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Wagner GJ, Bogart LM, Klein DJ, Lawrence SJ, Goggin K, Gizaw M, Mutchler MG. Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV. AIDS Behav 2024; 28:408-420. [PMID: 38060112 PMCID: PMC10876751 DOI: 10.1007/s10461-023-04233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
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Wroe EB, Mailosi B, Price N, Kachimanga C, Shah A, Kalanga N, Dunbar EL, Nazimera L, Gizaw M, Boudreaux C, Dullie L, Neba L, McBain RK. Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi. BMJ Open 2022; 12:e063701. [PMID: 36442898 PMCID: PMC9710473 DOI: 10.1136/bmjopen-2022-063701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa. DESIGN Prospective cohort study. SETTING Primary and secondary level health facilities in Neno District, Malawi. PARTICIPANTS New adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017. MAIN OUTCOME MEASURES We quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency). RESULTS The annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p<0.05, in all instances), but not for diabetes (p>0.05). CONCLUSIONS IC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi's HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes.
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Affiliation(s)
- Emily B Wroe
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, MA, USA
| | | | - Natalie Price
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | | | - Adarsh Shah
- Harvard Kennedy School, Cambridge, Massachusetts, USA
| | - Noel Kalanga
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth L Dunbar
- Department of Human Centered Design, University of Washington, Seattle, WA, USA
| | | | | | - Chantelle Boudreaux
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Liberty Neba
- Clinton Health Access Initiative, Lilongwe, Malawi
| | - Ryan K McBain
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- RAND Corporation, Santa Monica, California, USA
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Bogart LM, Mutchler MG, Goggin K, Ghosh-Dastidar M, Klein DJ, Saya U, Linnemayr S, Lawrence SJ, Tyagi K, Thomas D, Gizaw M, Bailey J, Wagner GJ. Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV. AIDS Behav 2022; 27:1573-1586. [PMID: 36399252 PMCID: PMC9673878 DOI: 10.1007/s10461-022-03921-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Matt G. Mutchler
- APLA Health & Wellness, Los Angeles, CA USA ,California State University Dominguez Hills, Carson, CA USA
| | - Kathy Goggin
- Children’s Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO USA
| | | | - David J. Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | | | - Damone Thomas
- APLA Health & Wellness, Los Angeles, CA USA ,HEALING with HOPE Corp., Los Angeles, CA USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | - Glenn J. Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
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Wagner GJ, Wagner Z, Gizaw M, Saya U, MacCarthy S, Mukasa B, Wabukala P, Linnemayr S. Increased Depression during COVID-19 Lockdown Associated with Food Insecurity and Antiretroviral Non-Adherence among People Living with HIV in Uganda. AIDS Behav 2022; 26:2182-2190. [PMID: 34570315 PMCID: PMC8475428 DOI: 10.1007/s10461-021-03371-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
The health and economic threats posed by the COVID-19 pandemic can be sources of great distress among people living with HIV, which in turn can impact the management of their HIV disease. We examined change in depression from pre- to post-lockdown restrictions and correlates of elevated depressive symptoms, including antiretroviral therapy (ART) adherence. Participants enrolled in a randomized controlled trial of an ART adherence intervention in Uganda. The month-12 follow-up assessment was fully administered just prior to the start of the pandemic-related lockdown in March 2020; at the conclusion of the lockdown three months later, we administered a mixed-methods phone-based assessment. ART adherence was electronically monitored throughout the study period, including during and after the lockdown. Depression was assessed with the 8-item Patient health questionnaire (PHQ-8), on which scores > 9 signify a positive screen for elevated depressive symptoms. A sample of 280 participants completed both the month-12 and post-lockdown assessments. Rates of elevated depressive symptoms nearly tripled from month 12 (n = 17, 6.1%) to the post-lockdown assessment (n = 50, 17.9%; McNemar test < .001). Elevated depressive symptoms at post-lockdown were associated with being female, indicators of economic struggles at month 12 (unemployment, low income, high food insecurity), and lower ART adherence during the 3-month lockdown period [mean of 71.9% (SD = 27.9) vs. 80.8% (SD = 24.1) among those not depressed; p = .041] in bivariate analysis. In multiple regression analysis, higher food insecurity [adj. OR (95% CI) = 4.64 (2.16–9.96)] and perception that the pandemic negatively impacted ART adherence [adj. OR (95% CI) = 1.96 (1.22–3.16)] remained associated with a greater likelihood of elevated depressive symptoms, when other correlates were controlled for. Qualitative data suggested that economic stressors (lack of food, work, and money) were key contributors to elevated depressive symptoms, and these stressors led to missed ART doses because of lack of food and stress induced forgetfulness. Elevated depressive symptoms significantly increased during the COVID-19 lockdown and was associated with food insecurity and reduced ART adherence. Mechanisms for identifying and treating depression and food insecurity are needed to help PLHIV cope with and mitigate the harmful effects of unexpected crises that may impede disease management and access to food.
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Affiliation(s)
| | - Zachary Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
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Maglione MA, Chen C, Franco M, Gizaw M, Shahidinia N, Baxi S, Hempel S. Effect of patient characteristics on posttraumatic stress disorder treatment retention among veterans: A systematic review. J Trauma Stress 2022; 35:718-728. [PMID: 34800059 DOI: 10.1002/jts.22757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
To identify baseline patient characteristics (i.e., demographic and psychological factors, military background) associated with better posttraumatic stress disorder (PTSD) treatment retention among veterans, we conducted a systematic review. After an electronic database search for studies of PTSD treatment in veterans, two reviewers independently screened the literature for eligibility, abstracted study-level information, and assessed risk of bias. As most studies used multivariate models to assess multiple potential predictors of retention simultaneously, the results were described narratively. The GRADE approach, adapted for prognostic literature, was used to assess the overall quality of evidence (QoE). In total, 19 studies reported in 25 publications met the inclusion criteria (n = 6 good quality, n = 9 fair quality, n = 4 poor quality). Definitions of treatment completion and dropout varied, and some studies lumped different therapy approaches together. Older age and higher treatment expectations were associated with better retention (moderate QoE). In 5 of 6 studies, baseline PTSD severity was not associated with retention, and the remaining study reported an association between better retention and more severe PTSD symptoms; the presence of more co-occurring psychiatric disorders was associated with better retention (moderate QoE). QoE was low or insufficient to support conclusions for any other characteristics due to inconsistent results, imprecision, potential publication bias, possible study population overlap, study limitations, or lack of studies. More research is needed regarding the associations between modifiable factors (e.g., motivation, barriers, expectations) and retention, and consistent definitions of treatment completion and minimally adequate treatment should be adopted throughout the field.
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Affiliation(s)
- Margaret A Maglione
- RAND Corporation, Santa Monica, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | | - Susanne Hempel
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Mindry D, Gizaw M, Gwokyalya V, Hurley E, Finocchario-Kessler S, Beyeza-Kashesya J, Wagner GJ, Wanyenze RK, Goggin K. Provider Perspectives on Navigating Relationship Challenges in Assisting HIV-Affected Couples to Meet Their Reproductive Goals: Lessons Learned from a Safer Conception Counseling Intervention in Uganda. AIDS Behav 2022; 26:425-433. [PMID: 34324071 DOI: 10.1007/s10461-021-03397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 12/01/2022]
Abstract
In Uganda, 60% of HIV-affected couples are serodiscordant, many of whom want children. There is a need to assess their reproductive intentions and provide appropriate services that limit transmission risks while meeting reproductive goals. Our Choice intervention engaged male and female HIV-infected clients and their partners in safer conception counseling (SCC) or family planning based on their childbearing decision. We report findings of provider experiences and recommendations for engaging couples in SCC. The intervention was implemented in four clinics offering either SCC1, an intensive training and supervision arm, or SCC2, utilizing the Ministry of Health's standard approach. Qualitative interviews were conducted at 12 (N = 23) and 24 months (N = 25) after initiation of the intervention. Many partners attended at least some SCC sessions, although engaging male partners was more challenging. Providers reported partner involvement improved understanding and facilitated successful implementation of SCM, whereas confusion and challenges were common when the client participated alone. Providers shared successful strategies for engaging male partners.
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Affiliation(s)
- Deborah Mindry
- Center for Womens Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
| | | | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Emily Hurley
- Schools of Medicine and Pharmacy, Childrens Mercy Research Institute, University of Missouri, Kansas, MO, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas, MO, USA
| | - Jolly Beyeza-Kashesya
- Department of Reproductive Medicine, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | | | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kathy Goggin
- Schools of Medicine and Pharmacy, Childrens Mercy Research Institute, University of Missouri, Kansas, MO, USA
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Gizaw M, Harries AD, Ade S, Tayler-Smith K, Ali E, Firdu N, Yifter H. Diabetes mellitus in Addis Ababa, Ethiopia: admissions, complications and outcomes in a large referral hospital. Public Health Action 2015; 5:74-8. [PMID: 26400605 DOI: 10.5588/pha.14.0107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING The Black Lion Referral Hospital, Addis Ababa, Ethiopia. OBJECTIVE To document indications for admission, complications and outcomes of patients with diabetes mellitus (DM) admitted between 2010 and 2013. DESIGN A descriptive retrospective study using medical files. RESULTS Of 8048 admissions, 523 (6.5%) had DM; of these, 418 medical records were retrieved: 301 (72%) patients had type 2 and 104 (28%) type 1 disease, with male sex (62%) and older age (median age 60 years) being features of type 2 disease. Main admission diagnoses for type 2 disease were diabetic foot ulcer (39%) and cardiovascular disease (21%); for type 1 disease, it was diabetic ketoacidosis (62%). Hypertension, neuropathy, nephropathy, retinopathy and diabetic foot accounted for 85% of the 756 existing complications. Overall in-patient mortality was 21%. Of the 89 deaths, 77 occurred among patients with type 2 disease; the main indications for admission were diabetic foot ulcer/gangrene and cardiovascular disease. CONCLUSION DM, especially type 2 DM, is an important cause of admission to Ethiopia's largest referral hospital. Many patients had already developed disease-related complications at admission, and mortality was high. There is a need to improve awareness about and care for DM in Ethiopia.
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Affiliation(s)
- M Gizaw
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France ; National Tuberculosis Programme, Cotonou, Benin
| | - K Tayler-Smith
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - E Ali
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - N Firdu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - H Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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