV status through a review process of digital text-messaged and emailed photos. Participants completed a one-time online survey consisting of the Connor-Davidson Resilience Scale, The Index of Engagement in HIV Care, and the Medical Mistrust Index. We ran a regression-based moderation analysis using the Johnson-Neyman Technique to estimate regions of significance. RESULTS The sample (N = 212) was 80.5% Black and 19.5% Latinx with a mean age of 25.8 years (SD = 2.84). Higher resilience scores were associated with higher HIV care engagement scores (b = 0.72, p = .003), and medical mistrust moderated this relationship as evidenced by a mistrust by resilience interaction (b = -0.16, p = .01). Our regions of statistical significance showed that as mistrust increased, the size of the resilience-engagement association decreased. CONCLUSION Resilience may be a protective factor associated with greater participation and sense of connection to HIV care, but is diminished by mistrust of the medical system at large. This suggest that systems-level changes, in addition to individual-level interventions, are needed to address medical mistrust to fully harness the resilience of young PLWH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- John A. Sauceda
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | - Chadwick K. Campbell
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, San Diego, CA
| | - Samuel O. Ndukwe
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA
| | - Parya Saberi
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
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14
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Cox AB, Jaiswal J, LoSchiavo C, Witte T, Wind S, Griffin M, Halkitis PN. Medical Mistrust Among a Racially and Ethnically Diverse Sample of Sexual Minority Men. LGBT Health 2023; 10:471-479. [PMID: 37418567 PMCID: PMC10623470 DOI: 10.1089/lgbt.2022.0252] [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] [Indexed: 07/09/2023] Open
Abstract
Purpose: Medical mistrust is a barrier to health care utilization and is associated with suboptimal health outcomes. Research on mistrust among sexual minority men (SMM) is limited and largely focuses on Black SMM and HIV, with few studies assessing mistrust among SMM of other race/ethnicities. The purpose of this study was to examine differences in medical mistrust among SMM by race. Methods: From February 2018 to February 2019, a mixed-methods study examined the health-related beliefs and experiences of young SMM in New York City. The Group-Based Medical Mistrust Scale (GBMMS) was used to measure medical mistrust related to race, and a modified version of the scale assessed mistrust related to one's "sexual/gender minority" status (Group-Based Medical Mistrust Scale-Sexual/Gender Minority [GBMMS-SGM]). With an analytic sample of 183 cisgender SMM, a one-way multivariate analysis of variance was used to examine differences in GBMMS and GBMMS-SGM scores by race/ethnicity [Black, Latinx, White, "Another Racial Group(s)"]. Results: There were significantly different GBMMS scores by race, with participants of color reporting higher levels of race-based medical mistrust than White participants. This finding is supported by effect sizes ranging from moderate to large. Differences in GBMMS-SGM scores by race were borderline; however, the effect size for Black and White participants' GBMMS-SGM scores was moderate, indicating that higher GBMMS-SGM scores among Black participants is meaningful. Conclusion: Multilevel strategies should be used to earn the trust of minoritized populations, such as addressing both historical and ongoing discrimination, moving beyond implicit bias trainings, and strengthening the recruitment and retention of minoritized health care professionals.
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Affiliation(s)
- Amanda B. Cox
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Tricia Witte
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, Alabama, USA
| | - Stefanie Wind
- Department of Educational Studies in Psychology, Research Methodology and Counseling, University of Alabama, Tuscaloosa, Alabama, USA
| | - Marybec Griffin
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
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15
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Anthony M, Farkouh C, Abdi P. Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America. Dermatol Pract Concept 2023; 13:e2023167. [PMID: 37557146 PMCID: PMC10412004 DOI: 10.5826/dpc.1303a167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | - Parsa Abdi
- Memorial University Faculty of Medicine, St. John’s, Newfoundland, Canada
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16
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Jones PD, Lai JC, Bajaj JS, Kanwal F. Actionable Solutions to Achieve Health Equity in Chronic Liver Disease. Clin Gastroenterol Hepatol 2023; 21:1992-2000. [PMID: 37061105 PMCID: PMC10330625 DOI: 10.1016/j.cgh.2023.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/08/2023] [Accepted: 03/26/2023] [Indexed: 04/17/2023]
Abstract
There are well-described racial and ethnic disparities in the burden of chronic liver diseases. Hispanic persons are at highest risk for developing nonalcoholic fatty liver disease, the fastest growing cause of liver disease. Hepatitis B disproportionately affects persons of Asian or African descent. The highest rates of hepatitis C occur in American Indian and Alaskan Native populations. In addition to disparities in disease burden, there are also marked racial and ethnic disparities in access to treatments, including liver transplantation. Disparities also exist by gender and geography, especially in alcohol-related liver disease. To achieve health equity, we must address the root causes that drive these inequities. Understanding the role that social determinants of health play in the disparate health outcomes that are currently observed is critically important. We must forge and/or strengthen collaborations between patients, community members, other key stakeholders, health care providers, health care institutions, professional societies, and legislative bodies. Herein, we provide a high-level review of current disparities in chronic liver disease and describe actionable strategies that have potential to bridge gaps, improve quality, and promote equity in liver care.
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Affiliation(s)
- Patricia D Jones
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jasmohan S Bajaj
- Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
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17
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Bogart LM, Mutchler MG, Goggin K, Ghosh-Dastidar M, Klein DJ, Saya U, Linnemayr S, Lawrence SJ, Tyagi K, Thomas D, Gizaw M, Bailey J, Wagner GJ. Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV. AIDS Behav 2023; 27:1573-1586. [PMID: 36399252 PMCID: PMC9673878 DOI: 10.1007/s10461-022-03921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
| | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | | | - Damone Thomas
- APLA Health & Wellness, Los Angeles, CA, USA
- HEALING with HOPE Corp., Los Angeles, CA, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Jeff Bailey
- APLA Health & Wellness, Los Angeles, CA, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
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18
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Hill M, Truszczynski N, Newbold J, Coffman R, King A, Brown MJ, Radix A, Kershaw T, Kirklewski S, Sikkema K, Haider MR, Wilson P, Hansen N. The mediating role of social support between HIV stigma and sexual orientation-based medical mistrust among newly HIV-diagnosed gay, bisexual, and other men who have sex with men. AIDS Care 2023; 35:696-704. [PMID: 36205058 PMCID: PMC10079779 DOI: 10.1080/09540121.2022.2119472] [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: 10/25/2021] [Accepted: 08/25/2022] [Indexed: 10/10/2022]
Abstract
HIV-related stigma and medical mistrust are significant challenges to addressing HIV inequities among gay, bisexual, and other men who have sex with men (MSM). HIV-related stigma is associated with high levels of medical mistrust, but there is limited knowledge regarding the mechanisms that link these variables. We examined the potential mediating roles of social support and coping in the relationship between perceived HIV stigma and sexual orientation based-medical mistrust among newly HIV-diagnosed MSM. We hypothesized that HIV-related stigma would be associated with mistrust and that social support, and coping would mediate this relationship. Data were obtained from 202 newly HIV-diagnosed (<1 year) MSM receiving care at community HIV clinics in New York. A path model indicated that HIV stigma was directly related to greater sexual orientation based medical mistrust, and that this relationship was mediated by social support. However, coping did not mediate the relationship between HIV stigma and mistrust. Efforts to increase social support and decrease stigma are critical for strengthening relationships between MSM and HIV care networks. Future research should assess the feasibility of designing and implementing interventions focused on increasing social network support and improving trust in the medical community among newly HIV-diagnosed MSM.
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Affiliation(s)
- Miranda Hill
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | - Robert Coffman
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Aisha King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Sally Kirklewski
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Kathleen Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Patrick Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Nathan Hansen
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
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19
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Andler C, Schmidt AR, Chang TP, Cho CS. Examining trust between supervisors and trainees in the pediatric emergency department. AEM EDUCATION AND TRAINING 2023; 7:e10857. [PMID: 37064493 PMCID: PMC10090487 DOI: 10.1002/aet2.10857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/19/2023]
Abstract
Objective Lack of trust between supervisors and trainees can have harmful consequences. Trust has been examined between physicians, patients, and staff in multiple settings but has not been examined in a bidirectional manner in the pediatric emergency department (PED). Debra Meyerson in 1996 discussed the theory of swift trust, a type of trust that develops quickly between temporary groups through reliance on categories. Meyerson describes categories as groups unified by social identities such as gender or profession. We explored the applicability of swift trust in the relationship between supervisors and trainees in the PED. Methods This multimethods study used qualitative interviews and the validated interpersonal mistrust trust measure (IMTM) to assess baseline trusting style. PED attendings from a single institution and residents from various training levels, specialties, and institutions rotating through the same PED were sampled until thematic saturation was reached. Interviews were analyzed using directed content analysis. IMTM scores were triangulated with interviewee's reported trusting styles. Results Seventeen PED attendings and 16 residents participated. Residents and attendings emphasized different factors that influence trust. Common factors across groups included affect, the need for vulnerability, and appropriate communication. Most described reliance on certain categories (level of training, specialty, etc.) when making trusting decisions. Categories such as gender and race were noted to be unimportant when making trusting decisions about others, although some participants believed these attributes played into decisions made by others. Quantitative data from the IMTM supported qualitative conclusions regarding trusting style. Conclusions The trusting relationship between supervisors and trainees in the PED dovetails with the swift trust theory. Common factors that influence trust reveal entry points for attendings and residents to improve trust and ultimately prevent negative patient outcomes. Future studies may examine how reliance on categories influences an individual's trust in their colleagues.
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Affiliation(s)
- Caroline Andler
- Division of Emergency and Transport MedicineChildren's Hospital Los Angeles (CHLA)Los AngelesCaliforniaUSA
| | - Anita R. Schmidt
- Division of Emergency and Transport MedicineChildren's Hospital Los Angeles (CHLA)Los AngelesCaliforniaUSA
| | - Todd P. Chang
- Division of Emergency and Transport MedicineChildren's Hospital Los Angeles (CHLA)Los AngelesCaliforniaUSA
| | - Christine S. Cho
- Division of Emergency and Transport MedicineChildren's Hospital Los Angeles (CHLA)Los AngelesCaliforniaUSA
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20
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West BS, Diaz JE, Philbin MM, Mauro PM. Past-year medical and non-medical opioid use by HIV status in a nationally representative US sample: Implications for HIV and substance use service integration. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208976. [PMID: 36827878 PMCID: PMC10100645 DOI: 10.1016/j.josat.2023.208976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023]
Abstract
AIM In the context of the continued overdose epidemic, recent population estimates of opioid use in highly affected groups, such as people at risk for or people living with HIV (PLWH), are essential for service planning and provision. Although nonmedical opioid use is associated with HIV transmission and with lowered adherence and care engagement, most studies rely on clinic-based samples and focus on medical use of opioids only. We examine associations between opioid-related outcomes by HIV status in a community-based nationally representative sample. METHODS The 2015-2019 National Survey on Drug Use and Health included 213,203 individuals aged 18 and older. Respondents self-reported whether a health care professional ever told them they had HIV/AIDS (i.e., HIV-positive/PLWH, HIV-negative, HIV-unknown). Opioid-related outcomes included past-year medical opioid use and past-year nonmedical (i.e., prescription opioid and heroin) use. Multinomial logistic regression estimated adjusted relative risk ratios between past-year opioid-related outcomes and HIV status, controlling for age, gender, race/ethnicity, income, population density, and year. RESULTS In 2015-2019, 0.2 % of respondents were PLWH and 0.3 % self-reported an HIV-unknown status. Past-year medical opioid use was 37.3 % among PLWH, 30.4 % among HIV-negative and 21.9 % among HIV-unknown individuals. Past-year nonmedical use was 11.1 % among PLWH, 4.2 % among HIV-negative and 7.2 % among HIV-unknown individuals. Compared to HIV-negative individuals, PLWH had 3.21 times higher risk of past-year nonmedical use vs. no use (95 % CI:2.02-5.08) and 2.02 times higher risk of past-year nonmedical vs. medical opioid use only (95 % CI:1.24-2.65). CONCLUSION Nonmedical opioid use prevalence was almost three times higher among PLWH than HIV-negative individuals. Because opioid use and its related harms disproportionately burden PLWH, integrating HIV and substance use prevention and treatment services may improve both HIV-related and opioid-related outcomes, including overdose.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, United States of America.
| | - José E Diaz
- SUNY Downstate Health Sciences University Department of Medicine, United States of America
| | - Morgan M Philbin
- University of California San Francisco School of Medicine, United States of America
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, United States of America
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Lyons N, Bhagwandeen B, Todd S, Boyce G, Samaroo-Francis W, Edwards J. Correlates and Predictors of COVID-19 Vaccine Hesitancy Among Persons Living With HIV in Trinidad and Tobago. Cureus 2023; 15:e35961. [PMID: 37051005 PMCID: PMC10085522 DOI: 10.7759/cureus.35961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Persons living with HIV may be at risk of more severe forms of COVID-19 infection and minimizing health risks largely depends on their acceptance of the COVID-19 vaccinations. OBJECTIVE This study examined the correlates and predictors of COVID-19 vaccine hesitancy among persons living with HIV in Trinidad and Tobago. METHODS A cross-sectional survey using a structured interview was conducted. Data were compiled on patient socio-demographics, diagnosed chronic diseases, psychological factors, and decisions to take the COVID-19 vaccine. Pearson χ2 tests examined the associations between study variables and COVID-19 vaccine hesitancy, and multivariable logistic regression analyses examined its predictors. RESULTS In this study, 84% were virally suppressed, i.e., HIV viral load <1000 copies/ml. COVID-19 vaccine hesitancy was found to be 39%. Univariate analysis showed that higher vaccine hesitancy was significantly associated with females (OR 2.02, 95% CI 1.23-3.33) and patients of mixed ethnicity (OR 1.84, 95% CI 1.07-3.15). In our multivariable analysis, psychological factors namely, confidence in the COVID-19 vaccine (OR 0.16, 95% CI 0.05-0.47), the perceived benefits of the vaccine (OR 0.54, 95% CI 0.37-0.79), and cues to action (OR 0.68, 95% CI 0.47-0.97) were observed as predictors of COVID-19 vaccine hesitancy. CONCLUSION Psychological factors such as confidence in the COVID-19 vaccine, perceived benefits of the vaccine, and cues to action were possible predictors of COVID-19 vaccine hesitancy. This study underscored the continued need for strategies to increase confidence and knowledge about the benefits of taking the COVID-19 vaccine among persons living with HIV.
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Christopoulos KA, Grochowski J, Mayorga-Munoz F, Hickey MD, Imbert E, Szumowski JD, Dilworth S, Oskarsson J, Shiels M, Havlir D, Gandhi M. First Demonstration Project of Long-Acting Injectable Antiretroviral Therapy for Persons With and Without Detectable Human Immunodeficiency Virus (HIV) Viremia in an Urban HIV Clinic. Clin Infect Dis 2023; 76:e645-e651. [PMID: 35913500 PMCID: PMC9907477 DOI: 10.1093/cid/ciac631] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH) based on trials that only included participants with viral suppression. We performed the first LAI-ART demonstration project to include PWH unable to achieve or maintain viral suppression due to challenges adhering to oral ART. METHODS Ward 86 is a large HIV clinic in San Francisco that serves publicly insured and underinsured patients. We started patients on LAI-ART via a structured process of provider referral, multidisciplinary review (MD, RN, pharmacist), and monitoring for on-time injections. Inclusion criteria were willingness to receive monthly injections and a reliable contact method. RESULTS Between June 2021 and April 2022, 51 patients initiated LAI-ART, with 39 receiving at least 2 follow-up injections by database closure (median age, 46 years; 90% cisgender men, 61% non-White, 41% marginally housed, 54% currently using stimulants). Of 24 patients who initiated injections with viral suppression (median CD4 cell count, 706 cells/mm3), 100% (95% confidence interval [CI], 86%-100%) maintained viral suppression. Of 15 patients who initiated injections with detectable viremia (median CD4 cell count, 99 cells/mm3; mean log10 viral load, 4.67; standard deviation, 1.16), 12 (80%; 95% CI, 55%-93%) achieved viral suppression, and the other 3 had a 2-log viral load decline by a median of 22 days. CONCLUSIONS This small demonstration project of LAI-ART in a diverse group of patients with high levels of substance use and marginal housing demonstrated promising early treatment outcomes, including in those with detectable viremia due to adherence challenges. More data on LAI-ART in hard-to-reach populations are needed.
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Affiliation(s)
- Katerina A Christopoulos
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Janet Grochowski
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Francis Mayorga-Munoz
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Matthew D Hickey
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Elizabeth Imbert
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - John D Szumowski
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Samantha Dilworth
- Division of Prevention Science, University of California–San Francisco, San Francisco, California, USA
| | - Jon Oskarsson
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Mary Shiels
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Diane Havlir
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California–San Francisco, San Francisco, California, USA
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Ham L, Montoya JL, Serrano V, Yeager S, Paltin D, Pasipanodya EC, Marquine MJ, Hoenigl M, Ramers CB, Kua J, Moore DJ. High Psychosocial Burden Relates to Poorer Antiretroviral Treatment Adherence Among Black/African American People with HIV. AIDS Patient Care STDS 2023; 37:103-113. [PMID: 36689195 PMCID: PMC9963477 DOI: 10.1089/apc.2022.0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Black/African American communities continue to be disproportionately impacted by HIV with Black people with HIV (PWH) exhibiting poorer outcomes along the HIV treatment cascade. Psychosocial burden may, in part, explain these health disparities among PWH. We implemented a culturally adapted intervention [individualized Texting for Adherence Building (iTAB)] to improve ART adherence among 89 Black PWH in San Diego, CA. We aimed to (1) characterize psychosocial risk factors (depression, negative life events, discrimination, medical mistrust) hypothesized to be barriers to HIV outcomes among Black PWH and (2) determine if these factors influence intervention engagement, HIV outcomes, and self-reported physical and mental health. We identified three levels of psychosocial burden (low, moderate, high) through hierarchical cluster analysis. Participants in the high burden cluster (n = 25) experienced the highest levels of depression, negative life events, and discrimination, in addition to the poorest intervention outcomes, HIV outcomes, and physical and mental health compared to low and moderate burden clusters. Participants in the low (n = 29) burden cluster had less medical mistrust than the moderate (n = 34) and high burden clusters, but low and moderate clusters did not differ on any outcomes. Overall, self-reported ART adherence was 83%, which is above estimates of ART adherence in the Western region of the United States. The iTAB intervention shows promise in improving HIV-related outcomes among Black PWH with low to moderate psychosocial burden; however, additional supports may need to be identified for those with high psychosocial burden.
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Affiliation(s)
- Lillian Ham
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jessica L. Montoya
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Samantha Yeager
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dafna Paltin
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | | | - Maria J. Marquine
- Geriatrics Division, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Medical University of Graz, Graz, Austria
| | - Christian B. Ramers
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - John Kua
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
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Rogers BG, Harkness A, Satyanarayana S, Pachankis J, Safren SA. Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:741-750. [PMID: 35536492 PMCID: PMC10463180 DOI: 10.1007/s10508-021-02263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Pre-exposure prophylaxis for HIV or "PrEP" holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around "safe sex," and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned with Ending the HIV Epidemic priorities to increase PrEP use among young sexual minority men living in an HIV epicenter.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, 11 Fourth Street, Providence, RI, 02906, USA.
- Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA.
| | - Audrey Harkness
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Satyanand Satyanarayana
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Steven A Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- The Fenway Institute, Boston, MA, USA
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25
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Bensken WP, Fernandez Baca Vaca G, Alberti PM, Khan OI, Ciesielski TH, Jobst BC, Williams SM, Stange KC, Sajatovic M, Koroukian SM. Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid: A Case of Potential Inequities. Neurol Clin Pract 2023; 13:e200101. [PMID: 36865639 PMCID: PMC9973322 DOI: 10.1212/cpj.0000000000200101] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/03/2022] [Indexed: 01/13/2023]
Abstract
Background and Objectives Being on a newer, second-, and third-generation antiseizure medication (ASM) may represent an important marker of quality of care for people with epilepsy. We sought to examine whether there were racial/ethnic differences in their use. Methods Using Medicaid claims data, we identified the type and number of ASMs, as well as the adherence, for people with epilepsy over a 5-year period (2010-2014). We used multilevel logistic regression models to examine the association between newer-generation ASMs and adherence. We then examined whether there were racial/ethnic differences in ASM use in models adjusted for demographics, utilization, year, and comorbidities. Results Among 78,534 adults with epilepsy, 17,729 were Black, and 9,376 were Hispanic. Overall, 25.6% were on older ASMs, and being solely on second-generation ASMs during the study period was associated with better adherence (adjusted odds ratio: 1.17, 95% confidence interval [CI]: 1.11-1.23). Those who saw a neurologist (3.26, 95% CI: 3.13-3.41) or who were newly diagnosed (1.29, 95% CI: 1.16-1.42) had higher odds of being on newer ASMs. Importantly, Black (0.71, 95% CI: 0.68-0.75), Hispanic (0.93, 95% CI: 0.88-0.99), and Native Hawaiian and Other Pacific Island individuals (0.77, 95% CI: 0.67-0.88) had lower odds of being on newer ASMs when compared with White individuals. Discussion Generally, racial and ethnic minoritized people with epilepsy have lower odds of being on newer-generation ASMs. Greater adherence by people who were only on newer ASMs, their greater use among people seeing a neurologist, and the opportunity of a new diagnosis point to actionable leverage points for reducing inequities in epilepsy care.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Guadalupe Fernandez Baca Vaca
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Philip M Alberti
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Omar I Khan
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Timothy H Ciesielski
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Barbara C Jobst
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Martha Sajatovic
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences (WPB, THC, SMW, KCS, MS), School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Neurology (GFBV), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH; AAMC Center for Health Justice (PMA), Association of American Medical Colleges, Washington, DC; Epilepsy Center of Excellence (OIK), Baltimore VA Medical Center, US Department of Veterans Affairs, MD; Department of Neurology and Geisel School of Medicine (BCJ), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Center for Community Health Integration (KCS, MS), Department of Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; and Departments of Neurology and Psychiatry (SMK), University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, OH
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Turan B, Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Brown-Friday J, Gange S, Kassaye S, Pence BW, Turan JM. Resilience and Optimism as Moderators of the Negative Effects of Stigma on Women Living with HIV. AIDS Patient Care STDS 2022; 36:474-482. [PMID: 36484762 PMCID: PMC9805859 DOI: 10.1089/apc.2022.0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Resilience and optimism may not only have main effects on health outcomes, but may also moderate and buffer negative effects of stressors. We examined whether dispositional resilience and optimism moderate the associations between HIV-related stigma in health care settings and health-related outcomes (trust in HIV health care providers and depression symptoms) among women living with HIV (WLHIV). One thousand four hundred five WLHIV in nine US cities completed validated questionnaires for cross-sectional analyses. Higher self-reported experienced and anticipated stigma and lower resilience and optimism were associated with higher depression symptoms and with lower trust in HIV providers. Importantly, resilience moderated the effects of experienced stigma (but not of anticipated stigma): When resilience was high, the association of experienced stigma with higher depression symptoms and lower trust in HIV providers was weaker compared with when resilience was low. Further, significant moderation effects suggested that when optimism was high, experienced and anticipated stigma was both less strongly associated with depression symptoms and with lower trust in one's HIV care providers compared with when optimism was low. Thus, the effects of experienced stigma on depression symptoms and provider trust were moderated by both resilience and optimism, but the effects of anticipated stigma were moderated only by optimism. Our findings suggest that in addition to their main effects, resilience and optimism may function as buffers against the harmful effects of stigma in health care settings. Therefore, optimism and resilience may be valuable intervention targets to reduce depression symptoms or improve trust in providers among populations that experience or anticipate stigma, such as WLHIV.
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Affiliation(s)
- Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Henna Budhwani
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, TED University, Ankara, Turkey
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Deborah J. Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center (UMMC), Jackson, Mississippi, USA
| | | | - Gina M. Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adaora A. Adimora
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N. Taylor
- College of Medicine, Division of Infectious Disease, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Janet Brown-Friday
- Albert Einstein College of Medicine-Montefiore Medical Center, New York, New York, USA
| | - Stephen Gange
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seble Kassaye
- Department of Medicine/Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Brian W. Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janet M. Turan
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- School of Medicine, Department of Pubic Health, Koc University, Istanbul, Turkey
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27
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Gbadamosi SO, Trepka MJ, Dawit R, Bursac Z, Raymond A, Ladner RA, Sheehan DM. A Comparative Analysis of Different HIV Viral Load Suppression Definitions Among Clients Receiving Care in the Miami-Dade Ryan White HIV/AIDS Program. AIDS Behav 2022; 26:3576-3588. [PMID: 35536517 PMCID: PMC9561086 DOI: 10.1007/s10461-022-03694-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
The study's objective was to examine variations in viral load (VL) suppression definitions among clients in the Ryan White Program (RWP). Data from clients enrolled in the RWP during 2017 were examined to calculate the proportion of virally suppressed clients using three definitions: recent viral suppression, defined as having a suppressed VL (< 200 copies/mL) in the last test in 2017; maintained viral suppression, having a suppressed VL for both the first and last tests in 2017; and sustained viral suppression, having all tests in 2017 showing suppression. Relative differences across all three definitions were computed. Recent viral suppression measures were higher than maintained and sustained viral suppression measures by 7.0% and 10.1%, respectively. Significant relative differences in definitions by demographic, socioeconomic and clinical status were observed. It may be beneficial for care planning to report not only estimates of recent viral suppression but maintained and sustained viral suppression as well.
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Affiliation(s)
- Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Andrea Raymond
- Department of Immunology and Nanomedicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA.
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
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28
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Rohan EA, Gallaway MS, Huang GC, Ng D, Boehm JE, Samarasinha R, Stachon K. Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors. JCO Oncol Pract 2022; 18:e1704-e1715. [PMID: 35939778 PMCID: PMC9835932 DOI: 10.1200/op.22.00078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural). METHODS This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017. RESULTS Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services. CONCLUSION Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.
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Affiliation(s)
- Elizabeth A. Rohan
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - M. Shayne Gallaway
- Arizona Department of Public Health, Phoenix, AZ
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Jennifer E. Boehm
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ruvini Samarasinha
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Stachon
- American College of Surgeons, Commission on Cancer, Chicago, IL
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29
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Khaderi S, Kanwal F. Changing epidemiology of hepatocellular cancer in the United States: Winning the battle but it is not over yet. Hepatology 2022; 76:546-548. [PMID: 35388520 DOI: 10.1002/hep.32512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Saira Khaderi
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Xue J, Deng Z, Wu T, Chen Z. Patient distrust toward doctors in online health communities: integrating distrust construct model and social-technical systems theory. INFORMATION TECHNOLOGY & PEOPLE 2022. [DOI: 10.1108/itp-03-2021-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis article aims to explore the factors influencing patients' distrust toward doctors in online health community.Design/methodology/approachThis study leveraged the distrust construct model and socio-technical systems theory to establish a research model. The authors used the survey method to validate the research model by developing and distributing questionnaires to online health community users. 518 valid responses were collected.FindingsThe data analysis results showed that patients' distrusting beliefs were significantly related to their distrust toward doctors in online health communities. Meanwhile, social factors included perceived egoism and lack of expertise; whereas technical factors included no structural assurance, and lack of third-party recognition.Originality/valueThis study not only provides a solid and comprehensive theoretical understanding of patient distrust toward doctors in online health communities but also could serve as the basis to relieve the distrust between patients and doctors in online health communities, or even in the offline environment.
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31
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Jones WD. An Ecological Theory Application and Expansion to the COVID-19 Pandemic's Impact on African Americans and Contributors to Vaccine Hesitancy. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:456-467. [PMID: 34970946 DOI: 10.1080/19371918.2021.2020200] [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: 06/14/2023]
Abstract
The COVID-19 pandemic has highlighted numerous social and health disparities within the United States, particularly those that impact African Americans. African Americans have been overrepresented in the number of COVID-19 hospitalizations and deaths and have demonstrated lower vaccine inoculation compared to other ethnic groups. This article applies Urie Bronfenbrenner's Ecological Theory to the disproportionate impact the COVID-19 pandemic has had on African Americans and contributors to vaccine hesitancy while offering an expansion to the theory utilizing the Health Belief Model. The Health Belief Model was utilized to address the intervention limitations of the Ecological Theory as the better determine which system(s) would be most advantageous to for health intervention(s). This article extends the social work knowledge base and application by offering implications for practice and research.
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Affiliation(s)
- Willie D Jones
- Wayne State University School of Social Work, Wayne State University, Detroit, Michigan, USA
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Sharpless L, Kershaw T, Hatcher A, Alexander KA, Katague M, Phillips K, Willie TC. IPV, PrEP, and Medical Mistrust. J Acquir Immune Defic Syndr 2022; 90:283-290. [PMID: 35364598 PMCID: PMC9203922 DOI: 10.1097/qai.0000000000002956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for women experiencing intimate partner violence (IPV). This study aimed to examine (1) relationships between physical, sexual, and psychological IPV and women's PrEP communication with a health care provider and domestic violence advocate; and (2) how IPV-specific medical mistrust modifies the association between IPV and PrEP communication. METHODS Data were from 2 studies conducted in Connecticut and Baltimore, MD on adult women experiencing IPV (N = 272). Logistic regressions examined associations between IPV, PrEP communication, and IPV-specific medical mistrust. RESULTS The average age was 25.7. The most common identity was non-Hispanic black (37.1%), followed by non-Hispanic white (33.8%), Hispanic (20.6%), and non-Hispanic another racial group (8.5%). Higher severity of psychological IPV was associated with more embarrassment to initiate a PrEP discussion with a health care provider (P = 0.009) or domestic violence advocate (P = 0.026). However, women with more severe psychological IPV were more willing to accept a PrEP recommendation from a health care provider (P = 0.033) or domestic violence advocate (P = 0.044). IPV-specific medical mistrust modified the association between physical IPV and willingness to accept a PrEP recommendation by a domestic violence advocate, such that women with physical IPV were significantly less likely to accept a PrEP recommendation by a domestic violence advocate, but only for women with high IPV-specific medical mistrust (P = 0.021). CONCLUSIONS PrEP initiation among women experiencing IPV may be strengthened by addressing and dismantling systems that perpetuate IPV-specific medical mistrust and stigma against IPV survivors.
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Affiliation(s)
- Laurel Sharpless
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill NC, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven CT, USA
| | - Abigail Hatcher
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill NC, USA
| | - Kamila A. Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore MD, USA
| | - Marina Katague
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla CA, USA
| | - Karlye Phillips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Tiara C. Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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Choi J, Lieff SA, Meltzer GY, Grivel MM, Chang VW, Yang LH, Des Jarlais DC. Anti-Vaccine Attitudes among Adults in the U.S. during the COVID-19 Pandemic after Vaccine Rollout. Vaccines (Basel) 2022; 10:933. [PMID: 35746539 PMCID: PMC9228411 DOI: 10.3390/vaccines10060933] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023] Open
Abstract
Even though vaccination is the most effective measure against COVID-19 infections, vaccine rollout efforts have been hampered by growing anti-vaccine attitudes. Based on current knowledge, we identified three domains (beliefs, discrimination, and news) as our correlates of primary interest to examine the association with anti-vaccine attitudes. This is one of the first studies to examine key correlates of anti-vaccine attitudes during the critical early stages of vaccine implementation in the United States. An online survey was administered in May 2021 to a non-representative, nationally based sample of adults (N = 789). Using multivariable logistic regression analysis, we found that individuals who expressed worry about COVID-19 (OR = 0.34, 95% CI 0.21, 0.55) and had greater knowledge of COVID-19 (OR = 0.50, 95% CI 0.25, 0.99) were less likely to hold anti-vaccine attitudes. Conversely, individuals who held stigmatizing views of COVID-19 (OR = 2.47, 95% CI 1.53, 3.99), had experienced racial discrimination (OR = 2.14, 95% CI 1.25, 3.67) and discrimination related to COVID-19 (OR = 2.84, 95% CI 1.54, 5.24), and who had been watching Fox News (OR = 3.95, 95% CI 2.61, 5.97) were more likely to hold anti-vaccine attitudes. These findings suggest COVID-19 beliefs, experiences of discrimination, and news sources should be considered when designing targeted approaches to address the anti-vaccine movement.
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Affiliation(s)
- Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
| | - Sarah A. Lieff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
| | - Gabriella Y. Meltzer
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
| | - Margaux M. Grivel
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
| | - Virginia W. Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10003, USA
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Don C. Des Jarlais
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA; (S.A.L.); (G.Y.M.); (M.M.G.); (V.W.C.); (L.H.Y.); (D.C.D.J.)
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
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Meyers-Pantele SA, Sullivan P, Mansergh G, Hirshfield S, Stephenson R, Horvath KJ. Race-Based Medical Mistrust, HIV-Related Stigma, and ART Adherence in a Diverse Sample of Men Who Have Sex with Men with HIV. AIDS Behav 2022; 26:1456-1466. [PMID: 34669061 PMCID: PMC9007843 DOI: 10.1007/s10461-021-03500-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
Disparities in antiretroviral treatment (ART) access by race for men who have sex with men (MSM) with HIV persist. We assessed whether race-based medical mistrust and HIV stigma impact ART adherence among MSM with HIV. Longitudinal data were drawn from a RCT of a messaging intervention to promote sexual health among MSM. Regression models tested associations between baseline race-based medical mistrust, HIV stigma, and ART adherence at follow-up. In multivariable models with the overall sample of MSM with HIV (n = 383), baseline medical mistrust was negatively associated with ART adherence 3-months post-baseline. Among participants of color (i.e., Black/African American, Hispanic/Latino, or another race; n = 301), HIV stigma was negatively associated with optimal ART adherence 6-months post-baseline. Medical mistrust was longitudinally associated with reduced ART adherence among racially and ethnically diverse MSM with HIV. HIV-related services might prioritize patients reporting medical mistrust for additional supports.
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Affiliation(s)
- Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities and the School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Perceived discrimination, adherence to antiretroviral therapy, and HIV care engagement among HIV-positive black adults: the mediating role of medical mistrust. J Behav Med 2022; 45:285-296. [PMID: 35028783 PMCID: PMC8957584 DOI: 10.1007/s10865-021-00277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Perceived discrimination and medical mistrust are contributors to HIV inequities. The current study examined whether medical mistrust mediated the associations between perceived discrimination and adherence to antiretroviral therapy (ART) as well as care engagement in a sample of 304 Black adults living with HIV. Perceived discrimination and medical mistrust were measured using validated scales; ART adherence was electronically monitored for a month; care engagement was determined by medical record data. Results support significant total indirect effects from perceived discrimination (due to HIV-serostatus, race, sexual orientation) to ART adherence through three types of medical mistrust (towards healthcare organizations, one's physician, and HIV-specific mistrust). The total indirect effects were also significant for care engagement and were largely driven by mistrust towards one's own physician. Findings suggest interventions at the provider or healthcare organization levels should address medical mistrust to improve the health and well-being of Black Americans living with HIV.
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Starks TJ, Skeen SJ, Scott Jones S, Gurung S, Millar BM, Ferraris C, Ventuneac A, Parsons JT, Sparks MA. Effectiveness of a Combined Motivational Interviewing and Cognitive Behavioral Intervention to Reduce Substance Use and Improve HIV-Related Immune Functioning. AIDS Behav 2022; 26:1138-1152. [PMID: 34537912 DOI: 10.1007/s10461-021-03467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/01/2022]
Abstract
This study evaluated the effectiveness of Project PLUS, a 6-session Motivational Interviewing and Cognitive Behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence among PLWH. In a quasi-experimental design, 84 participants from a network of three comprehensive care clinics in New York City received the intervention immediately post-baseline (the Immediate condition) and 90 were assigned to a Waitlist control. Viral load and CD4 data were extracted from electronic medical records (EMR) for a No-Intervention comparison cohort (n = 120). Latent growth curve analyses did not show a consistent pattern of significant between-group differences post-intervention or across time in ART adherence or substance use severity between Immediate and Waitlist participants. Additionally, Immediate intervention participants did not differ significantly from the Waitlist or No-Treatment groups on viral load or CD4 post-intervention or across time. The potential to detect intervention effects may have been limited by the use of a quasi-experimental design, the high quality of standard care at these clinics, or inadequate intervention dose.Trial Registration: ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: NCT02390908; https://clinicaltrials.gov/ct2/show/NCT02390908.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA.
| | - Simone J Skeen
- PRIDE Health Research Consortium, Hunter College of CUNY, New York, NY, USA
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Sitaji Gurung
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Christopher Ferraris
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ana Ventuneac
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Martha A Sparks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ward KM, Falade-Nwulia O, Moon J, Sutcliffe CG, Brinkley S, Haselhuhn T, Katz S, Herne K, Arteaga L, Mehta SH, Latkin C, Brooner RK, Sulkowski MS. Nonadherence to Ledipasvir/Sofosbuvir Did Not Predict Sustained Virologic Response in a Randomized Controlled Trial of Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Persons Who Use Drugs. J Infect Dis 2022; 225:903-911. [PMID: 34543417 PMCID: PMC8889293 DOI: 10.1093/infdis/jiab477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eliminating hepatitis C virus (HCV) will require effective treatment delivery to persons with substance use disorders (SUDs). We evaluated the relationship between ledipasvir/sofosbuvir treatment persistence (receiving 84 tablets), adherence, and sustained virologic response (SVR) in persons with human immunodeficiency virus (HIV)/HCV coinfection. METHODS Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under 1 of 3 conditions (usual care, peer mentors, and cash incentives). We used self-report, pharmacy pill counts, and expected date of refill to examine adherence. Persistent participants were categorized as high adherence (taking ≥90% of doses) or low adherence (taking <90% of doses). RESULTS Most participants persisted on treatment after initiation (n = 105), with 95% (n = 100) achieving SVR. One third (34%) of participants had moderate/heavy alcohol use by the biomarker phosphatidylethanol ([Peth] ≥50 ng/mL), and 44% had urine toxicology positive for cocaine or heroin at enrollment. The proportion of persons with high adherence was 72% (n = 76), and the proportion of persons with low adherence was 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (relative risk = 2.77; 95% confidence interval, 1.50-5.12), SVR did not vary according to adherence (P = .702), and most participants (97%) with low adherence achieved SVR. CONCLUSIONS Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.
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Affiliation(s)
- Kathleen M Ward
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Juhi Moon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sherilyn Brinkley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Taryn Haselhuhn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Katz
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kayla Herne
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lilian Arteaga
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Ding A, Dixon SW, Ferries EA, Shrank WH. The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. J Manag Care Spec Pharm 2022; 28:379-386. [PMID: 35199574 PMCID: PMC10372970 DOI: 10.18553/jmcp.2022.28.3.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medication nonadherence in the United States contributes to 125,000 deaths and 10% of hospitalizations annually. The pain of preventable deaths and the personal costs of nonadherence are borne disproportionately by Black, Latino, and other minority groups because nonadherence is higher in these groups due to a variety of factors. These factors include socioeconomic challenges, issues with prescription affordability and convenience of filling and refilling them, lack of access to pharmacies and primary care services, difficulty taking advantage of patient engagement opportunities, health literacy limitations, and lack of trust due to historical and structural discrimination outside of and within the medical system. Solutions to address the drivers of lower medication adherence, specifically in minority populations, are needed to improve population outcomes and reduce inequities. While various solutions have shown some traction, these solutions have tended to be challenging to scale for wider impact. We propose that integrated medical and pharmacy plans are well positioned to address racial and ethnic health disparities related to medication adherence. DISCLOSURES: This study was not supported by any funding sources other than employment of all authors by Humana Inc. Humana products and programs are referred to in this article.
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Bateman LB, Hall AG, Anderson WA, Cherrington AL, Helova A, Judd S, Kimberly R, Oates GR, Osborne T, Ott C, Ryan M, Strong C, Fouad MN. Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model. Am J Health Promot 2022; 36:288-295. [PMID: 34719985 PMCID: PMC8770578 DOI: 10.1177/08901171211045038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest intervention strategies. APPROACH Ninety minute virtual focus groups (N = 8), segmented by county, race and ethnicity were conducted with stakeholders from 3 vulnerable Alabama counties. PARTICIPANTS Participants (N = 67) were primarily African American and Latinx, at least 19 years, and residents or stakeholders in Jefferson, Mobile, and Dallas counties. SETTING Focus groups took place virtually over Zoom. METHODS The semi-structured guide explored perceptions of COVID-19, with an emphasis on barriers and facilitators to vaccine uptake. Focus groups lasted approximately 90 minutes and were audio recorded, transcribed, and analyzed by a team of 3 investigators, according to the guidelines of Thematic Analysis using NVivo 12. To provide guidance in the development of interventions to decrease vaccine hesitancy, we examined how themes fit with the constructs of the Health Belief Model. RESULTS We found that primary themes driving COVID-19 vaccine hesitancy, ordered from most to least discussed, are mistrust, fear, and lack of information. Additionally, interventions to decrease vaccine hesitancy should be multi-modal, community engaged, and provide consistent, comprehensive messages delivered by trusted sources.
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Affiliation(s)
- Lori B Bateman
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allyson G Hall
- School of Health Professions, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - William A Anderson
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea L Cherrington
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Helova
- School of Public Health, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- School of Public Health, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Kimberly
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriela R Oates
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany Osborne
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Corilyn Ott
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa Ryan
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Strong
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mona N Fouad
- School of Medicine, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
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Gutierrez-Colina AM, Wetter SE, Mara CA, Guilfoyle S, Modi AC. Racial Disparities in Medication Adherence Barriers: Pediatric Epilepsy as an Exemplar. J Pediatr Psychol 2022; 47:620-630. [PMID: 35024854 PMCID: PMC9172841 DOI: 10.1093/jpepsy/jsac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To evaluate how racial disparities in medication adherence barriers relate to key clinical outcomes (i.e., seizure control and adherence) in pediatric epilepsy and to identify the most critical barriers in determining health outcomes in Black youth and White youth. METHODS This observational study included a sample of youth aged 2-17 years with epilepsy obtained by combining data from four different studies. A total of 226 caregivers and 43 adolescents reported on adherence barriers. An electronic monitor was used to measure adherence to the primary antiepileptic drug. Racial disparities in individual barriers were examined. The relative importance of different types of barriers in determining clinical outcomes was evaluated in both Black and White youth. RESULTS Adherence barriers, including running out of medications, access to pharmacies, competing demands, and difficulty swallowing, disproportionally affected Black children with epilepsy compared to White children. System- and community-level barriers emerged as the most important in determining seizure outcomes among Black youth. Both system- and individual-level barriers, on the other hand, were important for adherence outcomes. CONCLUSIONS System- and community-level barriers, as opposed to individual-level barriers, are more highly endorsed by Black families compared to White families. These barriers are also the most critical in driving seizure outcomes among Black youth. There is a critical need to shift from a primary focus on individual-level barriers to an approach that deliberately targets larger systemic barriers to reduce the existing adherence and health disparities that affect Black children with pediatric conditions.
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Affiliation(s)
- Ana M Gutierrez-Colina
- Correspondence concerning this article should be addressed to Avani C. Modi, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave. (MLC 7039-Adherence Center), Cincinnati, OH 45229, USA. E-mail:
| | - Sara E Wetter
- Department of Clinical & Health Psychology, University of Florida, USA
| | - Constance A Mara
- Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, USA
| | - Shanna Guilfoyle
- Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, USA
| | - Avani C Modi
- Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, USA
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Webb Hooper M, Mitchell C, Marshall VJ, Cheatham C, Austin K, Sanders K, Grafton LL. Responding to healthcare distrust among underserved communities: Phase II. Psychooncology 2022; 31:3-8. [PMID: 34985177 DOI: 10.1002/pon.5841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Medical distrust is both a psychosocial construct and an underappreciated individual social determinant of health with the potential to affect oncology care and clinical trial participation. A community-based participatory research effort, called the Forward Movement Project (FMP), identified multilevel factors affecting trust for healthcare and research in an underserved urban community. In FMP Phase II, we implemented a community-responsive approach to provide lay-oriented education and address misinformation, with the goal of beginning to remediate distrust for healthcare systems and biomedical research. METHODS Community residents (N = 154 adults, 64% male, M = 61.5 years old, 53% annual income <$10,000, 83% African American/Black) engaged in participant-driven dialogues with oncology clinicians/clinical researchers and support services professionals. A program evaluation focused on trust for healthcare and biomedical research. RESULTS Participants reported positive evaluations of both the program and the cancer center clinicians and staff, who were rated as trustworthy (80% strong agreement). However, trust for healthcare systems ("Strongly agree" = 58%) and medical researchers ("Strongly agree" = 50%) following the program was moderate. Over half of the sample (52%) strongly agreed they would participate in a clinical trial compared to before joining this study. CONCLUSION Findings supported the user-generated program approach. The FMP is an example of a model for true community engaged research and has implications for rebuilding trust in healthcare and research.
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Affiliation(s)
- Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Charlene Mitchell
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Vanessa J Marshall
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, Ohio, USA
| | - Chesley Cheatham
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, Ohio, USA
| | | | - Kimberly Sanders
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Lena L Grafton
- NEOMED-CSU Partnership for Urban Health, Cleveland State University, Cleveland, Ohio, USA
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Dangerfield DT, Ober AJ, Li MJ, Allen S, Bluthenthal RN. HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:54-62. [PMID: 34939988 PMCID: PMC8718261 DOI: 10.1097/jnc.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group-specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
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Affiliation(s)
| | | | - Michael J. Li
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sophia Allen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Michel KG, Ocampo JMF, Spence AB, Wang C, Kikkisetti A, Doyle A, Merenstein D, Goparaju L, Kassaye SG. High Provider Trust Associates with High HIV Antiretroviral Adherence Among Women Living with HIV in a Metropolitan Washington, DC Cohort. AIDS Patient Care STDS 2022; 36:17-25. [PMID: 34910888 PMCID: PMC8905303 DOI: 10.1089/apc.2021.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Trust in providers and health care systems (HCSs) has been associated with higher HIV antiretroviral (ART) adherence; however, most previous studies enrolled primarily men and did not concurrently assess provider trust, HCS distrust, and clinical/biological outcomes. We enrolled 239 Washington, DC Women's Interagency HIV Study (WIHS) women: 167 with HIV (WWH) and 72 without HIV. In 2006 and 2017-2018, women completed surveys on provider trust and HCS distrust. Clinical, social, and demographic covariates were obtained during the 2017-2018 WIHS study visit. Descriptive analyses included chi-squared and Mann-Whitney tests. Wilcoxon signed-rank tests assessed trust measure change over time. Logistic (provider trust) and linear (HCS distrust) models were constructed in R. The majority of women were African American/Black (76.9%) with a median age of 52 (interquartile range 48, 58) and currently insured (99.6%). In multi-variable analyses, women with HIV (WWH) had higher odds of high provider trust [adjusted odds ratio (aOR) 2.90, 95% confidence interval (CI) 1.34, 6.45], with ≥95% ART adherence associated with high provider trust among only WWH (aOR 4.13, 95% CI 1.14, 15.92). Multi-variable models also showed 3.40-point higher HCS distrust scores among WWH who reported ≥95% ART adherence (p = 0.03). CD4 count and HIV viral load were not associated with provider trust or HCS distrust. Provider (p = 0.67) and HCS (p = 0.65) trust did not significantly change in this population at two time points for 10 years. Self-reported antiretroviral therapy adherence significantly associated with high provider trust, yet also with high HCS distrust, revealing a nuanced relationship to providers and the HCS among WWH.
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Affiliation(s)
- Katherine G. Michel
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.,Address correspondence to: Katherine G. Michel, PhD, MPH, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA
| | - Joanne Michelle F. Ocampo
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Amanda Blair Spence
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Cuiwei Wang
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Anjali Kikkisetti
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Allison Doyle
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Lakshmi Goparaju
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seble G. Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
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Duthely LM, Sanchez-Covarrubias AP, Prabhakar V, Brown MR, Thomas TES, Montgomerie EK, Potter JE. Medical Mistrust and Adherence to Care Among a Heterogeneous Cohort of Women Living with HIV, Followed in a Large, U.S. Safety Net Clinic. Health Equity 2021; 5:681-687. [PMID: 34909537 PMCID: PMC8665805 DOI: 10.1089/heq.2020.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To explore the relationship between medical mistrust, as measured by the Group-Based Medical Mistrust (GBMM) scale, and HIV care adherence among a cohort of minority women receiving care in a U.S. safety net clinic. Methods: English-, Spanish-, and Haitian Creole (Creole)-speaking patients with a recent history of nonadherence to care were surveyed. Results: English speakers endorsed the highest level of mistrust, followed by Spanish speakers and Creole speakers. Creole speakers endorsed lower mistrust, lower suspicion of providers, and lower levels of “perceived health care disparities.” Higher mistrust was associated significantly with lower medication adherence, and lower rates of viral suppression (nonsignificant). Conclusion: Understanding perceptions of medical care and the relationship to HIV care adherence is an important step to addressing negative health outcomes for ethnic minority women with HIV. Clinical Trial Registration Number: NCT03738410.
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Affiliation(s)
- Lunthita M Duthely
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alex P Sanchez-Covarrubias
- Divisions of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Varsha Prabhakar
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan R Brown
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tanya E S Thomas
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Emily K Montgomerie
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - JoNell E Potter
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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45
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Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa. AIDS Behav 2021; 25:3967-3977. [PMID: 33999300 PMCID: PMC8127851 DOI: 10.1007/s10461-021-03307-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/04/2023]
Abstract
We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.
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46
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Diaz-Martinez J, Tamargo JA, Delgado-Enciso I, Liu Q, Acuña L, Laverde E, Barbieri MA, Trepka MJ, Campa A, Siminski S, Gorbach PM, Baum MK. Resilience, Anxiety, Stress, and Substance Use Patterns During COVID-19 Pandemic in the Miami Adult Studies on HIV (MASH) Cohort. AIDS Behav 2021; 25:3658-3668. [PMID: 34009479 PMCID: PMC8132028 DOI: 10.1007/s10461-021-03292-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 01/11/2023]
Abstract
We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIV-uninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.
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Affiliation(s)
- Janet Diaz-Martinez
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Javier A Tamargo
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Qingyun Liu
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Leonardo Acuña
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Eduardo Laverde
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Manuel A Barbieri
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Pamina M Gorbach
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marianna K Baum
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
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He N, Cleland CM, Gwadz M, Sherpa D, Ritchie AS, Martinez BY, Collins LM. Understanding Medical Distrust Among African American/Black and Latino Persons Living With HIV With Sub-Optimal Engagement Along the HIV Care Continuum: A Machine Learning Approach. SAGE OPEN 2021; 11:10.1177/21582440211061314. [PMID: 35813871 PMCID: PMC9262282 DOI: 10.1177/21582440211061314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Medical distrust is a potent barrier to participation in HIV care and medication use among African American/Black and Latino (AABL) persons living with HIV (PLWH). However, little is known about sociodemographic and risk factors associated with distrust. We recruited adult AABL PLWH from low socio-economic status backgrounds with insufficient engagement in HIV care (N = 512). Participants completed structured assessments on three types of distrust (of health care providers, health care systems, and counter-narratives), HIV history, and mental health. We used a type of machine learning called random forest to explore predictors of trust. On average, participants were 47 years old (SD = 11 years), diagnosed with HIV 18 years prior (SD = 9 years), and mainly male (64%) and African American/Black (69%). Depression and age were the most important predictors of trust. Among those with elevated depressive symptoms, younger participants had less trust than older, while among those without depression, trust was greater across all ages. The present study adds nuance to the literature on medical distrust among AABL PLWH and identifies junctures where interventions to build trust are needed most.
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Affiliation(s)
- Ning He
- New York University Silver School of Social Work, USA
| | | | - Marya Gwadz
- New York University Silver School of Social Work, USA
| | - Dawa Sherpa
- New York University Silver School of Social Work, USA
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Dhairyawan R, Okhai H, Hill T, Sabin CA. Differences in HIV clinical outcomes amongst heterosexuals in the United Kingdom by ethnicity. AIDS 2021; 35:1813-1821. [PMID: 33973878 PMCID: PMC7611528 DOI: 10.1097/qad.0000000000002942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN Cohort analysis. METHODS Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
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Affiliation(s)
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Teresa Hill
- Institute for Global Health, University College London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, UK
- National Institute for Health Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, University College London, London, UK
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Understanding Willingness to Participate in HIV Biomedical Research: A Mixed Methods Investigation. AIDS Behav 2021; 25:2699-2711. [PMID: 34129144 DOI: 10.1007/s10461-021-03257-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Biomedical research often enrolls people living with HIV (PLWH) receiving effective treatment to complete invasive procedures. This mixed methods study characterized determinants of willingness to undergo specific biomedical procedures among PLWH. In 2017, 61 participants (77% Black) from Miami completed a quantitative assessment examining willingness to participate. A subset of 19 participants completed an in-depth qualitative interview. Across all procedures, there was greater willingness to participate if asked by a primary care provider and if experimental results were shared. However, half of participants reported that they would experience undue influence (i.e., excessive persuasion) to participate from their primary care provider. In thematic analyses, altruism and personal benefit were identified as facilitators while medication changes, confidentiality, and perceived stigma were identified as barriers to participation in HIV biomedical research. Addressing participants' expectations and mitigating potential undue influence from primary care providers could optimize the ethical conduct of HIV biomedical studies.
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50
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López-Cevallos DF, Flórez KR, Derose KP. Examining the association between religiosity and medical mistrust among churchgoing Latinos in Long Beach, CA. Transl Behav Med 2021; 11:114-121. [PMID: 31628472 DOI: 10.1093/tbm/ibz151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and potentially high mistrust. In-person, self-administered surveys were collected among 767 adult Latinos attending three Latino churches (one Catholic and two Pentecostal) in Long Beach, CA. Measures included a previously validated 12-item medical mistrust scale, religiosity (religious denomination, length and frequency of attendance, and number of groups or ministries involved in), health care access, and sociodemographic factors. Medical mistrust score was 2.47 (standard deviation [SD] = 0.77; range 1-5). Almost two-thirds of participants (62%) attended religious services frequently (once a week or more), and the majority attended a Catholic church (80%). About half of the participants had attended their church for ≥5 years (50%) and participated in one to two church groups or ministries (53%). Multivariable analyses show that Pentecostal church congregation and those identifying as Mexican/Chicano were negatively associated with medical mistrust. On the contrary, participating in church groups or ministries and having an immigrant parent were positively associated with medical mistrust. Our findings suggest that church-based health initiatives should consider church denomination, length of attendance, participation in groups or ministries, and ethnic differences to address medical mistrust issues among Latino congregants.
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Affiliation(s)
- Daniel F López-Cevallos
- School of Language, Culture and Society, College of Liberal Arts, Oregon State University, Corvallis, OR, USA
| | - Karen R Flórez
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kathryn P Derose
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, CA, USA
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