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Pakhomova TE, Nicholson V, Fischer M, Ferguson J, Moore DM, Salters K, Lester RT, Kremer H, Dawydiuk N, Barrios R, Parashar S. Exploring Primary Healthcare Experiences and Interest in Mobile Technology Engagement Amongst an Urban Population Experiencing Barriers to Care. Qual Health Res 2023:10497323231167829. [PMID: 37225177 DOI: 10.1177/10497323231167829] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Mobile phone-based engagement approaches provide potential platforms for improving access to primary healthcare (PHC) services for underserved populations. We held two focus groups (February 2020) with residents (n = 25) from a low-income urban neighbourhood (downtown Vancouver, Canada), to assess recent healthcare experiences and elicit interest in mobile phone-based healthcare engagement for underserved residents. Note-based analysis, guided by interpretative description, was used to explore emerging themes. Engagement in PHC was complicated by multiple, intersecting personal-level and socio-structural factors, and experiences of stigma and discrimination from care providers. Perceived inadequacy of PHC services and pervasive discrimination reported by participants indicate a significant and ongoing need to improve client-provider relationships to address unmet health needs. Mobile phone-based engagement was endorsed, highlighting phone ownership and client-provider text-messaging, facilitated by non-clinical staff such as peers, as helpful to strengthening retention and facilitating care team connection. Concerns raised included reliability, cost, and technology and language accessibility.
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Affiliation(s)
- Tatiana E Pakhomova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Matthew Fischer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Joanna Ferguson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Richard T Lester
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hayden Kremer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Nicole Dawydiuk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
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Closson K, Nicholson V, Lee M, McLinden T, Cassidy-Matthews C, G Card K, E Marziali M, Trigg J, Wang L, Parashar S, S G Montaner J, Gibbs A, Hart TA, Kaida A, Hogg RS. Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada. AIDS Care 2023; 35:296-305. [PMID: 36169492 DOI: 10.1080/09540121.2022.2126959] [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] [Indexed: 10/14/2022]
Abstract
Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007-2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0-3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07-1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Megan E Marziali
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Vorobyova A, Braley MS, Burgess H, Grieve S, Lyndon S, Wesseling T, Parashar S. Depressive symptoms among people living with HIV in permanent supportive housing: Findings from a community-based participatory study in Vancouver, Canada. J Community Psychol 2022; 50:3778-3791. [PMID: 35579573 DOI: 10.1002/jcop.22871] [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: 08/02/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
Permanent supportive housing (PSH) is an intervention addressing housing needs among marginally housed individuals. Little is known about whether and how PSH influences depressive symptoms among people living with HIV (PLHIV). This article shares results from a community-based study that, in 2016-2017, interviewed 24 residents of a PSH facility designated for PLHIV in Vancouver, Canada. The themes of taking control; social connectedness; conviviality; and relationships and supports described how the PSH environment affected depressive symptoms among the residents.
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Affiliation(s)
- Anna Vorobyova
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - McKenzie S Braley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Heather Burgess
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sean Grieve
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sharyle Lyndon
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tim Wesseling
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Surita Parashar
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Vorobyova A, Marante A, Cardinal C, Magagula P, Lyndon S, Braley M, Inglis K, Parashar S. Finding the Balance: Embracing the Two-Eyed Seeing Approach to Understand what Cultural Safety in Care Means to Older Adults Living with HIV. J Appl Gerontol 2022; 41:2063-2073. [PMID: 35582747 DOI: 10.1177/07334648221100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes-Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles-indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).
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Affiliation(s)
- Anna Vorobyova
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Antonio Marante
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Claudette Cardinal
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Patience Magagula
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Sharyle Lyndon
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - McKenzie Braley
- Department of Psychology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kathleen Inglis
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Surita Parashar
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Shroba J, Bandelier C, Pandya A, Parashar S, Portnoy J. P113 OUTCOMES OF PEANUT ORAL IMMUNOTHERAPY IN AN ALLERGY CLINIC. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.131] [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: 11/27/2022]
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Parashar S, Raje N. M077 A CASE OF AN ELEVATED TRYPTASE. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.238] [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: 11/15/2022]
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Burgess H, Jongbloed K, Vorobyova A, Grieve S, Lyndon S, Wesseling T, Salters K, Hogg RS, Parashar S, Pearce ME. The "Sticky Notes" Method: Adapting Interpretive Description Methodology for Team-Based Qualitative Analysis in Community-Based Participatory Research. Qual Health Res 2021; 31:1335-1344. [PMID: 33825561 DOI: 10.1177/10497323211002489] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Community-based participatory research (CBPR) has a long history within HIV research, yet little work has focused on facilitating team-based data analysis within CBPR. Our team adapted Thorne's interpretive description (ID) for CBPR analysis, using a color-coded "sticky notes" system to conduct data fragmentation and synthesis. Sticky notes were used to record, visualize, and communicate emerging insights over the course of 11 in-person participatory sessions. Data fragmentation strategies were employed in an iterative four-step process that was reached by consensus. During synthesis, the team created and recreated mind maps of the 969 sticky notes, from which we developed categories and themes through discussion. Flexibility, trust, and discussion were key components that facilitated the evolution of the final process. An interactive, team-based approach was central to data co-creation and capacity building, whereas the "sticky notes" system provided a framework for identifying and sorting data.
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Affiliation(s)
- Heather Burgess
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kate Jongbloed
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Vorobyova
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sean Grieve
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sharyle Lyndon
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tim Wesseling
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margo E Pearce
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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Salters KA, Parent S, Nicholson V, Wang L, Sereda P, Pakhomova TE, Kibel M, Chau W, Closson K, Parashar S, Barrios R, Montaner JSG, Hogg RS. The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada. BMC Public Health 2021; 21:680. [PMID: 33832472 PMCID: PMC8028792 DOI: 10.1186/s12889-021-10714-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. This study aims to illuminate persistent threats to the health and longevity of under-served PLWH in British Columbia (BC), Canada. Methods Between 2007 and 2010, 1000 PLWH across BC were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study and completed a cross-sectional survey on their HIV-care experiences and healthcare engagement. The sample generally reflects an under-served population of PLWH. A linkage to the provincial Vital Statistics registry is used in this analysis in order to examine overall mortality and cause-specific mortality trends; probability of death was modeled using logistic regression for participants with ongoing clinical monitoring (n = 910). Results By June 2017, 208 (20.8%) participants had died. The majority of deaths 57 (27.4%) were attributed to drug-related complications or overdoses, 39 (18.8%) were attributed to HIV-related complications, and 36 (17.3%) to non-AIDS-defining malignancies. We observed elevated odds of death among PLWH who smoked tobacco (aOR: 2.11, 95% CI: 1.38, 3.23), were older (aOR: 1.06 per one-year increase, 95% CI: 1.04, 1.08), indicated heavy alcohol consumption (aOR: 1.57, 95% CI: 1.11, 2.22), and reported unstable housing (aOR: 1.96, 95% CI: 1.37, 2.80); while higher CD4 cell count was protective (aOR: 0.87 per 100-unit increase, 95% CI: 0.79, 0.94) as was male gender), though non-significant (aOR: 0.73, 95% CI: 0.49, 1.07). Conclusions Overdose is - the leading cause of mortality among a cohort of under-served PLWH in BC, Canada. Public health efforts to end the HIV epidemic and support the health and well-being of PLWH are being thwarted by persistent health inequities and the enormous and persistent risks facing people who use drugs. Integrated low-barrier primary care is essential for supporting under-served PLWH, and safe drug supply is needed to support PLWH who use drugs.
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Affiliation(s)
- Kate A Salters
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Stephanie Parent
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Tatiana E Pakhomova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Mia Kibel
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - William Chau
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health University of British Columbia, Vancouver, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Marziali ME, McLinden T, Card KG, Closson K, Wang L, Trigg J, Salters K, Lima VD, Parashar S, Hogg RS. Social Isolation and Mortality Among People Living with HIV in British Columbia, Canada. AIDS Behav 2021; 25:377-388. [PMID: 32797358 PMCID: PMC7427496 DOI: 10.1007/s10461-020-03000-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Social isolation, a risk factor for poor health within the general population, may be exacerbated by unique challenges faced by people living with HIV (PLHIV). This analysis examines the association between social isolation and all-cause mortality among a cohort of PLHIV experiencing multiple social vulnerabilities. The analytical sample included 936 PLHIV ≥ 19 years, living in British Columbia, Canada, and enrolled in the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010). Participants were classified as Socially Connected (SC), Minimally Isolated (MI) or Socially Isolated (SI) via latent class analysis. Cross-sectional survey data was linked to longitudinal clinical data from a provincial HIV treatment database. Mortality was assessed longitudinally up to and including December 31st, 2017. Through multivariable logistic regression, an association between SI and all-cause mortality was found (adjusted OR: 1.48; 95% CI 1.08, 2.01). These findings emphasize the need to mitigate effects of social isolation among PLHIV.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kiffer G Card
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kalysha Closson
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jason Trigg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D Lima
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Koehn K, Burgess H, Lyndon S, Lu M, Ye M, Hogg RS, Parashar S, Barrios R, Salters KA. Characteristics of older adults living with HIV accessing home and community care services in British Columbia, Canada. AIDS Care 2020; 33:121-130. [PMID: 32476454 DOI: 10.1080/09540121.2020.1770673] [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] [Indexed: 10/24/2022]
Abstract
Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n = 503) and rehabilitation (7.73%, n = 433). Those who received HCC were more likely to be female (aOR = 1.56, 95% CI = 1.24, 1.98), have a history of injection drug use (aOR = 1.88, 95% CI = 1.57, 2.25), have a higher Charlson comorbidity score (aOR = 1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR = 2.17, 95% CI = 1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.
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Affiliation(s)
- Katrina Koehn
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | | | - Michelle Lu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Monica Ye
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Vancouver Coastal Health Authority, Vancouver, Canada
| | - Kate A Salters
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Marziali ME, Card KG, McLinden T, Closson K, Wang L, Trigg J, Salters K, Lima VD, Parashar S, Hogg RS. Correlates of social isolation among people living with HIV in British Columbia, Canada. AIDS Care 2020; 33:566-574. [PMID: 32342701 DOI: 10.1080/09540121.2020.1757607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/12/2022]
Abstract
Our study aims to define and identify correlates of social isolation among people living with HIV (PLHIV). The Longitudinal Investigation into Supportive and Ancillary health services (LISA) study provided a cross-sectional analytic sample of 996 PLHIV in British Columbia, Canada (sampled between 2007 and 2010). Individuals marginalized by socio-structural inequities were oversampled; sampling bias was addressed through inverse probability of participation weighting. Through latent class analysis, three groups were identified: Socially Connected (SC) (n = 364, 37%), Minimally Isolated (MI) (n = 540, 54%) and Socially Isolated (SI) (n = 92, 9%). Correlates of the SI and MI classes, determined through multivariable multinomial regression using the SC class as a reference, include: recent violence (aOR 1.61, 95%CI 1.28-2.02 [MI vs. SC]; aOR 2.04, 95%CI 1.41-2.96 [SI vs. SC]) and a mental health diagnosis (aOR 1.50, 95% CI 1.31-1.72 [MI vs. SC]; aOR 1.43, 95%CI 1.11-1.83 [SI vs. SC]). Women (aOR 0.47; 95%CI 0.32-0.68 [SI vs. SC]), individuals of Indigenous ancestry (aOR 0.59; 95%CI 0.40-0.87 [SI vs. SC]) and people identifying as gay or lesbian (aOR 0.37; 95%CI 0.26-0.52 [SI vs. SC]) were less likely to experience isolation. These findings highlight the importance of supporting communities fostering connectedness and identifies populations susceptible to isolation.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D Lima
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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12
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Allan B, Closson K, Collins AB, Kibel M, Pan S, Cui Z, McLinden T, Parashar S, Lima VD, Chia J, Yip B, Barrios R, Montaner JSG, Hogg RS. Physicians' patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting. BMJ Open 2019; 9:e023957. [PMID: 30898806 PMCID: PMC6475242 DOI: 10.1136/bmjopen-2018-023957] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the impact of physicians' patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada. DESIGN Observational cohort study from 1 January 2000 to 31 December 2013. SETTING BC Centre for Excellence in HIV/AIDS' (BC-CfE) Drug Treatment Program, where HAART is available at no cost. PARTICIPANTS PLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study. OUTCOME MEASURES All-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency. STATISTICAL ANALYSIS We examined the relationships between patient characteristics, physicians' patient base composition, the location of the practice, and physicians' experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models. RESULTS A total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34-49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23-170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004-2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000-2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians' patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03-1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality. CONCLUSIONS Our findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians' patient bases and survival.
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Affiliation(s)
- Beverly Allan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Mia Kibel
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shenyi Pan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Taylor McLinden
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Viviane Dias Lima
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Chia
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Benita Yip
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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13
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Kesselring S, Osborne C, Bever A, Salters K, Cui Z, Chia J, Moore DM, Parashar S, Kaida A, Samji H, Duddy J, Gabler K, Howard T, Nash D, McCandless LC, Patterson TL, Corneil T, Montaner JSG, Hogg RS. Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study. AIDS Care 2018; 31:885-892. [PMID: 30466303 DOI: 10.1080/09540121.2018.1549722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. 'Late initiation' was defined as CD4 cell count ≤500 cells/µL at ART initiation and 'delayed initiation' as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR]: 1.06 per year, 95% confidence interval [95% CI]: 1.01-1.12) and inversely associated with wanting to start ART at diagnosis (AOR: 0.06, 95% CI: 0.02-0.21). Variables associated with late initiation were older age (AOR: 1.09 per year, 95% CI: 1.03-1.15) and medical reason(s) for initiation (AOR: 5.00, 95% CI: 1.41-17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI: 0.90-0.98) and history of incarceration (AOR: 0.12, 95% CI: 0.03-0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.
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Affiliation(s)
- Sarah Kesselring
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Charles Osborne
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Andrea Bever
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Kate Salters
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Zishan Cui
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Jason Chia
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - David M Moore
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Surita Parashar
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Angela Kaida
- c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Hasina Samji
- c Simon Fraser University , Burnaby , British Columbia , Canada.,d British Columbia Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Janice Duddy
- e Pacific AIDS Network , Vancouver , British Columbia , Canada
| | - Karyn Gabler
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Terry Howard
- f Engage Study Knowledge User , Vancouver , British Columbia , Canada
| | - Denis Nash
- g City University of New York School of Public Health , New York , NY , USA.,h City University of New York Institute for Implementation Science in Population Health , New York , NY , USA
| | | | | | - Trevor Corneil
- j Interior Health Authority , Kelowna , British Columbia , Canada
| | - Julio S G Montaner
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Robert S Hogg
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
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14
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Closson K, Palmer AK, Collins AB, Salters K, Zhang W, Montaner JSG, Hogg RS, Parashar S. Factors associated with low neighborhood cohesion among women living with HIV impacted by social-structural inequities in British Columbia. AIDS Care 2017; 30:318-324. [PMID: 28814104 DOI: 10.1080/09540121.2017.1363368] [Citation(s) in RCA: 2] [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: 10/19/2022]
Abstract
Built and social environments, including one's perception of their environment, are important determinants of health. The intersection of gender and HIV status may complicate the role of neighborhood cohesion in safety, personal well-being, and health outcomes for populations impacted by social and structural inequities. Among women in particular, social cohesion within the neighborhood they reside in may have a greater influence on health outcomes compared to their male counterparts. We sought to examine perception of neighborhood cohesion (validated scale with a range 0-100, with higher scores indicating higher perceived neighborhood cohesion) among women living with HIV, impacted by social-structural inequities, receiving combination antiretroviral therapy, and enrolled in the Longitudinal Investigations into Supportive Ancillary health services (LISA) study in British Columbia, Canada. Cross-sectional data on neighborhood cohesion and socio-demographic data were collected in an interviewer-administered survey. Of the 1,000 LISA participants interviewed, 908 (including 249 women and 659 men) had complete data for the variables of interest. At the bivariate level, women had worse perceived neighborhood cohesion scores compared to men (median: 56 [95% CI: 44-66] vs. 60 [95% CI: 47-71]). Multivariable model results indicated that for women living with HIV in our sample, greater neighborhood cohesion scores were positively associated with stable housing (β coefficient = 7.85; 95% CI: 3.61, 12.10, p < 0.001), and negatively associated with greater perceived HIV stigma (β coefficient = -1.19; 95% CI: -2.24 to-0.15; p = 0.025). The results illustrate the gendered nature of experiencing built and social environments, and highlight the need for women-centred interventions to address the social determinants of HIV burden associated with negative perceptions of neighborhood cohesion.
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Affiliation(s)
- Kalysha Closson
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Alexis K Palmer
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada
| | - Alexandra B Collins
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Kate Salters
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Wendy Zhang
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada
| | - Julio S G Montaner
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,c Division of AIDS , University of British Columbia , Vancouver , BC , Canada
| | - Robert S Hogg
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Surita Parashar
- a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
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15
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Ti L, Dong H, Kerr T, Turje RB, Parashar S, Min JE, Montaner J, Wood E, Milloy MJ. The effect of engagement in an HIV/AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis. HIV Med 2017; 18:580-586. [PMID: 28317290 DOI: 10.1111/hiv.12493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load (VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre (DPC; an HIV/AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy (HAART)-exposed HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. METHODS Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma. RESULTS Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients. CONCLUSIONS Our findings demonstrate that participating in an innovative HIV/AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
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Affiliation(s)
- L Ti
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Dong
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - T Kerr
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R B Turje
- Dr. Peter AIDS Foundation, Vancouver, BC, Canada
| | - S Parashar
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J E Min
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J Montaner
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - E Wood
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Lake S, Kerr T, Buxton J, Guillemi S, Parashar S, Montaner J, Wood E, Milloy MJ. Prescription Opioid Injection Among HIV-Positive People Who Inject Drugs in a Canadian Setting. AIDS Behav 2016; 20:2941-2949. [PMID: 27146887 DOI: 10.1007/s10461-016-1369-y] [Citation(s) in RCA: 6] [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] [Indexed: 11/26/2022]
Abstract
Prescription opioids (POs) are commonly prescribed to patients living with HIV/AIDS, while the illicit use of POs remains a major public health concern throughout Canada and the United States. We sought to identify the prevalence and correlates of PO injection among HIV-positive people who inject drugs (PWID) in Vancouver, Canada, where HIV/AIDS treatment and care is offered at no cost. We examined data from 634 individuals from an ongoing prospective cohort of HIV-positive PWID. Between December 2005 and November 2013, the median prevalence of recent PO injection was 24.2 % [interquartile range (IQR): 21.5-25.8 %]. In a multivariable generalized estimating equation model, Caucasian ethnicity, heroin injection, and drug dealing were positively associated with PO injection, while older age and methadone maintenance treatment were negatively associated with PO injection (all p < 0.05). Engagement on antiretroviral therapy was inversely associated with PO injection in a bivariable analysis, but did not remain significant after adjusting for heroin injection. These findings describe a particularly vulnerable sub-group of PWID who may benefit from targeted efforts to both minimize drug-related risk behaviors and support HIV/AIDS treatment.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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17
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Fernando S, McNeil R, Closson K, Samji H, Kirkland S, Strike C, Turje RB, Zhang W, Hogg RS, Parashar S. An integrated approach to care attracts people living with HIV who use illicit drugs in an urban centre with a concentrated HIV epidemic. Harm Reduct J 2016; 13:31. [PMID: 27876048 PMCID: PMC5120539 DOI: 10.1186/s12954-016-0121-2] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background People living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Methods Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use. Results Of the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15). Conclusions Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond.
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Affiliation(s)
- S Fernando
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - R McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - K Closson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - H Samji
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - C Strike
- University of Toronto, Toronto, Canada
| | | | - W Zhang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - S Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Science, Simon Fraser University, Burnaby, Canada.
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18
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Affiliation(s)
- Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Cathy Puskas
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Surita Parashar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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19
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Collins AB, Strike C, Guta A, Baltzer Turje R, McDougall P, Parashar S, McNeil R. "We're giving you something so we get something in return": Perspectives on research participation and compensation among people living with HIV who use drugs. Int J Drug Policy 2016; 39:92-98. [PMID: 27780116 DOI: 10.1016/j.drugpo.2016.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 02/22/2016] [Revised: 06/11/2016] [Accepted: 09/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Compensation for participating in research has been a fundamental element of the research apparatus despite concerns about its impact on incentivising participation. Researchers and research ethics boards acknowledge that compensation may prompt structurally vulnerable populations, such as people who use drugs (PWUD), to engage in research primarily out of financial need. Thus, institutional restrictions around compensation have been implemented. This study explores the ethical implications of compensation practices aimed at 'protecting' structurally vulnerable people living with HIV (PLHIV) who use drugs within the context of individuals' lived realities. METHODS We draw on five focus groups conducted in 2011 with 25 PLHIV who use drugs and access a community-based HIV care facility in Vancouver, Canada. This analysis focused on participants' perceptions of research compensation, which became the central point of discussion in each group. RESULTS Participants viewed research as a transactional process through which they could challenge the underpinnings of bioethics and bargain for compensation. Research compensation was thus critical to attracting participants and positioned as a 'legitimate' form of income. Participants' medicalised identities, specifically living with HIV, were fundamental to justifying compensation. The type of compensation (e.g. gift card, cash) also significantly impacted whether participants were fully compensated and, at times, served to exacerbate their structural vulnerability. CONCLUSION Research compensation is critical in shaping structurally vulnerable populations' participation and experiences with research and can further marginalize individuals. Practices surrounding research compensation, particularly for drug-using and HIV-positive populations, need to be evaluated to ensure participants are equitably compensated for the expertise they provide.
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Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | | | | | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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20
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Closson K, McNeil R, McDougall P, Fernando S, Collins AB, Baltzer Turje R, Howard T, Parashar S. Meaningful engagement of people living with HIV who use drugs: methodology for the design of a Peer Research Associate (PRA) hiring model. Harm Reduct J 2016; 13:26. [PMID: 27717364 PMCID: PMC5054577 DOI: 10.1186/s12954-016-0116-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Community-based HIV, harm reduction, and addiction research increasingly involve members of affected communities as Peer Research Associates (PRAs)—individuals with common experiences to the participant population (e.g. people who use drugs, people living with HIV [PLHIV]). However, there is a paucity of literature detailing the operationalization of PRA hiring and thus limited understanding regarding how affected communities can be meaningfully involved through low-barrier engagement in paid positions within community-based participatory research (CBPR) projects. We aim to address this gap by describing a low-threshold PRA hiring process. Results In 2012, the BC Centre for Excellence in HIV/AIDS and the Dr. Peter AIDS Foundation collaborated to develop a mixed-method CBPR project evaluating the effectiveness of the Dr. Peter Centre (DPC)—an integrative HIV care facility in Vancouver, Canada. A primary objective of the study was to assess the impact of DPC services among clients who have a history of illicit drug use. In keeping with CBPR principles, affected populations, community-based organizations, and key stakeholders guided the development and dissemination of a low-barrier PRA hiring process to meaningfully engage affected communities (e.g. PLHIV who have a history of illicit drug use) in all aspects of the research project. The hiring model was implemented in a number of stages, including (1) the establishment of a hiring team; (2) the development and dissemination of the job posting; (3) interviewing applicants; and (4) the selection of participants. The hiring model presented in this paper demonstrates the benefits of hiring vulnerable PLHIV who use drugs as PRAs in community-based research. Conclusions The provision of low-barrier access to meaningful research employment described herein attempts to engage affected communities beyond tokenistic involvement in research. Our hiring model was successful at engaging five PRAs over a 2-year period and fostered opportunities for future paid employment or volunteer opportunities through ongoing collaboration between PRAs and a diverse range of stakeholders working in HIV/AIDS and addictions. Additionally, this model has the potential to be used across a range of studies and community-based settings interested in meaningfully engaging communities in all stages of the research process. Electronic supplementary material The online version of this article (doi:10.1186/s12954-016-0116-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - R McNeil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - P McDougall
- Dr. Peter AIDS Foundation, Vancouver, Canada
| | - S Fernando
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - A B Collins
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - T Howard
- Positive living society and the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - S Parashar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Salters KA, Irick M, Anema A, Zhang W, Parashar S, Patterson TL, Chen Y, Somers J, Montaner JSG, Hogg RS. Harder-to-reach people living with HIV experiencing high prevalence of all-type mental health disorder diagnosis. AIDS Care 2016; 29:696-704. [PMID: 27609532 DOI: 10.1080/09540121.2016.1227763] [Citation(s) in RCA: 6] [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: 10/21/2022]
Abstract
People living with HIV/AIDS (PHA) often concurrently cope with mental health disorders that may greatly influence HIV and other health-related outcomes. The objective of this study was to examine the prevalence and correlates of self-reported mental health disorder diagnosis among a cohort of harder-to-reach HIV-positive individuals in British Columbia, Canada. Between 2007 and 2010, 1000 PHA who had initiated ART were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study. Socio-demographic, behavioral, health-care utilization and psychosocial information was collected through interviewer-led questionnaires and linked to longitudinal clinical variables through the provincial Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. We identified the prevalence of all-type and specific mental health disorders among this population. Of the 916 participants included in this analysis, 494 (54%) reported ever having a mental health disorder diagnosis. Mood (85%) and anxiety (65%) disorders were the two most frequently reported mental health conditions. Self-reported all-type mental health disorder was independently associated with decreased overall functioning (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] = 0.83-0.98) and life satisfaction (AOR = 0.81, 95% CI = 0.74-0.89), and having higher stigma score (AOR = 1.11, 95%CI = 1.02-1.21). Participants reporting any mental health disorder were more likely to report a history of sexual assault (AOR = 2.45, 95% CI = 1.75-3.43) and to have used case management services (AOR = 1.63, 95%CI = 1.17-2.27). Our findings uncovered a high burden of mental health disorders among harder-to-reach PHA and suggest that PHA with at least one mental health disorder diagnosis are disproportionately impacted by sexual violence and stigma.
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Affiliation(s)
- Kate A Salters
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Marina Irick
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada
| | - Aranka Anema
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada
| | - Wendy Zhang
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada
| | - Surita Parashar
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Thomas L Patterson
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,c Department of Psychiatry , University of California, San Diego , La Jolla , CA , USA
| | - Yalin Chen
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada
| | - Julian Somers
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Julio S G Montaner
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,d Department of Medicine, Faculty of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Robert S Hogg
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
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Parashar S, Collins AB, Montaner JSG, Hogg RS, Milloy MJ. Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs. Curr Opin HIV AIDS 2016; 11:507-513. [PMID: 27254749 PMCID: PMC5055433 DOI: 10.1097/coh.0000000000000297] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. RECENT FINDINGS The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social-structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. SUMMARY The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.
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Affiliation(s)
- Surita Parashar
- aBritish Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, VancouverbFaculty of Health Sciences, Simon Fraser University, BurnabycDepartment of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Collins AB, Parashar S, Closson K, Turje RB, Strike C, McNeil R. Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study. Health Place 2016; 40:169-77. [PMID: 27341275 DOI: 10.1016/j.healthplace.2016.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/20/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022]
Abstract
This study examines the influence of territorial stigma on access to HIV care and other support services. Qualitative interviews were conducted with thirty people living with HIV (PLHIV) who use drugs recruited from the Dr. Peter Centre (DPC), an HIV care facility located in Vancouver, Canada's West End neighbourhood that operates under a harm reduction approach. Findings demonstrated that territorial stigma can undermine access to critical support services and resources in spatially stigmatized neighbourhoods among PLHIV who use drugs who have relocated elsewhere. Furthermore, PLHIV moving from spatially stigmatized neighbourhoods - in this case, Vancouver's Downtown Eastside - to access HIV care services experienced tension with different groups at the DPC (e.g., men who have sex with me, people who use drugs), as these groups sought to define who constituted a'normative' client. Collectively, these findings demonstrate the urgent need to consider the siting of HIV care services as the epidemic evolves.
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Affiliation(s)
| | | | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Loh J, Kennedy MC, Wood E, Kerr T, Marshall B, Parashar S, Montaner J, Milloy MJ. Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting. AIDS Care 2016; 28:1448-54. [PMID: 27248328 DOI: 10.1080/09540121.2016.1189498] [Citation(s) in RCA: 6] [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: 10/21/2022]
Abstract
Homelessness is common among people who use drugs (PWUD) and, for those living with HIV/AIDS, an important contributor to sub-optimal HIV treatment outcomes. This study aims to investigate the relationship between the duration of homelessness and the likelihood of plasma HIV-1 RNA viral load (VL) non-detectability among a cohort of HIV-positive PWUD. We used data from the ACCESS study, a long-running prospective cohort study of HIV-positive PWUD linked to comprehensive HIV clinical records including systematic plasma HIV-1 RNA VL monitoring. We estimated the longitudinal relationship between the duration of homelessness and the likelihood of exhibiting a non-detectable VL (i.e., <500 copies/mL plasma) using generalized linear mixed-effects modelling. Between May 1996 and June 2014, 922 highly active antiretroviral therapy-exposed participants were recruited and contributed 8188 observations. Of these, 4800 (59%) were characterized by non-detectable VL. Participants reported they were homeless in 910 (11%) interviews (median: six months, interquartile range: 6-12 months). A longer duration of homelessness was associated with lower odds of VL non-detectability (adjusted odds ratio = 0.71 per six-month period of homelessness, 95% confidence interval: 0.60-0.83) after adjustment for age, ancestry, drug use patterns, engagement in addiction treatment, and other potential confounders. Longer durations of episodes of homelessness in this cohort of HIV-positive illicit drug users were associated with a lower likelihood of plasma VL non-detectability. Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS.
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Affiliation(s)
- Jane Loh
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Mary Clare Kennedy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Brandon Marshall
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Surita Parashar
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Julio Montaner
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - M-J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
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Parashar S. At home in the margins. Med Anthropol Theory 2016; 3:122-135. [PMID: 28191508 PMCID: PMC5298921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This photo essay explores what constitutes 'home' for people living with HIV in Vancouver's Downtown Eastside. It is a collaboration between myself and eight community researchers - four women and four men - who are living with HIV and have experienced significant periods of homelessness in this context. Over the course of four weeks in 2011, the community researchers were trained in Photovoice methods and took photographs of their homes and neighbourhoods using disposable film cameras.
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Marshall BD, Elston B, Dobrer S, Parashar S, Hogg RS, Montaner JS, Kerr T, Wood E, Milloy MJ. The population impact of eliminating homelessness on HIV viral suppression among people who use drugs. AIDS 2016; 30:933-42. [PMID: 26636924 DOI: 10.1097/qad.0000000000000990] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to estimate the change in viral suppression prevalence if homelessness were eliminated from a population of HIV-infected people who use drugs. DESIGN Community-recruited prospective cohort of HIV-infected people who use drugs in Vancouver, Canada. Behavioural information was collected at baseline and linked to a province-wide HIV/AIDS treatment database. The primary outcome was viral suppression (<50 copies/ml) measured during subsequent routine clinical care. METHODS We employed an imputation-based marginal modelling approach. First, we used modified Poisson regression to estimate the relationship between homelessness and viral suppression (adjusting for sociodemographics, substance use, addiction treatment, and other confounders). Then, we imputed an outcome probability for each individual while manipulating the exposure (homelessness). Population viral suppression prevalence under realized and 'housed' scenarios were obtained by averaging these probabilities across the study population. Bootstrapping was conducted to calculate 95% confidence limits. RESULTS Of 706 individuals interviewed between January 2005 and December 2013, the majority were men (66.0%), of white race/ethnicity (55.1%), and had a history of injection drug use (93.6%). At first study visit, 223 (31.6%) reported recent homelessness, and 37.8% were subsequently identified as virally suppressed. Adjusted marginal models estimated a 15.1% relative increase [95% confidence interval (CI) 9.0-21.7%) in viral suppression in the entire population - to 43.5% (95% CI 39.4-48.2%) - if all homeless individuals were housed. Among those homeless, eliminating this exposure would increase viral suppression from 22.0 to 40.1% (95% CI 35.1-46.1%), an 82.3% relative increase. CONCLUSION Interventions to house homeless, HIV-positive individuals who use drugs could significantly increase population viral suppression. Such interventions should be implemented as a part of renewed HIV/AIDS prevention and treatment efforts.
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Lee PC, Dietsche L, Dooley J, Parashar S. Improving Film Die Flow Uniformity Using Optimization Methods Coupled with Finite Element Computational Fluid Dynamics (CFD) Analysis. INT POLYM PROC 2015. [DOI: 10.3139/217.2887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The aim of this study was to evaluate various optimization strategies to be used with computational fluid dynamics (CFD), in order to optimize the geometry for a polymer die to meet the dual objectives of uniform flow at the exit with minimal pressure drop. 3D finite element simulations using the numerically optimized geometry predict a more uniform flow than simulations using the baseline geometry. However, some of the initial optimized results yielded die geometries that would be impractical to fabricate. Additional constraints were placed on the allowable geometric parameters and solution space to push the optimization towards more feasible optimal solutions. Thus we have shown how CFD-based optimization methods, coupled with knowledge of die design technology and fabrication techniques can lead to the design of better performing polymer dies.
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Affiliation(s)
- P. C. Lee
- School of Engineering , University of Vermont, Burlington, VT , USA
| | - L. Dietsche
- The Dow Chemical Company , Midland, MI , USA
| | - J. Dooley
- The Dow Chemical Company , Midland, MI , USA
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Richardson LA, Milloy MJS, Kerr TH, Parashar S, Montaner JSG, Wood E. Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care. J Epidemiol Community Health 2013; 68:93-6. [PMID: 24153247 DOI: 10.1136/jech-2013-202918] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs in Vancouver, Canada. METHODS Data were derived from a prospective cohort study of HIV seropositive people who use illicit drugs (n=666) during the period of May 1996-June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and socioeconomic factors. RESULTS In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared with no employment was significantly associated with a lower risk of death (adjusted HR=0.44, 95% CI 0.22 to 0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, plasma viral load and baseline CD4 T-cell count. CONCLUSIONS These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment and persistently elevated levels of preventable mortality among this highly marginalised population.
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Affiliation(s)
- Lindsey A Richardson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, , Vancouver, Canada
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Parashar S, Chan K, Milan D, Grafstein E, Palmer AK, Rhodes C, Montaner JSG, Hogg RS. The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting. AIDS Care 2013; 26:53-64. [PMID: 23656484 DOI: 10.1080/09540121.2013.793281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The social-structural challenges experienced by people living with HIV (PHA) have been shown to contribute to increased use of the emergency department (ED). This study identified factors associated with frequent and nonurgent ED use within a cohort of people accessing antiretroviral therapy (ART) in a Canadian setting. Interviewer-administered surveys collected socio-demographic information; clinical variables were obtained through linkages with the provincial drug treatment registry; and ED admission data were abstracted from the Department of Emergency Medicine database. Multivariate logistic regression was used to compute odds of frequent and nonurgent ED use. Unstable housing was independently associated with ED use (adjusted odds ratio [AOR] =1.94, 95% confidence interval [CI] 1.24-3.04]), having three or more ED visits within 6 months of the interview date [AOR: 2.03 (95% CI: 1.07-3.83)] and being triaged as nonurgent (AOR = 2.71, 95% CI: 1.19-6.17). Frequent and nonurgent use of the ED in this setting is associated with conditions requiring interventions at the social-structural level. Supportive housing may contribute to decreased health-care costs and improved health outcomes amongst marginalized PHA.
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Affiliation(s)
- Surita Parashar
- a BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada
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Duncan KC, Salters K, Forrest JI, Palmer AK, Wang H, O'Brien N, Parashar S, Cescon AM, Samji H, Montaner JS, Hogg RS. Cohort Profile: Longitudinal Investigations into Supportive and Ancillary health services. Int J Epidemiol 2012; 42:947-55. [PMID: 22461127 DOI: 10.1093/ije/dys035] [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: 12/12/2022] Open
Abstract
The Longitudinal Investigations into Supportive and Ancillary health services (LISA) study is a cohort of people living with HIV/AIDS who have ever accessed anti-retroviral therapy (ART) in British Columbia, Canada. The LISA study was developed to better understand the outcomes of people living with HIV with respect to supportive services use, socio-demographic factors and quality of life. Between July 2007 and January 2010, 1000 participants completed an interviewer-administered questionnaire that included questions concerning medical history, substance use, social and medical support services, food and housing security and other social determinants of health characteristics. Of the 1000 participants, 917 were successfully linked to longitudinal clinical data through the provincial Drug Treatment Program. Within the LISA cohort, 27% of the participants are female, the median age is 39 years and 32% identify as Aboriginal. Knowledge translation activities for LISA include the creation of plain language summaries, internet resources and arts-based engagement activities such as Photovoice.
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Affiliation(s)
- Katrina C Duncan
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Milloy MJ, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, Montaner J, Wood E. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS 2012; 26:60-7. [PMID: 22107040 DOI: 10.1089/apc.2011.0169] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite the advent of effective antiretroviral therapy (ART), HIV-seropositive injection drug users (IDU) continue to suffer from elevated levels of morbidity and mortality. Evidence is needed to identify social- and structural-level barriers to effective ART. We investigated the impact of homelessness on plasma HIV RNA response among illicit drug users initiating ART in a setting with free and universal access to HIV care. We accessed data from a long-running prospective cohort of community-recruited IDU linked to comprehensive HIV clinical monitoring and ART dispensation records. Using Cox proportional hazards with recurrent events modeling, we estimated the independent effect of homelessness on time to plasma HIV viral load suppression. Between May 1996 and September 2009, 247 antiretroviral naïve individuals initiated ART and contributed 1755 person-years of follow-up. Among these individuals, the incidence density of plasma HIV RNA suppression less than 500 copies/mm(3) was 56.7 (95% confidence interval [CI]: 46.9-66.0) per 100 person-years. In unadjusted analyses, homelessness was strongly associated with lower rates suppression (hazard ratio = 0.56, 95% CI: 0.40-0.78, p = 0.001), however, after adjustment for adherence this association was no longer significant (adjusted hazard ratio = 0.79, 95% CI: 0.56-1.11, p = 0.177). Homelessness poses a significant structural barrier to effective HIV treatment. However, since this relationship appears to be mediated by lower levels of ART adherence, interventions to improve adherence among members of this vulnerable population are needed.
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Affiliation(s)
- M.-J. Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - David R. Bangsberg
- Massachusetts General Hospital Centre for Global Health, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
- British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
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Parashar S, Palmer AK, O'Brien N, Chan K, Shen A, Coulter S, Montaner JSG, Hogg RS. Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among individuals living with HIV who are unstably housed. AIDS Behav 2011; 15:1612-22. [PMID: 21850442 PMCID: PMC5291740 DOI: 10.1007/s10461-011-0026-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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: 02/06/2023]
Abstract
Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72-13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.
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Affiliation(s)
- Surita Parashar
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
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Parashar S, Palmer A, O'Brien N, Chan K, Milan D, Samji H, Montaner J, Hogg R. O2-S5.03 Sex, drugs and structural interventions: unstable housing associated with increased HIV risk behaviour in a cohort of people on treatment in British Columbia, Canada. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.93] [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: 11/04/2022]
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Parashar S, Palmer A, O'Brien N, Chan K, Shen A, Coulter S, Montaner J, Hogg R. P5-S4.06 Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among a cohort of unstably housed people living with HIV in BC, Canada. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.547] [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: 11/04/2022]
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Krantz DS, Whittaker KS, Francis JL, Rutledge T, Johnson BD, Barrow G, McClure C, Sheps DS, York K, Cornell C, Bittner V, Vaccarino V, Eteiba W, Parashar S, Vido DA, Merz CNB. Psychotropic medication use and risk of adverse cardiovascular events in women with suspected coronary artery disease: outcomes from the Women's Ischemia Syndrome Evaluation (WISE) study. Heart 2009; 95:1901-6. [PMID: 19666461 DOI: 10.1136/hrt.2009.176040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study investigated the relation between psychotropic medication use and adverse cardiovascular (CV) events in women with symptoms of myocardial ischaemia undergoing coronary angiography. METHOD Women enrolled in the Women's Ischemia Syndrome Evaluation (WISE) were classified into one of four groups according to their reported antidepressant and anxiolytic medication usage at study intake: (1) no medication (n = 352); (2) anxiolytics only (n = 67); (3) antidepressants only (n = 58); and (4) combined antidepressant and anxiolytics (n = 39). Participants were followed prospectively for the development of adverse CV events (for example, hospitalisations for non-fatal myocardial infarction, stroke, congestive heart failure and unstable angina) or all-cause mortality over a median of 5.9 years. RESULTS Use of antidepressant medication was associated with subsequent CV events (HR 2.16, 95% CI 1.21 to 3.93) and death (HR 2.15, 95% CI 1.16 to 3.98) but baseline anxiolytic use alone did not predict subsequent CV events and death. In a final regression model that included demographics, depression and anxiety symptoms, and risk factors for cardiovascular disease, women in the combined medication group (that is, antidepressants and anxiolytics) had higher risk for CV events (HR 3.98, CI 1.74 to 9.10, p = 0.001 and all-cause mortality (HR 4.70, CI 1.7 to 2.97, p = 0.003) compared to those using neither medication. Kaplan-Meier survival curves indicated that there was a significant difference in mortality among the four medication groups (p = 0.001). CONCLUSIONS These data suggest that factors related to psychotropic medication such as depression refractory to treatment, or medication use itself, are associated with adverse CV events in women with suspected myocardial ischaemia.
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Affiliation(s)
- D S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Champney KP, Frederick PD, Bueno H, Parashar S, Foody J, Merz CNB, Canto JG, Lichtman JH, Vaccarino V. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart 2009; 95:895-9. [PMID: 19147625 DOI: 10.1136/hrt.2008.155804] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Younger, but not older, women have a higher mortality than men of similar age after a myocardial infarction (MI). We sought to determine whether this relationship is true for both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI). DESIGN Retrospective cohort study. SETTING 1057 USA hospitals participant in the National Registry of Myocardial Infarction between 2000 and 2006. PATIENTS 126 172 STEMI and 235 257 NSTEMI patients. MAIN OUTCOME MEASURE Hospital death. RESULTS For both STEMI and NSTEMI, the younger the patient's age, the greater the excess mortality risk for women compared with men, while older women fared similarly (STEMI) or better (NSTEMI) than men (p<0.0001 for the age-sex interaction). In STEMI, the unadjusted women-to-men RR was 1.68 (95% CI 1.41 to 2.01), 1.78 (1.59 to 1.99), 1.45 (1.34 to 1.57), 1.08 (1.02 to 1.14) and 1.03 (0.98 to 1.07) for age <50 years, age 50-59, age 60-69, age 70-79 and age 80-89, respectively. For NSTEMI, corresponding unadjusted RRs were 1.56 (1.31 to 1.85), 1.42 (1.27 to 1.58), 1.17 (1.09 to 1.25), 0.92 (0.88 to 0.96) and 0.86 (0.83 to 0.89). After adjusting for risk status, the excess risk for younger women compared with men decreased to approximately 15-20%, while a better survival of older NSTEMI women compared with men persisted. CONCLUSIONS Sex-related differences in short-term mortality are age-dependent in both STEMI and NSTEMI patients.
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Affiliation(s)
- K P Champney
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30306, USA
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Bhargava S, Kasliwal A, Parashar S, Parashar VK, Goyal V, Bana A. Anaesthetic Management of a Post Total Laryngectomy Patient Undergoing CABG. Ann Card Anaesth 2005. [DOI: 10.4103/0971-9784.37959] [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: 04/03/2023] Open
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Bhargava S, Kasliwal A, Parashar S, Parashar VK, Goyal V, Bana A. Anaesthetic management of a post total laryngectomy patient undergoing CABG. Ann Card Anaesth 2005; 8:64-6. [PMID: 17823491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- S Bhargava
- Department of Cardiothoracic Anaesthesia, Santokba Durlabhji Memorial Hospital, Jaipur, India
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Parashar S. Patient Satisfaction - A valid tool of quality assurance (C. Q. I). J Family Community Med 1995; 2:7-8. [PMID: 23012218 PMCID: PMC3437127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- S Parashar
- Professor of Surgery, King Faisal University, College of Medicine & Medical Sciences Dammam, Consultant Surgeon, King Fahd Hospital AI-Khobar: P O. Box 40015, AI-Khobar 31952, K.S.A
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Garg P, Marya SK, Singh M, Parashar S. Retroperitoneal sponge causing painless haematuria. Trop Doct 1993; 23:92-3. [PMID: 8488592 DOI: 10.1177/004947559302300224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P Garg
- Department of Surgery, Medical College & Hospital, Rohtak, Haryana, India
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Hegazi M, Shawan S, Wafiq A, Taha SA, Parashar S. Rectus andominis myocutaneous flap: Analysis of 40 cases. Ann Saudi Med 1992; 12:476-9. [PMID: 17587027 DOI: 10.5144/0256-4947.1992.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a series of 40 cases who underwent reconstructive procedures using rectus abdominis myocutaneous units. The transplanted tissue comprised superior pedicle (26 cases), inferior pedicle (11 cases), and as free muscle flap (3 cases). The application fell into three groups i.e.; 1. breast and chest wall reconstruction; 2. groin, genital, and trochanteric area; and 3. leg and heel ulcer. The results show that surgical dissection of flaps is relatively easy and has a wide range of applications that can be used for different surgical reconstructive problems. Surgical dissection has a low incidence of complication for flap viability as well as for donor site.
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Affiliation(s)
- M Hegazi
- Departments of Surgery and Urology, King Faisal University, Dammam, Saudi Arabia
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Abstract
Isolated involvement of the pancreas in Salmonella typhi bacteraemia is rare. A case of pancreatic abscess due to S. typhi is reported which was managed conservatively.
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Affiliation(s)
- P Garg
- Department of Surgery, Medical College & Hospital, Rohtak, Haryana, India
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Garg P, Parashar S. Spontaneous rupture of the spleen. Trop Doct 1991; 21:123. [PMID: 1926557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Parashar S, Fernandes H. Plasma zinc in acute myocardial infarction. J Assoc Physicians India 1982; 30:9-12. [PMID: 7169405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Parashar S, Bhandary S, Menezes S, Kamat L, Hede SS, Fernandes H, Bangotra AK. Auto immune haemolytic anaemia. J Assoc Physicians India 1981; 29:679-82. [PMID: 7338503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bangotra AK, Parashar S, Bhandary SV, De Souza P. Pulmonary cyst. Indian J Chest Dis Allied Sci 1979; 21:155-8. [PMID: 521087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Parashar S, Rao R, Tikare SK, Tikare SS. Chloramphenicol induced reversible bone marrow suppression. A case report. J Postgrad Med 1972; 18:90-2. [PMID: 5037129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Afonso E, Tikare SK, Parashar S, Dias VP. Monoclonal immunoglobulinopathies in Goa. Indian J Med Res 1971; 59:1083-9. [PMID: 5161553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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