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Payton IK, Starkweather AR, Canidate SS, Westmoreland DA, Lyon DE. Psychosocial Distress Among Young Men Who Have Sex With Men: A Scoping Review. J Psychosoc Nurs Ment Health Serv 2024; 62:11-17. [PMID: 38537109 DOI: 10.3928/02793695-20240322-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE Psychosocial distress negatively impacts coping and adaptation among young men (aged 18 to 44 years) who have sex with men (YMSM) with, or at risk of acquiring, HIV. However, the stressors and risky behaviors associated with psychosocial distress that impair viral suppression have not been clearly explicated. The current scoping review was conducted to explore the extant literature and identify research gaps. METHOD PubMed and CINAHL were searched for peer-reviewed publications, with a total of eight articles meeting inclusion criteria. RESULTS Stressors that contributed to psychosocial distress included HIV+ status, stigma, discrimination, insufficient resources, exposure to community violence, and incarceration. Risky behaviors impacting viral suppression were condomless anal sex, drug use, and medication nonadherence. CONCLUSION Understanding and addressing psychosocial distress is imperative for providing holistic care tailored to the unique health care needs of YMSM. A better understanding of stressors and associated risky behaviors will aid efforts to mitigate psychosocial distress and reduce viral load among YMSM. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 11-17.].
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Forney DJ, Sheehan DM, Dale SK, Li T, De La Rosa M, Spencer EC, Sanchez M. The Impact of HIV-Related Stigma on Racial/Ethnic Disparities in Retention in HIV Care Among Adults Living with HIV in Florida. J Racial Ethn Health Disparities 2024; 11:2498-2508. [PMID: 37495905 PMCID: PMC10811278 DOI: 10.1007/s40615-023-01715-1] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Our study examines the effects of distinct HIV stigma subtypes on retention in care and racial-ethnic differences among persons with HIV (PWH). METHODS Using Florida Medical Monitoring Project 2015-2017 data, we analyzed patients' clinical and behavioral characteristics. We analyzed 89,889 PWH in Florida (50.0% non-Hispanic Blacks, 20.8% Hispanics, 29.2% non-Hispanic whites). HIV stigma subtypes, negative self-image, anticipated stigma, personalized stigma, and retention in care were examined with logistic regressions. RESULTS People with high negative self-image and anticipated stigma were less likely to be retained (CI: 0.84-0.92; 0.47-0.53). The association between HIV-related stigma subtypes and retention in care differed between Black, White, and Hispanic participants. Negative self-image was associated with higher retention rates among Hispanics (CI: 5.64-9.26) and Whites (CI: 1.04-1.27), while low retention rates among Blacks (0.617-0.686). The likelihood of staying in care was lower across all racial-ethnic groups when the anticipated stigma was high or moderate. In contrast, personalized stigma increased retention across all racial-ethnic groups. CONCLUSION Results showed that distinct types of HIV stigma differentially impact retention, and these associations differ by race and ethnicity. Future interventions should address the effect HIV stigma subtypes have on racially minoritized PWH retention.
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Affiliation(s)
- Derrick J Forney
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA.
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA.
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA.
| | - Diana M Sheehan
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Miami, USA
| | - Sannisha K Dale
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA
- Department of Psychology, University of Miami, Coral Gables, Miami, USA
| | - Tan Li
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
| | | | - Mariana Sanchez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
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Kiernan JS, Dahman BA, Krist AH, Neigh GN, Kimmel AD. Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South. Am J Prev Med 2024; 66:770-779. [PMID: 38101464 PMCID: PMC11034789 DOI: 10.1016/j.amepre.2023.12.008] [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: 05/25/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Federally Qualified Health Centers may increase access to HIV prevention, care, and treatment for at-risk populations. METHODS A pooled cross section of ZIP Code Tabulation Areas from cites in the U.S. South with high HIV diagnoses were used to examine Federally Qualified Health Center density and indicators of HIV epidemic control. The explanatory variable was Federally Qualified Health Center density-number of Federally Qualified Health Centers in a ZIP Code Tabulation Areas' Primary Care Service Area per low-income population-high versus medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) (1) number of new HIV diagnoses, (2) percentage late diagnosis, (3) percentage linked to care, and (4) percentage virally suppressed, which was assessed over 1 year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZIP Code Tabulation Area-level sociodemographic and city-level HIV funding variables, with state-fixed effects, and data analysis was completed in 2022-2023. Sensitivity analyses included (1) examining ZIP Code Tabulation Areas with fewer non-Federally Qualified Health Center primary care providers, (2) controlling for county-level primary care provider density, (3) excluding the highest HIV prevalence ZIP Code Tabulation Areas, and (4) excluding Florida ZIP Code Tabulation Areas. RESULTS High-density ZIP Code Tabulation Areas had a lower percentage of late diagnosis and virally suppressed, a higher percentage linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high density was associated with a greater number of new diagnoses (number or percentage=5.65; 95% CI=2.81, 8.49), lower percentage of late diagnosis (-3.71%; 95% CI= -5.99, -1.42), higher percentage linked to care (2.13%; 95% CI=0.20, 4.06), and higher percentage virally suppressed (1.87%; 95% CI=0.53, 2.74) than medium/low density. CONCLUSIONS Results suggest that access to Federally Qualified Health Centers may benefit community-level HIV epidemic indicators.
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Affiliation(s)
- Jessica S Kiernan
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | - Bassam A Dahman
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Alex H Krist
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - April D Kimmel
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, Virginia
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Greene E, Walcott M, Guerra L, Tieu HV, Nandi V, Soler J, Diaz J, Curriero F, Latkin C, Bosompem A, Frye V. Correlates of concordance between self-reported and lab-confirmed viral load among Black and Latine men who have sex with men (BLMSM) living with HIV in New York City. AIDS Care 2024; 36:661-671. [PMID: 37399515 PMCID: PMC10761596 DOI: 10.1080/09540121.2023.2229816] [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: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Sustained viral suppression is one of the four strategies in the U.S. Department of Health and Human Services' (HHS) plan to end the HIV epidemic in the United States. Individuals living with HIV must understand their viral load accurately for this strategy to be effective. We conducted cross-sectional analyses using baseline data from the NNHIV longitudinal study among men who have sex with men (MSM) living with HIV in New York City to identify factors associated with concordant knowledge between self-reported and lab-confirmed viral load. Of 164 Black and/or Latine participants, 67% (n = 110) reported that their viral load was undetectable, however lab tests showed only 44% (n = 72) had an undetectable viral load (<20 copies/ml). Overall, 62% of the sample (n = 102) had concordant HIV viral load knowledge (agreement of self-reported and lab viral load). In multivariable regression, those with unstable housing (PR = 0.52, 0.30-0.92) and those who had higher levels of beliefs of racism in medicine scale (PR = 0.76, 0.59-0.97) were less likely to have concordant knowledge. Our study underscores the need for implementing measures to improve viral load knowledge, U = U messaging, and strategies to achieve and maintain undetectable viral load status to reduce the burden of HIV at the population level.
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Affiliation(s)
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Lauren Guerra
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, NY, NY
| | - Vijay Nandi
- Laboratory of Data Analytic Services, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jorge Soler
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jose Diaz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Frank Curriero
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Carl Latkin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Victoria Frye
- CUNY School of Medicine, NY, NY
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
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Nguyen TQ, Roberts Lavigne LC, Brantner CL, Kirk GD, Mehta SH, Linton SL. Estimation of place-based vulnerability scores for HIV viral non-suppression: an application leveraging data from a cohort of people with histories of using drugs. BMC Med Res Methodol 2024; 24:21. [PMID: 38273277 PMCID: PMC10809603 DOI: 10.1186/s12874-023-02133-x] [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: 05/01/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
The relationships between place (e.g., neighborhood) and HIV are commonly investigated. As measurements of place are multivariate, most studies apply some dimension reduction, resulting in one variable (or a small number of variables), which is then used to characterize place. Typical dimension reduction methods seek to capture the most variance of the raw items, resulting in a type of summary variable we call "disadvantage score". We propose to add a different type of summary variable, the "vulnerability score," to the toolbox of the researchers doing place and HIV research. The vulnerability score measures how place, as known through the raw measurements, is predictive of an outcome. It captures variation in place characteristics that matters most for the particular outcome. We demonstrate the estimation and utility of place-based vulnerability scores for HIV viral non-suppression, using data with complicated clustering from a cohort of people with histories of injecting drugs.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA.
| | | | | | | | | | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA
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Waldrop D, Murden R, Montilus MC, Balthazar M, Irwin C, Holstad M, Ownby RL. Durable viral suppression among persons with HIV in the deep south: an observational study. AIDS Care 2023; 35:1836-1843. [PMID: 36259779 PMCID: PMC10113604 DOI: 10.1080/09540121.2022.2136350] [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: 10/31/2021] [Accepted: 10/09/2022] [Indexed: 01/27/2023]
Abstract
This study assessed predictors of stable HIV viral suppression in a racially diverse sample of persons living with HIV (PWH) in the southern US. A total of 700 PWH were recruited from one of four HIV clinics in Metro Atlanta, GA. Data were collected from September 2012 to July 2017, and HIV viral loads were retrieved from EMR for 18 months. The baseline visits and EMR data were used for current analyses. Durable viral suppression was categorized as 1. Remain suppressed, 2. Remain unsuppressed, and 3. Unstable suppression. The number of antiretroviral medications and age were significantly associated with durable viral suppression. Older age, fewer ART medications and availability of social support were positively associated with durable viral suppression over the 18-month observation period. Findings suggest that regimen complexity is potentially a better predictor of viral suppression than self-reported medication adherence. The need for consensus on the definition of durable viral suppression is also urged.
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Affiliation(s)
- Drenna Waldrop
- Research Operations, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Raphiel Murden
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Monique Balthazar
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Crista Irwin
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
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Ward MK, Fernandez SB, Sheehan DM, Li T, Dawit R, Fennie K, Beach MC, Brock P, Ladner R, Trepka MJ. Sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression in the Miami-Dade County Ryan White Program, 2017. AIDS Care 2023; 35:1437-1442. [PMID: 35621306 PMCID: PMC9701240 DOI: 10.1080/09540121.2022.2080800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
This exploratory study examined sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression (SVS). The study population included 6,489 Miami-Dade Ryan White Program (RWP) clients receiving services during 2017; administrative data was analyzed. SVS was defined as having all viral load tests during 2017 below 200 copies/ml. Multilevel logistic regression models accounted for clustering by medical case management site. Models were stratified by sex. Overall, a higher proportion of females did not achieve SVS (23.5%) than males (18.1%). For females (n = 1,503), having acquired HIV perinatally and not having a partner oradult household member were associated with not achieving SVS. For males (n = 4,986), lacking access to food, Black or Haitian race/ethnicity, problematic substance use, and unknown physician were associated with not achieving SVS. For both sexes, younger age, lower household income, ever having an AIDS diagnosis, feeling depressed or anxious, and experiencing homelessness were associated with not achieving SVS. Elements of the transition from adolescent to adult HIV care that may differentially impact female clients and factors associated with disclosure should be explored further. Male clients may require additional support for food security. Improving culturally specific care for Haitian and non-Hispanic Black male clients should also be explored.
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Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, Florida, USA
| | | | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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RIVERA AS, RUSIE LK, FEINSTEIN MJ, SIDDIQUE J, LLOYD-JONES DM, BEACH LB. Intersectionality-informed analysis of durable viral suppression disparities in people with HIV. AIDS 2023; 37:1285-1296. [PMID: 37070543 PMCID: PMC10556196 DOI: 10.1097/qad.0000000000003565] [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: 04/19/2023]
Abstract
OBJECTIVE The aim of this study was to examine drivers of durable viral suppression (DVS) disparities among people with HIV (PWH) using quantitative intersectional approaches. DESIGN A retrospective cohort analysis from electronic health records informed by intersectionality to better capture the concept of interlocking and interacting systems of oppression. METHODS We analyzed data of PWH seen at a LGBTQ federally qualified health center in Chicago (2012-2019) with at least three viral loads. We identified PWH who achieved DVS using latent trajectory analysis and examined disparities using three intersectional approaches: Adding interactions, latent class analysis (LCA), and qualitative comparative analysis (QCA). Findings were compared with main effects only regression. RESULTS Among 5967 PWH, 90% showed viral trajectories consistent with DVS. Main effects regression showed that substance use [odds ratio (OR) 0.56, 0.46-0.68] and socioeconomic status like being unhoused (OR: 0.39, 0.29-0.53), but not sexual orientation or gender identity (SOGI) were associated with DVS. Adding interactions, we found that race and ethnicity modified the association between insurance and DVS ( P for interaction <0.05). With LCA, we uncovered four social position categories influenced by SOGI with varying rates of DVS. For example, the transgender women-majority class had worse DVS rates versus the class of mostly nonpoor white cisgender gay men (82 vs. 95%). QCA showed that combinations, rather than single factors alone, were important for achieving DVS. Combinations vary with marginalized populations (e.g. black gay/lesbian transgender women) having distinct sufficient combinations compared with historically privileged groups (e.g. white cisgender gay men). CONCLUSION Social factors likely interact to produce DVS disparities. Intersectionality-informed analysis uncover nuance that can inform solutions.
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Affiliation(s)
- Adovich S. RIVERA
- Institute for Public Health and Management, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Kaiser Permanente South California Department of Research and Evaluation, Pasadena, CA, USA
| | | | - Matthew J. FEINSTEIN
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juned SIDDIQUE
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M. LLOYD-JONES
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren B. BEACH
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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O’Shea J, Fanfair RN, Williams T, Khalil G, Brady KA, DeMaria A, Villanueva M, Randall LM, Jenkins H, Altice FL, Camp N, Lucas C, Buchelli M, Samandari T, Weidle PJ. The Cooperative Re-Engagement Controlled Trial (CoRECT): Durable Viral Suppression Assessment. J Acquir Immune Defic Syndr 2023; 93:134-142. [PMID: 36812382 PMCID: PMC10962216 DOI: 10.1097/qai.0000000000003178] [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: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND A collaborative, data-to-care strategy to identify persons with HIV (PWH) newly out-of-care, combined with an active public health intervention, significantly increases the proportion of PWH re-engaged in HIV care. We assessed this strategy's impact on durable viral suppression (DVS). METHODS A multisite, prospective randomized controlled trial for out-of-care individuals using a data-to-care strategy and comparing public health field services to locate, contact, and facilitate access to care versus the standard of care. DVS was defined as the last viral load, the viral load at least 3 months before, and any viral load between the 2 were all <200 copies/mL during the 18-month postrandomization. Alternative definitions of DVS were also analyzed. RESULTS Between August 1, 2016-July 31, 2018, 1893 participants were randomized from Connecticut (n = 654), Massachusetts (n = 630), and Philadelphia (n = 609). Rates of achieving DVS were similar in the intervention and standard-of-care arms in all jurisdictions (all sites: 43.4% vs 42.4%, P = 0.67; Connecticut: 46.7% vs 45.0%, P = 0.67; Massachusetts: 40.7 vs 44.4%, P = 0.35; Philadelphia: 42.4% vs 37.3%, P = 0.20). There was no association between DVS and the intervention (RR: 1.01, CI: 0.91-1.12; P = 0.85) adjusting for site, age categories, race/ethnicity, birth sex, CD4 categories, and exposure categories. CONCLUSION A collaborative, data-to-care strategy, and active public health intervention did not increase the proportion of PWH achieving DVS, suggesting additional support to promote retention in care and antiretroviral adherence may be needed. Initial linkage and engagement services, through data-to-care or other means, are likely necessary but insufficient for achieving DVS for all PWH.
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Affiliation(s)
- Jesse O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - George Khalil
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | | | - Liisa M. Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Heidi Jenkins
- Connecticut Department of Public Health, Hartford, CT
| | | | - Nasima Camp
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Crystal Lucas
- Philadelphia Department of Public Health, Philadelphia, PA
| | | | - Taraz Samandari
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paul J. Weidle
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Dawit R, Trepka MJ, Duncan DT, Gbadamosi SO, Li T, Pires SF, Ladner RA, Sheehan DM. Factors Associated with Geographic Patterns of Poor Sustained Viral Suppression in Miami-Dade County Florida, 2017. J Racial Ethn Health Disparities 2023; 10:357-366. [PMID: 35099764 PMCID: PMC9339030 DOI: 10.1007/s40615-021-01227-w] [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: 10/28/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Identifying geographic locations most affected by the HIV epidemic is essential to addressing disparities that impact people living with HIV. This study sought to identify individual and neighborhood-level factors that are associated with residing in geographic hotspots of poor sustained HIV viral suppression. METHODS Using data from the Miami-Dade County Ryan White HIV/AIDS program, spatial autocorrelation of poor sustained viral suppression (at least 1 laboratory test ≥ 200 copies/ml in 2017) was investigated using Global Moran's I followed by Local Moran's I and Getis Ord Gi* statistics by ZIP code tabulation areas (ZCTAs). Subsequently, multivariable logistic regression analysis was conducted to identify factors associated with residing in geographic hotspots of poor sustained viral suppression. RESULTS Several ZCTAs in the northern part of the county, accounting for 1/3 of the Ryan White program clients, had significantly higher clustering of poor sustained viral suppression. Client-level sociodemographic characteristics such as race/ethnicity, age, and poverty, and neighborhood-level characteristics (socioeconomic disadvantage index, residential instability index, and racial/language homogeneity index) were significantly associated with living in a hotspot of poor sustained viral suppression. CONCLUSION These findings highlight that spatial variation in sustained viral suppression exists within the county. Targeted strategies that address structural factors and the needs of people with HIV living in specified geographic areas may improve their HIV health outcomes and contribute towards local, regional, and national goals of ending the HIV epidemic.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, 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, Miami, FL, 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Stephen F Pires
- Department of Criminology & Criminal Justice, Steven J. Green School of International & Public Affairs, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd #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, 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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REMIEN RH, DĀCUS JD, FARLEY JE, HUGHES JP, GAMBLE T, WANG Z(Z, BATEY DS, MAYER KH, DEL RIO C, BALÁN IC, IRVIN R, MITCHELL KM, CUMMINGS V, ESHLEMAN SH, CONSERVE DF, KNOX J, YU K, BEYRER C. HTPN 078: an enhanced case management study to achieve viral suppression among viremic HIV-positive men who have sex with men in the United States. AIDS 2023; 37:217-231. [PMID: 36541636 PMCID: PMC9983736 DOI: 10.1097/qad.0000000000003411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES After identifying and recruiting men who have sex with men living with HIV and virally unsuppressed, this study attempted to enhance treatment and care via case management to increase the proportion who achieved viral suppression. DESIGN Participants were randomized into one of two study arms: standard of care (SOC) or enhanced case management (CM) intervention. Participants were followed for 12 months with quarterly study assessments, with blood collected for CD4+ cell count testing, HIV viral load testing (primary prespecified outcome), and plasma storage. METHODS Participants identified via respondent-driven sampling and direct recruitment and were invited to participate in the randomized controlled trial. The CM intervention provided a wide range of support services including, health education, clinical care coordination, medication adherence support, and social service assistance. The month-12 assessment included questions about healthcare utilization, stigma, substance use, and mental health. RESULTS Among the 144 participants virally unsuppressed at baseline, most had had a previous positive HIV test result; were Black, non-Hispanic, gay and bisexual men, aged 22-50. Among the 128 participants at the last study visit, 68 were virally suppressed, with no statistically significant difference between the CM and SOC arms (viral suppression 42% and 53%, respectively; adjusted odds ratio = 0.62 [P = 0.15; 95% confidence interval: 0.32, 1.2]). CONCLUSIONS Reaching targets of at least 90% sustained viral suppression among all people with HIV will likely require more than an individual-level CM approach that addresses barriers to optimal care and treatment at multiple levels.
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Affiliation(s)
- Robert H. REMIEN
- Reprints: Robert H. Remien, PhD, HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons,
| | - Jagadīśa-devaśrī DĀCUS
- Correspondence: Jagadīśa-devaśrī Dācus, PhD, The Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern Feinberg School of Medicine, 625 N. Michigan Avenue, Room 14-055, Chicago, IL 60611,
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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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13
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Wood BR, Bauer K, Lechtenberg R, Buskin SE, Bush L, Capizzi J, Crutsinger-Perry B, Erly SJ, Menza TW, Reuer JR, Golden MR, Hughes JP. Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis. J Acquir Immune Defic Syndr 2022; 90:538-545. [PMID: 35499527 PMCID: PMC9283242 DOI: 10.1097/qai.0000000000003007] [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: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Project Extension for Community Health Outcomes (ECHO) aims to connect community providers to academic specialists, deliver longitudinal clinical mentorship and case consultations, plus encourage dissemination of knowledge and resources. The impact on outcomes for persons with HIV (PWH) is uncertain. SETTING PWH in Washington and Oregon outside of the Seattle and Portland metro areas, January 2011 to March 2018. METHODS Using viral load (VL) surveillance data, we assessed difference in the percentage of PWH who were virally suppressed among PWH whose providers participated versus did not participate in Project ECHO. Analyses included multiple mixed-effects regression models, adjusting for time and for patient, provider, and clinic characteristics. RESULTS Based on 65,623 VL results, Project ECHO participation was associated with an increase in the percentage of patients with VL suppression (13.7 percentage points greater; P < 0.0001), although the effect varied by estimated provider PWH patient volume. The difference was 14.7 percentage points ( P < 0.0001) among patients of providers who order <20 VL's/quarter and 2.3 and -0.6 percentage points among patients of providers who order 20-40 or >40 VL's/quarter, respectively ( P > 0.5). The magnitude of difference in VL suppression was associated with the number of sessions attended. Among patients of lower-volume providers who did not participate, VL suppression was 6.2 percentage points higher if providers worked in a clinic where another provider did participate ( P < 0.0001). CONCLUSION Project ECHO is associated with improvement in VL suppression for PWH whose providers participate or work in the same clinic system as a provider who participates, primarily because of benefits for patients of lower-volume providers.
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Affiliation(s)
- Brian R. Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | - Karin Bauer
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | | | - Susan E. Buskin
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lea Bush
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Jeff Capizzi
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | | | - Timothy W. Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Matthew R. Golden
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Ward MK, Fernandez SB, Sheehan DM, Li T, Dawit R, Fennie K, Beach MC, Brock P, Ladner R, Trepka MJ. Sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression in the Miami-Dade County Ryan White Program, 2017. AIDS Care 2022. [DOI: https://doi.org.10.1080/09540121.2022.2080800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, Sarasota, Florida, USA
| | | | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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Hanna DB, Felsen UR, Anastos K, Bauman LJ, Fiori KP, Ginsberg MS, Watnick D, Chambers EC. ASSOCIATION OF SOCIAL NEEDS WITH UNCONTROLLED VIREMIA IN PEOPLE WITH HIV. AIDS Behav 2022; 26:3740-3745. [PMID: 35583573 PMCID: PMC10091511 DOI: 10.1007/s10461-022-03703-8] [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: 05/03/2022] [Indexed: 11/01/2022]
Abstract
Using a tool integrated into the electronic health record, we determined prevalence of 10 social needs among 377 people with HIV (PWH) and 27,833 patients without HIV receiving care in the Montefiore Health System. PWH (median age 53) were 55% women, 41% Black, 44% Hispanic. 33% of PWH reported at least one social need vs. 18% among patients without HIV, with healthcare transportation and housing needs significantly higher among PWH in adjusted analyses. PWH reporting transportation needs were 27% less likely to be virologically suppressed (< 200 copies/mL, adjusted prevalence ratio 0.73, 95% CI 0.55-0.96) compared with PWH without transportation needs.
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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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Phillips G, McCuskey D, Ruprecht MM, Curry CW, Felt D. Structural Interventions for HIV Prevention and Care Among US Men Who Have Sex with Men: A Systematic Review of Evidence, Gaps, and Future Priorities. AIDS Behav 2021; 25:2907-2919. [PMID: 33534056 PMCID: PMC7856612 DOI: 10.1007/s10461-021-03167-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to decrease HIV transmission and increase engagement in care, especially for men who have sex with men (MSM), particularly Black and Latinx MSM. A systematic literature review was conducted to assess the current state of structural interventions; only two studies detailing structural interventions related to HIV for Black and Latinx MSM in the US were identified. An additional 91 studies which discussed structural-level barriers to optimal HIV outcomes among MSM, yet which did not directly evaluate a structural intervention, were also identified. While this paucity of findings was discouraging, it was not unexpected. Results of the systematic review were used to inform guidelines for the implementation and evaluation of structural interventions to address HIV among MSM in the U.S. These include deploying specific interventions for multiply marginalized individuals, prioritizing the deconstruction of structural stigma, and expanding the capacity of researchers to evaluate “natural” policy-level structural interventions through a standardization of methods for rapid evaluative response, and through universal application of sex, sexual orientation, and gender identity demographic measures.
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Affiliation(s)
- Gregory Phillips
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David McCuskey
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan M Ruprecht
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Case Western Reserve University Undergraduate Studies, Cleveland, OH, USA
| | - Dylan Felt
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gebrezgi MT, Trepka MJ, Gbadamosi SO, Fennie KP, Ramirez-Ortiz D, Li T, Fernandez SB, Brock P, Ladner RA, Sheehan DM. Development and Validation of Vulnerable and Enabling Indices for HIV Viral Suppression among People with HIV Enrolled in the Ryan White Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137048. [PMID: 34280985 PMCID: PMC8297082 DOI: 10.3390/ijerph18137048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). METHODS We used Ryan White Program (RWP) data and principal component analysis to develop general and gender- and racial/ethnic-specific indices. We assessed internal reliability (Cronbach's alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. RESULTS Three general factors accounting for 79.2% of indicators' variability surfaced: mental health, drug use, and socioeconomic status (Cronbach's alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender- or racial/ethnic-specific indices did not improve psychometric performance. DISCUSSION General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender- and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Kristopher P. Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bayshore Rd, Sarasota, FL 34243, USA;
| | - Daisy Ramirez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA;
| | - Sofia B. Fernandez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Petra Brock
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Robert A. Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
- Correspondence:
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Moore DM, Cui Z, Skakoon‐Sparling S, Sang J, Barath J, Wang L, Lachowsky N, Cox J, Lambert G, Noor SW, Grace D, Jollimore J, Apelian H, Lal A, Parlette A, Hart TA. Characteristics of the HIV cascade of care and unsuppressed viral load among gay, bisexual and other men who have sex with men living with HIV across Canada's three largest cities. J Int AIDS Soc 2021; 24:e25699. [PMID: 33929091 PMCID: PMC8086033 DOI: 10.1002/jia2.25699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Treatment as prevention strategies have been variously applied across provinces in Canada. We estimated HIV care cascade indicators and correlates of unsuppressed viral load (VL) among gay, bisexual and other men who have sex with men (GBM) recruited in Vancouver, Toronto and Montreal. METHODS Sexually active GBM, aged ≥16 years, were recruited through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview and tests for HIV and other sexually transmitted infections (STIs). We conducted bivariate analyses comparing RDS-adjusted proportions across cities. We used multivariable logistic regression to examine factors associated with having a measured VL ≥ 200 copies/mL with data pooled from all three cities. RESULTS We recruited 1179 participants in Montreal, 517 in Toronto and 753 in Vancouver. The RDS-adjusted HIV prevalence was 14.2% (95% CI 11.1 to 17.2) in Montreal, 22.1% (95% CI 12.4 to 31.8) in Toronto and 20.4% (95% CI 14.5 to 26.3) in Vancouver (p < 0.001). Of participants with confirmed HIV infection, 3.3% were previously undiagnosed in Montreal, 3.2% undiagnosed in Toronto and 0.2% in Vancouver (p = 0.154). In Montreal, 87.6% of GBM living with HIV were receiving antiretroviral therapy (ART) and 10.6% had an unsuppressed VL; in Toronto, 82.6% were receiving ART and 4.0% were unsuppressed; in Vancouver, 88.5% were receiving ART and 2.6 % were unsuppressed (p < 0.001 and 0.009 respectively). Multivariable modelling demonstrated that participants in Vancouver (adjusted odds ratio [AOR]=0.23; 95% CI 0.06 to 0.82), but not Toronto (AOR = 0.27; 95% CI 0.07 to 1.03), had lower odds of unsuppressed VL, compared to Montreal, as did older participants (AOR 0.93 per year; 95% CI 0.89 to 0.97), those at high-risk for hazardous drinking (AOR = 0.19; 95% CI 0.05 to 0.70), those with a primary care provider (AOR = 0.11; 95% CI 0.02 to 0.57), and those ever diagnosed with other STIs (AOR = 0.12; 95% CI 0.04 to 0.32). CONCLUSIONS GBM living in Montreal, Toronto and Vancouver are highly engaged in HIV testing and treatment and all three cities have largely achieved the 90-90-90 targets for GBM. Nevertheless, we identified disparities which can be used to identify GBM who may require additional interventions, in particular younger men and those who are without a regular primary care provider.
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Affiliation(s)
- David M Moore
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
- University of British ColumbiaVancouverBCCanada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | | | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
- University of VictoriaVictoriaBCCanada
| | - Joseph Cox
- McGill UniversityMontréalQCCanada
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQCCanada
| | - Gilles Lambert
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQCCanada
- Institut national de santé publique du QuébecMontréalQCCanada
| | - Syed W Noor
- Ryerson UniversityTorontoONCanada
- School of Human SciencesLouisiana State University ShreveportShreveportUSA
| | | | | | | | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | | | - Trevor A Hart
- Ryerson UniversityTorontoONCanada
- University of TorontoTorontoONCanada
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Mayer KH, Nelson L, Hightow-Weidman L, Mimiaga MJ, Mena L, Reisner S, Daskalakis D, Safren SA, Beyrer C, Sullivan PS. The persistent and evolving HIV epidemic in American men who have sex with men. Lancet 2021; 397:1116-1126. [PMID: 33617771 PMCID: PMC9639667 DOI: 10.1016/s0140-6736(21)00321-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 01/06/2023]
Abstract
Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.
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Affiliation(s)
- Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Fenway Health, Boston, MA, USA.
| | - LaRon Nelson
- School of Nursing, Yale University, New Haven, CT, USA
| | | | - Matthew J Mimiaga
- Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leandro Mena
- Medical Center, University of Mississippi, Jackson, MS, USA
| | - Sari Reisner
- Boston Children's Hospital, Fenway Health, Boston, MA, USA
| | | | | | - Chris Beyrer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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21
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Elgalib A, Al-Wahaibi A, Shah S, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, Al-Rawahi B, Al-Abri S. Predictors of virologic failure among people living with HIV in Oman: a national study from the Middle East. Int J STD AIDS 2020; 32:239-245. [DOI: 10.1177/0956462420956850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a cross-sectional analysis to determine HIV virologic failure and its associated factors among Omani people living with HIV who are on ART for > 6 months. Patients (n = 1427) were identified from a central national HIV surveillance dataset. Two-thirds (67%) of patients were male, and the median age was 39 years (IQR, 32-48 years). Out of 1427 patients, 14.4% had virologic failure (HIV viral load [VL] ≥ 200 copies/ml). The multivariate analysis showed that patients aged 25-49 years (adjusted odds ratio [aOR]: 1.76, 95% CI: 1.01-3.08) were significantly more likely to fail treatment, compared to those aged ≥ 50 years. Besides, having “Other” HIV risk factor (compared to heterosexuals, aOR: 1.82, 95% CI: 1.02-3.24) and receiving HIV care outside the capital Muscat (compared to those cared for in Muscat, aOR: 1.73, 95% CI: 1.11-2.7) were independently associated with virologic failure. HIV viral suppression (85.6%) in Oman is encouraging; however, further strategies, mainly targeting patients who are young (<50 years), those not disclosing their HIV risk factor and those attending HIV treatment centres outside Muscat, are required to enhance HIV treatment outcome in Oman.
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Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Adil Al-Wahaibi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Hanan Al-Kindi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
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22
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Satre DD, Parthasarathy S, Silverberg MJ, Horberg M, Young-Wolff KC, Williams EC, Volberding P, Campbell CI. Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study. BMC Health Serv Res 2020; 20:1030. [PMID: 33176760 PMCID: PMC7656679 DOI: 10.1186/s12913-020-05856-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/22/2020] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care utilization and HIV clinical outcomes among individuals newly enrolled in insurance coverage following implementation of the ACA. METHODS Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N = 880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1-$999 and > = $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts; viral suppression at HIV RNA < 75 copies/mL). RESULTS Health care use was greatest immediately after enrollment and decreased over 3 years. Those with high deductibles were less likely to use primary care (OR = 0.64, 95% CI = 0.49-0.84, p < 0.01) or psychiatry OR = 0.59, 95% CI = 0.37, 0.94, p = 0.03) than those with no deductible. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR] = 0.40, 95% CI = 0.18-0.86; p = 0.02), but ADAP was associated with more psychiatry visits (RR = 2.22, 95% CI = 1.24-4.71; p = 0.01). Those with high deductibles were less likely to have viral suppression (OR = 0.65, 95% CI = 0.42-1.00; p = 0.05), but ADAP enrollment was associated with viral suppression (OR = 2.20, 95% CI = 1.32-3.66, p < 0.01). Black (OR = 0.35, 95% CI = 0.21-0.58, p < 0.01) and Hispanic (OR = 0.50, 95% CI = 0.29-0.85, p = 0.01) PWH were less likely to be virally suppressed. CONCLUSIONS In this sample of PWH newly enrolled in an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization, high deductibles were associated with worse HIV outcomes, but support from ADAP appeared to help patients achieve viral suppression. Race/ethnic disparities remain important to address even among those with access to insurance coverage.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
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