Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care

For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.

FRAMEWORKS OF THE RELATIONSHIP BETWEEN HIV AND AGING AMONG HIV CLINIC PROVIDERS: A QUALITATIVE STUDY

As a result of advancements in antiretroviral therapy (ART), people living with HIV (PLWH) are living longer: it is estimated that 70% of PLWH in the US will be over the age of 50 by 2030, raising questions of what it means to age with HIV and how to care for these individuals most effectively. To qualitatively explore how providers who care for older PLWH and other comorbidities conceptualize the relationship between HIV and aging, we conducted 11 semi-structured interviews with physicians, RN case managers, and administrators at two health systems’ HIV clinics in New York City and the Hudson Valley between November 2019 and July 2020. We coded the interviews, developing a codebook through an iterative process, and thematically analyzed the data. Analysis revealed a range of interrelationships between HIV, aging, and comorbidities across pathophysiological and psychosocial dimensions. Providers commonly espoused that, for older PLWH, comorbidities are comparatively more difficult to manage than HIV and constitute the primary driver of pathophysiology and/or mortality. In contrast, providers viewed patients as regarding HIV as more deadly and engaging with HIV care more diligently, which providers related to patients’ long-term experiences of living through the HIV/AIDS epidemic. Providers’ comorbidity-centric framings of the clinical relationship between HIV, aging, and comorbidities mark a departure from HIV-dominant forms of thinking. Our findings have important implications for interdisciplinary care management and suggest how to support the development of asset-based approaches to encourage patient engagement with comorbidity care based on fidelity to HIV regimens.

Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State

BACKGROUND

Older persons living with HIV (PLWH) need routine healthcare to manage HIV and other comorbidities. This mixed methods study investigated digital equity, constituted as access, use and quality, of HIV and specialty telehealth services for PLWH > 50 years during the initial wave of the COVID-19 pandemic when services transitioned to remote care.

METHODS

A survey of closed and open-ended questions was administered to 80 English (N = 63) and Spanish (N = 17) speaking PLWH receiving HIV care at an Academic Medical Center (N = 50) or a Federally Qualified Health Center (N = 30) in New York State. Quantitative analyses examined characteristics predicting telehealth use and visit quality. Qualitative analyses utilized thematic coding to reveal common experiences. Results were integrated to deepen the interpretation.

RESULTS

Telehealth access and use were shaped by multiple related and unstable factors including devices and connectivity, technology literacy, and comfort including privacy concerns. Participants demonstrated their substantial effort to achieve the visit. The majority of patients with a telehealth visit perceived it as worse than an in-person visit by describing it as less interpersonal, and resulting in poorer outcomes, particularly participants with less formal education. Technology was not only a barrier to access, but also influenced perceptions of quality.

CONCLUSIONS

In the COVID-19 pandemic initial wave, barriers to using telehealth were unequally distributed to those with more significant access and use challenges. Beyond these barriers, examining the components of equity indicate further challenges replicating in-person care using telehealth formats for older PLWH. Work remains to establish telehealth as both equitable and desirable for this population.

The COVID-19 Patient in the Surgical Intensive Care Unit

COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.

Malignant Degeneration of Biopsy-Proven Hamartoma to Chondrosarcoma

Pulmonary hamartomas are benign lesions that are often managed conservatively in the absence of respiratory symptoms. Increasing reports of malignant transformation question if a more aggressive treatment or surveillance practice for these lesions is warranted in adult patients. Herein, we describe a case of a 67-year-old man with a long history of pulmonary hamartoma that demonstrated malignant degeneration into spindle cell malignancy with chondromatous differentiation. This case illustrates the aggressive nature of sarcomatous disease arising from hamartomas and, with a handful of other cases in the literature, points to the question of whether pulmonary hamartomas arising in late adulthood should follow a more intensive treatment or surveillance algorithm given increased concern for malignant potential.

An apparent outbreak of cutaneous papillomatosis in merino sheep in patagonia, Argentina

A retrospective study was performed on skin samples from an outbreak of cutaneous papillomatosis in Merino sheep that occurred in 1995. The samples were processed for routine histology, electron microscopy and immunocytochemistry for papilloma viruses. Particles of approximately 55 nm diameter were found in some nuclei of the stratum granulosum cells, while immunocytochemistry gave positive staining of cell nuclei in this layer. This study confirms that papillomas associated with papillomaviruses occur in sheep in Patagonia.

Leucocyte aggregation in burned patients

Leucocyte aggregation describes one type of biophysical behaviour of white cells. To test whether this parameter is changed in burned patients, 15 burn victims were investigated immediately after admission into hospital. Cell counts and aggregation were measured and related to the prognosis of the injury. Compared with normal controls, burning injury is associated with higher white cell counts and enhanced leucocyte aggregation. Fatal injuries showed a (non-significant) tendency for higher aggregation values than survivors. There are significant positive correlations between white cell counts, maximal aggregation values and the burned body surface area. The results suggest that leucocyte aggregation is pathologically enhanced in response to burns. Possibly this alteration is of prognostic importance.

Efficacy of maduramicin against ionophore-tolerant field isolates of coccidia in broilers

Maduramicin ammonium was given at 2.5-8 ppm in the feed to broilers experimentally infected with coccidia recently isolated from broiler farms where ionophores had been used for several years. Infection pressure varied from mild to severe in five trials: mortality in unmedicated controls ranged from 0 to 59%, intestinal lesion scores were high, and weight gain was depressed by the infections. The cultures of Eimeria were partly resistant to ionophores: birds medicated with monensin at 100-121 ppm had only modest reductions in lesion scores and incomplete protection against weight loss or mortality. Control of infections by maduramicin was significant at 4 ppm but best at 5-7 ppm. Maduramicin was more effective than monensin or narasin, but about the same as salinomycin, in reducing lesions and mortality and in protecting performance. Maduramicin was well tolerated within the dose range of 5-7 ppm.