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Dhungana RR, Pedisic Z, Dhimal M, Bista B, de Courten M. Hypertension screening, awareness, treatment, and control: a study of their prevalence and associated factors in a nationally representative sample from Nepal. Glob Health Action 2022; 15:2000092. [PMID: 35132939 PMCID: PMC8843246 DOI: 10.1080/16549716.2021.2000092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The growing burden of hypertension is emerging as one of the major healthcare challenges in low- and middle-income countries (LMICs), such as Nepal. Given that they are struggling to deliver adequate health services, some LMICs have significant gaps in the cascade of hypertension care (including screening, awareness, treatment, and control). This results in uncontrolled hypertension, placing a high burden on both patients and healthcare providers. Objective The objective of this study was to quantify the gaps in hypertension screening, awareness, treatment, and control in the Nepalese population. Methods We used the data from a pooled sample of 9682 participants collected through two consecutive STEPwise approach to Surveillance (STEPS) surveys conducted in Nepal in 2013 and 2019. A multistage cluster sampling method was applied in the surveys, to select nationally representative samples of 15- to 69-year-old Nepalese individuals. Prevalence ratios were calculated using multivariable Poisson regression. Results Among the hypertensive participants, the prevalence of hypertension screening was 65.9% (95% CI: 62.2, 69.5), the prevalence of hypertension awareness was 20% (95% CI: 18.1, 22.1), the prevalence of hypertension treatment was 10.3% (95% CI: 8.8, 12.0), and the prevalence of hypertension control was 3.8% (95% CI: 2.9, 4.9). The unmet need of hypertension treatment and control was highest amongst the poorest individuals, the participants from Lumbini and Sudurpaschim provinces, those who received treatment in public hospitals, the uninsured, and those under the age of 30 years. Conclusions The gaps in the cascade of hypertension care in Nepal are large. These gaps are particularly pronounced among the poor, persons living in Lumbini and Sudurpaschim provinces, those who sought treatment in public hospitals, those who did not have health insurance, and young people. National- and local-level public health interventions are needed to improve hypertension screening, awareness, treatment, and control in Nepal.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | | | - Maximilian de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Australia
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2
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Cioe PA, Pinkston M, Tashima KT, Kahler CW. Peer navigation for smoking cessation in smokers with HIV: Protocol for a randomized clinical trial. Contemp Clin Trials 2021; 110:106435. [PMID: 33992767 PMCID: PMC8590703 DOI: 10.1016/j.cct.2021.106435] [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: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent possible targets for smoking cessation interventions. Peer navigators (PNs) have been integrated into HIV care with great success to improve engagement and adherence to antiretroviral therapy. However, no clinical trial has evaluated the potential for PNs to provide social support and improve NRT adherence for smoking cessation. We developed a treatment protocol that targets social support, adherence, and self-efficacy for quitting by incorporating PNs into a smoking cessation program. This randomized trial will test whether this approach results in higher rates of 7-day point prevalence abstinence at 12- and 24-weeks, compared to standard treatment. METHODS Seventy-two smokers with HIV will be randomized to either Peer Navigation Social Support for smoking cessation (PNSS-S) or standard cessation counseling. All participants will meet with a nurse for a smoking cessation counseling session, which will include discussion of FDA-approved cessation pharmacotherapy. Participants assigned to PNSS-S will receive weekly phone calls from the PN for 12 weeks. The PN will address readiness to quit, using medication to quit, common barriers to cessation, high risk situations, slip management, and maintaining abstinence. Smoking cessation outcomes will be measured at 4, 12, and 24 weeks following the baseline appointment. CONCLUSION Results from this study will provide preliminary evidence of whether incorporating a peer navigator-based intervention into smoking cessation treatment can improve smoking cessation outcomes in PWH.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
| | - Megan Pinkston
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Karen T Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
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Kutnick AH, Leonard NR, Gwadz MV. "Like I Have No Choice": A Qualitative Exploration of HIV Diagnosis and Medical Care Experiences While Incarcerated and Their Effects. Behav Med 2019; 45:153-165. [PMID: 31343965 PMCID: PMC6730550 DOI: 10.1080/08964289.2019.1591338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is estimated that one in six Black and Latino adult persons living with HIV (PLWH) spend time in correctional institutions each year. Yet after release, PLWH of color evidence poor HIV health outcomes across the HIV care continuum. This study, guided by an ecological approach and Critical Race Theory, sought to understand the lived experiences of socioeconomically disadvantaged PLWH of color who received an HIV diagnosis and/or medical care while incarcerated, and the ways in which those experiences influenced engagement in medical care after release. Drawn from a larger study in Brooklyn, NY, in 2013-2016, a subset of 28 participants who received in-depth qualitative interviews were purposively sampled for a secondary analysis of participants who received an HIV diagnosis and/or medical care while incarcerated. Using an Interpretive Phenomenological Analysis, we found participant's experiences were shaped by longstanding mistrust of the medical establishment. While incarcerated, lack of autonomy, substandard medical care, and poor social support exacerbated medical mistrust and avoidance of HIV medical care long after release. Engagement in HIV medical care and treatment were also impacted by a dynamic interplay of factors including substance use, prolonged periods of denial, poverty, and repeated bouts of incarceration. Given that experiences of HIV diagnosis and medical care while incarcerated have long-ranging, adverse effects, we argue that a better understanding of the ways in which PLWH of color experience HIV diagnosis and medical care while incarcerated may serve to inform intervention efforts within correctional institutions to improve HIV health outcomes.
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Affiliation(s)
- Alexandra H. Kutnick
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA
| | - Noelle R. Leonard
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA,Silver School of Social Work, New York University, New York, NY, USA
| | - Marya V. Gwadz
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA,Silver School of Social Work, New York University, New York, NY, USA
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4
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Lama JR, Brezak A, Dobbins JG, Sanchez H, Cabello R, Rios J, Bain C, Ulrich A, De la Grecca R, Sanchez J, Duerr A. Design Strategy of the Sabes Study: Diagnosis and Treatment of Early HIV Infection Among Men Who Have Sex With Men and Transgender Women in Lima, Peru, 2013-2017. Am J Epidemiol 2018. [PMID: 29522079 DOI: 10.1093/aje/kwy030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Sabes Study evaluated a treatment-as-prevention intervention among cisgender men who have sex with men and transgender women in Lima, Peru-populations disproportionately affected by the human immunodeficiency virus (HIV) epidemic. The intervention was designed to prevent onward transmission of HIV by identifying HIV-negative high-risk individuals, testing them monthly for the presence of HIV, and then rapidly treating those who became HIV-positive. The main outcome of interest was the development of a model predicting the population-level impact of early detection of HIV infection and immediate initiation of antiretroviral therapy in this population. From July 2013 to September 2015, a total of 3,337 subjects were screened for HIV; 2,685 (80.5%) were negative, and 2,109 began monthly testing. We identified 256 individuals shortly after HIV acquisition, 216 of whom were enrolled in the treatment phase of the study. All participants were followed for 48 weeks (follow-up ended in 2017) and were then referred to the Peruvian Ministry of Health to continue receiving free HIV care and treatment. Initial findings from this intervention demonstrate that it is possible to recruit high-risk individuals, screen them for HIV, continue to test those who are initially HIV-negative in order to identify incident cases shortly after acquisition, and then rapidly link them to health care.
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Affiliation(s)
| | - Audrey Brezak
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | - Carolyn Bain
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Angela Ulrich
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert De la Grecca
- Center for Technological, Biomedical and Environmental Research, National University of San Marcos, Lima, Peru
| | - Jorge Sanchez
- Center for Technological, Biomedical and Environmental Research, National University of San Marcos, Lima, Peru
| | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda. ADVANCES IN PUBLIC HEALTH 2018. [DOI: 10.1155/2018/7540587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37%) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95% CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95% CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95% CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.
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Kan M, Garfinkel DB, Samoylova O, Gray RP, Little KM. Social network methods for HIV case-finding among people who inject drugs in Tajikistan. J Int AIDS Soc 2018; 21 Suppl 5:e25139. [PMID: 30033684 PMCID: PMC6055120 DOI: 10.1002/jia2.25139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION HIV testing programmes have struggled to reach the most marginalized populations at risk for HIV. Social network methods such as respondent-driven sampling (RDS) and peer-based active case-finding (ACF) may be effective in overcoming barriers to reaching these populations. We compared the client characteristics, proportion testing HIV positive (yield), and number of new cases found through two RDS strategies and an ACF approach to HIV case-finding among people who inject drugs (PWID) in Tajikistan. METHODS Routine programme data from adult PWID recruited to testing under the HIV Flagship Project in Tajikistan were analysed to compare client demographic and clinical characteristics across the three approaches. We also compared the number of previously untested clients, the number of new HIV cases found, and the yield across the case-finding strategies, and evaluated predictors of new HIV diagnosis using fixed-effects logistic regression. RESULTS From 24 October 2016 to 30 June 2017, Flagship tested 10,300 PWID for HIV, including 2143 under RDS with unrestricted waves (RDS1, yield: 1.5%), 3517 under restricted RDS (RDS2, yield: 2.6%), and 4640 under ACF (yield: 1.5%). Clients recruited under ACF were similar in age (35.8 vs. 36.8) and gender (91% vs. 90% male) to those recruited through RDS, though ACF clients were more likely to report being a first-time tester (85.1% vs. 68.3%, p < 0.001). After controlling for age, sex, previous testing history and accounting for clustering at the site level, we found that clients tested under both RDS1 (aOR: 1.74, 95% CI: 1.04 to 2.90) and RDS2 (aOR: 1.54, 95% CI: 1.11 to 2.15) had higher odds of testing newly positive for HIV relative to clients recruited through ACF. We did not find significant differences in the odds of new HIV infection between those recruited from RDS1 versus RDS2 (aOR: 1.12, 95% CI: 0.67 to 1.86). CONCLUSIONS RDS-based interventions resulted in higher yields and overall case-finding, especially when recruitment was restricted. However, ACF identified a higher proportion of first-time testers. To find at least 90% of PWID living with HIV in Tajikistan, it may be necessary to implement multiple case-finding approaches concurrently to maximize testing coverage.
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Affiliation(s)
- Maxim Kan
- Regional Monitoring & Evaluation Advisor, Population Services International (PSI)/Central AsiaAlmatyKazakhstan
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Gwadz M, Leonard NR, Honig S, Freeman R, Kutnick A, Ritchie AS. Doing battle with "the monster:" how high-risk heterosexuals experience and successfully manage HIV stigma as a barrier to HIV testing. Int J Equity Health 2018; 17:46. [PMID: 29678188 PMCID: PMC5910579 DOI: 10.1186/s12939-018-0761-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of “individuals residing in HRA” (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma. Methods In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive. Results Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was “better not to know” one’s HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism. Conclusions In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to HIV testing, because adopting another stigmatized status is dangerous. They also find ways to manage stigma to engage in testing, even if not at recommended levels. Findings highlight strategies to reduce HIV stigma at the levels of communities, institutions, and individuals to improve rates of annual HIV testing necessary to eliminate HIV transmission and reduce HIV-related racial and ethnic health disparities among IR-HRA.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Sylvie Honig
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Robert Freeman
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
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Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. AIDS 2018; 32:407-417. [PMID: 29381558 DOI: 10.1097/qad.0000000000001733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
: The current review re-conceptualizes seek and test strategies, particularly given the changing importance of HIV testing as care continuum entry for persons irrespective of their HIV status. Care continuum entry advances previous seek and test strategies for client engagement with two next-generation functions: use of testing to engage (or re-engage) HIV negative clients in preexposure prophylaxis (PrEP) care; and testing individuals who may already be known positives for care continuum re-entry. We review existing seek and test strategies for most impacted community members with a goal of optimizing care continuum entry as we move towards HIV transmission elimination. These strategies are context, sub-group, community and epidemic-specific. This review is timely, given the initiation of routine PrEP care, which shifts and broadens our conceptualization of care continuum entry triggered by the HIV testing event. In addition, as the epidemic becomes more concentrated, focusing on re-engagement of HIV-infected persons becomes increasingly important given that transmission events involve both those acutely and newly infected as well as the large numbers who may not be virally suppressed. We start with examination of routine testing in healthcare settings, emphasizing its potential role in re-engagement for persons out of care. Subsequently, we describe risk-based testing to identify key populations. We then review network-based approaches and their impact on the epidemic. We close with future directions for individual and combination care continuum entry strategies most relevant to elimination of HIV transmission in the United States.
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Stevens ER, Nucifora K, Zhou Q, Braithwaite RS, Cleland CM, Ritchie AS, Kutnick AH, Gwadz MV. Cost-Effectiveness of Peer- Versus Venue-Based Approaches for Detecting Undiagnosed HIV Among Heterosexuals in High-Risk New York City Neighborhoods. J Acquir Immune Defic Syndr 2018; 77:183-192. [PMID: 29135654 PMCID: PMC5762425 DOI: 10.1097/qai.0000000000001578] [Citation(s) in RCA: 4] [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
INTRODUCTION We used a computer simulation of HIV progression and transmission to evaluate the cost-effectiveness of a scale-up of 3 strategies to seek out and test individuals with undiagnosed HIV in New York City (NYC). SETTING Hypothetical NYC population. METHODS We incorporated the observed effects and costs of the 3 "seek and test" strategies in a computer simulation of HIV in NYC, comparing a scenario in which the strategies were scaled up with a 1-year implementation or a long-term implementation with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The 3 approaches were respondent-driven sampling (RDS) with anonymous HIV testing ("RDS-A"), RDS with a 2-session confidential HIV testing approach ("RDS-C"), and venue-based sampling ("VBS"). RESULTS RDS-A was the most cost-effective strategy tested. When implemented for only 1 year and then stopped thereafter, using a societal perspective, the cost per quality-adjusted life-year (QALY) gained versus no intervention was $812/QALY, $18,110/QALY, and $20,362/QALY for RDS-A, RDS-C, and VBS, respectively. When interventions were implemented long term, the cost per QALY gained versus no intervention was cost-saving, $31,773/QALY, and $35,148/QALY for RDS-A, RDS-C, and VBS, respectively. When compared with RDS-A, the incremental cost-effectiveness ratios for both VBS and RDS-C were dominated. CONCLUSIONS The expansion of the RDS-A strategy would substantially reduce HIV-related deaths and new HIV infections in NYC, and would be either cost-saving or have favorable cost-effectiveness.
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Affiliation(s)
| | - Kimberly Nucifora
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Qinlian Zhou
- Department of Population Health, NYU School of Medicine, New York, NY
| | | | - Charles M. Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | - Amanda S. Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | - Alexandra H. Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | - Marya V Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
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Juarez-Cuellar A, Chang YP. HIV Testing in Urban Transgender Individuals: A Descriptive Study. Transgend Health 2017; 2:151-155. [PMID: 29159309 PMCID: PMC5685202 DOI: 10.1089/trgh.2016.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
HIV testing is considered the initial component of HIV eradication strategies. This study aimed to describe HIV testing in urban, transgender individuals in western New York. The study uses HIV testing intake data from a sample of self-identified transgender males and females volunteering for an HIV test at a community-based healthcare organization. Transgender individuals with some characteristics were found to have more HIV tests including female gender, black, HIV status (positive), a history of incarceration, sex worker, housing situation, and self-referral. The findings can be used to tailor future interventions to encourage HIV testing in transgender populations.
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Affiliation(s)
- Adrian Juarez-Cuellar
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
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Cleland CM, Lanza ST, Vasilenko SA, Gwadz M. Syndemic Risk Classes and Substance Use Problems among Adults in High-Risk Urban Areas: A Latent Class Analysis. Front Public Health 2017; 5:237. [PMID: 28936431 PMCID: PMC5594078 DOI: 10.3389/fpubh.2017.00237] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022] Open
Abstract
Substance use problems tend to co-occur with risk factors that are especially prevalent in urban communities with high rates of poverty. The present study draws on Syndemics Theory to understand profiles of risk and resilience and their associations with substance use problems in a population at risk for adverse outcomes. African-American/Black and Hispanic heterosexual adults (N = 2,853) were recruited by respondent-driven sampling from an urban area with elevated poverty rates, and completed a structured assessment battery covering sociodemographics, syndemic factors (that is, multiple, co-occurring risk factors), and substance use. More than one-third of participants (36%) met criteria for either an alcohol or a drug problem in the past year. Latent class analysis identified profiles of risk and resilience, separately for women and men, which were associated with the probability of a substance use problem. Almost a third of women (27%) and 38% of men had lower risk profiles-patterns of resilience not apparent in other types of analyses. Profiles with more risk and fewer resilience factors were associated with an increased probability of substance use problems, but profiles with fewer risk and more resilience factors had rates of substance use problems that were very similar to the general adult population. Relative to the lowest risk profile, profiles with the most risk and fewest resilience factors were associated with increased odds of a substance use problem for both women [adjusted odds ratio (aOR) = 8.50; 95% CI: 3.85-18.74] and men (aOR = 11.68; 95% CI: 6.91-19.74). Addressing syndemic factors in substance use treatment and prevention may yield improved outcomes.
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Affiliation(s)
- Charles M. Cleland
- Center for Drug Use and HIV Research, New York University Meyers College of Nursing, New York, NY, United States
| | - Stephanie T. Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Sara A. Vasilenko
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Marya Gwadz
- Center for Drug Use and HIV Research, New York University Meyers College of Nursing, New York, NY, United States
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Kutnick AH, Gwadz MV, Cleland CM, Leonard NR, Freeman R, Ritchie AS, McCright-Gill T, Ha K, Martinez BY. It's a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals. Front Public Health 2017; 5:100. [PMID: 28540287 PMCID: PMC5423945 DOI: 10.3389/fpubh.2017.00100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
After HIV diagnosis, heterosexuals in high-poverty urban areas evidence delays in linkage to care and antiretroviral therapy initiation compared to other groups. Yet barriers to/facilitators of HIV care among these high-risk heterosexuals are understudied. Under the theory of triadic influence, putative barriers to HIV care engagement include individual/attitudinal-level (e.g., fear, medical distrust), social-level (e.g., stigma), and structural-level influences (e.g., poor access). Participants were African-American/Black and Hispanic adults found newly diagnosed with HIV (N = 25) as part of a community-based HIV testing study with heterosexuals in a high-poverty, high-HIV-incidence urban area. A sequential explanatory mixed-methods design was used. We described linkage to HIV care and clinical outcomes [CD4 counts, viral load (VL) levels] over 1 year, and then addressed qualitative research questions about the experience of receiving a new HIV diagnosis, its effects on timely engagement in HIV care, and other barriers and facilitators. Participants were assessed five times, receiving a structured interview battery, laboratory tests, data extraction from the medical record, a post-test counseling session, and in-person/phone contacts to foster linkage to care. Participants were randomly selected for qualitative interviews (N = 15/25) that were recorded and transcribed, then analyzed using systematic content analysis. Participants were 50 years old, on average (SD = 7.2 years), mostly male (80%), primarily African-American/Black (88%), and low socioeconomic status. At the first follow-up, rates of engagement in care were high (78%), but viral suppression was modest (39%). Rates improved by the final follow-up (96% engaged, 62% virally suppressed). Two-thirds (69%) were adequately retained in care over 1 year. Qualitative results revealed multi-faceted responses to receiving an HIV diagnosis. Problems accepting and internalizing one’s HIV status were common. Reaching acceptance of one’s HIV-infected status was frequently a protracted and circuitous process, but acceptance is vital for engagement in HIV care. Fear of stigma and loss of important relationships were potent barriers to acceptance. Thus, partially as a result of difficulties accepting HIV status, delays in achieving an undetectable VL are common in this population, with serious potential negative consequences for individual and public health. Interventions to foster acceptance of HIV status are needed.
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Affiliation(s)
- Alexandra H Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Marya Viorst Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Charles M Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Robert Freeman
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Kathy Ha
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Belkis Y Martinez
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
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13
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Gwadz M, Cleland CM, Perlman DC, Hagan H, Jenness SM, Leonard NR, Ritchie AS, Kutnick A. Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection Among High-Risk Heterosexuals in New York City. J Acquir Immune Defic Syndr 2017; 74:499-507. [PMID: 28267698 PMCID: PMC5341134 DOI: 10.1097/qai.0000000000001257] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venue-based sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.
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Affiliation(s)
- Marya Gwadz
- *Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY;†Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; and‡Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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14
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Garcia RI, Tiwari T, Ramos-Gomez F, Heaton B, Orozco M, Rasmussen M, Braun P, Henshaw M, Borrelli B, Albino J, Diamond C, Gebel C, Batliner TS, Barker JC, Gregorich S, Gansky SA. Retention strategies for health disparities preventive trials: findings from the Early Childhood Caries Collaborating Centers. J Public Health Dent 2016; 77:63-77. [PMID: 27759164 DOI: 10.1111/jphd.12182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify successful strategies for retention of participants in multiyear, community-based randomized controlled trials (RCTs) aiming to reduce early childhood caries in health disparities populations from diverse racial/ethnic backgrounds and across diverse geographic settings. METHODS Four RCTs conducted by the Early Childhood Caries Collaborating Centers (EC4), an initiative of the National Institute of Dental and Craniofacial Research, systematically collected information on the success of various strategies implemented to promote participant retention in each RCT. The observational findings from this case series of four RCTs were tabulated and the strategies rated by study staff. RESULTS Participant retention at 12 months of follow-up ranged from 52.8 percent to 91.7 percent, and at 24 months ranged from 53.6 percent to 85.9, across the four RCTs. For the three RCTs that had a 36-month follow-up, retention ranged from 53.6 percent to 85.1 percent. Effectiveness of different participant retention strategies varied widely across the RCTs. CONCLUSIONS Findings from this case series study may help to guide the design of future RCTs to maximize retention of study participants and yield needed data on effective interventions to reduce oral health disparities.
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Affiliation(s)
- Raul I Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Tamanna Tiwari
- Department of Applied Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Francisco Ramos-Gomez
- Division of Growth and Development, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Brenda Heaton
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Mario Orozco
- Division of Growth and Development, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Rasmussen
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Patricia Braun
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle Henshaw
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Belinda Borrelli
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Judith Albino
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Courtney Diamond
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Christina Gebel
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Terrence S Batliner
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judith C Barker
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Steven Gregorich
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A Gansky
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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15
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Gwadz M, Cleland CM, Kutnick A, Leonard NR, Ritchie AS, Lynch L, Banfield A, McCright-Gill T, Del Olmo M, Martinez B. Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection in New York City. Front Public Health 2016; 4:76. [PMID: 27200330 PMCID: PMC4846660 DOI: 10.3389/fpubh.2016.00076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/08/2016] [Indexed: 12/28/2022] Open
Abstract
Background The Centers for Disease Control and Prevention recommends persons at high risk for HIV infection in the United States receive annual HIV testing to foster early HIV diagnosis and timely linkage to health care. Heterosexuals make up a significant proportion of incident HIV infections (>25%) but test for HIV less frequently than those in other risk categories. Yet factors that promote or impede annual HIV testing among heterosexuals are poorly understood. The present study examines individual/attitudinal-, social-, and structural-level factors associated with past-year HIV testing among heterosexuals at high risk for HIV. Methods Participants were African-American/Black and Hispanic heterosexual adults (N = 2307) residing in an urban area with both high poverty and HIV prevalence rates. Participants were recruited by respondent-driven sampling in 2012–2015 and completed a computerized structured assessment battery covering background factors, multi-level putative facilitators of HIV testing, and HIV testing history. Separate logistic regression analysis for males and females identified factors associated with past-year HIV testing. Results Participants were mostly male (58%), African-American/Black (75%), and 39 years old on average (SD = 12.06 years). Lifetime homelessness (54%) and incarceration (62%) were common. Half reported past-year HIV testing (50%) and 37% engaged in regular, annual HIV testing. Facilitators of HIV testing common to both genders included sexually transmitted infection (STI) testing or STI diagnosis, peer norms supporting HIV testing, and HIV testing access. Among women, access to general medical care and extreme poverty further predicted HIV testing, while recent drug use reduced the odds of past-year HIV testing. Among men, past-year HIV testing was also associated with lifetime incarceration and substance use treatment. Conclusion The present study identified gaps in rates of HIV testing among heterosexuals at high risk for HIV, and both common and gender-specific facilitators of HIV testing. Findings suggest a number of avenues for increasing HIV testing rates, including increasing the number and types of settings offering high-quality HIV testing; promoting STI as well as HIV testing; better integrating STI and HIV testing systems; implementing peer-driven social/behavioral intervention approaches to harness the positive influence of social networks and reduce unfavorable shared peer norms; and specialized approaches for women who use drugs.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Laura Lynch
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Angela Banfield
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Montserrat Del Olmo
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Belkis Martinez
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
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16
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Gwadz M, Cleland CM, Jenness SM, Silverman E, Hagan H, Ritchie AS, Leonard NR, McCright-Gill T, Martinez B, Swain Q, Kutnick A, Sherpa D. Exploring Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection Recruited with Venue-based Sampling. ACTA ACUST UNITED AC 2016; 7. [PMID: 27104046 PMCID: PMC4836844 DOI: 10.4172/2155-6113.1000544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Annual HIV testing is recommended for high-risk populations in the United States, to identify HIV infections early and provide timely linkage to treatment. However, heterosexuals at high risk for HIV, due to their residence in urban areas of high poverty and elevated HIV prevalence, test for HIV less frequently than other risk groups, and late diagnosis of HIV is common. Yet the factors impeding HIV testing in this group, which is predominantly African American/Black and Latino/Hispanic, are poorly understood. The present study addresses this gap. Using a systematic community-based sampling method, venue-based sampling (VBS), we estimate rates of lifetime and recent (past year) HIV testing among high-risk heterosexuals (HRH), and explore a set of putative multi-level barriers to and facilitators of recent testing, by gender. Participants were 338 HRH African American/Black and Latino/Hispanic adults recruited using VBS, who completed a computerized structured assessment battery guided by the Theory of Triadic Influence, comprised of reliable/valid measures on socio-demographic characteristics, HIV testing history, and multi-level barriers to HIV testing. Logistic regression analysis was used to identify factors associated with HIV testing within the past year. Most HRH had tested at least once (94%), and more than half had tested within the past year (58%), but only 37% tested annually. In both men and women, the odds of recent testing were similar and associated with structural factors (better access to testing) and sexually transmitted infection (STI) testing and diagnosis. Thus VBS identified serious gaps in rates of annual HIV testing among HRH. Improvements in access to high-quality HIV testing and leveraging of STI testing are needed to increase the proportion of HRH testing annually for HIV. Such improvements could increase early detection of HIV, improve the long-term health of individuals, and reduce HIV transmission by increasing rates of viral suppression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Dawa Sherpa
- New York University College of Nursing, USA; The BCAP Collaborative Research Team, USA
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17
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Gwadz M, Cleland CM, Leonard NR, Kutnick A, Ritchie AS, Banfield A, Hagan H, Perlman DC, McCright-Gill T, Sherpa D, Martinez BY. Hybrid STTR intervention for heterosexuals using anonymous HIV testing and confidential linkage to care: a single arm exploratory trial using respondent-driven sampling. BMC Public Health 2015; 15:1133. [PMID: 26572865 PMCID: PMC4647497 DOI: 10.1186/s12889-015-2451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated 14 % of the 1.2 million individuals living with HIV in the U.S. are unaware of their status. Yet this modest proportion of individuals with undiagnosed HIV is linked to 44-66 % of all new infections. Thus innovative intervention approaches are needed to seek out and test those with undiagnosed HIV, and link them to HIV treatment with high retention, an approach referred to as "Seek, Test, Treat, and Retain" (STTR). The present protocol describes a creative "hybrid" STTR approach that uses anonymous HIV testing followed by confidential care linkage, focused on heterosexuals at high risk (HHR) for HIV, who do not test as frequently as, and are diagnosed later, than other risk groups. METHODS/DESIGN This is a single-arm exploratory intervention efficacy trial. The study has two phases: one to seek out and test HHR, and another to link those found infected to HIV treatment in a timely fashion, with high retention. We will recruit African American/Black and Latino adult HHR who reside in urban locations with high poverty and HIV prevalence. Participants will be recruited with respondent-driven sampling, a peer recruitment method. The "Seek and Test" phase is comprised of a brief, convenient, single-session, anonymous HIV counseling and testing session. The "Treat and Retain" component will engage those newly diagnosed with HIV into a confidential research phase and use a set of procedures called care navigation to link them to HIV primary care. Participants will be followed for 6 months with objective assessment of outcomes (using medical records and biomarkers). DISCUSSION Undiagnosed HIV infection is a major public health problem. While anonymous HIV testing is an important part of the HIV testing portfolio, it does not typically include linkage to care. The present study has potential to produce an innovative, brief, cost-effective, and replicable STTR intervention, and thereby reduce racial/ethnic disparities in HIV/AIDS. TRIAL REGISTRATION ClinicalTrials.gov, NCT02421159 , Registered April 15, 2015.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Noelle R Leonard
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Angela Banfield
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Holly Hagan
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
- Mount Sinai Beth Israel Medical Center, 120 East 16th Street, New York, NY, USA.
| | - David C Perlman
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
- Mount Sinai Beth Israel Medical Center, 120 East 16th Street, New York, NY, USA.
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Dawa Sherpa
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Belkis Y Martinez
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
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