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Fordjuoh J, Dolezal C, Bhengu N, Harrison AD, Exner TM, Hanass-Hancock J, Hoffman S. Peer-to-Peer Chain Recruitment for Enrolling Young South African Women into an HIV Pre-exposure Prophylaxis (PrEP) Intervention Study: How Did It Perform? AIDS Behav 2024; 28:1782-1794. [PMID: 38416275 DOI: 10.1007/s10461-023-04256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/29/2024]
Abstract
Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.
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Affiliation(s)
- Judy Fordjuoh
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Nonhlonipho Bhengu
- South African Medical Research Council, Gender and Health Research Unit, Durban, South Africa
| | - Abigail D Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jill Hanass-Hancock
- South African Medical Research Council, Gender and Health Research Unit, Durban, South Africa
| | - Susie Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Feldman MB, Montero N, Thomas JA, Hoffman S, Nguyen N, Lentz CL, Sukumaran S, Mellins CA. Durable Viral Suppression Among Young Adults Living with HIV Receiving Ryan White Services in New York City. AIDS Behav 2023; 27:3197-3205. [PMID: 37084103 DOI: 10.1007/s10461-023-04040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
Identifying factors associated with durable viral suppression (DVS) can inform interventions to support young adults living with HIV (YALWH) in sustaining optimal health. We examined associations between client characteristics and DVS among YALWH aged 18-29 who completed an intake assessment and received ≥ 1 Ryan White Part A service in New York City from 1/2017 to 12/2019. Individuals were classified as achieving DVS at least once if they had ≥ 2 suppressed viral load test results ≥ 90 days apart with: (a) no intervening unsuppressed viral load test results in a 12-month period; and (b) no unsuppressed viral load test results after achieving DVS in that 12-month period. Of 2208 YALWH, 92.1% (n = 2034) had sufficient data in the New York City HIV Surveillance Registry to ascertain DVS status. Of these, 68% achieved DVS at least once. Controlling for ART prescription status at intake, YALWH with higher incomes were significantly more likely to achieve DVS at least once. YALWH with lifetime and recent histories of incarceration and/or drug use were significantly less likely to achieve DVS. Our findings underscore the potential role of tailored harm reduction and post-incarceration programs in reducing health inequities among YALWH.
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Affiliation(s)
- Matthew B Feldman
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA.
- JEVS Human Services, 1845 Walnut Street, Philadelphia, PA, 19103, USA.
| | - Noelisa Montero
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA
| | - Jacinthe A Thomas
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody L Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Stephen Sukumaran
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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3
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Khalifa A, Ssekubugu R, Lessler J, Wawer M, Santelli JS, Hoffman S, Nalugoda F, Lutalo T, Ndyanabo A, Ssekasanvu J, Kigozi G, Kagaayi J, Chang LW, Grabowski MK. Implications of rapid population growth on survey design and HIV estimates in the Rakai Community Cohort Study (RCCS), Uganda. BMJ Open 2023; 13:e071108. [PMID: 37495389 PMCID: PMC10373715 DOI: 10.1136/bmjopen-2022-071108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Since rapid population growth challenges longitudinal population-based HIV cohorts in Africa to maintain coverage of their target populations, this study evaluated whether the exclusion of some residents due to growing population size biases key HIV metrics like prevalence and population-level viremia. DESIGN, SETTING AND PARTICIPANTS Data were obtained from the Rakai Community Cohort Study (RCCS) in south central Uganda, an open population-based cohort which began excluding some residents of newly constructed household structures within its surveillance boundaries in 2008. The study includes adults aged 15-49 years who were censused from 2019 to 2020. MEASURES We fit ensemble machine learning models to RCCS census and survey data to predict HIV seroprevalence and viremia (prevalence of those with viral load >1000 copies/mL) in the excluded population and evaluated whether their inclusion would change overall estimates. RESULTS Of the 24 729 census-eligible residents, 2920 (12%) residents were excluded from the RCCS because they were living in new households. The predicted seroprevalence for these excluded residents was 10.8% (95% CI: 9.6% to 11.8%)-somewhat lower than 11.7% (95% CI: 11.2% to 12.3%) in the observed sample. Predicted seroprevalence for younger excluded residents aged 15-24 years was 4.9% (95% CI: 3.6% to 6.1%)-significantly higher than that in the observed sample for the same age group (2.6% (95% CI: 2.2% to 3.1%)), while predicted seroprevalence for older excluded residents aged 25-49 years was 15.0% (95% CI: 13.3% to 16.4%)-significantly lower than their counterparts in the observed sample (17.2% (95% CI: 16.4% to 18.1%)). Over all ages, the predicted prevalence of viremia in excluded residents (3.7% (95% CI: 3.0% to 4.5%)) was significantly higher than that in the observed sample (1.7% (95% CI: 1.5% to 1.9%)), resulting in a higher overall population-level viremia estimate of 2.1% (95% CI: 1.8% to 2.4%). CONCLUSIONS Exclusion of residents in new households may modestly bias HIV viremia estimates and some age-specific seroprevalence estimates in the RCCS. Overall, HIV seroprevalence estimates were not significantly affected.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- ICAP, Columbia University, New York, New York, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Global and Sexual Health, Karolinska Institutet, Stockholm, Sweden
| | - Justin Lessler
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Santelli
- Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Centre for Clinical and Behavioural Studies, Columbia University Irving Medical Centre, New York, New York, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Hoffman S, Jamison K, Pathela P, Gonzalez-Argoti T, Rivera A, Leu CS, Hubbard S, Castro M, Borges C, Gandhi A, Edelstein Z, Myers J, Mantell JE, Bauman LJ. Health Care Provider Decisions to Initiate Oral HIV Preexposure Prophylaxis in New York City Public Sexual Health Clinics. Sex Transm Dis 2023; 50:386-394. [PMID: 36749905 PMCID: PMC10838661 DOI: 10.1097/olq.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Oral HIV preexposure prophylaxis (PrEP) is safe and effective but underutilized. Health care providers' beliefs about PrEP and attitudes toward people who could benefit may affect PrEP access. METHODS This mixed-methods study (2016-2018) was conducted in 8 New York City public sexual health clinics that implemented a PrEP program. Data included 32 in-depth qualitative interviews with clinicians, quantitatively coded to reflect their PrEP beliefs; a provider questionnaire; and 6 months of medical record visit data for these providers. Among patients with a PrEP indication, we examined the odds of a patient being initiated on PrEP associated with providers' PrEP beliefs and demographic characteristics, and patient characteristics. RESULTS Providers reported strong support for offering PrEP to eligible patients. The majority denied concerns about possible development of drug-resistant viral strains, giving PrEP to people who might not benefit, and PrEP toxicity. Nevertheless, about one-third agreed with each of these concerns, and 55% thought PrEP use might limit condom use. Of 2176 patients with a PrEP indication, 20% were initiated. Providers with more restrictive PrEP beliefs did not have lower odds of initiating patients on PrEP. Women as well as Black and Latinx patients were less likely to be initiated on PrEP. CONCLUSIONS Contrary to our hypotheses, providers' negative PrEP beliefs did not seem to reduce initiation of PrEP for eligible patients. This may be attributable to clear clinical protocols, strong staff support, and training on implementing PrEP in this setting. Racial and gender disparities in PrEP uptake urgently require attention.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Kelly Jamison
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Preeti Pathela
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | | | - Angelic Rivera
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Stephanie Hubbard
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Michael Castro
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Christine Borges
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Anisha Gandhi
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Zoe Edelstein
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Julie Myers
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
| | - Laurie J. Bauman
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
- Albert Einstein College of Medicine; Department of
Psychiatry and Behavioral Sciences, Bronx NY, USA
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Tross S, Spector AY, Ertl MM, Berg H, Turrigiano E, Hoffman S. A Qualitative Study of Barriers and Facilitators of PrEP Uptake Among Women in Substance Use Treatment and Syringe Service Programs. AIDS Behav 2023; 27:1162-1172. [PMID: 36318430 PMCID: PMC10796210 DOI: 10.1007/s10461-022-03853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
Abstract
PrEP is an HIV prevention option that could benefit substance-involved women, a high-risk population with low PrEP uptake. Little is known about their interest in PrEP. This qualitative study used in-depth interviews to examine PrEP willingness, barriers, and facilitators among 16 women in outpatient psychosocial substance use treatment, methadone, and/or harm reduction/syringe programs in NYC. All expressed willingness to use PrEP, but only during periods of perceived risk. Women perceived themselves to be at high risk for HIV when engaging in active substance use and/or transactional sex. They perceived themselves to be at low risk and therefore unmotivated to take PrEP when abstinent from these activities. Paradoxically, a major barrier to using PrEP was anticipated interference from substance use and transactional sex, the very same activities that create a perception of risk. Facilitators of PrEP use included perceptions of it as effortless (as opposed to barrier methods during sex) and effective, safe, and accessible. Other barriers included fear of stigma and doubts about adhering daily. Recommendations for best PrEP implementation practices for substance-involved women included tailored and venue-specific PrEP information and messaging, PrEP discussion with trusted medical providers, and on-site PrEP prescription in substance use treatment and harm reduction programs.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA.
| | - Anya Y Spector
- Department of Human Services, Stella and Charles Guttman Community College, City University of New York, New York, NY, USA
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA
| | - Hayley Berg
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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6
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Hanass-Hancock J, Bhengu N, Exner T, Magusthwa S, Harrison A, Dolezal C, Miller L, Bauman L, Hoffman S. Masibambane-Ladies Chat: Developing an Online Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women. AIDS Educ Prev 2023; 35:14-35. [PMID: 36735226 PMCID: PMC10847036 DOI: 10.1521/aeap.2023.35.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.
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Affiliation(s)
- Jill Hanass-Hancock
- South African Medical Research Council, Gender and Health Research Unit, Durban, South Africa, and UKZN, School of Health Sciences, Durban, South Africa
| | | | - Theresa Exner
- Columbia University and the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, New York, New York
| | | | - Abigail Harrison
- Brown University School of Public Health, Providence, Rhode Island
| | - Curtis Dolezal
- Columbia University and the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, New York, New York
| | - Lori Miller
- ICAP, Mailman School of Public Health, Columbia University
| | - Laurie Bauman
- Albert Einstein College of Medicine, Bronx, New York
| | - Susie Hoffman
- Columbia University and the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, New York, New York
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Ayton S, Schwitters A, Mantell JE, Nuwagaba-Biribonwoha H, Hakim A, Hoffman S, Biraro S, Philip N, Wiesner L, Gummerson E, Brown K, Nyogea D, Barradas D, Nzima M, Fischer-Walker C, Payne D, Mulenga L, Mgomella G, Kirungi WL, Maile L, Aibo D, Musuka G, Mugurungi O, Low A. Male partner age, viral load, and HIV infection in adolescent girls and young women: evidence from eight sub-Saharan African countries. AIDS 2023; 37:113-123. [PMID: 36129107 PMCID: PMC11000148 DOI: 10.1097/qad.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/13/2022]
Abstract
OBJECTIVE We aimed to elucidate the role of partnerships with older men in the HIV epidemic among adolescent girls and young women (AGYW) aged 15-24 years in sub-Saharan Africa. DESIGN Analysis of Population-based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS We examined associations between reported partner age and recent HIV infection among AGYW, incorporating male population-level HIV characteristics by age-band. Recent HIV infection was defined using the LAg avidity assay algorithm. Viremia was defined as a viral load of more than 1000 copies/ml, regardless of serostatus. Logistic regression compared recent infection in AGYW with older male partners to those reporting younger partners. Dyadic analysis examined cohabitating male partner age, HIV status, and viremia to assess associations with AGYW infection. RESULTS Among 17 813 AGYW, increasing partner age was associated with higher odds of recent infection, peaking for partners aged 35-44 (adjusted odds ratio = 8.94, 95% confidence interval: 2.63-30.37) compared with partners aged 15-24. Population-level viremia was highest in this male age-band. Dyadic analyses of 5432 partnerships confirmed the association between partner age-band and prevalent HIV infection (male spousal age 35-44-adjusted odds ratio = 3.82, 95% confidence interval: 2.17-6.75). Most new infections were in AGYW with partners aged 25-34, as most AGYW had partners in this age-band. CONCLUSION These results provide evidence that men aged 25-34 drive most AGYW infections, but partners over 9 years older than AGYW in the 35-44 age-band confer greater risk. Population-level infectiousness and male age group should be incorporated into identifying high-risk typologies in AGYW.
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Affiliation(s)
- Sarah Ayton
- ICAP at Columbia University, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Amee Schwitters
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral, Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York
| | | | - Avi Hakim
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susie Hoffman
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, HIV Center for Clinical and Behavioral, Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York
| | | | | | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Lloyd Mulenga
- Department of Infectious Diseases, Zambia Ministry of Health and University Teaching Hospital, Lusaka, Zambia
| | - George Mgomella
- US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | - Limpho Maile
- Family Health Division, Ministry of Health, Maseru, Lesotho
| | | | | | - Owen Mugurungi
- AIDS and TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Andrea Low
- ICAP at Columbia University, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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8
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Kreniske P, Hoffman S, Ddaaki W, Nakyanjo N, Spindler E, Ssekyewa C, Isabirye D, Nakubulwa R, Proscovia N, Daniel L, Haba N, Maru M, Thompson J, Chen IS, Nalugoda F, Ssekubugu R, Lutalo T, Ott MA, Santelli JS. Capacity to Consent to Research Among Adolescent-Parent Dyads in Rakai, Uganda. J Pediatr 2022:S0022-3476(22)01020-4. [PMID: 36402433 DOI: 10.1016/j.jpeds.2022.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study. STUDY DESIGN Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests. RESULTS Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8). CONCLUSIONS The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches.
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Affiliation(s)
- Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY.
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Esther Spindler
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
| | | | | | | | | | - Lee Daniel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Nao Haba
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
| | - Mahlet Maru
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Julia Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Ivy S Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Mary A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
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9
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Niebauer J, Binder C, Iscel A, Klenk S, Capelle C, Kahr M, Cadjo S, Lichtenauer M, Toma A, Zoufaly A, Hoffman S, Charwat-Resl S, Krestan C, Wenisch C, Bonderman D. Cardiopulmonary long-term effects in patients after hospitalization due to COVID-19 infection. Eur Heart J 2022. [PMCID: PMC9619510 DOI: 10.1093/eurheartj/ehac544.249] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac and pulmonary effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and possible long-term impairments after hospitalization because of Covid-19 infection as well as to try to identify predictors for Long-Covid. Methods This was a prospective, multicenter registry study. Patients with verified Covid-19 infection, who were treated as in-patients at our dedicated Covid hospital (Clinic Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During the study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), chest computed tomography (CT) scan, lung function test and a comprehensive list of laboratory parameters including cardiac bio markers. Results Between July 2020 and October 2021, 150 patients were recruited. Sixty patients (40%) were female and the average age was 53.5±14.5 years. Of all patients, 92% had been admitted to our general ward and 8% had a severe course of disease, requiring admission to our intensive care unit. Six months after discharge the majority of patients still experienced symptoms and 75% fulfilled the criteria for Long-Covid. Only 24% were completely asymptomatic (figure 1). Echocardiography detected reduced global longitudinal strain (GLS) in 11%. Cardiac MRI revealed pericardial effusion in 18%. Furthermore, cardiac MRI showed signs of former peri- or myocarditis in 4%. Pulmonary CT scans identified post-infectious residues, such as bilateral ground glass opacities and fibrosis in 22%. Exertional dyspnea was associated with either reduced forced vital capacity measured during pulmonary function tests in 11%, with reduced GLS and/or diastolic dysfunction, thus providing evidence for a cardiac and/or pulmonary cause. Independent predictors for Long-Covid were markers of a more severe disease course like length of in-hospital stay, admission to an intensive care unit, type of ventilation as well as higher NT-proBNP and/or troponin levels. Conclusion Even 6 months after recovery from Covid-19 infection, the majority of previously hospitalized patients still suffer from at least one symptom, such as chronic fatigue and/or exertional dyspnea. While there was no association between fatigue and cardiopulmonary abnormalities, impaired lung function, reduced GLS and/or diastolic dysfunction were significantly more prevalent in patients presenting with exertional dyspnea. On chest CT approximately one fifth of all patients showed post infectious changes in chest CT including evidence for myo- and pericarditis as well as accumulation of pericardial effusions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Major fund
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Affiliation(s)
- J Niebauer
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Binder
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - A Iscel
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - S Klenk
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Capelle
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - M Kahr
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - S Cadjo
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - M Lichtenauer
- Salzburg university hospital, Department of Cardiology, internal intensive medicine and emergency medicine , Salzburg , Austria
| | - A Toma
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - A Zoufaly
- Klinik Favoriten, Department of Infectious Diseases , Vienna , Austria
| | - S Hoffman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - S Charwat-Resl
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Krestan
- Klinik Favoriten, Department of Radiology , Vienna , Austria
| | - C Wenisch
- Klinik Favoriten, Department of Infectious Diseases , Vienna , Austria
| | - D Bonderman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
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Kostelnik S, Hoffman S, Nelson H, Hogg J, Andre T, Valliant M. Relationship between Pre-Practice Urine Specific Gravity Hydration Levels and the Type of Sustained Practice Outcomes in Collegiate Football Athletes. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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11
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Hoffman S, Kostelnik S, Valliant M. Prevalence of Dehydration Among American Collegiate Football Athletes with Sickle Cell Trait. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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12
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Bergam S, Harrison AD, Benghu N, Khumalo S, Tesfay N, Exner T, Miller L, Dolezal C, Hanass-Hancock J, Hoffman S. Women's Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa. AIDS Behav 2022; 26:2881-2890. [PMID: 35218452 PMCID: PMC9378426 DOI: 10.1007/s10461-022-03632-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/01/2022]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) offers effective HIV prevention. In South Africa, PrEP is publicly available, but use among young women remains low. We explored young women's perceptions of PrEP to inform a gender-focused intervention to promote PrEP uptake. Six focus group discussions and eight in-depth interviews exploring perceptions of PrEP were conducted with forty-six women not using PrEP, ages 18-25, from central Durban. Data were thematically analyzed using a team-based consensus approach. The study was conducted among likely PrEP users: women were highly-educated, with 84.8% enrolled in post-secondary education. Qualitative data revealed intersecting social stigmas related to HIV and women's sexuality. Women feared that daily PrEP pills would be confused with anti-retroviral treatment, creating vulnerability to misplaced HIV stigma. Women also anticipated that taking PrEP could expose them to assumptions of promiscuity from the community. To address these anticipated community-level reactions, women suggested community-facing interventions to reduce the burden on young women considering PrEP. Concerns around PrEP use in this group of urban, educated women reflects layered stigmas that may inhibit future PrEP use. Stigma-reducing strategies, such as media campaigns and educational interventions directed at communities who could benefit from PrEP, should re-frame PrEP as an empowering and responsible choice for young women.
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Affiliation(s)
- S Bergam
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Paediatric Infectious Disease, Nelson Mandela School of Medicine, University of KwaZulu Natal, Umbilo, Durban, Kwa-Zulu Natal, South Africa.
| | - A D Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - N Benghu
- Gender and Health Research Unit, South African Medical Research Council, Durban, Kwa-Zulu Natal, South Africa
| | - S Khumalo
- Gender and Health Research Unit, South African Medical Research Council, Durban, Kwa-Zulu Natal, South Africa
| | - N Tesfay
- Gender and Health Research Unit, South African Medical Research Council, Durban, Kwa-Zulu Natal, South Africa
| | - T Exner
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University, New York, NY, USA
| | - L Miller
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - C Dolezal
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University, New York, NY, USA
| | - J Hanass-Hancock
- Gender and Health Research Unit, South African Medical Research Council, Durban, Kwa-Zulu Natal, South Africa
| | - S Hoffman
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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13
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Faro EZ, Mantell JE, Gonzalez-Argoti T, Hoffman S, Edelstein Z, Tsoi B, Bauman LJ. Implementing PrEP Services in Diverse Health Care Settings. J Acquir Immune Defic Syndr 2022; 90:S114-S128. [PMID: 35703763 PMCID: PMC9204802 DOI: 10.1097/qai.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services. SETTING In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type. METHODS Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies. RESULTS Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation. CONCLUSION Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
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Affiliation(s)
- Elissa Z Faro
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Joanne E Mantell
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Susie Hoffman
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and
| | - Zoe Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Benjamin Tsoi
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Laurie J Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
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14
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Hoffman S, Zhang A, Nguyen N, Tsong R, Chen I, Wei Y, Lutalo T, Nalugoda F, Kennedy CE, Grabowski MK, Santelli J. Incident HIV Infection Among Young Men Associated With Female Sexual Partner Types Identified Through Latent Class Analysis, Rakai, Uganda. J Acquir Immune Defic Syndr 2022; 90:124-131. [PMID: 35125472 PMCID: PMC9203866 DOI: 10.1097/qai.0000000000002928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual partner characteristics are important determinants of HIV acquisition, but little is known about partner types of young men in sub-Saharan Africa. METHODS Sexually active men aged 15-24 years from 5 rounds (2005-2013) of the Rakai Community Cohort Study in Uganda reported characteristics of up to 4 past-year female partners. Partner types were identified using latent class analysis. HIV incidence rates (IRs) were calculated by partner-type combinations, and individual-level risk adjusted IR ratios (aIRRs) relative to the lowest incidence type were estimated using the Poisson regression with generalized estimating equations. RESULTS Young men (N = 1771) reported 4539 past-year female sexual partners. Three partner types were identified: type A: noncohabiting, student, medium duration partnerships; type B: cohabiting, nonstudent, longer duration partnerships; and type C: noncohabiting, nonstudent shorter duration partnerships. Type C partners engaged in the most HIV-related risk behaviors. Many men (29%) had more than 1 partner type/round. IR overall was 9.8/1000 person-years [95% confidence interval (CI): 4.7 to 20.6]. IR was 4.0 (95% CI: 1.2 to 12.7) for men with type A partners alone (41% of men). Relative to them, IR for those with type B partners alone (25%) was not significantly different. Men with type C partners alone (5%) had higher risk (aIRR = 3.2; 95% CI: 1.0 to 9.9), as did men with >1 partner type, including men with both type A and type B partners (12%; aIRR = 6.3; 95% CI: 2.5 to 15.9) and men with type C and other partner types (17%; aIRR = 4.3; 95% CI: 1.7 to 10.8). CONCLUSIONS Partner-type combination was strongly associated with HIV incidence; type C partners and having more than 1 partner type were the riskiest patterns.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
- Department of Epidemiology Columbia University Mailman School of Public Health, New York, United States
| | - Adina Zhang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
| | - Rachel Tsong
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ivy Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - M. Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - John Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, United States
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15
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Danvers AA, Chew Murphy E, Avila K, Gonzalez-Argoti T, Edwards AR, Hoffman S, Mantell JE, Bauman LJ, Dolan SM. Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention. Front Reprod Health 2022; 4:832287. [PMID: 36303639 PMCID: PMC9580770 DOI: 10.3389/frph.2022.832287] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The objective of this study was to understand how women perceive the role of their Obstetrician and Gynecologist (OBGYN) in screening for and providing preexposure prophylaxis (PrEP) for HIV prevention. Methods We recruited women ages 18–45 years receiving obstetric or gynecological care at an academic medical center in the Bronx, NY. Thirty participants were enrolled: 10 seeking care for family planning, 10 seeking prenatal care, and 10 seeking care for a sexually transmitted infection. We screened participants for HIV acquisition risk using a PrEP screening tool. We conducted face-to-face, semi-structured interviews, which were audio-recorded, transcribed, and entered into Dedoose for analysis of themes using a grounded theory approach. Results Sixty percent of the participants were Latinx and 33% African American. Seventy percent had one or more risk factors for HIV acquisition based on the PrEP screening tool, indicating they would benefit from a PrEP discussion. Three main themes emerged from the analysis of interview data. Participants viewed OBGYNs as experts in sexual and reproductive healthcare and believed they were experts in PrEP. Participants were concerned about “PrEP stigma”, being judged by their clinicians as being sexually promiscuous if they expressed a need for PrEP. Lastly, when participants trusted their OBGYN, that trust became a facilitator for women to consider PrEP and offset stigma as a barrier to identifying patients who are candidates for PrEP. Conclusion Women established in care with an OBGYN are enthusiastic about having access to PrEP services incorporated into their sexual and reproductive healthcare. A universal approach to HIV prevention would avert stigma surrounding HIV care and prevention.
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Affiliation(s)
- Antoinette A. Danvers
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Antoinette A. Danvers
| | - Emma Chew Murphy
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karina Avila
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Angelic Rivera Edwards
- Montefiore School Health Program, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Susie Hoffman
- Department of Epidemiology, Joseph L. Mailman School of Public Health at Columbia University, New York, NY, United States
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Laurie J. Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, United States
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Harrison A, Bhengu N, Miller L, Exner T, Tesfay N, Magutshwa S, Khumalo S, Bergam S, Hoffman S, Hanass-Hancock J. “You tell him that ‘baby, I am protecting myself’”: Women’s agency and constraint around willingness to use pre-exposure prophylaxis in the Masibambane Study. Womens Health (Lond Engl) 2022; 18:17455057221087117. [PMID: 35306944 PMCID: PMC8935570 DOI: 10.1177/17455057221087117] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To explore women’s willingness to consider using pre-exposure prophylaxis for HIV prevention in the context of gendered relationship dynamics, in Durban, South Africa. Methods: As formative research prior to development of a gender-informed intervention to introduce pre-exposure prophylaxis to young, urban, educated women, we conducted six focus-group discussions and eight in-depth interviews with 46 women ages 18–25 years, who were not current pre-exposure prophylaxis users. Women were recruited from clinic and community settings using a criterion-based snowball sampling technique. Qualitative data were coded and analyzed thematically, with a team-based consensus approach for final coding, analytical decisions, and data interpretation. Results: Women clearly understood the benefits of pre-exposure prophylaxis for themselves and their partners, focusing on promoting health and their right to protect themselves from HIV infection. At the same time, and in accordance with findings from other studies, women were realistic about the concerns that would arise among male partners, including disapproval, loss of trust, possible loss of the relationship, and in some instances, the potential for violence, if they were to propose pre-exposure prophylaxis use. To resolve this tension, some women advocated for covert use as the best option for themselves and others argued for disclosure, proposing various approaches to working with partners to adopt pre-exposure prophylaxis. The suggestion that both partners use pre-exposure prophylaxis was made repeatedly. Thus, women sought to avoid discussions of trust or lack of trust and a partner’s possible infidelities, choosing instead to focus on preserving or even building a relationship through suggesting pre-exposure prophylaxis use. Conclusion: Women offered diverse narratives on agency and constraint in relation to choosing pre-exposure prophylaxis as a future prevention strategy, as well as ways to engage with their male partners about pre-exposure prophylaxis. These findings speak to the need for interventions to bolster women’s confidence, sense of empowerment, and their communication and decision-making skills for successful HIV prevention.
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Affiliation(s)
- Abigail Harrison
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
| | - Nonhlonipho Bhengu
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Lori Miller
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Nonkululeko Tesfay
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Slindile Magutshwa
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Silindile Khumalo
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Scarlett Bergam
- Brown University, School of Public Health, International Health Institute, Providence, RI, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Jill Hanass-Hancock
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
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17
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Santelli JS, Chen IS, Nabukalu D, Lutalo T, Spindler EJ, Chang LW, Grabowski MK, Grilo SA, Kreniske P, Wei Y, Nalugoda F, Hoffman S, Maru M, Chu S, Ssewamala FM, Byansi W, Kagaayi J, Wawer MJ, Gray RH, Serwadda D, Makumbi F. HIV combination prevention and declining orphanhood among adolescents, Rakai, Uganda, 2001-18: an observational community cohort study. Lancet HIV 2022; 9:e32-e41. [PMID: 34973171 PMCID: PMC9125395 DOI: 10.1016/s2352-3018(21)00275-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa because of HIV-related mortality. Little is known about the contribution of HIV interventions, such as antiretroviral therapy (ART) and male medical circumcision, to more recent trends in orphanhood. In this study, we examined trends over time in maternal-only, paternal-only, and double orphanhood among adolescents before and after ART and male medical circumcision became widely available in the Rakai region of south-central Uganda. We sought to understand the association between adolescent orphanhood and HIV combination prevention (community-level ART use and prevalence of male medical circumcision). We hypothesised that increasing combination prevention, including greater use of ART and higher prevalence of male medical circumcision, would be associated with a lower probability of orphanhood. METHODS We examined the prevalence of orphanhood among adolescents aged 15-19 years, before and after roll-out of ART in mid-2004 and male medical circumcision in 2007, using data from 28 continuously followed communities within the Rakai Community Cohort Study. We used multinomial logistic regression with clustered SEs to estimate adjusted relative risk ratios (RRs) for maternal-only, paternal-only, and double orphanhood compared with non-orphanhood over 11 survey rounds between 2001 and 2018. Controlling for community HIV prevalence, household socioeconomic status, and adolescent age, we examined the association between community prevalence of ART use among people living with HIV and prevalence of male circumcision, including traditional circumcision. The primary outcome was orphanhood among adolescents aged 15-19 years. FINDINGS Orphanhood declined from 52% (920 of 1768 participants) in 2001-02 to 23% (592 of 2609 participants) by 2016-18 (p<0·0001), while double orphanhood declined from 20% (346 of 1768 participants) to 3% (86 of 2609 participants) (p<0·0001). Community prevalence of ART use among people living with HIV increased from 11% (105 of 945 participants) in 2005-06 to 78% (1163 of 1485 participants) in 2016-18. Male circumcision rates rose from 19% (147 of 790 participants) in 2005-06 to 65% (3535 of 5433 participants) in 2016-18. In the multinomial logistic regression model, a 10% increase in community prevalence of ART use was associated with a decrease in maternal orphanhood (adjusted relative RR 0·90, 95% CI 0·85-0·95) and double orphanhood (0·80, 0·75-0·85). In the post-ART era, a 10% increase in the community prevalence of male circumcision was associated with a decrease in paternal orphanhood (2005-18, adjusted relative RR 0·92, 0·87-0·97) and double orphanhood (0·91, 0·85-0·98). INTERPRETATION Widespread availability and uptake of HIV combination prevention was associated with marked reductions in orphanhood among adolescents. Reductions in orphanhood promise improved health and social outcomes for young people. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases.
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Affiliation(s)
- John S Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ivy S Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Esther J Spindler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stephanie A Grilo
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mahlet Maru
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sofia Chu
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Maria J Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald H Gray
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Makumbi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Niebauer JH, Binder- Rodriguez C, Iscel A, Klenk S, Badr-Eslam R, Cadjo S, Kahr M, Hoffman S, Reiter-Malqvist S, Boeck R, Wenisch C, Krestan C, Lichtenauer M, Bonderman D. Long-term cardiopulmonary effects after Covid-19 infection. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1742] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic of 2020 has an influence on people's lives worldwide, impacting global health and putting pressure on health care systems. Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and long-term impairment after Covid-19 infection.
Methods
This study was a prospective, multicenter registry study. Patients with verified COVID-19 infection, who were treated at our dedicated COVID hospital (Klinik Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During each study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), pulmonary computed tomography (CT) scan, lung function test, spiroergometry and six-minute walk test (6MWT), and a comprehensive list of laboratory parameters including cardiac bio markers such as brain natriuretic peptide (NTpro BNP) and troponin T.
Results
In this interim analysis of an ongoing trial, the first 65 patients are presented. Baseline values are shown in table 1: 34 (59%) were male and the median age was 48.5 years (36.4–59.3). 86% of all patients included so far had an only mild to moderate course of disease and 14% of them had a severe course and were admitted to our intensive care unit. At the time of the study visit, the majority of patients still complained about symptoms: 40% presented with fatigue and weakness, 36% with exertional dyspnea, 21% with vertigo, 17% had an impaired taste or smell. Only 28% were completely asymptomatic (figure 1). From a cardiac perspective, the only abnormal findings noted in echocardiography studies were reduced left ventricular global longitudinal strain. Cardiac MRI revealed pericardial effusion in 19%, however, these were only minimal (≤9mm) and not visible in echocardiography. Furthermore, cardiac MRI showed positive late gadolinium enhancement in 11%. Pulmonary function tests were abnormal in 16%. Pulmonary CT scans showed post infectious residues like bilateral ground glass opacities and fibrosis in 45%. Exercise capacity as measured by the 6-minute walk test with BORG Dyspnea Score and by spiroergometry was reduced in almost 40% of our study participants.
Conclusions
This interim analysis showed that most previously hospitalized patients still suffer from chronic fatigue, exertional dyspnea and impaired cardiopulmonary function after Covid-19 infection. Furthermore, even though cardiac and pulmonary imaging revealed numerous pathologic findings, and exercise capacity was reduced, no correlations could be found with persisting symptoms.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Klink Favoriten and Medical University hospital Vienna
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Affiliation(s)
- J H Niebauer
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - C Binder- Rodriguez
- AKH Wien, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Iscel
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - S Klenk
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - R Badr-Eslam
- AKH Wien, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Cadjo
- AKH Wien, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Kahr
- AKH Wien, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Hoffman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - S Reiter-Malqvist
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - R Boeck
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
| | - C Wenisch
- Klinik Favoriten, Department of Infectious Diseases, Vienna, Austria
| | - C Krestan
- Klinik Favoriten, Department of Radiology, Vienna, Austria
| | - M Lichtenauer
- University hospital Salzburg, Department of Internal Medicine II, Division of Cardiology, Salzburg, Austria
| | - D Bonderman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine, Vienna, Austria
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Santelli JS, Chen I, Makumbi F, Wei Y, Nalugoda F, Lutalo T, Spindler E, Grilo SA, Deisher A, Grabowski K, Hoffman S, Kagaayi J, Chang LW, Gray R, Wawer M, Serwadda D. Household wealth and HIV incidence over time, rural Uganda, 1994-2018. AIDS 2021; 35:1835-1843. [PMID: 34132219 PMCID: PMC8373447 DOI: 10.1097/qad.0000000000002989] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between household wealth and HIV incidence in rural Uganda over time from 1994 to 2018. In research conducted early in the epidemic, greater wealth (i.e. higher socioeconomic status, SES) was associated with higher HIV prevalence in sub-Saharan Africa (SSA); this relationship reversed in some settings in later years. DESIGN Analysis of associations over time in a population-based open cohort of persons 15-49 years from 17 survey-rounds in 28 continuously followed communities of the Rakai Community Cohort Study (RCCS). METHODS The RCCS sample averaged 8622 individuals and 5387 households per round. Principal components analysis was used to create a nine-item asset-based measure of household wealth. Poisson regression with generalized estimating equation (GEE) and exchangeable correlation structure was used to estimate HIV incidence rate ratios (IRRs) by SES quartile, survey-round, sex, and age group. RESULTS From 1994 to 2018, SES rose considerably, and HIV incidence declined from 1.45 to 0.40 per 100 person-years (IRR = 0.39, 95% CI = 0.32--0.47, P < 0.001). HIV incidence was similar by SES category in the initial survey intervals (1994-1997); however, higher SES groups showed greater declines in HIV incidence over time. Multivariable analyses showed significant associations between HIV incidence and SES (IRR = 0.55 for highest compared with lowest quartile, 95% CI = 0.45--0.66, P < 0.001) controlling for time, sex, and age group. CONCLUSION Beyond the early years of the RCCS, higher SES was associated with lower HIV incidence and SES gradients widened over time. The poor, like other key populations, should be targeted for HIV prevention, including treatment as prevention.
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Affiliation(s)
- John S. Santelli
- Department of Population and Family Health, Mailman School of Public Health
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
| | - Ivy Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Fred Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Tom Lutalo
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Esther Spindler
- Department of Population and Family Health, Mailman School of Public Health
| | - Stephanie A. Grilo
- Department of Population and Family Health, Mailman School of Public Health
| | - Andrea Deisher
- Department of Population and Family Health, Mailman School of Public Health
| | - Katherine Grabowski
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Joseph Kagaayi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Larry W. Chang
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ronald Gray
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Maria Wawer
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - David Serwadda
- Rakai Health Sciences, Program, Kalisizo, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
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20
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Mantell JE, Exner TM, Bai D, Leu CS, Beksinska M, Mabude Z, Hoffman S, Smit JA. Perceived male partner attitudes toward the female condom predict female university students' use of the female condom. Int J STD AIDS 2021; 31:753-762. [PMID: 32631211 DOI: 10.1177/0956462420912986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female and male condoms are the only methods that prevent both sexually transmitted infections (STIs), including HIV, and unintended pregnancy. Despite continuing high STI rates, few studies investigate factors predicting whether women initiating female condom (FC) use sustain use. Using data from a randomized trial, we examined predictors of sustained FC use at five-month follow-up (FU2) among female university students in South Africa who participated in either a one-session, information-only, group-delivered Minimal Intervention or a two-session, group-delivered Enhanced Intervention. In the final multiple logistic regression model, believing one's partner holds positive attitudes toward the FC (aOR = 1.40; p = 0.028), and greater FC use for vaginal sex at previous assessment (aOR) = 1.19; p = 0.008) were associated with greater odds of FC use at FU2. Excluding number of FC-protected occasions at FU1 from the analysis, discussing FC use with partner (aOR = 2.89; p = 0.071) and believing one's partner holds positive attitudes toward the FC (aOR = 1.63; p < 0.001) were associated with greater odds of use at FU2. The FC empowers women to protect themselves from both STIs and unintended pregnancy, but targeted interventions are needed to address men's negative attitudes toward the device. Engaging men as FC champions to support and promote FC use, along with marketing campaigns targeted to men, may expand FC coverage and enhance uptake.
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Affiliation(s)
- Joanne E Mantell
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Theresa M Exner
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Dan Bai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
| | - Zonke Mabude
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
| | - Susie Hoffman
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer A Smit
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
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21
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Sy KTL, Tariq S, Ramjee G, Blanchard K, Leu CS, Kelvin EA, Exner TM, Gandhi AD, Lince-Deroche N, Mantell JE, O’Sullivan LF, Hoffman S. Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study. PLoS One 2021; 16:e0246744. [PMID: 33606712 PMCID: PMC7895397 DOI: 10.1371/journal.pone.0246744] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010-2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19-0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01-1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19-0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.
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Affiliation(s)
- Karla Therese L. Sy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Shema Tariq
- Institute for Global Health, University College London, London, United Kingdom
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Elizabeth A. Kelvin
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
| | - Theresa M. Exner
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Anisha D. Gandhi
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Joanne E. Mantell
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | | | - Susie Hoffman
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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22
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Hoffman S, Leu CS, Ramjee G, Blanchard K, Gandhi AD, O'Sullivan L, Kelvin EA, Exner TM, Mantell JE, Lince-Deroche N. Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study. AIDS Behav 2020; 24:1181-1196. [PMID: 31677039 DOI: 10.1007/s10461-019-02688-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Linkage to care following an HIV diagnosis remains an important HIV care continuum milestone, even in the era of universal ART eligibility. In an 8-month prospective cohort study among 459 (309 women, 150 men) newly-diagnosed HIV-positive individuals in three public-sector clinics in Durban metropolitan region, South Africa, from 2010 to 2013, median time to return to clinic for CD4+ results (linkage) was 10.71 weeks (95% CI 8.52-12.91), with 54.1% 3-month cumulative incidence of linkage. At study completion (9.23 months median follow-up), 26.2% had not linked. Holding more positive outcome-beliefs about enrolling in care was associated with more rapid linkage [adjusted hazard ratio (AHR)each additional belief 1.31; 95% CI 1.05-1.64] and lower odds of never linking [adjusted odds ratio (AOR) 0.50; 95% CI 0.33-0.75]. Holding positive ARV beliefs was strongly protective against never linking to care. Age over 30 years (AHR 1.59; 95% CI 1.29-1.97) and disclosing one's HIV-positive status within 30 days of diagnosis (AHR 1.52; 95% CI 1.10-2.10) were associated with higher linkage rates and lower odds of never linking. Gender was not associated with linkage and did not alter the effect of other predictors. Although expanded access to ART has reduced some linkage barriers, these findings demonstrate that people's beliefs and social relations also matter. In addition to structural interventions, consistent ART education and disclosure support, and targeting younger individuals for linkage are high priorities.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
| | - Anisha D Gandhi
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
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23
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Geraghty L, Hoffman S, Schultz T, Porter K, Issa M, Rupert R, Bhateja P, Old M, Rocco J, Blakaj D, Bonomi M. Weekly Versus Tri-Weekly Paclitaxel and Carboplatin in Combination with Cetuximab in Recurrent/Metastatic Head and Neck Cancer Patients: a Toxicity Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.049] [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: 11/26/2022]
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24
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DiLorenzo MA, Parcesepe A, Tymejczyk O, Hoffman S, Elul B, Weiser SD, Remien RH, Kulkarni SG, Gadisa T, Melaku Z, Nash D. Psychosocial Factors Associated with Food Insufficiency Among People Living with HIV/AIDS (PLWH) Initiating ART in Ethiopia. AIDS Behav 2019; 23:3052-3057. [PMID: 30989554 DOI: 10.1007/s10461-019-02505-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/25/2022]
Abstract
Food insufficiency is associated with suboptimal HIV treatment outcomes. Less is known about psychosocial correlates of food insufficiency among PLWH. This sample includes 1176 adults initiating antiretroviral therapy at HIV clinics in Ethiopia. Logistic regression modeled the association of psychological distress, social support, and HIV-related stigma with food insufficiency. Among respondents, 21.4% reported frequent food insufficiency. Psychological distress [adjusted odds ratio (aOR) 2.61 (95% CI 1.79, 3.82)], low social support [aOR 2.20 (95% CI 1.57, 3.09)] and enacted stigma [aOR 1.69 (95% CI 1.26, 2.25)] were independently associated with food insufficiency. Food insufficiency interventions should address its accompanying psychosocial context.
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Affiliation(s)
- Madeline A DiLorenzo
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA.
| | - Angela Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Batya Elul
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
| | - Tsigereda Gadisa
- International Center for AIDS Care and Treatment Program (ICAP), Columbia University, Addis Ababa, Ethiopia
| | - Zenebe Melaku
- International Center for AIDS Care and Treatment Program (ICAP), Columbia University, Addis Ababa, Ethiopia
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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25
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Adam D, Schweitzer N, Hoffman S, Bednarz B. Development of a Monte Carlo-Based Microdosimetry Platform for the Analysis of Targeted Radionuclide Therapy Agents in Vitro. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1107] [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: 11/24/2022]
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26
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Merritt V, Jurick S, Crocker L, Keller A, Hoffman S, Jak A. B-75 A Preliminary Investigation of Predictors of Employment and Perception of Ability to Work in Combat-Exposed Veterans. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The purpose of this study was twofold: (1) to evaluate whether perception of one’s ability to work (a subjective rating) predicts employment status (an objective marker of functioning) in a sample of combat-exposed Veterans, and (2) to examine predictors of employment status and perception of work ability to determine whether the same sets of variables that predict employment status also predict perception of one’s ability to work.
Method
Combat-exposed Operation Enduring Freedom/Operation Iraqi Freedom Veterans (N = 83) completed self-report questionnaires assessing demographic characteristics, combat-related experiences, and psychiatric and neurobehavioral/health-related symptoms. Veterans also underwent a comprehensive neuropsychological assessment. Primary outcomes of interest were employment status (unemployed versus employed) and Veterans’ rating of a perceived decline in work ability (yes versus no).
Results
Logistic regression analyses showed that perception of work ability significantly predicted employment status (p = .046). Moreover, psychiatric and neurobehavioral/health-related symptoms significantly predicted employment status and perception of work ability (p = .001-.017), whereas demographic characteristics (i.e., service-connection disability rating) and combat-related experiences (i.e., number of traumatic brain injuries) only predicted perception of work ability (p = .010-.029). Cognition was not significantly associated with employment status or perception of work ability (p’s > .05).
Conclusions
Altogether, these findings support the notion that perception of one’s ability to work plays an important role in employment-related outcomes in combat-exposed Veterans. Future studies using larger samples are needed to confirm these findings, but our preliminary results suggest that perception of work ability may be a particularly important treatment target in this population.
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Merritt V, Jurick S, Crocker L, Hoffman S, Keller A, Jak A. Effects of Multiple Mild TBIs on Neuropsychological Functioning, Psychiatric Symptoms, and Neurobehavioral/Health-Related Symptoms in Combat-Exposed Veterans. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The purpose of this study was to examine the influence of multiple mild traumatic brain injuries (mTBI) on objective neuropsychological functioning and subjective symptom reporting in a sample of combat-exposed Veterans.
Method
Participants included 80 combat-exposed Iraq/Afghanistan Veterans (91.3% male; age: M = 34.33, SD = 6.44) divided into three groups based on mTBI history: 0 mTBIs (n = 33), 1-2 mTBIs (n = 26), and 3+ mTBIs (n = 21). Veterans with mTBI were assessed, on average, 7.5 years following their most recent mTBI. Participants underwent comprehensive neuropsychological testing and completed self-report measures assessing psychiatric and neurobehavioral/health-related symptoms.
Results
ANCOVAs adjusting for level of combat exposure showed no group differences on the memory and attention/executive functioning composite scores (p’s>.05). Additionally, groups did not differ with respect to symptoms of posttraumatic stress and depression (p’s>.05). In contrast, there were significant group differences on all neurobehavioral/health-related symptoms, including post-concussive symptom clusters (p’s < .001-.005), sleep problems (p = .024), pain symptoms (p < .001), and pain catastrophizing (p = .049). In general, Veterans with 3+ mTBIs self-reported the most severe symptoms, followed by Veterans with 1-2 mTBIs and 0 mTBIs.
Conclusions
History of multiple, remote mTBIs is associated with elevated subjective neurobehavioral/health-related symptoms in a dose-dependent fashion, but is not associated with objective neuropsychological functioning or ratings of psychiatric distress in combat-exposed Veterans. These results advance understanding of the long-term consequences of multiple mTBIs in this population and suggest that Veterans with 3 or more mTBIs may especially benefit from (1) early treatments aimed at ameliorating sleep and pain symptoms and (2) therapies that provide tools to temper catastrophic thinking about these symptoms.
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Jurick S, Merritt V, Crocker L, Iverson G, Hoffman S, Keller A, Jak A. The Role of Potentially Malleable Factors in Post-Concussive Symptoms and Objective Cognitive Outcomes in Iraq and Afghanistan Veterans with History of Mild TBI. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
We examined whether potentially malleable factors are associated with post-concussive symptoms (PCS) and cognition in Veterans with mild traumatic brain injury (mTBI) histories.
Method
Combat-exposed Iraq and Afghanistan Veterans with remote history of mTBI (N=48) completed a neuropsychological assessment and self-report questionnaires. Hierarchical linear regressions predicting PCS (Rivermead Post-Concussion Symptoms Questionnaire) and objective cognition included relevant demographic, injury, and psychiatric symptom variables in the first block and five malleable factors (TBI knowledge, self-efficacy, coping style, attribution of symptoms to mTBI, and uncommonly-endorsed symptoms [mild Brain Injury Atypical Symptoms (mBIAS) scale]) in the second block. Those with valid performance validity tests (n = 42) were included in the cognitive test analyses.
Results
With psychiatric symptoms and lifetime history of mTBIs entered first, malleable factors accounted for 14-17% of additional variance in PCS (p < .001). Lower self-efficacy (B = -.53, p < .001) and greater attribution of symptoms to mTBI (B = .21, p = .05) were associated with higher PCS, whereas an approach style of coping, TBI knowledge, and the mBIAS were not (p’s>.05). Regarding cognition, the malleable factors block accounted for 25% of additional variance in executive functioning (p = .04) with premorbid intelligence entered first. Specifically, higher mBIAS scores significantly predicted worse executive functioning (B = -.50, p = .004). No significant associations emerged when predicting attention/processing speed or memory (p’s>.05).
Conclusions
In combat-exposed Veterans with mTBI histories, potentially malleable factors contribute to clinical outcomes even after accounting for psychiatric symptoms. These malleable features are prime targets to augment during psychoeducation (e.g., uncommonly-endorsed symptoms, attribution of symptoms) and cognitive behavioral therapy (e.g., self-efficacy) in the context of chronic PCS.
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Crocker L, Keller A, Jurick S, Merritt V, Hoffman S, Jak A. A-18 Executive Dysfunction is Associated with Suicidal Ideation in Iraq/Afghanistan-era Combat-exposed Veterans. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Suicidal ideation (SI) is highly prevalent in Veterans and reducing Veteran suicide is a national priority. The present study examined factors associated with SI in combat-exposed Veterans in order to inform suicide prevention efforts.
Method
Combat-exposed Iraq/Afghanistan-era Veterans (N = 77) completed questionnaires detailing demographic characteristics and combat-related experiences, as well as structured interviews assessing history of mild traumatic brain injury (mTBI), current posttraumatic stress disorder (PTSD), and suicidality in the past month. Veterans also underwent a comprehensive neuropsychological assessment. Analyses examined differences between endorsers versus non-endorsers of current SI, as well as predictors of SI, with a focus on cognitive variables.
Results
There were no SI group differences in demographic variables, levels of combat exposure, or rates of PTSD, or mTBI history. However, independent samples t-tests indicated that those who endorsed SI demonstrated worse executive functioning relative to those who denied SI (t(75) = 2.74, p = .008), whereas no group differences were observed on measures of attention/processing speed or memory. A logistic regression analysis predicting SI indicated that executive functioning remained a significant predictor of SI (B = .94, OR = 2.55, p = .047) even when adjusting for age, years of education, level of combat exposure, history of mTBI, and PTSD diagnosis.
Conclusions
Executive dysfunction may make it difficult for Veterans to inhibit maladaptive negative thoughts (particularly suicidal thoughts), regulate emotions, and problem solve in stressful situations, thus contributing to suicidality. Interventions addressing executive dysfunction in combat-exposed Veterans with SI may be a promising adjunct to current suicide prevention efforts.
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Parcesepe A, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia. AIDS Behav 2018; 22:3815-3825. [PMID: 29453552 DOI: 10.1007/s10461-018-2059-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 01/15/2023]
Abstract
Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.
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Affiliation(s)
- Angela Parcesepe
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599-7445, USA.
| | - Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Robert Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Batya Elul
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Fifield J, O'Sullivan L, Kelvin EA, Mantell JE, Exner T, Ramjee G, Blanchard K, Hoffman S. Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans. AIDS Behav 2018; 22:3287-3295. [PMID: 29744766 DOI: 10.1007/s10461-018-2136-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/24/2022]
Abstract
Despite the salience of social support and violence as potential outcomes of disclosure, how pre-existing social support and relationship violence among people living with HIV shapes and influences HIV status disclosure has received limited attention. Following the Disclosure Process Model, this study investigated pre-disclosure support and violence-prone relationships as predictors of disclosure using data from a prospective study of 459 newly diagnosed South African women and men. Most (88%) disclosed their status to at least one person by their 8-month interview. Level of social support was unrelated to disclosure to a partner. However, those with higher levels of support had higher odds of disclosing to family and to others. Women in violence-prone relationships were more likely to report disclosure to a partner than were those not in such relationships, counter to expectations. The findings suggest that the same mechanisms may not explain processes of disclosure across all relationship types.
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Affiliation(s)
- Jocelyn Fifield
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Ariadne Labs, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA, USA.
- , 401 Park Drive, Boston, MA, 02115, USA.
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Nyirenda M, Street R, Reddy T, Hoffman S, Dawad S, Blanchard K, Exner TM, Kelvin EA, Mantell JE, Ramjee G. Food insecurity, HIV status and prior testing at South African primary healthcare clinics. S AFR J SCI 2018. [DOI: 10.17159/sajs.2018/4407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
HIV and food insecurity are two prominent causes of morbidity and mortality in sub-Saharan Africa. Food insecurity has been associated with risky sexual practices and poor access to healthcare services. We describe the association between household food insecurity and previous HIV testing and HIV status. We used logistic regression to analyse the association between food insecurity and prior HIV counselling and testing (HCT) and testing HIV positive. A total of 2742 adults who presented for HCT at three primary healthcare clinics in KwaZulu-Natal, South Africa, participated in the study. The prevalence of household food insecurity was 35%. The prevalence of food insecurity was highest in adults who had incomplete high schooling (43%), were unemployed (39%), and whose primary source of income was government grants (50%). Individuals who were food insecure had significantly higher odds of testing HIV positive (adjusted odds ratio 1.41, 95% CI 1.16–1.71), adjusted for demographic and socio-economic variables. There was no association between food insecurity and prior HCT. The findings of this study highlight the important role food insecurity may play in HIV risk. Interventions to turn food-insecure into food-secure households are needed to reduce their household members’ vulnerability to HIV acquisition. The absence of such interventions is likely to severely impact ambitious global targets of ending AIDS by 2030 through the 90-90-90 targets and test-and-treat-all initiatives.
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Affiliation(s)
- Makandwe Nyirenda
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Renee Street
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Suraya Dawad
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
- National Department of Health, Pretoria, South Africa
| | | | - Theresa M. Exner
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, City University of New York, New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
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Merritt V, Jurick S, Keller A, Hoffman S, DeFord N, Jak A. Adult Concussion - 3
Long-Term Neuropsychological and Neurobehavioral Outcomes in Combat Veterans with and Without Mild TBI and PTSD. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy060.21] [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: 11/14/2022] Open
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Parcesepe AM, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia, Ethiopia. AIDS Care 2018; 30:211-218. [PMID: 28774191 PMCID: PMC5748326 DOI: 10.1080/09540121.2017.1360998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Low decision-making power (DMP) has been associated with HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, greater attention to the mental health and well-being of HIV-positive women is needed. This study examined whether low DMP was associated with psychological distress, social support or health-related quality of life (HRQoL) among women initiating ART. The sample included 722 women aged 18 or older initiating ART during 2012-2013 at six HIV clinics in Oromia, Ethiopia. DMP was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). HRQoL was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural). Most respondents (63%) reported high DMP, followed by medium (27%) and low (10%) DMP. More than half (57%) reported psychological distress. Compared to medium DMP, low DMP among married or cohabitating women was associated with greater odds of low social support (aOR: 1.9 [1.3, 2.9]; high DMP among women not in a relationship was associated with greater odds of low social support (aOR: 4.4 [2.4, 8.1]) and psychological distress (aOR: 1.7 [1.1, 2.6]). Interventions to reduce psychological distress among women initiating ART should consider the familial context, as high DMP among women not in a relationship was associated with psychological distress. High DMP may indicate weak social ties and fewer material resources, particularly among women not in a relationship.
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Affiliation(s)
- Angela M Parcesepe
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | - Olga Tymejczyk
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
- c Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | - Robert Remien
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | | | - Sarah Gorrell Kulkarni
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | | | - Batya Elul
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | - Denis Nash
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
- c Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
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Tariq S, Hoffman S, Ramjee G, Mantell JE, Phillip JL, Blanchard K, Lince-Deroche N, Exner TM. "I did not see a need to get tested before, everything was going well with my health": a qualitative study of HIV-testing decision-making in KwaZulu-Natal, South Africa. AIDS Care 2018; 30:32-39. [PMID: 28695750 PMCID: PMC5699939 DOI: 10.1080/09540121.2017.1349277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/26/2017] [Indexed: 01/15/2023]
Abstract
Few studies have examined HIV-testing decision-making since the South African national HIV counseling and testing campaign in 2010-2011 and subsequent expansion in antiretroviral therapy (ART) eligibility in 2012. We describe HIV-testing decision-making and pathways to testing among participants in Pathways to Care, a cohort study of newly-diagnosed HIV-positive adults in KwaZulu-Natal. Our analysis is embedded within a theoretical framework informed by Arthur Kleinman's work on pluralistic healthcare systems, and the concept of diagnostic itineraries (i.e., the route taken to HIV testing). We conducted 26 semi-structured interviews in 2012, within one month of participants' diagnosis. Most (n = 22) deferred testing until they had developed symptoms, and then often sought recourse in non-biomedical settings. Of the eleven symptomatic participants who accessed professional medical services prior to testing, only three reported that a healthcare professional had offered or recommended an HIV test. Although ART emerged as an important motivator, offering hope of health and normalcy, fear of death and HIV-related stigma remained key barriers. Despite national policy changes in testing and treatment, health system and individual factors contributed to ongoing high levels of late diagnosis of HIV in this study population. Encouraging local health systems to direct clients toward HIV testing, and continuing to raise awareness of the benefits of routine testing remain important strategies to reduce delayed diagnoses.
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Affiliation(s)
- Shema Tariq
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
- b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Gita Ramjee
- c South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
- d Department of Global Health, School of Medicine , University of Washington , Seattle , WA , USA
| | - Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
| | - Jessica L Phillip
- c South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
| | - Kelly Blanchard
- e Ibis Reproductive Health , Cambridge , MA , USA
- f Ibis Reproductive Health , Johannesburg , South Africa
| | - Naomi Lince-Deroche
- e Ibis Reproductive Health , Cambridge , MA , USA
- f Ibis Reproductive Health , Johannesburg , South Africa
| | - Theresa M Exner
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
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Weintraub A, Mantell JE, Holt K, Street RA, Wilkey C, Dawad S, Masvawure TB, Hoffman S. 'These people who dig roots in the forests cannot treat HIV': Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs. Glob Public Health 2018; 13:115-127. [PMID: 28793809 PMCID: PMC5698148 DOI: 10.1080/17441692.2017.1359326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/19/2022]
Abstract
Relatively few empirical investigations of the intersection of HIV biomedical and traditional medicine have been undertaken. As part of preliminary work for a longitudinal study investigating health-seeking behaviours among newly diagnosed individuals living with HIV, we conducted semi-structured interviews with 24 urban South Africans presenting for HIV testing or newly enrolled in HIV care; here we explored participants' views on African traditional medicine (TM) and biomedical HIV treatment. Notions of acceptance/non-acceptance were more nuanced than dichotomous, with participants expressing views ranging from favourable to reproachful, often referring to stories they had heard from others rather than drawing from personal experience. Respect for antiretrovirals and biomedicine was evident, but indigenous beliefs, particularly about the role of ancestors in healing, were common. Many endorsed the use of herbal remedies, which often were not considered TM. Given people's diverse health-seeking practices, biomedical providers need to recognise the cultural importance of traditional health practices and routinely initiate respectful discussion of TM use with patients.
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Affiliation(s)
- Amy Weintraub
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Kelsey Holt
- b Women and Health Initiative , Harvard T.H. Chan School of Public Health , Boston , MA , USA
- c Ibis Reproductive Health , Cambridge , MA , USA
| | - Renée A Street
- d South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
| | - Catriona Wilkey
- e Hornby Zeller Associates , Inc. , South Portland , ME , USA
| | - Suraya Dawad
- f The Presidency Republic of South Africa , Pretoria , South Africa
| | - Tsitsi B Masvawure
- g Department of Sociology and Anthropology , College of the Holy Cross , Worcester , MA , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
- h Joseph Mailman School of Public Health, Department of Epidemiology , Columbia University , New York , NY , USA
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Kulkarni S, Tymejczyk O, Gadisa T, Lahuerta M, Remien RH, Melaku Z, El-Sadr W, Elul B, Nash D, Hoffman S. "Testing, Testing": Multiple HIV-Positive Tests among Patients Initiating Antiretroviral Therapy in Ethiopia. J Int Assoc Provid AIDS Care 2017; 16:546-554. [PMID: 29117777 DOI: 10.1177/2325957417737840] [Citation(s) in RCA: 12] [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: 11/16/2022] Open
Abstract
Repeat HIV testing after receiving a positive result has never been studied systematically and may give insight into reasons for delayed linkage to care. Among 831 adults in 6 secondary facilities in Oromia, Ethiopia, who completed an interviewer-administered structured questionnaire within 2 weeks of initiating antiretroviral therapy in 2012 to 2013, 110 (13.2%) reported having retested after an HIV-positive result. The odds of repeat (versus single) HIV-positive testing were higher among those who had doubted their HIV status (adjusted odds ratio [AOR]ref=nodoubt = 6.5; 95% confidence interval [CI]: 3.7-11.4) and those who initially tested at another facility, whether another secondary facility (AOR ref=studyfacility = 22.7; 95% CI: 11.0-46.9) or a lower-level facility (AORref=studyfacility = 19.1; 95% CI: 10.5-34.5). The odds of repeat (versus single) HIV-positive testing were lower among those who initially tested because of symptoms (AORref=not a reason = 0.40; 95% CI: 0.24-0.66). Median time between initial diagnosis and enrollment in care was 12.3 versus 1.0 month for repeat and single HIV-positive testers, respectively ( P < .001). Repeat HIV-positive testing-not a rare occurrence-appears to stem from doubt, seeking care at a facility other than where diagnosed, and testing for a reason other than having symptoms. Because repeat HIV-positive testing is associated with delay in linkage to care, providers should be aware of this potential when counseling those who test HIV positive.
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Affiliation(s)
- Sarah Kulkarni
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA
| | - Olga Tymejczyk
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA
| | - Tsigereda Gadisa
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Maria Lahuerta
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Robert H Remien
- 4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Zenebe Melaku
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Wafaa El-Sadr
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Batya Elul
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Denis Nash
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA.,4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Susie Hoffman
- 4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
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Del Priore G, Chen WT, Dong H, Hoffman S, Sokol G. Phase II trial of SM88 in non-metastatic biochemical recurrent prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Parcesepe AM, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. Psychological distress, health and treatment-related factors among individuals initiating ART in Oromia, Ethiopia. AIDS Care 2017; 30:338-342. [PMID: 28820273 DOI: 10.1080/09540121.2017.1363367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HIV diagnosis may be a source of psychological distress. Late initiation of antiretroviral therapy (ART) and treatment-related beliefs may intensify psychological distress among those recently diagnosed. This analysis describes the prevalence of psychological distress among people living with HIV (PLWH) and examines the association of recent HIV diagnosis, late ART initiation and treatment-related beliefs with psychological distress. The sample includes 1175 PLWH aged 18 or older initiating ART at six HIV clinics in Ethiopia. Psychological distress was assessed with Kessler Psychological Distress Scale. Scores ≥ 29 were categorized as severe psychological distress. Individuals who received their first HIV diagnosis in the past 90 days were categorized as recently diagnosed. Multivariable logistic regression modeled the association of recent diagnosis, late ART initiation and treatment-related beliefs on severe psychological distress, controlling for age, sex, education, area of residence, relationship status, and health facility. Among respondents, 29.5% reported severe psychological distress, 46.6% were recently diagnosed and 31.0% initiated ART late. In multivariable models, relative to those who did not initiate ART late and had longer time since diagnosis, odds of severe psychological distress was significantly greater among those with recent diagnosis and late ART initiation (adjusted OR [aOR]: 1.9 [95% CI 1.4, 2.8]). Treatment-related beliefs were not associated with severe psychological distress in multivariable models. Severe psychological distress was highly prevalent, particularly among those who were recently diagnosed and initiated ART late. Greater understanding of the relationship between psychological distress, recent diagnosis, and late ART initiation can inform interventions to reduce psychological distress among this population. Mental health screening and interventions should be incorporated into routine HIV clinical care from diagnosis through treatment.
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Affiliation(s)
- Angela M Parcesepe
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | - Olga Tymejczyk
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
| | - Robert Remien
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | | | - Sarah Gorrell Kulkarni
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA.,e Department of Epidemiology , Columbia University , New York , NY , USA
| | | | - Batya Elul
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | - Denis Nash
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
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Wagener R, Kretzmer H, Ammerpohl O, López C, Rohde M, Carillo-De-Santa-Pau E, Salaverria I, Szczepanowski M, Burkhardt B, Hummel M, Klapper W, Küppers R, Löffler M, Möller P, Neequaye J, Wößmann W, Lichter P, Stunnenberg H, Trümper L, Mbulaiteye S, Hoffman S, Siebert R. PROFILING OF DNA METHYLATION IN EPIDEMIOLOGICAL AND CLINICAL SUBGROUPS OF BURKITT LYMPHOMA IN THE FRAMEWORK OF THE MMML: ICGC AND BLUEPRINT CONSORTIA. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R. Wagener
- University of Ulm; Institute of Human Genetics; Ulm Germany
| | - H. Kretzmer
- LIFE Research Center for Civilization Diseases, University of Leipzig; Transcriptome Bioinformatics Group; Leipzig Germany
| | - O. Ammerpohl
- Christian-Albrechts-University; Campus Kiel, Institute of Human Genetics; Kiel Germany
| | - C. López
- University of Ulm; Institute of Human Genetics; Ulm Germany
| | - M. Rohde
- Justus-Liebig-University Giessen; Department od Pediatric Hematology and Oncology; Giessen Germany
| | - E. Carillo-De-Santa-Pau
- Spanish National Cancer Research Centre (CNIO); Structural Biology and BioComputing Programme; Madrid Spain
| | - I. Salaverria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hematopathology Unit, Hospital Clínic; Barcelona Spain
| | - M. Szczepanowski
- University Hospital Schleswig-Holstein Campus Kiel; Clinic of Internal Medicine II, Hematology Laboratory Section; Kiel Germany
| | - B. Burkhardt
- University Hospital Münster; Department of Pediatric Hematology and Oncology; Münster Germany
| | - M. Hummel
- Charité - University Medicine Berlin; Institute of Pathology; Berlin Germany
| | - W. Klapper
- University Hospital Schleswig-Holstein Campus Kiel/ Christian-Albrechts University Kiel; Institute of Hematopathology; Kiel Germany
| | - R. Küppers
- University of Duisburg-Essen; Institute of Cell Biology (Cancer Research); Essen Germany
| | - M. Löffler
- IMISE; Institute for Medical Informatics Statistics and Epidemiology; Leipzig Germany
| | - P. Möller
- Medical Faculty of the Ulm University; Institute of Pathology; Ulm Germany
| | - J. Neequaye
- University of Ghana Medical School; Department of Child Health; Accra Ghana
| | - W. Wößmann
- Justus-Liebig-University; 16 NHL-BFM Study Centre and Department of Paediatric Haematology and Oncology; Giessen Germany
| | - P. Lichter
- German Cancer Research Center; Division of Molecular Genetics; Heidelberg Germany
| | - H. Stunnenberg
- Radboud University; Molecular Biology, NCMLS, FNWI; Njimegen Netherlands
| | - L. Trümper
- Georg-August-University of Göttingen; Department of Hematology and Oncology; Göttingen Germany
| | - S.M. Mbulaiteye
- National Cancer Institute; National Institutes of Health, Division of Cancer Epidemiology and Genetics; Rockville USA
| | - S. Hoffman
- LIFE Research Center for Civilization Diseases, University of Leipzig; Transcriptome Bioinformatics Group; Leipzig Germany
| | - R. Siebert
- University of Ulm; Institute of Human Genetics; Ulm Germany
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Mantell JE, Cooper D, Exner TM, Moodley J, Hoffman S, Myer L, Leu CS, Bai D, Kelvin EA, Jennings K, Stein ZA, Constant D, Zweigenthal V, Cishe N, Nywagi N. Emtonjeni-A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study. AIDS Behav 2017; 21:905-922. [PMID: 27807792 PMCID: PMC5552040 DOI: 10.1007/s10461-016-1562-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (EI) (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care (SOC) provider-delivered intervention. The futility analysis showed that we cannot rule out the possibility that the EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC (p = 0.573), indicating that the intervention holds merit, and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit.
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Affiliation(s)
- J E Mantell
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
| | - D Cooper
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - T M Exner
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - J Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Hoffman
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - L Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C-S Leu
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - D Bai
- Department of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E A Kelvin
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Epidemiology and Biostatistics Department, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - K Jennings
- City of Cape Town Department of Health, Cape Town, South Africa
| | - Z A Stein
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - D Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - V Zweigenthal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - N Cishe
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - N Nywagi
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Hoffman S, Levasseur M, Mantell JE, Beksinska M, Mabude Z, Ngoloyi C, Kelvin EA, Exner T, Leu CS, Pillay L, Smit JA. Sexual and reproductive health risk behaviours among South African university students: results from a representative campus-wide survey. Afr J AIDS Res 2017; 16:1-10. [PMID: 28367750 PMCID: PMC5563261 DOI: 10.2989/16085906.2016.1259171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Among South African university students, HIV prevalence is lower than in age-peers, but at 3.8% it is not negligible. We examined prevalence of factors potentially associated with HIV risk, focusing on partnership characteristics and consistent condom use. We hypothesised that contraceptive-related factors, for example, desire to prevent pregnancy and not using hormonal contraceptives, would be positively associated with consistent condom use. Data were drawn from a representative interviewer-administered survey of 2nd to 4th year students conducted during registration at a university campus in KwaZulu-Natal. Of 576 students, 218 (83 women, 135 men) reported vaginal intercourse in the past 2 months. Of these, 7% of women and 43% of men reported past-year concurrent partnerships, and 24% knew/ suspected partner non-monogamy. Although reported condom use at last intercourse was 90%, 2-month consistent use was 53% (women) and 73% (men). Reported hormonal contraception use was low (women: 36.8%; men: 16.7%), and 68% used condoms for dual protection. In gender-stratified multivariable analyses, consistent condom use was higher for men who reported their partner did not use (vs. used) hormonal contraception (aOR = 5.84; 95%CI = 2.71, 12.57; p < 0.001) and who reported using condoms for dual protection (vs. single protection) (aOR = 2.46; 95%CI = 1.43, 4.25; p = 0.001). No contraception-related factors were associated with consistent condom use among women. Sexual partnership characteristics potentially place sexually active university students at high HIV risk and should be investigated further. Among men, but not women, contraceptive concerns were associated with consistent condom use. Promoting condoms for dual protection may resonate with students and should be continued.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY 10032, USA
| | - Michael Levasseur
- Department of Epidemiology, Drexel University School of Public Health
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Mags Beksinska
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Zonke Mabude
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Claudia Ngoloyi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Elizabeth A. Kelvin
- Epidemiology and Biostatistics Program, School of Urban Public Health, Hunter College & The CUNY School of Public Health, City University of New York, New York, NY 10035, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health at Columbia University, New York, NY
| | - Lavanya Pillay
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
| | - Jennifer A. Smit
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Maternal, Adolescent and Child Health Research (MatCH Research), University of the Witwatersrand, Durban 3629, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban 3627, South Africa
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Bai D, Leu CS, Mantell JE, Exner TM, Cooper D, Hoffman S, Kelvin EA, Myer L, Constant D, Moodley J. An Approach to Developing a Prediction Model of Fertility Intent Among HIV-Positive Women and Men in Cape Town, South Africa: A Case Study. AIDS Behav 2017; 21:597-609. [PMID: 27294266 DOI: 10.1007/s10461-016-1441-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
As a 'case-study' to demonstrate an approach to establishing a fertility-intent prediction model, we used data collected from recently diagnosed HIV-positive women (N = 69) and men (N = 55) who reported inconsistent condom use and were enrolled in a sexual and reproductive health intervention in public sector HIV care clinics in Cape Town, South Africa. Three theoretically-driven prediction models showed reasonable sensitivity (0.70-1.00), specificity (0.66-0.94), and area under the receiver operating characteristic curve (0.79-0.89) for predicting fertility intent at the 6-month visit. A k-fold cross-validation approach was employed to reduce bias due to over-fitting of data in estimating sensitivity, specificity, and area under the curve. We discuss how the methods presented might be used in future studies to develop a clinical screening tool to identify HIV-positive individuals likely to have future fertility intent and who could therefore benefit from sexual and reproductive health counseling around fertility options.
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Affiliation(s)
- Dan Bai
- Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheng-Shiun Leu
- Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
| | - Diane Cooper
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
- University of Western Cape School of Public Health, Cape Town, South Africa
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
- Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elizabeth A Kelvin
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Debbie Constant
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Jennifer Moodley
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Gadisa T, Tymejczyk O, Kulkarni SG, Hoffman S, Lahuerta M, Remien RH, Yigzaw M, Daba S, Elul B, Nash D, Melaku Z. Disclosure History Among Persons Initiating Antiretroviral Treatment at Six HIV Clinics in Oromia, Ethiopia, 2012-2013. AIDS Behav 2017; 21:70-81. [PMID: 26781869 DOI: 10.1007/s10461-016-1290-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
HIV status disclosure can help patients obtain support which may influence treatment adherence and subsequent healthcare needs. We examined the extent of disclosure and correlates of non-disclosure among 1180 adults newly initiating antiretroviral treatment (ART). While 91 % of those in a relationship shared their status with their partners, 14 % of the overall sample had not disclosed to anyone. Non-disclosure was positively associated with older age; control over household resources; and concerns about unintended disclosure, life disruptions, and family reactions. Knowing other HIV-positive people and longer time since diagnosis were associated with lower odds of non-disclosure. Most respondents reporting disclosure experienced supportive responses, frequently including decision to get an HIV test by confidants who had not known their own status. Although HIV status disclosure prior to ART initiation was high, some individuals cited concerns about unintended disclosure, gossip, and partner violence, and may benefit from additional disclosure support.
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Affiliation(s)
- Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Olga Tymejczyk
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, New York, NY, USA.
| | - Sarah Gorrell Kulkarni
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, New York, NY, USA
| | - Susie Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Maria Lahuerta
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Muluneh Yigzaw
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Shalo Daba
- Oromia State Regional Bureau of Health, Addis Ababa, Ethiopia
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
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Hoffman S, Exner TM, Lince-Deroche N, Leu CS, Phillip JL, Kelvin EA, Gandhi AD, Levin B, Singh D, Mantell JE, Blanchard K, Ramjee G. Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care. PLoS One 2016; 11:e0162085. [PMID: 27706150 PMCID: PMC5051894 DOI: 10.1371/journal.pone.0162085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study. METHODS Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported. RESULTS Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHRlinkage) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared p = 0.004). Of those who deferred blood draw, 48.3% cited clinic-related and 51.7% cited personal reasons. AHRlinkage was 0.60 (95%CI: 0.44, 0.82) for clinic-related and 0.53 (95%CI: 0.38, 0.75) for personal reasons relative to having day-of-diagnosis blood draw. CONCLUSIONS Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed-regardless of the reason for deferring-had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Theresa M. Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Jessica L. Phillip
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Elizabeth A. Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
| | - Anisha D. Gandhi
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | - Bruce Levin
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Dinesh Singh
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, Massachusetts, United States of America
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
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47
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Vo QT, Hoffman S, Nash D, El-Sadr WM, Tymejczyk OA, Gadisa T, Melaku Z, Kulkarni SG, Remien RH, Elul B. Gender Differences and Psychosocial Factors Associated with Quality of Life Among ART Initiators in Oromia, Ethiopia. AIDS Behav 2016; 20:1682-91. [PMID: 27091027 DOI: 10.1007/s10461-016-1396-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Health-related quality of life (HRQoL) is an important outcome to assess among persons living with HIV/AIDS, but few studies have been conducted in sub-Saharan Africa. We examined HRQoL among 1180 ART-initiating adults from six clinics in Ethiopia in 2012-2013, and compared the correlates of two subscale scores between women and men. Women scored significantly higher than men on both overall function (8.4 points higher) and life satisfaction (6.3 points higher). In multivariable models, psychological distress, low CD4+ count, unemployment, and food insecurity were associated with lower quality of life scores among women and men. Men whose last sexual encounter occurred 3 months to 1 year from the interview date had lower overall function and life satisfaction scores. Men between the ages of 30-39 had lower overall function scores. Protestant women and women in the low-middle social support category had lower life satisfaction scores. Assessment of HRQoL over time will help inform HIV care and treatment practices to ensure favorable patient outcomes.
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Affiliation(s)
- Quynh T Vo
- ICAP-Columbia University, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies at the NYS Psychiatric Institute, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Denis Nash
- Epidemiology and Biostatistics Program, City University of New York School of Public Health, New York, USA
| | - Wafaa M El-Sadr
- ICAP-Columbia University, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Olga A Tymejczyk
- Epidemiology and Biostatistics Program, City University of New York School of Public Health, New York, USA
| | - Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Sarah G Kulkarni
- Epidemiology and Biostatistics Program, City University of New York School of Public Health, New York, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies at the NYS Psychiatric Institute, Columbia University, New York, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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48
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Tymejczyk O, Hoffman S, Kulkarni SG, Gadisa T, Lahuerta M, Remien RH, Elul B, El-Sadr W, Melaku Z, Nash D. HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia. AIDS Behav 2016; 20:998-1008. [PMID: 26346333 DOI: 10.1007/s10461-015-1184-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To better understand patient beliefs, which may influence adherence to HIV care and treatment, we examined three dimensions of beliefs among Ethiopian adults (n = 1177) initiating antiretroviral therapy (ART). Beliefs about benefits of ART/HIV clinical care were largely accurate, but few patients believed in the ability of ART to prevent sexual transmission and many thought Holy Water could cure HIV. Factors associated with lower odds of accurate beliefs included advanced HIV, lack of formal education, and Muslim religion (benefits of ART/clinical care); secondary or university education and more clinic visits (ART to prevent sexual transmission); and pregnancy and Orthodox Christian religion (Holy Water). Assessment of patient beliefs may help providers identify areas needing reinforcement. In this setting, counselors also need to stress the benefits of ART as prevention and that Holy Water should not be used to the exclusion of HIV care and ART.
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Affiliation(s)
- Olga Tymejczyk
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, 2180 Third Avenue, New York, NY, 10035, USA.
| | - Susie Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Sarah Gorrell Kulkarni
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, 2180 Third Avenue, New York, NY, 10035, USA
| | - Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Maria Lahuerta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wafaa El-Sadr
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, School of Urban Public Health, Hunter College, City University of New York, 2180 Third Avenue, New York, NY, 10035, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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49
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Mantell JE, Smit JA, Exner TM, Mabude Z, Hoffman S, Beksinska M, Kelvin EA, Ngoloyi C, Leu CS, Stein ZA. Erratum to: Promoting Female Condom Use Among Female University Students in KwaZulu-Natal, South Africa: Results of a Randomized Behavioral Trial. AIDS Behav 2016; 20:949-50. [PMID: 26194425 DOI: 10.1007/s10461-015-1114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Harrison A, Hoffman S, Mantell JE, Smit JA, Leu CS, Exner TM, Stein ZA. Gender-Focused HIV and Pregnancy Prevention for School-Going Adolescents: The Mpondombili Pilot Intervention in KwaZulu-Natal, South Africa. J HIV AIDS Soc Serv 2016; 15:29-47. [PMID: 27642267 PMCID: PMC5019561 DOI: 10.1080/15381501.2014.999183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This pilot study evaluated a 15 session classroom intervention for HIV and pregnancy prevention among grade 8-10 boys and girls (ages 14-17) in rural South Africa, guided by gender-empowerment theory and implemented by teachers, nurses, and youth peer educators. Pre- and post-intervention surveys included 933 male and female students in two intervention and two comparison schools. MAIN OUTCOME condom use at last sex; secondary outcomes: partner communication; gender beliefs and values; perceived peer behaviors; self-efficacy for safer sex. At five months post-intervention, change in condom use did not differ between intervention and comparison schools. Intervention school youth had greater increases in self-efficacy for unsafe sex refusal [OR=1.61; 95% CI=1.01, 2.57] and condom use [OR=1.76; 95% CI=1.07, 2.89], partner communication [OR=2.42; 95% CI=1.27, 4.23], and knowledge of HIV testing opportunities [OR=1.76; 95% CI=1.08, 2.87]. This gender-focused pilot intervention increased adolescents' self-efficacy and partner communication, and has potential to improve preventive behaviors.
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Affiliation(s)
- Abigail Harrison
- Department of Behavioral and Social Sciences, School of Public Health, Brown University and Population Studies and Training Center, Providence, RI, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jennifer A Smit
- MatCH, University of the Witwatersrand, Durban, South Africa; School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA; Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Zena A Stein
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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