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Enogieru I, Blewitt-Golsch AL, Hart LJ, LeGrand S, Whetten K, Ostbye T, Johnson CY. Prevalence and correlates of workplace violence: descriptive results from the National Transgender Discrimination Survey. Occup Environ Med 2024:oemed-2023-109197. [PMID: 38499331 DOI: 10.1136/oemed-2023-109197] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To describe the lifetime prevalence of workplace harassment, physical violence and sexual assault against transgender and non-binary workers targeted due to their gender identity and to identify correlates of this workplace violence. METHODS This descriptive cross-sectional study used data from 4597 transgender or non-binary respondents from the 2008-2009 National Transgender Discrimination Survey. Respondents reported if they had ever experienced harassment, physical violence or sexual assault at work specifically because of their gender identity. We estimated the prevalence of each type of violence stratified by gender identity, race/ethnicity, age, educational attainment, history of working in the street economy (eg, sex industry, drug sales) and if people at work knew their gender identity. RESULTS Workplace violence was prevalent, with 50% of transgender and non-binary workers having ever experienced harassment, 7% physical violence and 6% sexual assault at work because of their gender identity. Harassment was common among all of these workers, but physical violence and sexual assault were more than twice as common among transfeminine and non-binary workers assigned male at birth, workers of colour, workers with low educational attainment and those who had ever worked in the street economy. CONCLUSIONS Transgender and non-binary workers commonly face violence at work because of their gender identity. Workplace violence prevention programmes should incorporate ways to prevent gender identity-based violence and facilitate channels for workers to report the occurrence of discrimination and violence.
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Affiliation(s)
- Idia Enogieru
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lauren J Hart
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kathryn Whetten
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
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Malta M, da Silva AB, da Silva CMF, LeGrand S, Seixas M, Benevides B, Kalume C, Whetten K. Addressing discrimination and violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: a mobile health intervention. BMC Public Health 2023; 23:2069. [PMID: 37872552 PMCID: PMC10591389 DOI: 10.1186/s12889-023-16857-4] [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] [Received: 09/05/2022] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons globally. Herein, we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance-Dandarah app. METHODS We conducted community-based participatory research (CBPR) between 2019 and 2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a 'word cloud', to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019. RESULTS Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks. CONCLUSIONS Rainbow Resistance-Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.
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Affiliation(s)
- Monica Malta
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Angelica Baptista da Silva
- Department of Human Rights, Health and Social Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cosme Marcelo Furtado da Silva
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Michele Seixas
- Civil Society Advisory Group, UN Women Brazil, Brasilia, Brazil
- Brazilian Articulation of Lesbians (ABL), Rio de Janeiro, Brazil
- Women's Group Felipa de Sousa, Rio de Janeiro, Brazil
| | | | | | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
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Malta M, Silva AB, Silva CMF, LeGrand S, Seixas M, Benevides B, Kalume C, Whetten K. Addressing Discrimination and Violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: A mobile Health intervention. Res Sq 2023:rs.3.rs-2034975. [PMID: 37034615 PMCID: PMC10081355 DOI: 10.21203/rs.3.rs-2034975/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons in the world. Herein we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance - Dandarah app. Methods We conducted community-based participatory research (CBPR) between 2019-2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a 'word cloud', to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019. Results Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible strategy for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks. Conclusions Rainbow Resistance - Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.
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Baptista Silva A, Malta M, da Silva CMFP, Kalume CC, Filha IGA, LeGrand S, Whetten K. The Dandarah App: An mHealth Platform to Tackle Violence and Discrimination of Sexual and Gender Minority Persons Living in Brazil. Int J Environ Res Public Health 2022; 20:280. [PMID: 36612598 PMCID: PMC9819566 DOI: 10.3390/ijerph20010280] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Discrimination and violence are widely experienced by sexual and gender minority (SGM) persons worldwide. More than one SGM person is murdered every day in Brazil because of their sexuality or gender identity, which is the highest reported homicide rate in the world. Alt-hough discrimination and violence against SGM persons in Brazil are considered to be hate crimes, reporting is still suboptimal due to fear of police SGM phobia and victim blaming. Accessible and easily disseminated interventions are urgently needed. Herein, we describe the develop-ment of an mHealth solution to help address violence against SGM persons, namely the Rainbow Resistance: Dandarah App, with a synthesis of key results and feedback from the SGM community after 24 months of using the app. Twenty-two focus group discussions (FGDs) were conducted with SGM persons living in six Brazilian states: Bahia, Federal District, São Paulo, Rio de Janeiro, Minas Gerais, Sergipe, and Pará. A total of 300 SGM persons participated in the FGDs. A thematic analysis was performed to interpret the qualitative data. Content themes related to aesthetics, us-ability, barriers to resources, and likes/dislikes about the intervention arose from the FGDs. Participants found the intervention to be user-friendly, endorsed more likes than dislikes, and suggested a few changes to the app. The findings suggest that the intervention is usable and fit for future ef-fectiveness testing, and that it could fill an important gap in the well-being of SGM persons living in a country with high levels of discrimination and violence towards this community, i.e., Brazil.
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Affiliation(s)
- Angélica Baptista Silva
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Mônica Malta
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Cosme Marcelo Furtado Passos da Silva
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Clarice Cavalcante Kalume
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Ianê Germano Andrade Filha
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
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5
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Sallabank G, Blackburn NA, Threats M, Pulley DV, Barry MC, LeGrand S, Harper GW, Bauermeister JA, Hightow-Weidman LB, Muessig KE. Media representation, perception and stigmatisation of race, sexuality and HIV among young black gay and bisexual men. Cult Health Sex 2022; 24:1729-1743. [PMID: 34895082 PMCID: PMC9188628 DOI: 10.1080/13691058.2021.2008506] [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] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Young Black gay and bisexual men who have sex with men experience stigma related to race, gender expression, sexuality and HIV status. Stigma impacts access to HIV care and prevention as well as interactions with healthcare providers. The amplification of stigma through popular media is under-researched in the health sciences. HealthMpowerment is a mobile phone optimised intervention to reduce sexual risk and support community-building for young Black gay and bisexual men (age 18-30). We analysed Forum conversations from 48 participants, 45.8% living with HIV. Of 322 stigma-relevant conversations, 18.9% referenced the media (e.g. television, news, social media) as a source of stigma. Forum conversations covered media representations of Black gay and bisexual men, media's influence on identity, and the creation of stigma by association with media representations. Cultural messages embedded in the media may accentuate stereotypes that influence perceptions of Black gay and bisexual men and disregard intersectional identities. HealthMpowerment provided a space to challenge stigmatising representations. Participants used HealthMpowerment to garner social support and celebrate positive media representations. Interventions for young Black gay and bisexual men should consider the influential role of media and include spaces for participants to process and address stigma.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Natalie A. Blackburn
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Threats
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deren V. Pulley
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan C. Barry
- Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gary W. Harper
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kathryn E. Muessig
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Songtaweesin WN, LeGrand S, Bandara S, Piccone C, Wongharn P, Moonwong J, Jupimai T, Saisaengjan C, Theerawit T, Muessig K, Hightow-Weidman L, Puthanakit T, Phanuphak N, Tangmunkongvorakul A. Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study. J Med Internet Res 2021; 23:e23852. [PMID: 34734828 PMCID: PMC8603178 DOI: 10.2196/23852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 08/26/2020] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. Objective This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. Methods We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. Results For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app’s features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. Conclusions The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. Trial Registration ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708
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Affiliation(s)
- Wipaporn Natalie Songtaweesin
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Shashika Bandara
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Caitlin Piccone
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Prissana Wongharn
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Juthamanee Moonwong
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Thidarat Jupimai
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Chutima Saisaengjan
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Tuangtip Theerawit
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thanyawee Puthanakit
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Choi SK, Boynton MH, Ennett S, Muessig K, Bauermeister J, LeGrand S, Hightow-Weidman L. Sexual Empowerment Among Young Black Men Who Have Sex with Men. J Sex Res 2021; 58:560-572. [PMID: 32897102 PMCID: PMC7937771 DOI: 10.1080/00224499.2020.1809614] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual empowerment represents an important HIV intervention strategy, yet limited attention has examined the multidimensional nature of sexual empowerment in prior studies. Using a sample (n = 465) of young Black men who have sex with men (MSM), we used confirmatory factor analysis (CFA) to test a multifactorial operationalization of sexual empowerment. CFA indicated that a bifactor model was best suited to characterize the sexual empowerment factor (SEF), suggesting that items for four sub-constructs (self-efficacy to refuse sexual behavior, emotional support, condom use self-efficacy, and social norms on condom use) contributed to their respective constructs, while also contributing to a latent sexual empowerment construct. We then examined the association between SEF and mental health outcomes (anxiety and depression symptoms) and safer sex intentions. SEF was negatively associated with mental health outcomes and positively associated with safer sex intentions. Ultimately, individuals with greater sexual empowerment might be better equipped to develop strategies to buffer their vulnerability to HIV. We discuss the implications of SEF as a bifactor during the design and evaluation of HIV risk-reduction interventions seeking to address sexual empowerment among MSM.
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Affiliation(s)
- Seul Ki Choi
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Marcella H. Boynton
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Ennett
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - José Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Lisa Hightow-Weidman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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8
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Blackburn NA, Dong W, Threats M, Barry M, LeGrand S, Hightow-Weidman LB, Soni K, Pulley DV, Bauermeister JA, Muessig K. Building Community in the HIV Online Intervention Space: Lessons From the HealthMPowerment Intervention. Health Educ Behav 2021; 48:604-614. [PMID: 33834892 DOI: 10.1177/10901981211003859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
BACKGROUND Mobile health platforms can facilitate social support and address HIV (human immunodeficiency virus) stigma but pose challenges for intervention design and participant engagement. Giddens's structuration theory, that individuals are shaped by-and shape-their communities through rules and resources that give them power to operate within these environments, provides a useful analytic framework for exploring these dynamic intervention spaces. METHOD Data were drawn from an online randomized controlled trial intervention (HealthMpowerment) for young Black men who have sex with men to reduce condomless anal intercourse. We applied a conversational analysis informed by structuration theory to 65 user-generated conversations that included stigma content. We aimed to understand how the interdependent relationship between the intervention space and participants' contributions might contribute to behavior change. RESULTS Thirty five intervention participants contributed to the analyzed conversations. Our analysis identified three types of conversational processes that may underlie behavior change: (1) Through intervention engagement, participants established norms and expectations that shaped their discussions; (2) participants used anecdotes and anonymity to reinforce norms; and (3) intervention staff members sought to improve engagement and build knowledge by initiating discussions and correcting misinformation, thus playing an integral role in the online community. CONCLUSIONS The lens of structuration theory usefully reveals potential behavior change mechanisms within the social interactions of an online intervention. Future design of these interventions to address HIV stigma should explicitly characterize the context in which individuals (study staff and participants) engage with one another in order to assess whether these processes are associated with improved intervention outcomes.
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Affiliation(s)
| | - Willa Dong
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Threats
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Rutgers University, New Brunswick, NJ
| | - Megan Barry
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Karina Soni
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deren V Pulley
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,University of California San Francisco, San Francisco, CA, USA
| | | | - Kate Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Acharya A, Agarwal R, Baker M, Baudry J, Bhowmik D, Boehm S, Byler KG, Chen S, Coates L, Cooper C, Demerdash O, Daidone I, Eblen J, Ellingson S, Forli S, Glaser J, Gumbart JC, Gunnels J, Hernandez O, Irle S, Kneller D, Kovalevsky A, Larkin J, Lawrence T, LeGrand S, Liu SH, Mitchell J, Park G, Parks J, Pavlova A, Petridis L, Poole D, Pouchard L, Ramanathan A, Rogers D, Santos-Martins D, Scheinberg A, Sedova A, Shen Y, Smith J, Smith M, Soto C, Tsaris A, Thavappiragasam M, Tillack A, Vermaas J, Vuong V, Yin J, Yoo S, Zahran M, Zanetti-Polzi L. Supercomputer-Based Ensemble Docking Drug Discovery Pipeline with Application to Covid-19. J Chem Inf Model 2020; 60:5832-5852. [PMID: 33326239 PMCID: PMC7754786 DOI: 10.1021/acs.jcim.0c01010] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 01/18/2023]
Abstract
We present a supercomputer-driven pipeline for in silico drug discovery using enhanced sampling molecular dynamics (MD) and ensemble docking. Ensemble docking makes use of MD results by docking compound databases into representative protein binding-site conformations, thus taking into account the dynamic properties of the binding sites. We also describe preliminary results obtained for 24 systems involving eight proteins of the proteome of SARS-CoV-2. The MD involves temperature replica exchange enhanced sampling, making use of massively parallel supercomputing to quickly sample the configurational space of protein drug targets. Using the Summit supercomputer at the Oak Ridge National Laboratory, more than 1 ms of enhanced sampling MD can be generated per day. We have ensemble docked repurposing databases to 10 configurations of each of the 24 SARS-CoV-2 systems using AutoDock Vina. Comparison to experiment demonstrates remarkably high hit rates for the top scoring tranches of compounds identified by our ensemble approach. We also demonstrate that, using Autodock-GPU on Summit, it is possible to perform exhaustive docking of one billion compounds in under 24 h. Finally, we discuss preliminary results and planned improvements to the pipeline, including the use of quantum mechanical (QM), machine learning, and artificial intelligence (AI) methods to cluster MD trajectories and rescore docking poses.
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Affiliation(s)
- A. Acharya
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - R. Agarwal
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996, USA
| | - M. Baker
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - J. Baudry
- The University of Alabama in Huntsville, Department of Biological Sciences. 301 Sparkman Drive, Huntsville, AL 35899, USA
| | - D. Bhowmik
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - S. Boehm
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - K. G. Byler
- The University of Alabama in Huntsville, Department of Biological Sciences. 301 Sparkman Drive, Huntsville, AL 35899, USA
| | - S.Y. Chen
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - L. Coates
- Neutron Scattering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - C.J. Cooper
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996, USA
| | - O. Demerdash
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - I. Daidone
- Department of Physical and Chemical Sciences, University of L’Aquila, I-67010 L’Aquila, Italy
| | - J.D. Eblen
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
| | - S. Ellingson
- University of Kentucky, Division of Biomedical Informatics, College of Medicine, UK Medical Center MN 150, Lexington KY, 40536, USA
| | - S. Forli
- Scripps Research, La Jolla, CA, 92037, USA
| | - J. Glaser
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - J. C. Gumbart
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - J. Gunnels
- HPC Engineering, Amazon Web Services, Seattle, WA 98121, USA
| | - O. Hernandez
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - S. Irle
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Chemical Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN 37996, USA
| | - D.W. Kneller
- Neutron Scattering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - A. Kovalevsky
- Neutron Scattering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - J. Larkin
- NVIDIA Corporation, Santa Clara, CA 95051, USA
| | - T.J. Lawrence
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - S. LeGrand
- NVIDIA Corporation, Santa Clara, CA 95051, USA
| | - S.-H. Liu
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
| | - J.C. Mitchell
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - G. Park
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - J.M. Parks
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996, USA
| | - A. Pavlova
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - L. Petridis
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
| | - D. Poole
- NVIDIA Corporation, Santa Clara, CA 95051, USA
| | - L. Pouchard
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - A. Ramanathan
- Data Science and Learning Division, Argonne National Lab, Lemont, IL 60439, USA
| | - D. Rogers
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | | | | | - A. Sedova
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830, USA
| | - Y. Shen
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996, USA
| | - J.C. Smith
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
| | - M.D. Smith
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830, USA
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996, USA
| | - C. Soto
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - A. Tsaris
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | | | | | - J.V. Vermaas
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - V.Q. Vuong
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Chemical Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN 37996, USA
| | - J. Yin
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - S. Yoo
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - M. Zahran
- Department of Biological Sciences, New York City College of Technology, The City University of New York (CUNY), Brooklyn, NY 11201, USA
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10
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Acharya A, Agarwal R, Baker M, Baudry J, Bhowmik D, Boehm S, Byler KG, Coates L, Chen SY, Cooper CJ, Demerdash O, Daidone I, Eblen JD, Ellingson S, Forli S, Glaser J, Gumbart JC, Gunnels J, Hernandez O, Irle S, Larkin J, Lawrence TJ, LeGrand S, Liu SH, Mitchell JC, Park G, Parks JM, Pavlova A, Petridis L, Poole D, Pouchard L, Ramanathan A, Rogers D, Santos-Martins D, Scheinberg A, Sedova A, Shen S, Smith JC, Smith MD, Soto C, Tsaris A, Thavappiragasam M, Tillack AF, Vermaas JV, Vuong VQ, Yin J, Yoo S, Zahran M, Zanetti-Polzi L. Supercomputer-Based Ensemble Docking Drug Discovery Pipeline with Application to Covid-19. ChemRxiv 2020:12725465. [PMID: 33200117 PMCID: PMC7668744 DOI: 10.26434/chemrxiv.12725465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 07/29/2020] [Indexed: 01/18/2023]
Abstract
We present a supercomputer-driven pipeline for in-silico drug discovery using enhanced sampling molecular dynamics (MD) and ensemble docking. We also describe preliminary results obtained for 23 systems involving eight protein targets of the proteome of SARS CoV-2. THe MD performed is temperature replica-exchange enhanced sampling, making use of the massively parallel supercomputing on the SUMMIT supercomputer at Oak Ridge National Laboratory, with which more than 1ms of enhanced sampling MD can be generated per day. We have ensemble docked repurposing databases to ten configurations of each of the 23 SARS CoV-2 systems using AutoDock Vina. We also demonstrate that using Autodock-GPU on SUMMIT, it is possible to perform exhaustive docking of one billion compounds in under 24 hours. Finally, we discuss preliminary results and planned improvements to the pipeline, including the use of quantum mechanical (QM), machine learning, and AI methods to cluster MD trajectories and rescore docking poses.
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Affiliation(s)
- A Acharya
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332
| | - R Agarwal
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996
| | - M Baker
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - J Baudry
- The University of Alabama in Huntsville, Department of Biological Sciences. 301 Sparkman Drive, Huntsville, AL 35899
| | - D Bhowmik
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
| | - S Boehm
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - K G Byler
- The University of Alabama in Huntsville, Department of Biological Sciences. 301 Sparkman Drive, Huntsville, AL 35899
| | - L Coates
- Neutron Scattering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
| | - S Y Chen
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973
| | - C J Cooper
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996
| | - O Demerdash
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - I Daidone
- Department of Physical and Chemical Sciences, University of L'Aquila, I-67010 L'Aquila, Italy
| | - J D Eblen
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
| | - S Ellingson
- University of Kentucky, Division of Biomedical Informatics, College of Medicine, UK Medical Center MN 150, Lexington KY, 40536
| | - S Forli
- Scripps Research, La Jolla, CA, 92037
| | - J Glaser
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830
| | - J C Gumbart
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332
| | - J Gunnels
- HPC Engineering, Amazon Web Services, Seattle, WA 98121
| | - O Hernandez
- Computer Science and Mathematics Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - S Irle
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
- Chemical Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN 37996
| | - J Larkin
- NVIDIA Corporation, Santa Clara, CA 95051
| | - T J Lawrence
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - S LeGrand
- NVIDIA Corporation, Santa Clara, CA 95051
| | - S-H Liu
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
| | - J C Mitchell
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - G Park
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973
| | - J M Parks
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996
| | - A Pavlova
- School of Physics, Georgia Institute of Technology, Atlanta, GA 30332
| | - L Petridis
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
| | - D Poole
- NVIDIA Corporation, Santa Clara, CA 95051
| | - L Pouchard
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973
| | - A Ramanathan
- Data Science and Learning Division, Argonne National Lab, Lemont, IL 60439
| | - D Rogers
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830
| | | | | | - A Sedova
- Biosciences Division, Oak Ridge National Lab, Oak Ridge, TN 37830
| | - S Shen
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
- Graduate School of Genome Science and Technology, University of Tennessee, Knoxville, TN, 37996
| | - J C Smith
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
| | - M D Smith
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, TN, 37830
- The University of Tennessee, Knoxville. Department of Biochemistry & Cellular and Molecular Biology, 309 Ken and Blaire Mossman Bldg. 1311 Cumberland Avenue Knoxville, TN, 37996
| | - C Soto
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973
| | - A Tsaris
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830
| | | | | | - J V Vermaas
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830
| | - V Q Vuong
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
- Chemical Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN 37996
| | - J Yin
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37830
| | - S Yoo
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973
| | - M Zahran
- Department of Biological Sciences, New York City College of Technology, The City University of New York (CUNY), Brooklyn, NY 11201
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Gomes de Jesus J, Belden CM, Huynh HV, Malta M, LeGrand S, Kaza VGK, Whetten K. Mental health and challenges of transgender women: A qualitative study in Brazil and India. Int J Transgend Health 2020; 21:418-430. [PMID: 34993520 PMCID: PMC8726648 DOI: 10.1080/26895269.2020.1761923] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Transgender women from low- and middle-income countries (LMICs) are understudied, their coping strategies and struggles underrecognised. Aims: This study aimed to explore the lived experiences of transgender women from two major cities located in Brazil and India, LMICs with high rates of transphobia and gender-based violence. Methods: We conducted a mixed-methods, exploratory study, including focus group discussions (FGDs) and brief survey interviews with 23 transgender women from Hyderabad, India and 12 transgender women from Rio de Janeiro, Brazil. Herein we present the combined (qualitative and quantitative) results related to discrimination, stigma, violence, and suicidality in transgender women's lives. Results: Three major themes emerged from FGDs: stigma and discrimination; violence, and suicidality. Lack of education and working opportunities influence high levels of poverty and engagement in survival sex work by transgender women in both cities. Study participants live in large cities with more than 6 million inhabitants, but transgender women reported chronic social isolation. Participants disclosed frequent suicide ideation and suicide attempts. Brief surveys corroborate FGD findings, identifying high prevalence of discrimination, intimate partner violence, suicidality and low social support. Discussion: Multiple layers of stigma, discrimination, violence and social isolation affect transgender women's quality of life in Hyderabad and Rio de Janeiro. Strategies sensitive to gender and culture should be implemented to tackle entrenched prejudice and social exclusion reported by transgender women. Additional social support strategies, better access to education and employment opportunities are also urgently needed. Improving the availability of evidence-based mental health interventions addressing the high prevalence of suicidality among transgender women from Hyderabad, India and Rio de Janeiro, Brazil should be prioritized.
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Affiliation(s)
- Jaqueline Gomes de Jesus
- Rio de Janeiro Federal Institute of Education, Science and Technology, Rio de Janeiro, Brazil
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
- Leader-Researcher of ODARA – Group of Interdisciplinary Research on Culture, Diversity and Identity, National Council for Scientific and Technological Development (CNPq), Brasilia, Brazil
| | - C. Micha Belden
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Hy V. Huynh
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Monica Malta
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Social Science, National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
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12
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Malta M, Gomes de Jesus J, LeGrand S, Seixas M, Benevides B, Silva MDD, Lana JS, Huynh HV, Belden CM, Whetten K. 'Our life is pointless … ': Exploring discrimination, violence and mental health challenges among sexual and gender minorities from Brazil. Glob Public Health 2020; 15:1463-1478. [PMID: 32436430 DOI: 10.1080/17441692.2020.1767676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/08/2023]
Abstract
Worldwide, Brazil has the highest prevalence of violence and hate crimes against sexual and gender minorities (SGMs) among countries with available data. To explore the impact of this scenario, we conducted a qualitative study with 50 SGMs from Rio de Janeiro, Brazil. Among the participants, 66% screened positive for generalised anxiety disorder, 46% for major depressive disorder and 39% for PTSD. A third reported low self-esteem (32%) and one quarter low social support (26%). Experiences of interpersonal discrimination were highly prevalent (>60%), while institutional discrimination related to employment or healthcare was reported by 46% of participants. Verbal abuse is very common (80%), followed by physical assault (40%). Sexual violence is highly frequent among women. Focus groups analysis highlighted three major domains: (1) stigma and discrimination (family, friends and partners, in schools and health services, influencing social isolation); (2) violence (bullying, harassment, physical and sexual violence); and (3) mental suffering (alcohol and drug abuse, depression, suicidality, anxiety). Our findings suggest a close synergy between experiences of discrimination and violence with selected mental disorders. This complex synergy might be better addressed by longer-term individual and group-level interventions that could foster social solidarity among the different groups that comprise SGMs.
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Affiliation(s)
- Monica Malta
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Social Science, National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Jaqueline Gomes de Jesus
- Rio de Janeiro Federal Institute of Education, Science and Technology, Rio de Janeiro, Brazil.,Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA.,Leader-Researcher of ODARA - Group of Interdisciplinary Research on Culture, Diversity and Identity, National Council for Scientific and Technological Development (CNPq), Brasilia, Brazil
| | - Sara LeGrand
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Michele Seixas
- UN Women Brazil, Civil Society Advisory Group, Brasilia, Brazil.,Felipa de Sousa Women's Group, Rio de Janeiro, Brazil
| | - Bruna Benevides
- National Association of Travestis and Transsexuals (ANTRA), Salvador, Brazil
| | - Maria das Dores Silva
- Department of Social Science, National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Jonas Soares Lana
- Rio de Janeiro Federal Institute of Education, Science and Technology, Rio de Janeiro, Brazil
| | - Hy V Huynh
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Charles M Belden
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
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13
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Montenegro L, Velasque L, LeGrand S, Whetten K, de Mattos Russo Rafael R, Malta M. Public Health, HIV Care and Prevention, Human Rights and Democracy at a Crossroad in Brazil. AIDS Behav 2020; 24:1-4. [PMID: 30903450 PMCID: PMC6755066 DOI: 10.1007/s10461-019-02470-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 01/05/2023]
Abstract
On January 2019, Brazil's new far-right president Jair Bolsonaro was sworn into office. Bolsonaro's administration supports downsizing the Brazilian Unified Health System (SUS), while increasing the size of the private health sector. The new administration might leave millions of Brazilians without medical care, including hundreds of thousands of people living with HIV/AIDS. Bolsonaro's administration, allied with a highly conservative Congress and sharp decreases in federal funding for public health, education and research, could jeopardize key health and human rights strategies focused on women, LGBTQ + individuals, Indigenous populations, and people living with HIV/AIDS.
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Affiliation(s)
- Luiz Montenegro
- Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health (DEMQS-ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - Ricardo de Mattos Russo Rafael
- Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Public Health Nursing Department, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Monica Malta
- Division of Equity, Gender and Population, Department of Psychiatry, University of Toronto, Toronto, Canada.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
- Social Science Department, Sergio Arouca National School of Public Health (DCS/ENSP), FIOCRUZ, Rio de Janeiro, Brazil.
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14
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Khandekar E, Kramer R, Ali AS, Al-Mafazy AW, Egger JR, LeGrand S, Mkali HR, McKay M, Ngondi JM. Evaluating Response Time in Zanzibar's Malaria Elimination Case-Based Surveillance-Response System. Am J Trop Med Hyg 2019; 100:256-263. [PMID: 30526729 DOI: 10.4269/ajtmh.17-0546] [Citation(s) in RCA: 4] [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] [Indexed: 01/13/2023] Open
Abstract
As countries transition toward malaria elimination, malaria programs rely on surveillance-response systems, which are often supported by web- and mobile phone-based reporting tools. Such surveillance-response systems are interventions for elimination, making it important to determine if they are operating optimally. A metric to measure this by is timeliness. This study used a mixed-methods approach to investigate the response time of Zanzibar's malaria elimination surveillance-response system, Malaria Case Notification (MCN). MCN conducts both passive and reactive case detection, supported by a mobile phone-based reporting tool called Coconut Surveillance. Using data obtained from RTI International and the Zanzibar Malaria Elimination Program (ZAMEP), analysis of summary statistics was conducted to investigate the association of response time with geography, and time series techniques were used to investigate trends in response time and its association with the number of reported cases. Results indicated that response time varied by the district in Zanzibar (0.6-6.05 days) and that it was not associated with calendar time or the number of reported cases. Survey responses and focus groups with a cadre of health workers, district malaria surveillance officers, shed light on operational challenges faced during case investigation, such as incomplete health records and transportation issues, which stem from deficiencies in aspects of ZAMEP's program management. These findings illustrate that timely response for malaria elimination depends on effective program management, despite the automation of web-based or mobile phone-based tools. For surveillance-response systems to work optimally, malaria programs should ensure that optimal management practices are in place.
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Affiliation(s)
- Eeshan Khandekar
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Randall Kramer
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Abdullah S Ali
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | | | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina
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15
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Rosengren AL, Menza TW, LeGrand S, Muessig KE, Bauermeister JA, Hightow-Weidman LB. Stigma and Mobile App Use Among Young Black Men Who Have Sex With Men. AIDS Educ Prev 2019; 31:523-537. [PMID: 31815533 PMCID: PMC6938279 DOI: 10.1521/aeap.2019.31.6.523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Young black men who have sex with men (YBMSM) are disproportionately affected by HIV. Intersectional stigmas are associated with increased HIV vulnerability, and worse outcomes for YBMSM with HIV. YBMSM find sex partners through sexual networking apps, but stigma on apps has been poorly studied. We conducted cross-sectional analysis of 324 YBMSM seeking sex partners through apps to assess stigma experiences in eight dimensions compared to non-users (N = 150). We conducted detailed stratified analyses to identify granular stigma data. App users had higher median scores than non-users in perceived HIV discrimination, perceived HIV stigma, experienced sexual minority stigma, racial discrimination, and perceived homophobia. We demonstrate higher levels of intersectional stigmas among app users than non-users, but did not find an overall increase in stigma with increasing app use. Considering the prominent role of apps in YBMSM sexual networking, interventions that reduce stigma on apps are needed.
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Affiliation(s)
- A Lina Rosengren
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Kathryn E Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Naar S, Hudgens MG, Brookmeyer R, Idalski Carcone A, Chapman J, Chowdhury S, Ciaranello A, Comulada WS, Ghosh S, Horvath KJ, Ingram L, LeGrand S, Reback CJ, Simpson K, Stanton B, Starks T, Swendeman D. Improving the Youth HIV Prevention and Care Cascades: Innovative Designs in the Adolescent Trials Network for HIV/AIDS Interventions. AIDS Patient Care STDS 2019; 33:388-398. [PMID: 31517525 DOI: 10.1089/apc.2019.0095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/23/2022] Open
Abstract
Dramatic decreases in HIV transmission are achievable with currently available biomedical and behavioral interventions, including antiretroviral therapy and pre-exposure prophylaxis. However, such decreases have not yet been realized among adolescents and young adults. The Adolescent Medicine Trials Network (ATN) for HIV/AIDS interventions is dedicated to research addressing the needs of youth at high risk for HIV acquisition as well as youth living with HIV. This article provides an overview of an array of efficient and effective designs across the translational spectrum that are utilized within the ATN. These designs maximize methodological rigor and real-world applicability of findings while minimizing resource use. Implementation science and cost-effectiveness methods are included. Utilizing protocol examples, we demonstrate the feasibility of such designs to balance rigor and relevance to shorten the science-to-practice gap and improve the youth HIV prevention and care continua.
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Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida
| | - Michael G. Hudgens
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ron Brookmeyer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Shrabanti Chowdhury
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrea Ciaranello
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, California
| | - LaDrea Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Kit Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
| | - Bonita Stanton
- Hackensack Meridian School of Medicine, Seton Hall University, Newark, New Jersey
| | - Tyrel Starks
- Department of Psychology, City University of New York–Hunter College, New York, New York
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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17
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Malta M, Silva AB, LeGrand S, Whetten K, Wells S. HIV/AIDS, human rights, and transgender people in Latin America. The Lancet Public Health 2019; 4:e279. [DOI: 10.1016/s2468-2667(19)30082-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/27/2022]
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18
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Bauermeister JA, Muessig KE, LeGrand S, Flores DD, Choi SK, Dong W, Sallabank G, Hightow-Weidman LB. HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention. AIDS Behav 2019; 23:742-752. [PMID: 30121727 DOI: 10.1007/s10461-018-2256-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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] [Indexed: 12/29/2022]
Abstract
HIV and sexuality stigma impede HIV prevention and care efforts. HealthMpowerment.org (HMP) is an interactive mobile phone- and web-based HIV prevention and care intervention for young Black men who have sex with men (YBMSM; ages 18-30) in the United States. HMP included three forums where participants could share their experiences. In this study, we explored whether engaging in stigma-related discussions was associated with changes in YBMSM's stigma-related scores throughout the trial. YBMSM (ages 18-30; N = 238) participating in HMP completed surveys at baseline, and 3 and 6 month follow-ups that included a series of scales focused on HIV and sexuality (internalized homophobia; sexual prejudice) stigma. Sixty-two participants contributed to the forums (1497 posts). We coded instances where YBMSM's conversations were stigma related (915 posts, 61.1%), including discussions of anticipated (74/915, 8.1%), experienced (125/915, 13.7%), internalized (410/915, 44.8%), and/or challenged (639/915, 69.8%) stigma regarding sexuality and HIV. Using a mixed methods approach, we examined whether changes in YBMSM's stigma scores were associated with stigma-related discussions within the forum. We controlled for age, HIV status, income, and educational attainment in these multivariable models. YBMSM who discussed experiencing HIV stigma in the forums reported decreases in perceived HIV stigma over time (b = - 0.37, p ≤ 0.05). YBMSM whose forum posts indicated anticipated HIV stigma reported increases in HIV stigma over time (b = 0.46, p ≤ 0.01). Participants who challenged sexuality-related stigma in forums had lower internalized homophobia (b = - 0.68, p ≤ 0.01) at baseline. YBMSM whose discussions focused on experiencing sexuality-related stigma reported increases in internalized homophobia (b = 0.39, p ≤ 0.01) and sexual prejudice (b = 0.87, p ≤ 0.05) over time. Developing strategies to combat stigma remains a key priority. HMP created an online space where YBMSM could discuss HIV and sexuality stigma. Although a limited number of HMP participants authored the majority of these forum discussions, the discussions were associated with changes in the sample's stigma scores over time. Online interventions (e.g., social media, apps) should consider the inclusion of forums to address stigma and test the efficacy of forums to improve YBMSM's HIV prevention and care continuum outcomes.
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Affiliation(s)
- J A Bauermeister
- University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, USA.
| | - K E Muessig
- University of North Carolina, Chapel Hill, NC, USA
| | | | - D D Flores
- University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, USA
| | - S K Choi
- University of North Carolina, Chapel Hill, NC, USA
| | - W Dong
- University of North Carolina, Chapel Hill, NC, USA
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19
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Galletly CL, Lechuga J, Glasman LR, DiFranceisco W, Broaddus MR, Dickson-Gomez JB, McAuliffe TL, Vega M, LeGrand S, Mena CA, Barlow ML, Montenegro JI. HIV Testing and Mistaken Beliefs about Immigration Laws. J Racial Ethn Health Disparities 2019; 6:668-675. [PMID: 30725380 DOI: 10.1007/s40615-019-00565-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/26/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 01/24/2023]
Abstract
Evidence suggests that migrants may underutilize USA health care because of misconceptions about immigration-related consequences of health care use. This study aimed to explore whether common misconceptions about the immigration consequences of seeking health care, receiving an HIV test, and being diagnosed with HIV were associated with participant self-report of never having received an HIV test. The study sample comprised 297 adult, sexually active, documented and undocumented Spanish-speaking Latino migrants. Participants completed a cross-sectional survey via ACASI. In multiple logistic regression analyses controlling for sociodemographic variables and HIV stigma, misconceptions about laws emerged as a strong predictor of never having received an HIV test (p < .001). Associations between participants' endorsement of misconceptions and their HIV testing history suggest that incorrect perceptions of laws do deter some subgroups of USA Latino migrants from HIV testing. Identifying misconceptions about negative immigration consequences of engaging in important health behaviors should be a community health research priority.
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Affiliation(s)
- Carol L Galletly
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA.
| | - Julia Lechuga
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA, 18015, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Wayne DiFranceisco
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Michelle R Broaddus
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Julia B Dickson-Gomez
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Miriam Vega
- UMMA Community Clinic, 5849 Crocker St, Unit K, Los Angeles, CA, 90003, USA
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive Campus Mailbox 90392, Durham, NC, 27710, USA
| | - Carla A Mena
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive Campus Mailbox 90392, Durham, NC, 27710, USA
| | - Morgan L Barlow
- Duke University, 206 Academic Advising and Resource Center Building Box 90694, Durham, NC, 27708, USA
| | - Judith I Montenegro
- The Latino Commission on AIDS, 24 West, 25th Street, 9th Floor, New York, NY, 10010, USA
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20
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Barry MC, Threats M, Blackburn NA, LeGrand S, Dong W, Pulley DV, Sallabank G, Harper GW, Hightow-Weidman LB, Bauermeister JA, Muessig KE. "Stay strong! keep ya head up! move on! it gets better!!!!": resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men. AIDS Care 2019; 30:S27-S38. [PMID: 30632775 PMCID: PMC6430674 DOI: 10.1080/09540121.2018.1510106] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Indexed: 11/25/2022]
Abstract
Overlapping stigmas related to sexual minority-, race/ethnicity-, and HIV-status pose barriers to HIV prevention and care and the creation of supportive social networks for young, Black, gay, bisexual, and other men who have sex with men (GBMSM). A risk-based approach to addressing the HIV epidemic focuses on what is lacking and reinforces negative stereotypes about already-marginalized populations. In contrast, a strengths-based approach builds on Black GBMSM’s existing strengths, recognizing the remarkable ways in which they are overcoming barriers to HIV prevention and care. HealthMpowerment (HMP) is an online, mobile phone optimized intervention that aimed to reduce condomless anal intercourse and foster community among young Black GBMSM (age 18–30). Applying a resilience framework, we analyzed 322 conversations contributed by 48 HMP participants (22/48 living with HIV) on the intervention website. These conversations provided a unique opportunity to observe and analyze dynamic, interpersonal resilience processes shared in response to stigma, discrimination, and life challenges experienced by young Black GBMSM. We utilized an existing framework with four resilience processes and identified new subthemes that were displayed in these online interactions: (1) Exchanging social support occurred through sharing emotional and informational support. (2) Engaging in health-promoting cognitive processes appeared as reframing, self-acceptance, endorsing a positive outlook, and agency and taking responsibility for outcomes. (3) Enacting healthy behavioral practices clustered into modeling sex-positive norms, reducing the risk of acquiring or transmitting HIV, and living well with HIV. (4) Finally, empowering other gay and bisexual youth occurred through role modeling, promoting self-advocacy, and providing encouragement. Future online interventions could advance strengths-based approaches within HIV prevention and care by intentionally building on Black GBMSM’s existing resilience processes. The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience among young Black GBMSM.
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Affiliation(s)
- Megan C Barry
- a Department of Maternal and Child Health, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Megan Threats
- b School of Information and Library Science , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Natalie A Blackburn
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Sara LeGrand
- d Duke Global Health Institute , Duke University , Durham , USA
| | - Willa Dong
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Deren V Pulley
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Greg Sallabank
- e Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , USA
| | - Gary W Harper
- f Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , USA
| | - Lisa B Hightow-Weidman
- g Institute for Global Health and Infectious Diseases , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Jose A Bauermeister
- h Department of Family and Community Health , University of Pennsylvania , Philadelphia , USA
| | - Kathryn E Muessig
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
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Choi SK, LeGrand S, Dong W, Muessig KE, Hightow-Weidman L. Condom use intentions mediate the relationships between psychosocial constructs and HIV sexual risk behavior in young Black men who have sex with men. AIDS Care 2019; 31:53-60. [PMID: 29950106 PMCID: PMC6301140 DOI: 10.1080/09540121.2018.1492695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 08/02/2017] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
HIV prevention interventions that reduce sexual risk behaviors among young Black men who have sex with men (YBMSM), the most severely affected population in the United States, are critical for reducing disparities in HIV infection. However, there are few theory-based sexual risk reduction interventions designed specifically for YBMSM. This study tested the applicability of the Integrated Behavioral Model (IBM), which theorizes that behavioral intentions mediate the relationship between psychosocial constructs and health behavior on condomless anal intercourse (CAI) among YBMSM. To test key constructs of the IBM, analyses were conducted with baseline data from the HealthMpowerment (HMP) randomized controlled trial. Logistic regression was used to examine the relationships between condom use self-efficacy, norms, attitudes, intentions, and environmental constraints, and CAI. Mediation analysis was conducted to determine if condom use intentions mediated the relationship between psychosocial constructs (i.e., condom use self-efficacy, norms, and attitudes) and CAI. Overall 55.7% reported one or more acts of CAI with a male partner in the past 3 months. Those who reported CAI in the 3 months prior to the baseline survey reported lower self-efficacy for condom use, lower condom use norms, more negative attitudes toward condom use, and lower condom use intentions at baseline than those who reported no CAI. In mediation analysis, the relationships between CAI and self-efficacy for condom use (estimated indirect effect = -0.004 (SE = 0.002)), condom use norms (-0.002 (SE = 0.001)) and attitudes toward condom use (-0.005 (SE = 0.002)) were mediated by condom use intentions. This study applied the IBM to sexual risk behavior among a sample of YBMSM. Results indicate that the relationships between condom use self-efficacy, norms, and attitudes, and CAI were mediated by condom use intentions. Future theory-informed interventions should focus on increasing self-efficacy for condom use, condom use norms, attitudes toward condom use, and condom use intentions to reduce CAI among YBMSM.
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Affiliation(s)
- Seul Ki Choi
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Sara LeGrand
- b Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Willa Dong
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Kathryn E Muessig
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Lisa Hightow-Weidman
- c Division of Global Health and Infectious Diseases , University of North Carolina , Chapel Hill , NC , USA
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McCumber M, Cain D, LeGrand S, Mayer KH, Murphy DA, Psioda MA, Seña AC, Starks TJ, Hudgens M. Adolescent Medicine Trials Network for HIV/AIDS Interventions Data Harmonization: Rationale and Development of Guidelines. JMIR Res Protoc 2018; 7:e11207. [PMID: 30578242 PMCID: PMC6320398 DOI: 10.2196/11207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 06/01/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program aims to defeat the rising HIV epidemic among adolescents and young adults in the United States. Objective This study aims to optimize cross-study analyses and comparisons of standardized measures (variables) collected in the ATN. Methods Guidelines were developed for harmonizing measures to be collected across ATN studies. Results Eight domains were identified for harmonization—Demographics and Socioeconomic Characteristics, Sexual Behavior and Risk, Substance Use and Abuse, HIV-Positive Cascade, HIV-Negative Cascade, Mental Health, Social Support and Isolation, and Pre-exposure Prophylaxis Cascade. Conclusions The collection of selected key measures in a uniform manner across studies facilitates the characterization of participant populations, comparisons between studies, and pooled analysis of data from multiple studies.
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Affiliation(s)
- Micah McCumber
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Demetria Cain
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Debra A Murphy
- Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, United States
| | - Matthew A Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tyrel J Starks
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States.,Department of Psychology, Hunter College, New York, NY, United States
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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LeGrand S, Knudtson K, Benkeser D, Muessig K, Mcgee A, Sullivan PS, Hightow-Weidman L. Testing the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10448. [PMID: 30563818 PMCID: PMC6315253 DOI: 10.2196/10448] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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] [Received: 03/19/2018] [Revised: 07/01/2018] [Accepted: 08/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background HIV prevalence is high among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM), particularly among minorities. Despite its proven efficacy and safety, the uptake of and adherence to pre-exposure prophylaxis (PrEP) among YMSM and YTWSM is currently limited. To date, evidence-based interventions to promote and sustain PrEP adherence have been limited and not shown to be highly efficacious. Given the widespread adoption of smartphones, mobile apps can be utilized to increase PrEP adherence for many YMSM and YTWSM. Objective The study consists of a formative research phase to develop an app-based intervention, P3 (Prepared, Protected, emPowered), to increase PrEP adherence, and a randomized controlled trial (RCT) to test its efficacy. P3 is a mobile app built on an established health platform, which includes social networking and game-based components to encourage PrEP adherence among YMSM and YTWSM. P3+ includes all P3 features plus adherence counseling delivered via two-way text messaging (short message service, SMS) through the app. Methods The formative research phase includes usability testing to assess users’ comprehension of P3’s educational content, understanding and use of intervention features, and overall impressions of app functionality, followed by app refinements. A subsequent field trial will identify and resolve any remaining technical challenges. A three-arm RCT (P3, P3+, and standard of care) will then be conducted at 6 iTech subject recruitment venues to assess intervention efficacy and to conduct a comparison of costs to deliver the 2 intervention arms. Results This is an ongoing research project with initial results from the formative work expected in 2020 and those from the RCT in 2021. Conclusions P3 aims to provide an engaging, interactive experience that is highly appealing for the target population, leveraging technology already heavily integrated into the lives of young people, and thus meeting users’ needs in a familiar, stimulating way. If efficacious, P3 could be a sustainable, easily disseminated, lower-cost PrEP intervention for YMSM and YTWSM. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions. Trial Registration ClinicalTrials.gov NCT03320512; https://clinicaltrials.gov/ct2/show/NCT03320512 (Archived by WebCite at http://www.webcitation.org/74OVZkICl) International Registered Report Identifier (IRRID) DERR1-10.2196/10448
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kelly Knudtson
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrew Mcgee
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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24
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Bauermeister JA, Muessig KE, Flores DD, LeGrand S, Choi S, Dong W, Harper GW, Hightow-Weidman LB. Stigma Diminishes the Protective Effect of Social Support on Psychological Distress Among Young Black Men Who Have Sex With Men. AIDS Educ Prev 2018; 30:406-418. [PMID: 30332312 PMCID: PMC6524771 DOI: 10.1521/aeap.2018.30.5.406] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Addressing stigma remains a pressing HIV priority globally. Young Black men who have sex with men (YBMSM, ages 18-30; N = 474) completed an in-person baseline survey and reported their experiences of externalized stigma (i.e., racial and sexuality discrimination), internalized stigma (i.e., homonegativity), social support, and psychological distress (i.e., anxiety and depression symptoms). We used structural equation modeling to test the association between stigma and psychological distress, and examined whether social support mediated the relationship between stigma and psychological distress. Recognizing that these associations may differ by HIV status, we compared our models by self-reported HIV status (n = 275 HIV negative/unknown; n = 199 living with HIV). Our findings suggest that YBMSM who experience stigma are more vulnerable to psychological distress and may have diminished buffering through social support. These effects are accentuated among YBMSM living with HIV, highlighting the need for additional research focused on the development of tailored stigma reduction interventions for YBMSM.
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Affiliation(s)
| | | | | | | | - Seulki Choi
- University of North Carolina, Chapel Hill, North Carolina
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25
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Mitchell JT, LeGrand S, Hightow-Weidman LB, McKellar MS, Kashuba AD, Cottrell M, McLaurin T, Satapathy G, McClernon FJ. Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial. JMIR Mhealth Uhealth 2018; 6:e10456. [PMID: 30201601 PMCID: PMC6231728 DOI: 10.2196/10456] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 06/16/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons. Objective The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback. Methods This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10). Results Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample—adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition. Conclusions This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed. Trial Registration ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq)
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.,Duke Center for Addiction Science and Technology, Durham, NC, United States
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research at Duke University, Duke Global Health Institute, Durham, NC, United States
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mehri S McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, United States
| | - Angela Dm Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mackenzie Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tony McLaurin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Goutam Satapathy
- Intelligent Automation Incorporated, Rockville, NC, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.,Duke Center for Addiction Science and Technology, Durham, NC, United States
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26
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Hightow-Weidman LB, Muessig K, Rosenberg E, Sanchez T, LeGrand S, Gravens L, Sullivan PS. University of North Carolina/Emory Center for Innovative Technology (iTech) for Addressing the HIV Epidemic Among Adolescents and Young Adults in the United States: Protocol and Rationale for Center Development. JMIR Res Protoc 2018; 7:e10365. [PMID: 30076126 PMCID: PMC6098243 DOI: 10.2196/10365] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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] [Received: 03/11/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Over a fifth of all new HIV infections in the United States occur among persons aged 13 24 years, with most of these diagnoses occurring among gay and bisexual males (81%). While the epidemic of HIV in the United States has leveled off for many age groups, the annual number of new HIV diagnoses among young men who have sex with men (YMSM; 13-24 years old) remains high. Traditional approaches to continuum improvement for youth have been insufficient, and targeted interventions are urgently needed for young people at risk for or infected with HIV. Interventions delivered through mobile health technology represent a promising approach for improving outcomes in this population. Mobile phones have nearly reached saturation among youth, making mobile technology a particularly promising tool for reaching this population. Objective The University of North Carolina/Emory Center for Innovative Technology (iTech) is a National Institutes of Health cooperative agreement as part of the Adolescent Medicine Trials Network for HIV/AIDS Interventions. iTech aims to impact the HIV epidemic by conducting innovative, interdisciplinary research on technology-based interventions across the HIV prevention and care continuum for adolescents and young adults in the United States, particularly YMSM, by providing the following: (1) evaluation of novel approaches to identifying youth with undiagnosed HIV infections; (2) evaluation of multilevel, combination prevention approaches, particularly relevant to gender- and sexual-minority youth facing co-occurring health risks; (3) evaluation of uptake of and adherence to biomedical prevention modalities; and 4) evaluation of interventions designed to promote or optimize engagement in care and antiretroviral therapy adherence in HIV-positive youth, to optimize viral load suppression. Methods iTech brings together multidisciplinary experts in the fields of adolescent HIV treatment and prevention, development and evaluation of technology-based interventions, HIV surveillance and epidemiology, and intervention design and evaluation. This initiative will support 8 efficacy trials and 2 exploratory projects, each led by 2 principal investigators. Taken together, the studies address all of the key steps of the HIV prevention and care continuum for youth in the United States. Each proposal uses technology in a scientifically rigorous and innovative way to access, engage, and impact at-risk or infected youth. Nine iTech subject recruitment venues are spread across 8 US cities. Three cores (management, analytic, and technology) support all iTech activities and form the research network’s infrastructure, facilitating all aspects of study implementation and evaluation. Results Formative work has already begun on many of the above-mentioned iTech trials. We expect the first randomized controlled trials to begin in mid-2018. Additional details can be found in the individual intervention protocol papers in this issue. Conclusions Through its comprehensive research portfolio, iTech aims to effectively advance HIV prevention and care for youth through technology-based, youth-relevant interventions that maximize adaptability and sustainability. Registered Report Identifier RR1-10.2196/10365
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Affiliation(s)
- Lisa B Hightow-Weidman
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eli Rosenberg
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY, United States
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Laura Gravens
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Hightow-Weidman L, Muessig K, Knudtson K, Srivatsa M, Lawrence E, LeGrand S, Hotten A, Hosek S. A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study. JMIR Public Health Surveill 2018; 4:e34. [PMID: 29712626 PMCID: PMC5952121 DOI: 10.2196/publichealth.8923] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Received: 09/08/2017] [Revised: 10/31/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions-particularly mobile health platforms-can provide tailored adherence interventions and allow YMSM to engage and connect with others. OBJECTIVE The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. METHODS AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. RESULTS Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. CONCLUSIONS AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kelly Knudtson
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | | | | | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Anna Hotten
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, United States
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LeGrand S, Muessig KE, Platt A, Soni K, Egger JR, Nwoko N, McNulty T, Hightow-Weidman LB. Epic Allies, a Gamified Mobile Phone App to Improve Engagement in Care, Antiretroviral Uptake, and Adherence Among Young Men Who Have Sex With Men and Young Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e94. [PMID: 29622527 PMCID: PMC5909052 DOI: 10.2196/resprot.8811] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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] [Received: 08/22/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 11/17/2022] Open
Abstract
Background In the United States, young men who have sex with men (YMSM) and transgender women who have sex with men (YTWSM) bear a disproportionate burden of prevalent and incident HIV infections. Once diagnosed, many YMSM and YTWSM struggle to engage in HIV care, adhere to antiretroviral therapy (ART), and achieve viral suppression. Computer-based interventions, including those focused on behavior change, are recognized as effective tools for engaging youth. Objective The purpose of the study described in this protocol is to evaluate the efficacy of Epic Allies, a theory-based mobile phone app that utilizes game mechanics and social networking features to improve engagement in HIV care, ART uptake, ART adherence, and viral suppression among HIV-positive YMSM and YTWSM. The study also qualitatively assesses intervention acceptability, perceived impact, and sustainability. Methods This is a two-group, active-control randomized controlled trial of the Epic Allies app. YMSM and YTWSM aged 16 to 24 inclusive, with detectable HIV viral load are randomized 1:1 within strata of new to care (newly entered HIV medical care ≤12 months of baseline visit) or ART-nonadherent (first entered HIV medical care >12 months before baseline visit) to intervention or control conditions. The intervention condition addresses ART adherence barriers through medication reminders and adherence monitoring, tracking of select adherence-related behaviors (eg, alcohol and marijuana use), an interactive dashboard that displays the participant’s adherence-related behaviors and provides tailored feedback, encouragement messages from other users, daily HIV/ART educational articles, and gamification features (eg, mini-games, points, badges) to increase motivation for behavior change and app engagement. The control condition features weekly phone-based notifications to encourage participants to view educational information in the control app. Follow-up assessments are administered at 13, 26, and 39 weeks for each arm. The primary outcome measure is viral suppression. Secondary outcome measures include engagement in care, ART uptake, ART adherence, and psychosocial barriers to engagement in care and ART adherence, including psychological distress, stigma, and social support. Results Baseline enrollment began in September 2015 and was completed in September 2016 (n=146), and assessment of intervention outcomes continued through August 2017. Results for primary and secondary outcome measures are expected to be reported in ClinicalTrials.gov by April 30, 2018. Conclusions If successful, Epic Allies will represent a novel adherence intervention for a group disproportionately impacted by HIV in the United States. Adherent patients would require less frequent clinic visits and experience fewer HIV-related secondary infections, thereby reducing health care costs and HIV transmission. Epic Allies could easily be expanded and adopted for use among larger populations of YMSM and YTWSM, other HIV-positive populations, and for those diagnosed with other chronic diseases such as diabetes and hypertension. Trial Registration ClinicalTrials.gov NCT02782130; https://clinicaltrials.gov/ct2/show/NCT02782130 (Archived by Webcite at http://www.webcitation.org/6yGODyerk)
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alyssa Platt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Karina Soni
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Lisa B Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Menza TW, Choi SK, LeGrand S, Muessig K, Hightow-Weidman L. Correlates of Self-Reported Viral Suppression Among HIV-Positive, Young, Black Men Who Have Sex With Men Participating in a Randomized Controlled Trial of An Internet-Based HIV Prevention Intervention. Sex Transm Dis 2018; 45:118-126. [PMID: 28876283 PMCID: PMC10987038 DOI: 10.1097/olq.0000000000000705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young, black men who have sex with men are disproportionately impacted by the US HIV epidemic, and HIV-positive, young, black men who have sex with men face stark disparities in HIV clinical outcomes. METHODS We performed an observational analysis of the 199 HIV-positive black men aged 18 to 30 years followed up for 12 months in healthMpowerment, a randomized controlled trial of an Internet-based HIV prevention intervention, to identify time-varying correlates of self-reported viral suppression using relative risk (RR) regression. RESULTS Retention at the 12-month visit was 84%. One hundred five (65%) of 162 participants reported being undetectable at baseline. At 3, 6, and 12 months, 83 (72%) of 115, 84 (82%) of 103, and 101 (86%) of 117 reported an undetectable viral load, respectively. In a multivariable model, participants who reported homelessness (RR, 0.85; 95% confidence interval [CI], 0.72-0.99), who had clinically significant depressive symptoms (RR, 0.88; 95% CI, 0.79-0.98), and who used methamphetamine or crack (RR, 0.61; 95% CI, 0.38-0.96) were less likely to report an undetectable viral load. Young men who engaged in condomless insertive anal intercourse were more likely to report viral suppression (RR, 1.14; 95% CI, 1.04-1.24). CONCLUSION HIV care for young, black men who have sex with men must be multidimensional to address medical needs in the context of mental health, substance use, and housing insecurity.
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Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS 2017; 12:432-441. [PMID: 28639990 PMCID: PMC5762120 DOI: 10.1097/coh.0000000000000401] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW We describe recent mobile health (mHealth) interventions supporting antiretroviral therapy (ART) medication adherence among HIV-positive MSM. RECENT FINDINGS Keyword searches (1 January 2016-13 May 2017) identified 721 citations. Seven publications reporting on six studies met inclusion criteria. Five studies focused on MSM. Interventions primarily employed text messaging (n = 4), whereas two focused on smartphone apps and one on social media. Three studies measured intervention impact on adherence and found increased ART use intentions (n = 1), self-reported adherence (n = 1), and viral suppression (n = 1, no control group). Other mHealth interventions for HIV-positive MSM focused on status disclosure and reducing sexual risk. SUMMARY mHealth interventions to support ART adherence among MSM show acceptability, feasibility, and preliminary efficacy. No recent mHealth interventions for MSM measured impact on viral suppression compared with a control condition despite earlier (pre-2015) evidence for efficacy. Studies are underway that include multiple features designed to improve adherence within complex smartphone or internet-based platforms. Areas for future growth include overcoming measurement and engagement challenges, developing tools for coordinating patient and provider adherence data, testing combination interventions, and adapting efficacious interventions for new languages and geographic settings.
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Abstract
PURPOSE OF REVIEW Technology-based HIV self-testing (HST) interventions have the potential to improve access to HIV testing among gay, bisexual, and other MSM, as well as address concerns about HST use, including challenges with linkage to appropriate follow-up services. This review examines studies that use technology-based platforms to increase or improve the experience of HST among MSM. RECENT FINDINGS Seven published studies and eight funded studies were included in this review. Comprehensive prevention interventions with free HST kit distribution and interventions that provide free HST kits and support the HST process address a greater number of barriers (e.g., access, correct use of testing kits, and correct interpretation of results) than studies that only distribute free HST kits through technology-based platforms. SUMMARY By addressing HIV-testing barriers and specific HST concerns, these interventions address a critical need to improve first time and repeat testing rates among MSM. Additional research is needed to determine the efficacy of recent formative HST interventions. If proven efficacious, scale-up of these strategies have the potential to increase HIV testing among MSM via expanded HST uptake.
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Hightow-Weidman L, LeGrand S, Choi SK, Egger J, Hurt CB, Muessig KE. Exploring the HIV continuum of care among young black MSM. PLoS One 2017; 12:e0179688. [PMID: 28662170 PMCID: PMC5491033 DOI: 10.1371/journal.pone.0179688] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young, black men who have sex with men (YBMSM) who experience disparities across the HIV care continuum. A more nuanced understanding of facilitators and barriers to engagement in care, missed visits, antiretroviral uptake, adherence and viral suppression could improve care and intervention design. METHODS A randomized controlled trial of an online intervention, healthMpowerment, enrolled 465 YBMSM (18-30 years); 193 identified as HIV-positive. Bivariable and multivariable analyses of baseline data explored predictors of: engagement in care, missed visits, antiretroviral uptake, self-reported adherence, and viral suppression. RESULTS Mean age was 24.9 years; most identified as gay (71.0%) and were receiving HIV care (89.1%). Among those in care, 52.1% reported no missed visits in the past 12 months, 41 (24.6%) reported one missed visit, and 39 (23.4%) reported two or more. Having insurance (prevalence odds ratio [POR] 4.5; 95% CI: 1.3, 15.8) and provider self-efficacy (POR 20.1; 95% CI: 6.1, 64.1) were associated with being in care. Those with a college degree (POR 9.1; 95% CI: 1.9, 45.2) and no recent marijuana (POR 2.6; 95% CI: 1.2, 5.6) or methamphetamine use (POR 5.4; 95% CI: 1.0, 28.5) were less likely to miss visits. Most (n = 153, 84.1%) had been prescribed antiretroviral therapy. A majority of participants (70.8%) reported ≥90% adherence; those with depressive symptoms had 4.7 times the odds of reporting adherence <90% (95% CI: 1.65, 13.37). Of participants who reported viral load testing in the past six months, 65% (n = 102) reported an undetectable viral load. Disclosure to sex partners was associated with viral suppression (POR 6.0; 95% CI: 1.6, 22.4). CONCLUSIONS Multi-level facilitators and barriers to engagement across the continuum of care were identified in this sample of YBMSM. Understanding the distinct needs of YBMSM at each stage of the continuum and addressing them through tailored approaches is critical for long term success in care.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Seul Ki Choi
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Christopher B. Hurt
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Abstract
Technology, including mobile technologies and social media, offers powerful tools to reach, engage, and retain youth and young adults in HIV prevention and care interventions both in the USA and globally. In this report, we focus on HIV, technology, and youth, presenting a synthesis of recently published (Jan 2014-May 2015) observational and experimental studies relevant for understanding and intervening on HIV risk, prevention, and care. We present findings from a selection of the 66 relevant citations identified, highlighting studies that demonstrate a novel approach to technology interventions among youth in regard to content, delivery, target population, or public health impact. We discuss current trends globally and in the USA in how youth are using technology, as well as emergent research issues in this field-including the need for new theories for developing technology-based HIV interventions and new metrics of engagement, exposure, and evaluation.
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Affiliation(s)
- Lisa B Hightow-Weidman
- Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building CB#7030, Chapel Hill, NC, 27599, USA.
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, 306 Rosenau Hall Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Jose Bauermeister
- Department of Health Behavior and Health Education School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Room 3822, Ann Arbor, MI, 48109-2029, USA.
| | - Chen Zhang
- Department of Health Behavior, University of North Carolina at Chapel Hill, 306 Rosenau Hall Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research Duke Global Health Institute, Duke University, 310 Trent Dr., Room 305, Durham, NC, 27710, USA.
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LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4:e6. [PMID: 27178752 PMCID: PMC4884268 DOI: 10.2196/games.5687] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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] [Received: 02/23/2016] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population’s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM.
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States.
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35
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Hightow-Weidman LB, Muessig KE, Pike EC, LeGrand S, Baltierra N, Rucker AJ, Wilson P. HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention. Health Educ Behav 2015; 42:493-9. [PMID: 25588932 DOI: 10.1177/1090198114562043] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 11/16/2022]
Abstract
BACKGROUND Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships. METHODS To assess the feasibility, acceptability, and preliminary outcomes, a 1-month pilot trial of HMP among 15 YBMSM/TW was conducted. RESULTS Retention was 100%. Mean age was 26 years, 60% were HIV-infected, 87% earned <$21,000, and 67% were uninsured. Despite the small sample size and limited intervention length, statistically significant improvements were seen in social support (p = .012), social isolation (p = .050), and depressive symptoms (p = .045). CONCLUSION The HMP pilot trial demonstrated feasibility and acceptability. Given the burden of the epidemic among YBMSM/TW, there is an imperative to develop, test, and scale up culturally appropriate interventions to both prevent HIV acquisition and limit onward transmission.
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Affiliation(s)
| | | | - Emily C Pike
- University of North Carolina at Chapel Hill, NC, USA
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LeGrand S, Muessig KE, Pike EC, Baltierra N, Hightow-Weidman LB. If you build it will they come? Addressing social isolation within a technology-based HIV intervention for young black men who have sex with men. AIDS Care 2014; 26:1194-200. [PMID: 24617609 DOI: 10.1080/09540121.2014.894608] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 10/25/2022]
Abstract
The rate of HIV infections among young black men who have sex with men (YBMSM) continues to rise at an alarming pace. YBMSM are particularly vulnerable to social isolation and a lack of social support due to experiences with racism and homophobia, which may have implications for sexual risk behaviors. The purpose of this study was to explore perceptions of social isolation and sense of community among YBMSM, the need for and receptivity to social networking features designed to reduce social isolation and build community within an Internet- and mobile phone-based primary and secondary HIV prevention intervention for YBMSM and to identify strategies to develop these features. Focus groups were conducted with 22 YBMSM aged 20-30 years at three sites in North Carolina. Data from the focus groups were thematically analyzed using NVivo. Feelings of social isolation and lack of a sense of community were strongly endorsed by participants with homophobia, lack of opportunities for social engagement, and a focus on sex rather than friendship in interpersonal relationships with other YBMSM cited as contributing factors. Participants were receptive to a social networking intervention designed to reduce social isolation and build community. Recommendations offered by participants to increase acceptability and usability of such features included: availability of information about healthy relationships, the ability to connect with other YBMSM and health care providers, and ensuring the site had ongoing facilitation by the study team as well as monitoring for inappropriate content. The development of a social networking feature of an HIV prevention intervention may present an opportunity to reduce social isolation, build community, and reduce risky sexual behaviors among YBMSM. The findings from this study are being used to inform the development of a social networking feature for an existing Internet- and mobile phone-based primary and secondary HIV prevention intervention for YBMSM.
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Affiliation(s)
- Sara LeGrand
- a Center for Health Policy and Inequalities Research, Duke Global Health Institute , Duke University , Durham , NC , USA
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37
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Muessig KE, Baltierra NB, Pike EC, LeGrand S, Hightow-Weidman LB. Achieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men. Digit Cult Educ 2014; 6:164-182. [PMID: 25593616 PMCID: PMC4292870] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Young, Black men who have sex with men and transgender women who have sex with men (YBMSM/TW) are at disproportionate risk for HIV and other sexually transmitted infections (HIV/STI). HealthMpowerment.org (HMP) is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV-positive and negative YBMSM/TW. The intervention is user-driven, provides social support, and utilises a point reward system. A four-week pilot trial was conducted with a diverse group of 15 YBMSM/TW. During exit interviews, participants described how HMP components led to behaviour changes such as asking partners' sexual history, increased condom use, and HIV/STI testing. The user-driven structure, interactivity, and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real-time. Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating. HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change. In this pilot trial, HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours.
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Affiliation(s)
- Kathryn E Muessig
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA ; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nina B Baltierra
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Pike
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lisa B Hightow-Weidman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men. AIDS Patient Care STDS 2013; 27:211-22. [PMID: 23565925 PMCID: PMC3624691 DOI: 10.1089/apc.2012.0404] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young black men who have sex with men (MSM) bear a disproportionate burden of HIV. Rapid expansion of mobile technologies, including smartphone applications (apps), provides a unique opportunity for outreach and tailored health messaging. We collected electronic daily journals and conducted surveys and focus groups with 22 black MSM (age 18-30) at three sites in North Carolina to inform the development of a mobile phone-based intervention. Qualitative data was analyzed thematically using NVivo. Half of the sample earned under $11,000 annually. All participants owned smartphones and had unlimited texting and many had unlimited data plans. Phones were integral to participants' lives and were a primary means of Internet access. Communication was primarily through text messaging and Internet (on-line chatting, social networking sites) rather than calls. Apps were used daily for entertainment, information, productivity, and social networking. Half of participants used their phones to find sex partners; over half used phones to find health information. For an HIV-related app, participants requested user-friendly content about test site locators, sexually transmitted diseases, symptom evaluation, drug and alcohol risk, safe sex, sexuality and relationships, gay-friendly health providers, and connection to other gay/HIV-positive men. For young black MSM in this qualitative study, mobile technologies were a widely used, acceptable means for HIV intervention. Future research is needed to measure patterns and preferences of mobile technology use among broader samples.
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Affiliation(s)
- Kathryn E Muessig
- Department of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Hightow-Weidman LB, Phillips G, Outlaw AY, Wohl AR, Fields S, Hildalgo J, LeGrand S. Patterns of HIV disclosure and condom use among HIV-infected young racial/ethnic minority men who have sex with men. AIDS Behav 2013; 17:360-8. [PMID: 23054043 DOI: 10.1007/s10461-012-0331-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent findings highlight the continued rise in cases of HIV infection among racial/ethnic minority young men who have sex with men (YMSM). In adults, disclosure of HIV status has been associated with decreased sexual risk behaviors but this has not been explored among YMSM. In this study of 362 HIV-infected racial/ethnic minority YMSM, rates of disclosure were high, with almost all disclosing their status to at least one person at baseline. The majority had disclosed to a family member, with higher disclosure rates to female relatives compared with males. After adjustment for site, disclosure to sex partners and boyfriends was associated with an increase in condom use during both oral and anal sex. Future studies should consider skills training to assist youth in the disclosure process, facilitate how to determine who in their family and friend social network can be safely disclosed to and support family-based interventions.
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Proeschold-Bell RJ, LeGrand S, Wallace A, James J, Moore HE, Swift R, Toole D. Tailoring health programming to clergy: findings from a study of United Methodist clergy in North Carolina. J Prev Interv Community 2012; 40:246-61. [PMID: 22694161 DOI: 10.1080/10852352.2012.680423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research indicating high rates of chronic disease among some clergy groups highlights the need for health programming for clergy. Like any group united by similar beliefs and norms, clergy may find culturally tailored health programming more accessible and effective. There is an absence of research on what aspects clergy find important for clergy health programs. We conducted 11 focus groups with United Methodist Church pastors and district superintendents. Participants answered open-ended questions about clergy health program desires and ranked program priorities from a list of 13 possible programs. Pastors prioritized health club memberships, retreats, personal trainers, mental health counseling, and spiritual direction. District superintendents prioritized for pastors: physical exams, peer support groups, health coaching, retreats, health club memberships, and mental health counseling. District superintendents prioritized for themselves: physical exams, personal trainers, health coaching, retreats, and nutritionists. Additionally, through qualitative analysis, nine themes emerged concerning health and health programs: (a) clergy defined health holistically, and they expressed a desire for (b) schedule flexibility, (c) accessibility in rural areas, (d) low cost programs, (e) institutional support, (f) education on physical health, and (g) the opportunity to work on their health in connection with others. They also expressed concern about (h) mental health stigma and spoke about (i) the tension between prioritizing healthy behaviors and fulfilling vocational responsibilities. The design of future clergy health programming should consider these themes and the priorities clergy identified for health programming.
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Affiliation(s)
- Rae Jean Proeschold-Bell
- Duke Global Health Institute, Duke University Center for Health Policy and Inequalities Research, Durham, North Carolina 27705, USA.
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Abstract
Mental health problems are highly prevalent among individuals with HIV and are consistently associated with negative health outcomes. However, mental illness often remains untreated due to significant psychosocial and physical barriers to treatment participation. The Collaborative HIV/AIDS Mental Health Program (CHAMP) assessed the outcomes associated with providing 9 months of in-home mental health counseling for 40 individuals with HIV and a Major Axis I mental disorder. The evidence-based Illness Management and Recovery Model was adapted for use with HIV-positive individuals for the study using a community-based participatory research approach. Study participants were surveyed at baseline, 5 and 9 months to assess for changes in health outcomes. Thirty-five percent of study participants were female, 80% African American, 33% self-identified as MSM and the average participant age was 43. Forty percent of participants were on psychotropic medication at baseline. Participants had an average of 8 counseling visits (median 9). Statistically significant decreases in the global Brief Symptom Inventory (BSI) score and a number of BSI symptoms dimensions including anxiety, depression, obsessive compulsive, phobic anxiety and hostility were detected, indicating a reduction of psychiatric symptoms. Statistically significant improvement was also identified for the SF-12 mental health scale, adaptive coping, overall social support and emotional support. No differences in psychiatric outcomes were identified by gender, race/ethnicity, or sexual preference. Findings from the CHAMP Study suggest that the use of in-home mental health treatment may be beneficial in engaging and treating HIV-positive individuals with comorbid mental health disorders.
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Affiliation(s)
- Susan S Reif
- Center for Health Policy and Inequalities Research, Duke University, Charlotte, North Carolina 28207, USA.
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Abstract
United Methodist clergy have been found to have higher than average self-reported rates of obesity, diabetes, asthma, arthritis, and high blood pressure. However, health diagnoses differ from physical health functioning, which indicates how much health problems interfere with activities of daily living. Ninety-five percent (n = 1726) of all actively serving United Methodist clergy in North Carolina completed the SF-12, a measure of physical health functioning that has US norms based on self-administered survey data. Sixty-two percent (n = 1074) of our sample completed the SF-12 by self-administered formats. We used mean difference tests among self-administered clergy surveys to compare the clergy SF-12 Physical Composite Scores to US-normed scores. Clergy reported significantly better physical health composite scores than their gender- and age-matched peers, despite above average disease burden in the same sample. Although health interventions tailored to clergy that address chronic disease are urgently needed, it may be difficult to elicit participation given pastors' optimistic view of their physical health functioning.
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Affiliation(s)
- Rae Jean Proeschold-Bell
- Duke University Global Health Institute, Duke University Center for Health Policy, Duke University, Box 90392, Durham, NC 27708-0392, USA.
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Parker A, Bot B, LeGrand S, Eckel-Passow J. Up-regulation of Endothelin-2 as a Common andEarly Event in localized Clear Cell Renal Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2010. [DOI: 10.1158/1055-9965.epi-19-3-aspo01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Despite incidence rates that have been rising for decades, the molecular underpinnings that support the development of clear cell renal cell carcinoma (ccRCC) remain unclear. Herein, we evaluate expression levels of the hypoxia-induced autocrine survival factor endothelin-2 (EDN2) in patient-matched ccRCC and normal kidney samples.
Methods: We identified 169 patients who underwent nephrectomy for histologically confirmed, localized ccRCC at our institution from 2000 to 2003 and had fresh-frozen tumor and normal kidney samples available. After mRNA was extracted from microdissected tissue, we conducted real time PCR to determine expression levels of EDN2. We normalized the expression data using four control genes and then fit linear mixed models to evaluate differential expression between tumor and normal samples. In addition, we explored potential interactions with relevant clinicopathologic characteristics including tumor stage and grade.
Results: Of the 161 patients analyzed, 65% were male, 58% were stage pT1, and 43% were nuclear grade 1 or 2. Overall, EDN2 expression was higher in tumor samples compared to paired normal samples with an average fold change (FC) of 2.0 (P-value < 0.0001). This over-expression in tumor versus normal tissue was apparent in early stage (pT1) tumors but not later stage (pT2, pT3) tumors (FC of 2.9 v. 1.1 respectively; interaction P-value = 0.001). Similarly, over-expression was more pronounced in low grade (1, 2) tumors compared to high grade (3, 4) tumors (FC of 3.5 v. 1.3 respectively; interaction P-value = 0.0002).
Conclusions: While independent validation is required, our patient-based data suggest that up-regulation of EDN2 is a common and early event in localized ccRCC. If confirmed in future studies, EDN2 could represent a target for the development of novel chemopreventive or neo-adjuvant therapeutics for ccRCC.
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Cornelius JB, LeGrand S, Jemmott LS. African American grandfamilies' attitudes and feelings about sexual communication: focus group results. J Assoc Nurses AIDS Care 2009; 20:133-40. [PMID: 19286125 DOI: 10.1016/j.jana.2008.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
Abstract
Little attention has been given to the responsibilities that African American grandparent caregivers face when they assume the role of raising their grandchildren. One particularly challenging task of grandparent caregivers is communicating with their grandchildren about sexuality issues. This study therefore examined the sexual communications and attitudes and feelings toward these communications between African American grandparent caregivers and their adolescent grandchildren (11-13 years of age). Focus group methodology was used to generate data about the grandparent/grandchild sexuality communication process and attitudes and feelings toward that process. The sample included 40 dyads of African American grandparents/grandchildren, for a total of 80 participants. Grandparents as well as their adolescent grandchildren desired open communication about sexuality issues, said that societal pressure makes sexual encounters hard to resist, and felt that they needed assistance with the sexuality communication process. Nurses can build upon the study's results to assist African American grandparents and their adolescent grandchildren with sexual communication.
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Abstract
This exploratory study uses survey methodology to generate data on grandparent-grandchild sexuality communications and attitudes and feelings about these processes. The sample includes 40 African American grandparent- grandchild dyads for a total of 80 participants recruited from five churches. One open-ended question asks the participants about their willingness to use churches as venues in HIV prevention. Grandparents have more positive attitudes and feelings about sexuality communications than their adolescent grandchildren. Both grandparents and their adolescent grandchildren are receptive to the idea of using churches as venues in HIV prevention and provide recommendations about how a church-based sexuality program could be developed. The role of grandparents is constantly being redefined; therefore, we must continue to examine the needs of this population and the grandchildren they are raising. Nurses can build on the study's findings to develop church-based sexuality programs.
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Davis M, Walsh D, Kirkova J, LeGrand S, Lagman R, Rybicki L. P-814 Symptom clusters and pain in advanced lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sarhill N, Mahmoud F, Walsh D, Nelson KA, Komurcu S, Davis M, LeGrand S, Abdullah O, Rybicki L. Evaluation of nutritional status in advanced metastatic cancer. Support Care Cancer 2003; 11:652-9. [PMID: 12920623 DOI: 10.1007/s00520-003-0486-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Accepted: 04/23/2003] [Indexed: 10/26/2022]
Abstract
Consecutive cancer referrals to a palliative medicine program were evaluated to assess nutritional status using a standard protocol. The study included 352 patients (180 men, 172 women; median age 61 years, range 22-94 years). The most common diagnosis was lung cancer. All had metastatic disease, 139 with gastrointestinal involvement. The most common gastrointestinal symptoms were weight loss ( n=307), anorexia ( n=285), and early satiety ( n=243). Of those with any weight loss, 71% had lost >or0% of their pre-illness weight. The most common factor identified which might have contributed to weight loss was hypophagia ( n=275/307). Men had lost weight more often and to a greater extent than women. Triceps skinfold (TSF) was measured in 337: 51% had values that suggested severe fat deficiency. Upper mid-arm muscle area (AMA) was measured in 349: 30% had evidence of significant muscle mass reduction. The body mass index (BMI) was normal or increased in most patients. Calculated resting energy expenditure (REE) ( n=324) was high in 41%. C-reactive protein was elevated in 74% of those measured ( n=50). We conclude that: (1).most of this group of cancer patients referred to palliative medicine had severe weight loss; (2).there was a gender difference in the severity and type of weight loss; (3).males lost more weight overall and more muscle than females; (4).males with any degree of weight loss had a higher REE than females; (5).a significant correlation existed between the time from diagnosis to death and the severity of weight loss in the prior month; (6).BMI was normal in most patients, suggesting precancer diagnosis obesity; and (7).both TSF and AMA correlated well with body composition of both fat and protein as determined by bioelectrical impedance.
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Affiliation(s)
- N Sarhill
- The Harry R Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
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Abstract
We conducted a prospective assessment of 50 consecutive admissions to an acute palliative medicine unit, using the bedside confusion scale (BSCS). Information including age, gender, diagnosis, and the presence or absence of brain metastasis was collected. Possible predisposing factors for delirium were recorded. Forty-one of 50 consecutive admissions were screened. There were 18 men and 23 women with a median age of 65 years (average: 60-75). The most common diagnoses among all were lung and breast cancer. Thirteen patients were delirious (BSCS score of > or = 2), 10 borderline (BSCS score = 1), and 21 normal (BSCS score = 0). Brain metastases and drugs appeared to be the most common predisposing factors of delirium. Forty percent of those that were delirious received haloperidol as symptomatic treatment. The BSCS is simple, portable, valid, quick, and easy to use by any medical team member. Delirium is common in hospitalized patients with advanced cancer.
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Affiliation(s)
- N Sarhill
- Harry R. Horvitz Center for Palliative Medicine (a World Health Organization Demonstration Project in Palliative Medicine), Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
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Abstract
Islam holds life as sacred and belonging to God and that all creatures will die one day. Suicide is forbidden. Muslims believe death is only a transition between two different lives. The terminally ill Muslim desires to perform five ritual requirements. Do not resuscitate (DNR) orders are acceptable. A deceased Muslim must always be buried after being ritually washed and wrapped. There are different Muslim schools of thought, but they are united regarding their views on death and dying.
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Affiliation(s)
- N Sarhill
- Department of Internal Medicine, St. Vincent Charity Hospital, Cleveland, Ohio, USA
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Sarhill N, Walsh D, Nelson KA, Homsi J, LeGrand S, Davis MP. Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. Am J Hosp Palliat Care 2001; 18:187-92. [PMID: 11406895 DOI: 10.1177/104990910101800310] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychostimulants such as methylphenidate are used for fatigue in cancer patients. We report a prospective, open-label, pilot study of the successful use of methylphenidate to treat fatigue in nine of 11 consecutive patients with advanced cancer. Seven had received radiation or chemotherapy, a median of three weeks (range from one to 30 weeks) prior to methylphenidate. A rapid onset of benefit was noted, even in the presence of mild anemia. Sedation and pain also improved in some. Only one patient had side effects severe enough to stop the medication.
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Affiliation(s)
- N Sarhill
- Harry R. Horvitz Center for Palliative Medicine, World Health Organization Demonstration Project in Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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