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Luo S, Jiao K, Zhang Y, Xu Y, Zhou J, Huang S, Li Y, Xiao Y, Ma W, He L, Ren X, Dai Z, Sun J, Li Q, Cheng F, Liang W. Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e47165. [PMID: 38502181 PMCID: PMC10988377 DOI: 10.2196/47165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022. OBJECTIVE This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM. METHODS An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention. RESULTS A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001). CONCLUSIONS Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.
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Affiliation(s)
- Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Kedi Jiao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yutong Xu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jingtao Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Siwen Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yongkang Xiao
- Department of Acute Infectious Diseases Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xianlong Ren
- Department of AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Zhen Dai
- Department of AIDS/STD Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Jiaruo Sun
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qingyu Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Tanner AE, Hall MA, Aguilar-Palma SK, Mann-Jackson L, Alonzo J, Bertoni AG, McCoy TP, Garcia M, Sucaldito AD, Turner MJ, Robles Arvizu J, Russell LP, Rhodes SD. Understanding uptake of COVID-19 testing, vaccination, and boosters among Spanish-speaking Latines in the United States: Qualitative insights from Spanish speakers and key informants. PLoS One 2024; 19:e0296812. [PMID: 38452119 PMCID: PMC10919869 DOI: 10.1371/journal.pone.0296812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Latine communities in the United States have been disproportionately affected by COVID-19. It is critical to gain a better understanding of the sociocultural determinants that challenge and facilitate COVID-19 testing, vaccination, and booster uptake within these vulnerable communities to inform culturally congruent strategies and interventions. METHODS In summer 2022, our community-based participatory research partnership conducted 30 key informant interviews and 7 focus groups with 64 Spanish-speaking Latine participants in North Carolina. Interviewees consisted of representatives from health and service organizations, most of whom were engaged with direct service to Spanish speakers. Interviews were conducted in either English or Spanish, depending on the preference of the participant; all focus groups were conducted in Spanish. Interviews and focus groups were conducted in person or by videoconference. RESULTS Twenty themes emerged that we organize into four domains: general perceptions about COVID-19; barriers to COVID-19 testing, vaccination, and booster uptake; facilitators to COVID-19 testing, vaccination, and booster uptake; and recommendations to promote testing, vaccination, and booster uptake. DISCUSSION Results underscore important sociocultural determinants of ongoing COVID-19 testing, vaccination, and booster uptake to consider in developing interventions for Spanish-speaking Latines in the United States. Based on this formative work, our partnership developed Nuestra Comunidad Saludable (Our Healthy Community). We are implementing the intervention to test whether trained peer navigators can increase COVID-19 testing, vaccination, and booster uptake among Spanish-speaking Latines through blending in-person interactions and mHealth (mobile health) strategies using social media.
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Affiliation(s)
- Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Mark A. Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest University School of Law, Winston-Salem, NC, United States of America
| | | | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Thomas P. McCoy
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Ana D. Sucaldito
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
| | - Mari Jo Turner
- Hispanic League, Inc, Winston-Salem, NC, United States of America
| | - Jose Robles Arvizu
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Laurie P. Russell
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
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Aurpibul L, Kaewpoowat Q, Detsakunathiwatchara C, Chairat S, Chaiwarith R, Tangmunkongvorakul A. Health Behaviors and Attitudes Toward HIV Clinic Among Young Men who Have Sex with Men Living with HIV in Chiang Mai, Thailand: A Mixed Methods Study. AIDS Behav 2024; 28:332-342. [PMID: 37542628 DOI: 10.1007/s10461-023-04132-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] [Accepted: 07/09/2023] [Indexed: 08/07/2023]
Abstract
Today, many young men who have sex with men (YMSM) with a new HIV infection were diagnosed and successfully linked to HIV services. Studies on their health behaviors while living with HIV and their attitude toward the HIV clinic are scarce. We characterized common health behaviors of YMSM and assessed their perspective towards the existing HIV services. We collected data from a self-administered questionnaire and in-depth interviews (IDI) using a mixed-method cross-sectional study design. A hundred YMSM, aged 18-24, who attended the HIV clinic were enrolled. Their median age was 23 years (interquartile range, IQR 21-24). Eighty-four (84%) were gay men. Their common health behaviors included 15 (15%) being current smokers and 30 (30%) using alcohol regularly. Sixty-four (64%) reported > 95% antiretroviral treatment adherence, while 32 (32%) self-reported adherence at 80-95%. Fifty-three (53%) reported 100% condom use, while 30 (30%) reported using a condom in > 80% of their sexual activities. From the questionnaire respondents, individual characteristics of providers were the most critical factor affecting participants' willingness to attend HIV services. From the IDI, social disclosure of HIV status was their primary concern, with the presence of self- and anticipating HIV-related stigma issues. In summary, YMSM living with HIV who regularly attended the HIV clinic had a low frequency of health risk behaviors. Most did not socially disclose their serostatus but could manage their health. They were generally satisfied with patient-friendly services while calling to protect their confidentiality and privacy.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Quanhathai Kaewpoowat
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, University of Iowa, Iowa, USA
| | | | - Suchada Chairat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Hirschhorn LR, Adetunji A, Ahonkhai AA, Oladeji B, Awolude OA, Kuhns LM, Onumabor J, Kuti KM, Omigbodun O, Johnson AK, Okonkwor O, Taiwo B, Garofalo R. Mixed methods implementation research to understand success of intensive combination approach to roll back the epidemic in Nigerian adolescents) (iCARE Nigeria) HIV testing uptake and linkage to care among young men focusing on young men who have sex with men in Ibadan. AIDS Res Ther 2023; 20:75. [PMID: 37904200 PMCID: PMC10617228 DOI: 10.1186/s12981-023-00574-4] [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: 12/26/2022] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND HIV seroprevalence in Nigeria is increasing among men who have sex with men (MSM) from 14% to 2007 to 23% in 2014, threatening progress towards ending the epidemic in the country. Expanding access to HIV testing and linkage to care for key populations, like young MSM (YMSM), is critical to end the HIV epidemic in Nigeria. The Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) pilot intervention successfully implemented a combination of evidence-based interventions utilizing peer navigators and popular social media apps and platforms to reach young men at risk for HIV exposure, including YMSM. We conducted sequential mixed methods explanatory implementation research to expand on the previously reported effectiveness and implementation outcomes and to explore the determinants and strategies which contributed to primary study results. METHODS We conducted key informant interviews and focus group discussions with 2 peer navigators and 3 study staff at the end of the pilot. We used directed content analysis to understand the quantitative results from the pilot. Using the Implementation Research Logic Model, we were able to identify and map strategies through mechanisms of action from barriers addressed to the reported implementation outcomes including feasibility, acceptability fidelity and adoption. RESULTS We found that iCARE Nigeria's pilot intervention implementers reported high feasibility, acceptability fidelity and adoption were associated with implementation of strategies which addressed many challenging contextual factors, including social stigma, online social networking, legal barriers surrounding MSM behavior, and the COVID-19 pandemic. These strategies included integration of stakeholders' interests, selection of experienced peer navigators including from the targeted population, training and supportive supervision using an implementation guide, ensuring safety (COVID and legal) and identification of clinics serving the targeted population. CONCLUSION Mixed methods using implementation research frameworks provided insights into the strategies and barriers and facilitators they addressed which may explain the success of the pilot. These results can inform strategies needed to scale-up the intervention to youth including YMSM in other areas in Nigeria and the region. TRIAL REGISTRATION ISRCTN ISRCTN94590823, https://doi.org/10.1186/ISRCTN94590823.
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Affiliation(s)
- Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, 14-013, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Ryan Family Center for Global Primary Care, Robert J Havey Institute of Global Health, Northwestern University, Chicago, USA.
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Aima A Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bibilola Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olutosin A Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lisa M Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jude Onumabor
- Initiative for the Advancement of Improved Health and Development, I-AIHD, Ibadan, Nigeria
| | - Kehinde M Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Staff Medical Services Department, University College Hospital, Ibadan, Nigeria
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Child and Adolescent Mental Health, College of Medicine,, Ibadan University, Ibadan, Nigeria
| | - Amy K Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, IL, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, IL, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Becker N, Kim HC, Bright DJ, Williams Iii R, Anguera JA, Arnold EA, Saberi P, Neilands TB, Pollack LM, Tan JY. Acceptability of the LetSync App Wireframes for an mHealth Intervention to Improve HIV Care Engagement and Treatment Among Black Partnered Sexual Minority Men: Findings from In-Depth Qualitative Interviews. JMIR Form Res 2023; 7:e43676. [PMID: 37624634 PMCID: PMC10492169 DOI: 10.2196/43676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care. OBJECTIVE We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app. METHODS We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement. RESULTS Participants indicated interest in the future LetSync app and noted that the wireframes' features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users' engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner's health needs, including access to and use of health care services; and facilitate participants' ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV. CONCLUSIONS Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services.
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Affiliation(s)
- Nozipho Becker
- Office for Inclusive Excellence, Colorado State University, Fort Collins, CO, United States
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Hyunjin C Kim
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Darius J Bright
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Robert Williams Iii
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Joaquin A Anguera
- Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Emily A Arnold
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Parya Saberi
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Judy Y Tan
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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Collins CB, Higa D, Taylor J, Wright C, Murray KH, Pitasi M, Greene Y, Lyles C, Edwards A, Andia J, Stallworth J, Alvarez J. Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV. AIDS Behav 2023; 27:2285-2297. [PMID: 36580166 PMCID: PMC10225340 DOI: 10.1007/s10461-022-03958-1] [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] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Up to 50% of those diagnosed with HIV in the U.S. are not retained in medical care. Care retention provides opportunity to monitor benefits of HIV therapy and enable viral suppression. To increase retention, there is a need to prioritize best practices appropriate for translation and dissemination for real-world implementation. Eighteen interventions from CDC's Compendium of Evidence-Based Interventions were scored using the RE-AIM framework to determine those most suitable for dissemination. A CDC Division of HIV Prevention workgroup developed a RE-AIM scale with emphasis on the Implementation and Maintenance dimensions and less emphasis on the Efficacy dimension since all 18 interventions were already identified as evidence-based or evidence-informed. Raters referenced primary efficacy publications and scores were averaged for a ranked RE-AIM score for interventions. Of 18 interventions, four included care linkage and 7 included viral suppression outcomes. Interventions received between 20.6 and 35.3 points (45 maximum). Scores were converted into a percentage of the total possible with ranges between 45.8 and 78.4%. Top four interventions were ARTAS (78.4%); Routine Screening for HIV (RUSH) (73.2%); Optn4Life (67.4%) and Virology Fast Track (65.9%). All four scored high on Implementation and Maintenance dimensions. Select items within the scale were applicable to health equity, covering topics such as reaching under-served focus populations and acceptability to that population. Navigation-enhanced Case Management (NAV) scored highest on the health equity subscale. RE-AIM prioritization scores will inform dissemination and translation efforts, help clinical staff select feasible interventions for implementation, and support sustainability for those interventions.
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Affiliation(s)
- Charles B Collins
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA.
| | - Darrel Higa
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jocelyn Taylor
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Carolyn Wright
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Kimberly H Murray
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Marc Pitasi
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Yvonne Greene
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Cynthia Lyles
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Arlene Edwards
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jonny Andia
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - JoAna Stallworth
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jorge Alvarez
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
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McCuistian C, Peteet B, Burlew K, Jacquez F. Sexual Health Interventions for Racial/Ethnic Minorities Using Community-Based Participatory Research: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2023; 50:107-120. [PMID: 33870765 PMCID: PMC9004606 DOI: 10.1177/10901981211008378] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Racial/ethnic minorities (REMs) continue to carry the burden of sexual health disparities in the United States, including increased health risks and lower proportions of preventative care. Community-based participatory research (CBPR) has been useful in developing interventions aimed at reducing these disparities. Specifically, partnership with the target group members has resulted in more culturally relevant intervention strategies. AIM The purpose of this systematic review was to analyze the existing research on sexual health interventions targeting U.S. REMs that were developed using CBPR, to highlight the role target group members played in the development of these interventions, and to explore the benefits and outcomes of these partnerships. METHOD Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guided the search of 46 thesauri terms for CBPR, sexual health, and REMs across six databases. RESULTS The initial search yielded 805 identified studies. After applying limiters, reviewing abstracts, and doing a full-text review, 24 appropriate studies were retained. The key findings indicated significant intervention outcomes such as increased health knowledge, attitude change, and behavioral intention that could reduce sexual risk-taking behaviors. Twelve studies detailed the methods for partnering with target group members to formulate interventions, highlighting the benefits related to recruitment, retention, and cultural relevance. DISCUSSION CBPR is well-positioned to address sexual health disparities among REMs. While community partnership strategies vary, the findings yield evidence that CBPR addressing sexual health disparities is achievable, can influence the effectiveness of interventions, and should be considered as an orientation in future sexual health research.
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Maragh-Bass AC, Hucks-Ortiz C, Beyrer C, Remien RH, Mayer K, del Rio C, Batey DS, Farley JE, Gamble T, Tolley EE. Multilevel Stigma and Its Associations with Medical Care Ratings Among Men Who Have Sex With Men in HPTN 078. J Prim Care Community Health 2023; 14:21501319231175362. [PMID: 37243342 PMCID: PMC10226292 DOI: 10.1177/21501319231175362] [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: 02/13/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Our research assessed associations between stigma-related variables and medical care ratings among clients with HIV in HIV Prevention Trials Network (HPTN) 078 who were men who have sex with men (MSM). METHODS Logistic regression explored care ratings, stigma, socio-demographics (N = 637). Qualitative thematic coding and themes explored stigmatizing experiences in different settings (N = 111). RESULTS Whites were twice as likely as African-Americans to report high care ratings (P < .05). Clients who reported familial exclusion due to having sex with men were 40% less likely to report high medical care ratings (P < .05). Clients who agreed healthcare providers think people with HIV "sleep around" were half as likely to report high care ratings (P < .08). Stigmatization included "treating me like they'll catch HIV from my hand," and care avoidance so others didn't "know I was having sex with men". CONCLUSIONS Providers can promote African American MSM client retention with more affirming healthcare provision, namely minimizing assumptions and addressing identities and client needs beyond just HIV care.
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Affiliation(s)
| | - Christopher Hucks-Ortiz
- Black AIDS Institute, Los Angeles, CA,
USA
- HIV Prevention Trials Network Black
Caucus, Los Angeles, CA, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | | | - Kenneth Mayer
- The Fenway Institute and Harvard
Medical School, Boston, MA, USA
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Tanner AE, Palakshappa D, Morse CG, Mann-Jackson L, Alonzo J, Garcia M, Wright E, Dharod A, Isom S, Sucaldito AD, Aviles LR, Rhodes SD. Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure. Trials 2022; 23:998. [PMID: 36510319 PMCID: PMC9743787 DOI: 10.1186/s13063-022-06924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM). METHODS In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes. TRIAL STATUS Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025. CONCLUSIONS This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04943861 . Registered on June 29, 2021.
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Affiliation(s)
- Amanda E. Tanner
- grid.266860.c0000 0001 0671 255XDepartment of Public Health Education, University of North Carolina Greensboro, Coleman 437E, Greensboro, NC 27402 USA
| | - Deepak Palakshappa
- grid.241167.70000 0001 2185 3318Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Caryn G. Morse
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lilli Mann-Jackson
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jorge Alonzo
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Manuel Garcia
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Elena Wright
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ajay Dharod
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott Isom
- grid.241167.70000 0001 2185 3318Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ana D. Sucaldito
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lucero Refugio Aviles
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott D. Rhodes
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Aviles LR, Galindo CA, Bessler PA, Courtenay-Quirk C, Smart BD, Garcia M, Goldenberg T, Sucaldito AD, Reboussin BA. Adapting a Group-Level PrEP Promotion Intervention Trial for Transgender Latinas During the COVID-19 Pandemic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:481-495. [PMID: 36454131 PMCID: PMC10552717 DOI: 10.1521/aeap.2022.34.6.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has profoundly affected the conduct of community-based and community-engaged research. Prior to the pandemic, our community-based participatory research partnership was testing ChiCAS, an in-person, group-level behavioral intervention designed to promote uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised gender-affirming hormone therapy among Spanish-speaking transgender Latinas. However, the pandemic required adaptations to ensure the safe conduct of the ChiCAS intervention trial. In this article, we describe adaptations to the trial within five domains. Transgender women are disproportionately affected by HIV, and it is essential to find ways to continue research designed to support their health within the context of the COVID-19 pandemic and future infectious disease outbreaks, epidemics, and pandemics. These adaptations offer guidance for ongoing and future community-based and community-engaged research during the COVID-19 pandemic and/or potential subsequent outbreaks (e.g., monkeypox), epidemics, and pandemics, particularly within under-served marginalized and minoritized communities.
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Affiliation(s)
| | | | | | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | | | | | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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12
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Song EY, Smart BD, Garcia M, McCoy TP, Schafer KR, Wilkin AM. Outcomes From a Randomized Trial of a Bilingual mHealth Social Media Intervention to Increase Care Engagement Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women With HIV. HEALTH EDUCATION & BEHAVIOR 2022; 49:975-984. [PMID: 36196926 PMCID: PMC10421562 DOI: 10.1177/10901981221125400] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The North Carolina Community Research Partnership developed, implemented, and tested weCare, a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps). METHODS We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the weCare intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%. RESULTS Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up. CONCLUSIONS An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between weCare and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors.
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Affiliation(s)
- Scott D Rhodes
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Jorge Alonzo
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Benjamin D Smart
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Manuel Garcia
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Aimee M Wilkin
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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13
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Hall MA, Bertoni AG, McCoy TP, Aguilar-Palma SK, Garcia M, Miranda D, Turner MJ. Increasing COVID-19 testing and vaccination among Spanish speakers in the USA: protocol for the development and evaluation of the Nuestra Comunidad Saludable intervention using a group-randomised trial design. BMJ Open 2022; 12:e066585. [PMID: 36385019 PMCID: PMC9670094 DOI: 10.1136/bmjopen-2022-066585] [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: 07/13/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Our community-based participatory research partnership aims to expand understanding of the social, ethical and behavioural implications of COVID-19 testing and vaccination to inform the development of an integrated intervention that harnesses community-based peer navigation and mHealth strategies to improve COVID-19 testing and vaccination; test the intervention; and develop and disseminate practice, research and policy recommendations to further increase COVID-19 testing and vaccination among Spanish-speaking Latine communities in the USA. METHODS AND ANALYSIS We will conduct 50 individual in-depth interviews with health providers, who have conducted COVID-19 testing and/or vaccination activities within Spanish-speaking communities, and with representatives from Latine-serving community-based organisations. We will also conduct six focus groups with 8-12 Spanish-speaking Latine community member participants each for a total number of about 60 focus group participants. Next, we will develop the Nuestra Comunidad Saludable intervention based on findings from interviews and focus groups and use a longitudinal group-randomised trial design with two arms (intervention and delayed intervention) to evaluate the impact of the intervention. We will recruit, enrol and collect baseline data from 20 community-based peer navigators (Navegantes) and their social network members (n=8 unique social network members per Navegante). Navegantes (coupled with their social networks) will be randomised to intervention or delayed intervention groups (10 Navegantes and 80 social network members per group). ETHICS AND DISSEMINATION Ethical approval for data collection was granted by the Wake Forest University School of Medicine Institutional Review Board. Following the description of study procedures, we will obtain consent from all study participants. Study findings will be disseminated through an empowerment theory-based community forum, peer-reviewed publications and presentations at scientific meetings, and reports and briefs for lay, community and practitioner audiences. TRIAL REGISTRATION NUMBER NCT05302908.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amanda E Tanner
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Wake Forest University School of Law, Winston-Salem, North Carolina, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | | | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Li M, Wu H, Yan H, Zunong J, Hui H, Li H, Yang Z, Vermund SH, Hu Y. HIV-Positive Men Are More Likely to Be Hyper Linked Within College Student Social Network - Northeast China, 2017-2018. China CDC Wkly 2022; 4:951-955. [PMID: 36483793 PMCID: PMC9713575 DOI: 10.46234/ccdcw2022.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022] Open
Abstract
What is already known about this topic? Men who have sex with men (MSM) bear a disproportionate burden of new human immunodeficiency virus (HIV) infections and young MSM demonstrate parallel internet-driven HIV incident infection and dynamic social network. What is added by this report? The HIV positive prevalence and incidence among college MSM were 3.8% and 2.9 per 100 person-years, respectively, while these rates were 13.9% and 10.5 per 100 person-years, respectively, among their social contacts. The overall HIV positive prevalence was 7.2% in Northeast China. HIV-positive MSM have comparatively more social contacts than HIV-seronegative MSM. What are the implications for public health practice? Hyper-linkages found in app-based social networks play an important role in HIV transmission via risky sexual behavior and suggest options for online intervention to promote HIV prevention.
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Affiliation(s)
- Menglong Li
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Huichao Wu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
- General Management Office, Xidan Campus, Peking Union Medical College Hospital, Beijing, China
| | - Hongmei Yan
- Department of HIV/STD Prevention and Control, Heilongjiang Provincial Center for Disease Control and Prevention, Harbin City, Heilongjiang Province, China
| | - Jiawulan Zunong
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Hongtao Hui
- Heilongjiang Kangtong Community, Harbin City, Heilongjiang Province, China
| | - Hailong Li
- Heilongjiang Kangtong Community, Harbin City, Heilongjiang Province, China
| | - Zhenhua Yang
- School of Computer and Information Engineering, Harbin University of Commerce, Harbin City, Heilongjiang Province, China
| | - Sten H. Vermund
- Dean of the office, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
- Yifei Hu,
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Jiao K, Wang C, Liao M, Ma J, Kang D, Tang W, Tucker JD, Ma W. A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial. BMC Med 2022; 20:341. [PMID: 36210434 PMCID: PMC9549628 DOI: 10.1186/s12916-022-02538-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China. METHODS The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies-text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants' preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention's effect. RESULTS A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21-2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39-4.17). CONCLUSIONS The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services. TRIAL REGISTRATION ChiCTR2000041282. Retrospectively registered on 23 December 2020.
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Affiliation(s)
- Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Chunmei Wang
- Shandong Public Health Clinical Center, Jinan, Shandong, People's Republic of China
| | - Meizhen Liao
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Jing Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Dianmin Kang
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China.
| | - Weiming Tang
- University of North Carolina Chapel Hill Project-China, Guangzhou, Guangdong, People's Republic of China.
| | - Joseph D Tucker
- University of North Carolina Chapel Hill Project-China, Guangzhou, Guangdong, People's Republic of China. .,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Individual level peer interventions for gay and bisexual men who have sex with men between 2000 and 2020: A scoping review. PLoS One 2022; 17:e0270649. [PMID: 35839245 PMCID: PMC9286286 DOI: 10.1371/journal.pone.0270649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Peer-led interventions are central to the global HIV response for gay and bisexual men who have sex with men [GBMSM]. Since the year 2000, technological advancements in HIV and an increased response to the health disparities faced by GBMSM outside of HIV, have contributed to the expanding scope of their content and delivery. This review sets out to characterise the evidence base for individual level peer interventions for GBMSM, overview approaches to implementing and evaluating them and identify future priorities for their delivery and evaluation. Methods A scoping review methodology was applied and evaluations of peer programs for GBMSM published in peer reviewed journals were identified via subject heading and keyword searches across five electronic databases. Titles and abstracts were reviewed, and full texts were assessed against eligibility criteria. A coding framework was used to extract data from included studies against intervention implementation and evaluation components. Results A total of 38 studies evaluating peer led interventions against effectiveness outcomes were deemed eligible for inclusion and coded into four intervention modalities; peer counselling [n = 6], groupwork programs [n = 15], peer navigation [n = 7] and peer education [n = 10]. Most addressed HIV [n = 32] and across intervention modalities, evaluations demonstrated compelling evidence of significant effect. Intervention effects on broader indicators of psychosocial wellbeing were not extensively evaluated. Expertise regarding the implementation and evaluation of peer interventions addressing HIV among GBMSM ought to be leveraged to expand the scope of peer intervention to meet the diverse health and wellbeing needs of GBMSM.
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Zhao Y, Li Z, Sheng Y. Timely linkage to care among men who have sex with men newly diagnosed with HIV: A structural equation model integrated HIV-related stigma framework. Nurs Health Sci 2022; 24:643-651. [PMID: 35633137 DOI: 10.1111/nhs.12960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022]
Abstract
HIV prevalence among men who have sex with men in China has increased dramatically, and timely linkage to care after being diagnosed with HIV is important to treatment success. This cross-sectional study aims to utilize structural equation modeling to test a hypothesized model of timely linkage to care adapted from the HIV-related stigma framework. Data were collected from 257 men who have sex with men living with HIV. The proportion of participants with timely linkage to care within one month was 63.42%. The model result showed a good fit. Higher HIV-related stigma was significantly associated with a lower level of social support, mental health, maladaptive coping (three mechanism variables), and attitude toward linkage to care. Higher CD4+ T-cell count, disclosure of HIV positivity to sexual partners, and greater convenience of accessing care were related to timely linkage to care (p< 0.05). These model results suggest that enhancing attention to family reactions and social support are needed for further research and interventions to accelerate newly diagnosed people's access to HIV care in China.
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Affiliation(s)
- Yafang Zhao
- Nursing Department, Chinese Academy of Medical Sciences Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of ICU, Chinese Academy of Medical Sciences Peking Union Medical College Hospital, Beijing, China
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Beijing, China
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18
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Dangerfield DT, Ober AJ, Anderson JN, Gorbach P, Bluthenthal RN. Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men. Public Health Nurs 2022; 39:153-160. [PMID: 34403517 PMCID: PMC8766864 DOI: 10.1111/phn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. METHODS Go-alongs with two virally suppressed BSMM LWHIV supplemented 27 in-depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go-alongs involved accompanying participants' follow-up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient-provider interactions. RESULTS We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient-provider interactions, and personal motivations to achieve viral suppression. CONCLUSION Clinic accessibility, co-located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV.
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Affiliation(s)
| | - Allison J. Ober
- Policy and Behavioral Science Researcher, RAND Corporation, Los Angeles, CA, USA
| | - Janeane N. Anderson
- Assitant Professor, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamina Gorbach
- Professor, University of California Los Angeles, Los Angeles, CA, USA
| | - Ricky N. Bluthenthal
- Professor, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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19
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Schafer KR, Tanner AE, Mann-Jackson L, Alonzo J, Song EY, Rhodes SD. Stigma, Social Support, and Substance Use in Diverse Men Who Have Sex With Men and Transgender Women Living with HIV in the US Southeast. South Med J 2022; 115:26-32. [PMID: 34964058 PMCID: PMC8726574 DOI: 10.14423/smj.0000000000001345] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) rates in the southeast United States are high and substance use is common among people living with HIV (PLWH). This study used baseline data from the weCare intervention study to examine factors associated with the use of alcohol, tobacco, and marijuana among racially and ethnically diverse young gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in the southeast who were newly diagnosed as having HIV, not linked to care, out of care, and/or not virally suppressed. METHODS Self-reported data were collected from 196 GBMSM and transgender women living with HIV via Audio Computer-Assisted Self-Interview at enrollment. Measures assessed demographics; stigma; social support; basic and clinical service needs; HIV disclosure; social media use; and recent use of alcohol, tobacco, and marijuana. Logistic regression identified correlates of past 30-day substance use. RESULTS In multivariable analysis, increased age and needing basic support services were associated with past 30-day tobacco, cigarette, electronic cigarette, and/or hookah use. Increased HIV-related stigma and needing basic support services were associated with past 30-day marijuana use. Being White and needing clinical support services were associated with infrequent or no past 30-day marijuana use. CONCLUSIONS HIV-related stigma and needing basic support services were associated with substance use among GBMSM and transgender women living with HIV in the southeastern United States. Routine screening for basic needs could identify GBMSM and transgender women living with HIV at risk for substance use and offer insight into intervention leverage points.
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Affiliation(s)
- Katherine R Schafer
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Amanda E Tanner
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Lilli Mann-Jackson
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Jorge Alonzo
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Eunyoung Y Song
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Scott D Rhodes
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
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20
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Bragard E, Macapagal K, Mustanski B, Fisher CB. Association of CAI Vulnerability and Sexual Minority Victimization Distress Among Adolescent Men Who Have Sex With Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2021; 8:496-505. [PMID: 34957315 DOI: 10.1037/sgd0000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent men who have sex with men (AMSM) are at high HIV risk. Condomless anal intercourse (CAI) increases HIV risk and has been associated with interpersonal power imbalances, such as asymmetries in decision-making authority, social status, and emotional dependence, between male sexual partners. AMSM experience high levels of psychological and physical victimization due to their sexual minority status. Sexual minority victimization (SMV) is similarly associated with low interpersonal power and may relate to the extent to which AMSM are vulnerable to partner influences to engage in CAI. This online survey study of AMSM 14-17 years (N = 143) tested the hypothesis that experiences and attitudes reflecting vulnerability to partner CAI influence (CAI Vulnerability) and distress in response to experienced sexual minority victimization (SMV Distress) would be positively associated with participant and partner condom non-use during anal sex (CAI frequency). Approximately 35% reported they or their partner(s) had never or rarely used a condom. Positive correlations were found among partners' CAI frequency during sex with the participant, CAI Vulnerability, and SMV Distress. Multiple regression indicated CAI Vulnerability significantly accounted for the relation between SMV Distress and partner's CAI frequency. Findings suggest that distress in response to SMV may be associated with a diminished sense of interpersonal control resulting in CAI Vulnerability and subsequent more frequent instances of partner CAI. HIV prevention strategies designed to increase condom use among AMSM have the potential to benefit from procedures aimed at increasing interpersonal sexual assertiveness and decreasing distress associated with sexual minority victimization.
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Affiliation(s)
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Feinberg School of Medicine, and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Celia B Fisher
- Department of Psychology, Fordham University.,Center for Ethics Education, Fordham University
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21
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Bezabih AM, Gerling K, Abebe W, Abeele VV. Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e25129. [PMID: 34890353 PMCID: PMC8709919 DOI: 10.2196/25129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.
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Affiliation(s)
- Alemitu Mequanint Bezabih
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathrin Gerling
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vero Vanden Abeele
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
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22
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Shuper PA. The Role of Alcohol-Related Behavioral Research in the Design of HIV Secondary Prevention Interventions in the Era of Antiretroviral Therapy: Targeted Research Priorities Moving Forward. AIDS Behav 2021; 25:365-380. [PMID: 33987783 DOI: 10.1007/s10461-021-03302-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
HIV secondary prevention focuses on averting onward HIV transmission, which can be realized when people living with HIV enact requisite HIV care continuum-related behaviors to achieve viral suppression, and engage in condom-protected sex when virally unsuppressed. Alcohol has been detrimentally linked to all aspects of HIV secondary prevention, and although a growing number of behavioral interventions account for and address alcohol use within this realm, further efforts are needed to fully realize the potential of such initiatives. The present article proposes a series of targeted priorities to inform the future design, implementation, and evaluation of alcohol-related behavioral intervention research within the scope of HIV secondary prevention. These priorities and corresponding approaches account for the challenges of resource-constrained clinic environments; capitalize on technology; and address key comorbidities. This framework provides the foundation for a range of alcohol-related behavioral interventions that could potentially enhance global HIV secondary prevention efforts in the years ahead.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.
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23
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Waters AR, Tennant K, Cloyes KG. Cultivating LGBTQ+ Competent Cancer Research: Recommendations from LGBTQ+ Cancer Survivors, Care Partners, and Community Advocates. Semin Oncol Nurs 2021; 37:151227. [PMID: 34753639 DOI: 10.1016/j.soncn.2021.151227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sexual and gender minority (SGM) or LGBTQ+ communities were designated as a National Institutes of Health (NIH) disparity population in 2016, yet research exploring SGM cancer disparities is still limited. Thus, we sought the insight of LGBTQ+ cancer survivors, care partners, and community advocates to learn their recommendations for cultivating competent and inclusive cancer research for LGBTQ+ individuals. DATA SOURCES We conducted a focus group with LGBTQ+ survivors and care partners of LGBTQ+ survivors who were 18 years or older (N = 8) and interviews with community advocates who are leaders in LGBTQ+ cancer (N = 8). The focus group and interviews were recorded, transcribed, and qualitatively analyzed using an inductive thematic analysis. CONCLUSION Qualitative analysis elicited an overarching theme of cultivating competent research for LGBTQ+ individuals, including three subthemes: (i) Cisheteronormativity: An inhospitable ecosystem for LGBTQ+ patients, survivors, and care partners, (ii) Study design: Shifting from invasive 'othering' to a sustainable community-driven climate, and (iii) Recruitment and data collection: Ways to cultivate ecosystem health. Cultivating inclusive, competent research with SGM populations is crucial for addressing health disparities and improving cancer survivors' and care partners' health. IMPLICATIONS FOR NURSING PRACTICE Recommendations from LGBTQ+ survivors, care partners, and community advocates ranged from small alterations to systemic changes, highlighting the multifaceted yet feasible process of cultivating LGBTQ+ competent cancer research. The process of cultivating competent research for LGBTQ+ populations will take substantial investment from researchers, providers, and health systems.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah.
| | - Karrin Tennant
- College of Nursing, University of Utah, Salt Lake City, Utah
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24
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HIV care continuum interventions for Black men who have sex with men in the USA. Lancet HIV 2021; 8:e776-e786. [PMID: 34695375 DOI: 10.1016/s2352-3018(21)00241-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Disparities persist along the HIV care continuum among Black men who have sex with men (MSM) in the USA. As part of an initiative funded by the Health Resources and Services Administration's HIV/AIDS Bureau (US Department of Health and Human Services), we searched for recently published interventions focused on improving HIV care continuum outcomes among Black MSM with HIV in the USA. Our search identified 14 interventions, all of which were associated with at least one statistically significant outcome. Medication adherence was the most common outcome of interest, and linkage to care was the least common. More than half of the interventions focused on younger populations and took place in the US South. Interventions used a range of strategies to increase cultural relevance and address common barriers to optimal HIV outcomes for Black MSM. Several interventions harnessed social media, text messaging, and smartphone apps to facilitate social support, deliver HIV education, and encourage medication adherence. Interventions were delivered mostly at the individual or interpersonal level, although three made system-level changes to address structural barriers. Notably missing were interventions focused on minimising behavioural health barriers, and interventions directly addressing social determinants of health such as housing. To accelerate the pace of implementation and scale-up of interventions for Black MSM with HIV, public health entities can pilot emerging interventions in real-world settings, and use an implementation science approach to evaluate outcomes and assess the implementation strategies that drive or hinder effectiveness.
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25
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Ma A, Comstock SE, Oyeside OA. Typologies of Sexual Health Vulnerability Predicting STI Preventive Behaviors Among Latinx Adults in the U.S.: A Latent Class Analysis Approach. J Immigr Minor Health 2021; 24:1288-1299. [PMID: 34655371 DOI: 10.1007/s10903-021-01293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
Vulnerability to poor sexual health among U.S. Latinx populations is poorly understood, despite high STI rates. We examined how vulnerability typologies differ in their STI preventive behaviors. Using data from the 2016 National Health Interview Survey, we performed latent class analysis to test the association between sexual health vulnerability and HIV testing, hepatitis testing or vaccination, and HPV vaccination from a subsample of Latinx adults. Three classes emerged: Under-Employed Females with Health Care Access, Slightly Under-Employed Females with Some Health Care Access, and Employed Males without Health Care Access. Slightly Under-Employed Females with Some Health Care Access were associated with lack of HIV testing, hepatitis B and C testing, and HPV vaccination. Employed Males without Health Care Access were associated with lack of HIV testing and HPV vaccination. Sexual health vulnerability may be associated with certain STI preventive behaviors, which can inform and refine sexual health promotion programming.
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Affiliation(s)
- Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA.
| | - Sara E Comstock
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA
| | - Oluwadamilola A Oyeside
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA
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26
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Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep 2021; 18:443-457. [PMID: 34152554 DOI: 10.1007/s11904-021-00568-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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Affiliation(s)
- Laura B Whiteley
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth M Olsen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Enyonam Odoom
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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27
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EREBOTS: Privacy-Compliant Agent-Based Platform for Multi-Scenario Personalized Health-Assistant Chatbots. ELECTRONICS 2021. [DOI: 10.3390/electronics10060666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context. Asynchronous messaging is increasingly used to support human–machine interactions, generally implemented through chatbots. Such virtual entities assist the users in activities of different kinds (e.g., work, leisure, and health-related) and are becoming ingrained into humans’ habits due to factors including (i) the availability of mobile devices such as smartphones and tablets, (ii) the increasingly engaging nature of chatbot interactions, (iii) the release of dedicated APIs from messaging platforms, and (iv) increasingly complex AI-based mechanisms to power the bots’ behaviors. Nevertheless, most of the modern chatbots rely on state machines (implementing conversational rules) and one-fits-all approaches, neglecting personalization, data-stream privacy management, multi-topic management/interconnection, and multimodal interactions. Objective. This work addresses the challenges above through an agent-based framework for chatbot development named EREBOTS. Methods. The foundations of the framework are based on the implementation of (i) multi-front-end connectors and interfaces (i.e., Telegram, dedicated App, and web interface), (ii) enabling the configuration of multi-scenario behaviors (i.e., preventive physical conditioning, smoking cessation, and support for breast-cancer survivors), (iii) online learning, (iv) personalized conversations and recommendations (i.e., mood boost, anti-craving persuasion, and balance-preserving physical exercises), and (v) responsive multi-device monitoring interface (i.e., doctor and admin). Results. EREBOTS has been tested in the context of physical balance preservation in social confinement times (due to the ongoing pandemic). Thirteen individuals characterized by diverse age, gender, and country distribution have actively participated in the experimentation, reporting advancements in the physical balance and overall satisfaction of the interaction and exercises’ variety they have been proposed.
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28
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Kusemererwa S, Akena D, Nakanjako D, Kigozi J, Nanyunja R, Nanfuka M, Kizito B, Okello JM, Sewankambo NK. Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review. PLoS One 2021; 16:e0246471. [PMID: 33539424 PMCID: PMC7861356 DOI: 10.1371/journal.pone.0246471] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.
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Affiliation(s)
- Sylvia Kusemererwa
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
- * E-mail: ,
| | - Dickens Akena
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Kigozi
- Department for Outreaches, Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Nanyunja
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Mastula Nanfuka
- Department of TBSpeed, Makerere University Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Bennet Kizito
- Department of Monitoring and Evaluation, The AIDS Support Organization (TASO), Kampala, Uganda
| | - Joseph Mugisha Okello
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
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29
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Rhodes SD, Mann-Jackson L, Alonzo J, Garcia M, Tanner AE, Smart BD, Horridge DN, Van Dam CN, Wilkin AM. A Rapid Qualitative Assessment of the Impact of the COVID-19 Pandemic on a Racially/Ethnically Diverse Sample of Gay, Bisexual, and Other Men who Have Sex with Men Living with HIV in the US South. AIDS Behav 2021; 25:58-67. [PMID: 32830296 PMCID: PMC7443372 DOI: 10.1007/s10461-020-03014-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA.
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Benjamin D Smart
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Danielle N Horridge
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | | | - Aimee M Wilkin
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Martin P, Alberti C, Gottot S, Bourmaud A, de La Rochebrochard E. Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study. J Med Internet Res 2020; 22:e18650. [PMID: 33231552 PMCID: PMC7723739 DOI: 10.2196/18650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Participatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers. Objective The aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people. Methods Semistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis. Results The majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation. Conclusions The experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health.
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Affiliation(s)
- Philippe Martin
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Epidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), Université de Paris, Paris, France.,Institut National d'Etudes Démographiques (INED), UR14 - Sexual and Reproductive Health and Rights, Aubervilliers, France.,Centre de Recherche en épidémiologie et Santé des Populations (CESP) - UMR U1018 (UVSQ/INSERM), Université Paris-Saclay, Université Paris-Sud, Villejuif, France.,GDID Santé, Paris, France
| | - Corinne Alberti
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Epidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), Université de Paris, Paris, France
| | | | - Aurelie Bourmaud
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Epidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), Université de Paris, Paris, France
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (INED), UR14 - Sexual and Reproductive Health and Rights, Aubervilliers, France.,Centre de Recherche en épidémiologie et Santé des Populations (CESP) - UMR U1018 (UVSQ/INSERM), Université Paris-Saclay, Université Paris-Sud, Villejuif, France
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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Lee SB, Valerius J. mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review. JMIR Mhealth Uhealth 2020; 8:e14739. [PMID: 32568720 PMCID: PMC7486676 DOI: 10.2196/14739] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/24/2020] [Accepted: 06/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Antiretrovirals (ARVs) are key in the management of HIV. Although no cure exists, ARVs help patients live healthy lives and prevent transmission to others. Adherence to complex regimens is paramount to outcomes and in avoiding the emergence of drug-resistant viruses. The goal of therapy is to reach an undetectable viral load. However, adherence is a common problem, stemming from issues such as mental health, chaotic home situations, and busy work schedules. Mobile health (mHealth) represents a new approach in improving medication adherence, and multiple studies have been performed in this area. Objective This study aims to review the current implementation of mHealth in the management of HIV among different groups of patients. Methods We used PubMed, Academic Search Elite, and 1 journal database with various search terms to review the current implementation of mHealth in HIV care. Results Titles and abstracts were screened, and 61 papers were identified and fully reviewed. The literature was divided into lower- and higher-income nations, as defined by the United Nations. A total of 20 studies with quantitative results were identified, with 10 being text- and SMS-based interventions (the majority of these being in lower-income countries) and 8 being smartphone-based apps (primarily in higher-income countries). The majority of these studies determined whether there was an effect on adherence or biochemical parameters (viral load and CD4 count). Various qualitative studies have also been conducted, and many have focused on determining the specific design of interventions that were successful (frequency of messaging, types of messages, etc) as well as priorities for patients with regard to mHealth interventions. Conclusions There seems to be a role of mHealth in the management of HIV in lower-income nations; however, the optimal design of an intervention needs to be delineated. In higher-income countries, where the 2 significant risk factors were injection drugs and men who have sex with men, the benefit was less clear, and more research is needed.
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Affiliation(s)
- Stephen B Lee
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan College of Medicine, Regina, SK, Canada.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Joanne Valerius
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
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Rhodes SD, Mann-Jackson L, Alonzo J, Garcia M, Tanner AE, Smart BD, Horridge DN, Van Dam CN, Wilkin AM. A rapid qualitative assessment of the impact of the COVID-19 pandemic on a racially/ethnically diverse sample of gay, bisexual, and other men who have sex with men living with HIV in the US South. RESEARCH SQUARE 2020. [PMID: 32818212 PMCID: PMC7430588 DOI: 10.21203/rs.3.rs-57507/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.
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Tanner AE, Mann-Jackson L, Song EY, Alonzo J, Schafer KR, Ware S, Horridge DN, Garcia JM, Bell J, Hall EA, Baker LS, Rhodes SD. Supporting Health Among Young Men Who Have Sex With Men and Transgender Women With HIV: Lessons Learned From Implementing the weCare Intervention. Health Promot Pract 2020; 21:755-763. [PMID: 32757841 DOI: 10.1177/1524839920936241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young gay, bisexual, and other men who have sex with men and transgender women with HIV, particularly those who are racial or ethnic minorities, often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, an mHealth (mobile health) intervention where cyberhealth educators utilize established social media platforms (e.g., Facebook, texting, and GPS-based mobile applications ["apps"]) designed for social and sexual networking) to improve HIV-related care engagement and health outcomes. As part of the process evaluation of weCare, we conducted 32 interviews with intervention participants (n = 18) and HIV clinic providers and staff (n = 14). This article highlights three key intervention characteristics that promoted care engagement, including that weCare is (1) targeted (e.g., using existing social media platforms, similarity between intervention participants and cyberhealth educator, and implementation within a supportive clinical environment), (2) tailored (e.g., bidirectional messaging and trusting relationship between participants and cyberhealth educators to direct interactions), and (3) personalized (e.g., addressing unique care needs through messaging content and flexibility in engagement with intervention). In addition, interviewees' recommendations for improving weCare focused on logistics, content, and the ways in which the intervention could be adapted to reach a larger audience. Quality improvement efforts to ensure that mHealth interventions are relevant for young gay, bisexual, and other men who have sex with men and transgender women are critical to ensure care engagement and support health outcomes.
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Affiliation(s)
- Amanda E Tanner
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | | | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Samuella Ware
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | | | - Jonathan Bell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Logan S Baker
- University of Virginia's College at Wise, Wise, VA, USA
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Martin P, Cousin L, Gottot S, Bourmaud A, de La Rochebrochard E, Alberti C. Participatory Interventions for Sexual Health Promotion for Adolescents and Young Adults on the Internet: Systematic Review. J Med Internet Res 2020; 22:e15378. [PMID: 32735217 PMCID: PMC7428916 DOI: 10.2196/15378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/06/2019] [Accepted: 02/22/2020] [Indexed: 01/14/2023] Open
Abstract
Background The World Health Organization recommends the development of participatory sexuality education. In health promotion, web-based participatory interventions have great potential in view of the internet’s popularity among young people. Objective The aim of this review is to describe existing published studies on online participatory intervention methods used to promote the sexual health of adolescents and young adults. Methods We conducted a systematic review based on international scientific and grey literature. We used the PubMed search engine and Aurore database for the search. Articles were included if they reported studies on participatory intervention, included the theme of sexual health, were conducted on the internet (website, social media, online gaming system), targeted populations aged between 10 and 24 years, and had design, implementation, and evaluation methods available. We analyzed the intervention content, study implementation, and evaluation methods for all selected articles. Results A total of 60 articles were included, which described 37 interventions; several articles were published about the same intervention. Process results were published in many articles (n=40), in contrast to effectiveness results (n=23). Many of the 37 interventions were developed on websites (n=20). The second most used medium is online social networks (n=13), with Facebook dominating this group (n=8). Online peer interaction is the most common participatory component promoted by interventions (n=23), followed by interaction with a professional (n=16). Another participatory component is game-type activity (n=10). Videos were broadcast for more than half of the interventions (n=20). In total, 43% (n=16) of the interventions were based on a theoretical model, with many using the Information-Motivation-Behavioral Skills model (n=7). Less than half of the interventions have been evaluated for effectiveness (n=17), while one-third (n=12) reported plans to do so and one-fifth (n=8) did not indicate any plan for effectiveness evaluation. The randomized controlled trial is the most widely used study design (n=16). Among the outcomes (evaluated or planned for evaluation), sexual behaviors are the most evaluated (n=14), followed by condom use (n=11), and sexual health knowledge (n=8). Conclusions Participatory online interventions for young people’s sexual health have shown their feasibility, practical interest, and attractiveness, but their effectiveness has not yet been sufficiently evaluated. Online peer interaction, the major participatory component, is not sufficiently conceptualized and defined as a determinant of change or theoretical model component. One potential development would be to build a conceptual model integrating online peer interaction and support as a component.
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Affiliation(s)
- Philippe Martin
- Université de Paris, ECEVE, INSERM, Paris, France.,Institut National d'Etudes Démographiques, UR14 - Sexual and Reproductive Health and Rights, Paris, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Le Kremlin Bicetre, France.,GDID Santé, Paris, France
| | | | | | | | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques, UR14 - Sexual and Reproductive Health and Rights, Paris, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Le Kremlin Bicetre, France
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Dulli L, Ridgeway K, Packer C, Murray KR, Mumuni T, Plourde KF, Chen M, Olumide A, Ojengbede O, McCarraher DR. A Social Media-Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial. J Med Internet Res 2020; 22:e18343. [PMID: 32484444 PMCID: PMC7298637 DOI: 10.2196/18343] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs. OBJECTIVE This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support. METHODS We conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment. RESULTS A total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV. CONCLUSIONS Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV. TRIAL REGISTRATION ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318.
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Affiliation(s)
| | | | | | | | - Tolulope Mumuni
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Adesola Olumide
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Huntingdon B, de Wit J, Duracinsky M, Juraskova I. Belief, Covariates, and Impact of the "Undetectable = Untransmittable" Message Among People Living with HIV in Australia. AIDS Patient Care STDS 2020; 34:205-212. [PMID: 32396476 DOI: 10.1089/apc.2019.0300] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is effectively no risk of transmission of HIV from an HIV-positive person with consistent undetectable viral load (UDVL) to an HIV-negative person during sex. This has been publicly disseminated by an international health campaign called "undetectable = untransmittable" (U = U). This study extends previous research by examining confidence in the U = U message and potential covariates of confidence in U = U, as well as by assessing the perceived personal risk and sexual outcomes in a sample of people living with HIV (PLWH) in Australia. Between October 2017 and June 2018, 139 adult PLWH were recruited through clinics or community-based strategies. They completed an online questionnaire assessing participant characteristics, general agreement with the U = U message, confidence in U = U as an effective HIV prevention strategy, perceived personal risk of onward transmission, and sexual outcomes. While the majority of participants (70.5%) agreed with the general U = U message, only 48.2% were confident in U = U as an effective HIV transmission prevention strategy across sexual situations. Lack of confidence in U = U was more pronounced in the community subsample, minority group participants, and lower educated participants. A minority of PLWH with self-reported UDVL thought they could pass on HIV and indicated poor sexual outcomes, including sexual inactivity, reduced frequency of sex, and reduced sexual satisfaction. General agreement with the U = U message among PLWH may mask lack of confidence in U = U. Community-based information and education tailored to culturally diverse groups and people with low health literacy are required to promote accurate perception of risk of transmission of HIV with consistent UDVL.
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Affiliation(s)
- Ben Huntingdon
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
| | - John de Wit
- Center for Social Research in Health, UNSW Sydney, Sydney, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Duracinsky
- Hopital Hotel-Dieu, Unité de Recherche Clinique (URC-ECO), Paris, France
- EA 7334, Patient-Centered Outcomes Research, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Service de Médecine Interne et d'Immunologie Clinique, Hopital Bicetre, Kremlin-Bicetre, France
| | - Ilona Juraskova
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
- School of Psychology, Center for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia
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Chen H, Lin Z, Chen J, Li X, Zhao L, Chen W, Lin H. The impact of an interactive, multifaceted education approach for congenital cataract on parental anxiety, knowledge and satisfaction: A randomized, controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:321-327. [PMID: 31522896 DOI: 10.1016/j.pec.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction. METHODS This prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point. RESULTS A multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension-memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course. CONCLUSION The interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety. PRACTICE IMPLICATIONS This new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.
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Affiliation(s)
- Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc 2020; 23:e25439. [PMID: 31909896 PMCID: PMC6945883 DOI: 10.1002/jia2.25439] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Electronic and other new media technologies (eHealth) can facilitate large-scale dissemination of information and effective delivery of interventions for HIV care and prevention. There is a need to both monitor a rapidly changing pipeline of technology-based care and prevention methods and to assess whether the interventions are appropriately diversified. We systematically review and critically appraise the research pipeline of eHealth interventions for HIV care and prevention, including published studies and other funded projects. METHODS Two peer-reviewed literature databases were searched for studies describing the development, trial testing or implementation of new technology interventions, published from September 2014 to September 2018. The National Institutes of Health database of grants was searched for interventions still in development. Interventions were included if eHealth was utilized and an outcome directly related to HIV treatment or prevention was targeted. We summarized each intervention including the stage of development, eHealth mode of delivery, target population and stage of the HIV care and prevention continua targeted. RESULTS AND DISCUSSION Of 2178 articles in the published literature, 113 were included with 84 unique interventions described. The interventions utilize a variety of eHealth technologies and target various points on the prevention and care continua, with greater emphasis on education, behaviour change and testing than linkage to medical care. There were a variety of interventions for HIV care support but none for PrEP care. Most interventions were developed for populations in high income countries. An additional 62 interventions with funding were found in the development pipeline, with greater emphasis on managing HIV and PrEP care. CONCLUSIONS Our systematic review found a robust collection of eHealth interventions in the published literature as well as unpublished interventions still in development. In the published literature, there is an imbalance of interventions favouring education and behaviour change over linkage to care, retention in care, and adherence, especially for PrEP. The next generation of interventions already in the pipeline might address these neglected areas of care and prevention, but the development process is slow. Researchers need new methods for more efficient and expedited intervention development so that current and future needs are addressed.
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Affiliation(s)
| | - Anna Bratcher
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
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Using Social Media to Enhance Provider Network for HIV and Harm Reduction Service Integration in Vietnam. AIDS Behav 2019; 23:3175-3183. [PMID: 31154559 DOI: 10.1007/s10461-019-02542-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Social media can potentially serve as a platform to coordinate medical care among fragmented health sectors. This paper describes procedures of using social media to enhance antiretroviral therapy (ART) and methadone maintenance treatment (MMT) providers' virtual network for integrated service for HIV-positive people who inject drugs (PWID) in Vietnam. A total of 88 ART and MMT treatment providers participated in person group sessions followed by online virtual support to improve service integration. In-person reunions were held to reinforce Facebook participation and network activities. Content analysis was used to identify keywords and topic categories of the online information exchange. Both MMT and ART providers were actively engaged in online communications. Referral and treatment adherence were the two most frequently discussed topic areas by both the MMT and ART providers. Frequent cross-agency connections were observed. Online provider networks and communities could be built and useful to support treatment providers to improve service integration.
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Ghalehkhani N, Farhoudi B, Gouya MM, Sharifi H, SeyedAlinaghi S, Kamali K, Fahimfar N, Rajabpour Z, Doosti-Irani A, Sedaghat A, Mirzazadeh A. The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons. Int J STD AIDS 2019; 30:1257-1264. [PMID: 31558135 PMCID: PMC7008700 DOI: 10.1177/0956462419867573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test-treat-retain cascade analysis tool (2014). To measure the gaps, we check the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions (FGD) and fifty one in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom, only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) enrolled in HIV care. About 13% of all PLWH retained in HIV care and only 9% (6,745 people) had ever tested for CD4 count. Only 8% (6,018 people) of all PLWH received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those work best for key populations, is critical to reach the 90–90-90 targets.
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Affiliation(s)
- Nima Ghalehkhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Behnam Farhoudi
- Clinical Research Development Center, Amiralmomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | | | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoosh Kamali
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | - Nooshin Fahimfar
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | - Zahra Rajabpour
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan university of Medical Sciences, Hamadan, Iran
| | | | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Kay ES, Lacombe-Duncan A, Pinto RM. Predicting Retention in HIV Primary Care: Is There a Missed Visits Continuum Based on Patient Characteristics? AIDS Behav 2019; 23:2542-2548. [PMID: 30989552 DOI: 10.1007/s10461-019-02508-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Missing 3 + scheduled HIV primary care visits over a 1-year period increases mortality risk for people living with HIV (PLWH). We used electronic health data from PLWH (≥ 18 years old) at a southeastern US HIV clinic in 2016 to examine differences across patient-level characteristics and number of missed visits (1-2 vs. 0, 3 + vs. 0, 3 + vs. 1-2). In multivariable multinomial logistic regression analyses, poverty, lack of Ryan White HIV/AIDS Program support services, being uninsured, not having a high school degree, and being younger were significantly associated with 1-2 or 3 + missed visits (vs. 0 missed). Only poverty remained predictive of missing 3 + versus 1-2 visits (RR = 2.70, 95% CI 1.49-4.88). Patients at risk for missing 3 + visits present similar characteristics to patients who miss 1-2 visits. Interventions aimed at poverty reduction and increased access to education, health insurance, and support services may improve retention and, therefore, decrease mortality risk.
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Khawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS Res Ther 2019; 16:13. [PMID: 31189481 PMCID: PMC6560849 DOI: 10.1186/s12981-019-0229-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are amongst populations at-risk for HIV acquisition in Thailand. In youth MSM (aged 15-24 years), the incidence of HIV infection has substantially increased. However, data on HIV risk, risk perception and HIV testing and counseling (HTC) uptake among youth MSM in hotspots are limited. METHODS A subanalysis of a prospective study among Thai MSM attending a gay sauna was conducted. HIV risk and risk perception were assessed by an anonymous survey. The MSM were categorized as having actual "low-risk", "moderate-risk" and "high-risk" for HIV acquisition based on the validated study risk categorization tool. HTC was provided on-site with result notification within 1 h. HIV care establishment appointment was arranged by the counselors for HIV-infected participants. Care engagement within 1 year of diagnosis was subsequently assessed. RESULTS There were 358 MSM participants; 87 (24%) were youth MSM. Comparing to other MSM, youth MSM had significantly higher median number of lifetime sexual partners [2 (IQR 1-9) vs. 1 (IQR 0-1); P < 0.001), were more-likely to ever exchange sex for money (44% vs. 9%; P < 0.001) and have sexual partner who exchanged sex for money (8% vs. 1%; P < 0.001). Rates of consistent condom use in the past 3 months for anal, oral and vaginal sexes were low and not significantly different between youth and other MSM (51% vs. 61%, 26% vs. 35% and 72% vs. 61%, respectively). By using the study risk categorization tool, there were 68 youth MSM with moderate or high-risk for HIV acquisition, of which 43 (63%) had false perception of low HIV risk. Youth MSM were more likely than other MSM to accept HTC [68% vs. 33%, P < 0.001)] and to be first-time testers (42% vs. 28%, P = 0.07). By HTC, the rates of HIV infection tended to be higher among youth MSM comparing to other MSM [14/59 (24%) vs. 11/89 (12%); P = 0.07]. Among the 14 youth MSM newly-diagnosed with HIV infection, only 6 (43%) showed-up for continuity care after 1-year follow-up. CONCLUSIONS Youth MSM had substantial high HIV risk, false perception of low HIV risk and low rate of care engagement but demonstrated considerable rate of HTC uptake. Strategies to improve access to HTC, risk perception and linkage to care are needed for HIV prevention and management among the youth MSM.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | | | | | | | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | - Nittaya Phanuphak
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Abstract
PURPOSE OF REVIEW Multiple reviews have examined eHealth/mHealth interventions to address treatment adherence, including those focusing on youth living with HIV (YLWH). This review synthesizes results of prior reviews and recent studies (last 5 years) to provide a path forward for future research, acknowledging both lessons learned and gaps to be addressed. RECENT FINDINGS Recent studies provide further evidence for the feasibility and acceptability of technology-based HIV interventions. Formative research of more comprehensive smartphone applications and pilot studies of computer-delivered interventions provide additional guidance on YLWH's preferences for intervention components and show promising preliminary efficacy for impacting treatment adherence. Expanding access to technology among YLWH, in the United States (US) and globally, supports the continued focus on eHealth/mHealth interventions as a means to reduce disparities in clinical outcomes. Future research should lend greater focus to implementation and scale-up of interventions through the use of adaptive treatment strategies that include costing analyses, measuring and maximizing engagement, fostering information sharing between researchers, and building upon sustainable platforms.
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Enane LA, Vreeman RC, Foster C. Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV. Curr Opin HIV AIDS 2019; 13:212-219. [PMID: 29570471 DOI: 10.1097/coh.0000000000000459] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Adolescents living with HIV are the only age group with increasing HIV mortality at a time of global scale-up of access to antiretroviral therapy (ART). As a 'treat all' strategy is implemented worldwide, it is critically important to optimize retention and adherence for this vulnerable group. RECENT FINDINGS Adolescents and young adults living with HIV have poorer outcomes when compared with adults at each stage of the HIV care cascade, irrespective of income setting. Rates of viral suppression are lowest for adolescents living with HIV, and adherence to ART remains an enormous challenge. High-quality studies of interventions to improve linkage to, and retention in, care on suppressive ART are starkly lacking for adolescents and young adults living with HIV across the globe. However, examples of good practice are beginning to emerge but require large-scale implementation studies with outcome data disaggregated by age, route of infection, and income setting, and include young pregnant women and key populations groups. SUMMARY There is an urgent need for evidence-based interventions addressing gaps in the adolescent HIV care cascade, including supporting retention in care and adherence to ART.
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Affiliation(s)
- Leslie A Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH)
| | - Rachel C Vreeman
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH).,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Caroline Foster
- Departments of GUM/HIV and Pediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
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Canoy N, Thapa S, Hannes K. Transgender persons' HIV care (dis)engagement: a qualitative evidence synthesis protocol from an ecological systems theory perspective. BMJ Open 2019; 9:e025475. [PMID: 30670527 PMCID: PMC6347901 DOI: 10.1136/bmjopen-2018-025475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION There seems to be little information on interactional patterns of enabling and constraining factors contributing to HIV care engagement across systems and across time. Understanding these patterns from a (micro-meso-macro-exo) systems perspective can provide rich insights on relevant social networks affecting transgender populations. In this review, we will synthesise the wealth of literature on transgender persons' engagement in the HIV care continuum. METHODS AND ANALYSIS We will perform a networked systems approach to qualitative evidence synthesis of relevant qualitative research data generated from primary qualitative, mixed-method and evaluation studies exploring HIV care engagement among diverse transgender populations. Studies not using qualitative methods and studies not published in English will be excluded from this review. Empirical studies will be identified via a search in major databases such as PubMed, Scopus, ERIC, Embase, Web of Science, Sociological Abstracts, PsychInfo and Social Services Abstract in January 2019. Two reviewers will independently screen the studies for inclusion, assess their quality and extract data. In case some of the system levels in the network are ill-covered by empirical studies, non-empirical studies will be considered for inclusion. The qualitative evidence synthesis includes a summary of descriptive data (first order), an exploration of relationships between system levels or their components (second order) and a structured summary of research evidence through narrative synthesis. The narrative synthesis will be extended with an overall social network analysis that visualises important nodes and links cutting across ecological systems. ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. Review findings will be disseminated via peer-reviewed academic journals and a targeted information campaign towards organisations that work with our population of interest. PROSPERO REGISTRATION NUMBER CRD42018089956.
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Affiliation(s)
- Nico Canoy
- Department of Psychology, Ateneo de Manila University, Quezon City, Manila, Philippines
| | - Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karin Hannes
- Social Research Methodology Group, Faculty of Social Sciences, Leuven, Belgium
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Tanner AE, Song EY, Mann-Jackson L, Alonzo J, Schafer K, Ware S, Garcia JM, Arellano Hall E, Bell JC, Van Dam CN, Rhodes SD. Preliminary Impact of the weCare Social Media Intervention to Support Health for Young Men Who Have Sex with Men and Transgender Women with HIV. AIDS Patient Care STDS 2018; 32:450-458. [PMID: 30398955 PMCID: PMC6909718 DOI: 10.1089/apc.2018.0060] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Young racial/ethnic minority men who have sex with men (MSM) and transgender women with HIV often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, a social media intervention utilizing Facebook, texting, and GPS-based mobile social and sexual networking applications to improve HIV-related care engagement and health outcomes. We compared viral load suppression and clinic appointment attendance among 91 participants during the 12-month period before and after weCare implementation. McNemar's chi-square test analyses were conducted comparing the pre- and postintervention difference using paired data. Since February 2016, intervention staff and 91 intervention participants (79.1% African American and 13.2% Latino, mean age = 25) exchanged 13,830 messages during 3,758 conversations (average: 41.3 conversations per participant) across a variety of topics, including appointment reminders, medication adherence, problem solving, and reducing barriers. There were significant reductions in missed HIV care appointments (68.0% vs. 53.3%, p = 0.04) and increases in viral load suppression (61.3% vs. 88.8%, p < 0.0001) 12 months postimplementation. Our results highlight the initial success of weCare in improving care engagement and viral suppression. Social media is an important tool, especially for young MSM and transgender women, to support individual- (e.g., viral suppression) and community- (e.g., reduced transmission efficiency) level health. It may also be a useful tool for improving engagement with biomedical HIV prevention tools (e.g., PrEP use).
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Affiliation(s)
- Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Eunyoung Y. Song
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Katherine Schafer
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - J. Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Elias Arellano Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jonathan C. Bell
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Cornelius N. Van Dam
- Regional Center for Infectious Disease, Cone Health, Greensboro, North Carolina
- University of North Carolina AHEC-Greensboro, Greensboro, North Carolina
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Marent B, Henwood F, Darking M. Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews. JMIR Mhealth Uhealth 2018; 6:e184. [PMID: 30339132 PMCID: PMC6231792 DOI: 10.2196/mhealth.9856] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 11/14/2022] Open
Abstract
Background Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.
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Affiliation(s)
- Benjamin Marent
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
| | - Flis Henwood
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
| | - Mary Darking
- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
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- School of Applied Social Science, University of Brighton, Falmer, United Kingdom
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Zhao Y, Zhu X, Pérez AE, Zhang W, Shi A, Zhang Z, Gao P, Wang J, Yang C, Zaller N, Sun Y, Operario D, Zhang H. MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: a qualitative description. BMC Public Health 2018; 18:1146. [PMID: 30261856 PMCID: PMC6161330 DOI: 10.1186/s12889-018-6046-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 09/19/2018] [Indexed: 12/25/2022] Open
Abstract
Background HIV self-testing (HIVST) has demonstrated potential to expand HIV testing among key populations, including men who have sex with men (MSM) in China who have low testing rates. However, due to the autonomous nature of self-testing, people who undergo HIVST may lack access to relevant information and counseling support typically provided by in-person HIV testing counselors. WeChat, a popular smartphone application in China, offers a potential source of mobile health (mHealth) information and support for individuals using HIVST. This paper aimed to explore the opinions of MSM in China about the feasibility and potential concerns of using WeChat to support HIVST and reduce risk for HIV infection. Methods We conducted in-depth interviews with 36 MSM about their mobile smartphone usage and the use of WeChat for helping MSM self-administer HIVST kits in Hefei, China. Each interview was digitally recorded and transcribed. Transcripts were analyzed used content analysis method according to Elo and Kyngas. Results MSM described their use of WeChat and expressed cautious endorsement about using this platform to promote HIVST and disseminate HIV-related information. They described their preferences about the implementation features of an mHealth intervention to promote HIVST, including the delivery source of intervention messages, as well as message timing, frequency, form, tone, and content. Participants also described privacy-related concerns about receiving messages via WeChat and offered potential solutions. Conclusions Findings from this study show the potential utility of WeChat app-based messaging for engaging MSM in HIV self-testing and prevention. Future research is needed to integrate the concerns expressed in this analysis and evaluate a WeChat-based intervention to promote oral HIV self-testing, risk reduction, and health promotion among MSM in China.
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Affiliation(s)
- Yue Zhao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Xiaofang Zhu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Wenhan Zhang
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Anxia Shi
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Zhihua Zhang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Pan Gao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Jun Wang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nickolas Zaller
- Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yehuan Sun
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Don Operario
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Hongbo Zhang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China.
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Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada. AIDS Behav 2018. [PMID: 29536283 DOI: 10.1007/s10461-018-2063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133-1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742-0.898) and women (RR 0.748, 95% CI 0.559-1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations.
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