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Ciceron AC, Jeon MJ, Monroe AK, Clausen ME, Magnus M, Le D. HPV knowledge, screening barriers and facilitators, and sources of health information among women living with HIV: perspectives from the DC community during the COVID-19 pandemic. BMC Womens Health 2022; 22:110. [PMID: 35397535 PMCID: PMC8994173 DOI: 10.1186/s12905-022-01689-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background High-risk human papillomavirus (HPV) causes 99% of cervical cancer cases. Despite available prevention methods through the HPV vaccine and two screening modalities, women continue to die from cervical cancer worldwide. Cervical cancer is preventable, yet affects a great number of women living with HIV (WLH). Low screening rates among WLH further exacerbate their already high risk of developing cervical cancer due to immunosuppression. This study explores WLH’s current cervical cancer knowledge, screening barriers and facilitators, and sources of health information.
Methods Focus group discussions were conducted with 39 WLH aged 21 years old or older, who resided in the Washington-Baltimore Metropolitan Area. Emergent themes were classified and organized into overarching domains and assembled with representative quotations. Results The women had limited knowledge of HPV and the cervical cancer screening guidelines for WLH. Coronavirus 2019 (COVID-19) pandemic has amplified screening barriers due to decreased accessibility to usual medical appointment and cervical cancer screenings. Screening facilitators included knowing someone diagnosed with cervical cancer and provider recommendations. WLH indicated that they obtained health information through in-person education (providers, peer groups) and written literature. Due to the pandemic, they also had to increasingly rely on remote and technology-based communication channels such as the internet, social media, television, radio, email, and short message service (SMS) text messaging. Conclusions Future health interventions need to explore the possibility of sharing messages and increasing cervical cancer and HPV knowledge of WLH through the use of SMS and other technology-based channels.
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Affiliation(s)
- Annie Coriolan Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Min Jeong Jeon
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Anne Kress Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 5th Floor, Washington, DC, 20052, USA
| | - Michelle Elise Clausen
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 5th Floor, Washington, DC, 20052, USA
| | - Daisy Le
- Department of Policy, Populations, and Systems, School of Nursing, The George Washington University, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC, 20006, USA. .,Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 3rd Floor, Washington, DC, 20052, USA. .,George Washington University Cancer Center (GW Cancer Center), The George Washington University, 800 22nd Street NW, Suite 7000C (Science and Engineering Hall), Washington, DC, 20052, USA.
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Levy ME, Monroe AK, Horberg MA, Benator DA, Castel AD. Is low-level viraemia associated with serum lipid profiles among HIV controllers? HIV Med 2020; 21:e14-e16. [PMID: 32311819 DOI: 10.1111/hiv.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - M A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - D A Benator
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - A D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care 2017; 30:199-206. [PMID: 28793785 DOI: 10.1080/09540121.2017.1360993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.
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Affiliation(s)
- A K Monroe
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - J S Pena
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - R D Moore
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - K A Riekert
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - M N Eakin
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - S Kripalani
- c Division of General Internal Medicine and Public Health , Vanderbilt University Medical Center , Nashville , TN , USA
| | - G Chander
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Monroe AK, Zhang L, Jacobson LP, Plankey MW, Brown TT, Miller EN, Martin E, Becker JT, Levine AJ, Ragin A, Sacktor NC. The association between physical activity and cognition in men with and without HIV infection. HIV Med 2017; 18:555-563. [PMID: 28294530 DOI: 10.1111/hiv.12490] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES HIV-associated neurocognitive disorders are highly prevalent, and physical activity (PA) is a modifiable behaviour that may affect neurocognitive function. Our objective was to determine the association between PA and neurocognitive function and the effect of HIV on this association. METHODS PA was assessed in the Multicenter AIDS Cohort Study with the International Physical Activity Questionnaire. A neuropsychological test battery assessed global impairment and domain-specific impairment (executive function, speed of processing, working memory, learning, memory, and motor function) every 2 years. Semiannually, the Symbol Digit Modalities Test and Trail Making Test Parts A and B were performed. Adjusted logistic regression models were used to assess the PA-neurocognitive function association. Using longitudinal data, we also assessed the PA category-decline of neurocognitive function association with multivariate simple regression. RESULTS Of 601 men, 44% were HIV-infected. Low, moderate, and high PA was reported in 27%, 25%, and 48% of the HIV-infected men vs. 19%, 32% and 49% of the HIV-uninfected men, respectively. High PA was associated with lower odds of impairment of learning, memory, and motor function [odds ratio (OR) ranging from 0.52 to 0.57; P < 0.05 for all]. The high PA-global impairment association OR was 0.63 [95% confidence interval (CI) 0.39, 1.02]. Among HIV-infected men only, across multiple domains, the high PA-impairment association was even more pronounced (OR from 0.27 to 0.49). Baseline high/moderate PA was not associated with decline of any domain score over time. HIV infection was marginally associated with a higher speed of decline in motor function. CONCLUSIONS A protective effect of high PA on impairment in neurocognitive domains was observed cross-sectionally. Longitudinal PA measurements are needed to elucidate the PA-neurocognitive function relationship over time.
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Affiliation(s)
- A K Monroe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M W Plankey
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - T T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E N Miller
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - E Martin
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - J T Becker
- Departments of Psychiatry, Psychology, and Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - A J Levine
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - N C Sacktor
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Monroe AK, Dobs AS, Xu X, Palella FJ, Kingsley LA, Post WS, Witt MD, Brown TT. Low free testosterone in HIV-infected men is not associated with subclinical cardiovascular disease. HIV Med 2012; 13:358-66. [PMID: 22296297 DOI: 10.1111/j.1468-1293.2011.00988.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Low testosterone (T) is associated with cardiovascular disease (CVD) and increased mortality in the general population; however, the impact of T on subclinical CVD in HIV disease is unknown. This study examined the relationships among free testosterone (FT), subclinical CVD, and HIV disease. METHODS This was a cross-sectional analysis in 322 HIV-uninfected and 534 HIV-infected men in the Multicenter AIDS Cohort Study. Main outcomes were coronary artery calcification presence, defined as a coronary artery calcium (CAC) score >10 (CAC score was the geometric mean of the Agatston scores of two computed tomography replicates), and far wall common carotid intima-media thickness (IMT)/carotid lesion presence by B-mode ultrasound. RESULTS Compared with the HIV-uninfected men in our sample, HIV-infected men were younger, with lower body mass index (BMI) and more often Black. HIV-infected men had lower FT (age-adjusted FT 88.7 ng/dL vs. 101.7 ng/dL in HIV-uninfected men; P=0.0004); however, FT was not associated with CAC, log carotid IMT, or the presence of carotid lesions. HIV status was not associated with CAC presence or log carotid IMT, but was associated with carotid lesion presence (adjusted odds ratio 1.69; 95% confidence interval 1.06, 2.71) in HIV-infected men compared with HIV-uninfected men. CONCLUSIONS Compared with HIV-uninfected men, HIV-infected men had lower FT, as well as more prevalent carotid lesions. In both groups, FT was not associated with CAC presence, log carotid IMT, or carotid lesion presence, suggesting that FT does not influence subclinical CVD in this population of men with and at risk for HIV infection.
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Affiliation(s)
- A K Monroe
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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