Sex and race effects on risk for selected outcomes among elderly HIV-infected patients

You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men

BACKGROUND

Older Latinos living with the human immunodeficiency virus (HIV) have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. These health disparities are largely related to lifestyle and are either preventable or amenable to early detection or intervention. Despite existing resources to deliver an intervention to reduce this compounded health disparity, there is little information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. The Happy Older Latinos are Active (HOLA) intervention is an innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the HOLA health promotion intervention for older HIV-positive Latino men.

METHODS/DESIGN

HOLA, which is informed by Behavioral Activation and Social Learning theory is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW for 45 min, 3×/week for 16 weeks; (3) pleasant events (e.g., going to brunch with friends) scheduling. Eighteen community dwelling Latinos living with HIV aged 50+ will be recruited for this feasibility study adapting the HOLA intervention. Participants will be assessed at three time points (baseline, post-intervention, and 3 months post-intervention) on measures of cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning, and health-related quality of life.

CONCLUSIONS

If HOLA can be delivered successfully by CHWs, then the scalability, accessibility, and potential for dissemination is increased. Additionally, this study will inform feasibility and identify modifications needed in the design of a larger hypothesis testing study.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT03839212. Date of Registration: 8 February, 2019.

"Me Dieron Vida": The Effects of a Pilot Health Promotion Intervention to Reduce Cardiometabolic Risk and Improve Behavioral Health among Older Latinos with HIV

There are significant gaps in knowledge about the synergistic and disparate burden of health disparities associated with cardiovascular health issues, poorer mental health outcomes, and suboptimal HIV-care management on the health of older Latinos living with HIV (OLLWH). This pilot study sought to evaluate the feasibility and acceptability of an innovative application of an already established health-promotion intervention-Happy Older Latinos are Active (HOLA)-among this marginalized population. Eighteen self-identified Latino men with an undetectable HIV viral load and documented risk of cardiometabolic disease participated in this study. Although the attrition rate of 22% was higher than expected, participants attended 77% of the sessions and almost 95% of the virtual walks. Participants reported high satisfaction with the intervention, as evident by self-report quantitative (CSQ-8; M = 31, SD = 1.5) and qualitative metrics. Participants appreciated bonding with the community health worker and their peers to reduce social isolation. Results indicate that the HOLA intervention is an innovative way of delivering a health promotion intervention adapted to meet the diverse needs and circumstances of OLLWH, is feasible and acceptable, and has the potential to have positive effects on the health of OLLWH.

Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: a meta-analysis

OBJECTIVE

The burden of cancer among persons living with HIV/AIDS (PLWHA) is substantial and increasing. We assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries since 2000.

DESIGN

Meta-analysis.

METHODS

We searched PubMed to identify articles published in 2011-2013 reporting prevalence of smoking, alcohol consumption, overweight/obesity, and infection with human papillomavirus (HPV), hepatitis C virus (HCV) and hepatitis B virus (HBV) among PLWHA. We conducted random effects meta-analyses of prevalence for each risk factor, including estimation of overall, sex-specific, and HIV-transmission-group-specific prevalence. We compared prevalence in PLWHA with published prevalence estimates in US adults.

RESULTS

The meta-analysis included 113 publications. Overall summary prevalence estimates were current smoking, 54% [95% confidence interval (CI) 49-59%] versus 20-23% in US adults; cervical high-risk HPV infection, 46% (95% CI 34-58%) versus 29% in US females; oral high-risk HPV infection, 16% (95% CI 10-23%) versus 4% in US adults; anal high-risk HPV infection (men who have sex with men), 68% (95% CI 57-79%), with no comparison estimate available; chronic HCV infection, 26% (95% CI 21-30%) versus 0.9% in US adults; and HBV infection, 5% (95% CI 4-5%) versus 0.3% in US adults. Overweight/obesity prevalence (53%; 95% CI 46-59%) was below that of US adults (68%). Meta-analysis of alcohol consumption prevalence was impeded by varying assessment methods. Overall, we observed considerable study heterogeneity in prevalence estimates.

CONCLUSION

Prevalence of smoking and oncogenic virus infections continues to be extraordinarily high among PLWHA, indicating a vital need for risk factor reduction efforts.