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Becker N, Kim HC, Bright DJ, Williams Iii R, Anguera JA, Arnold EA, Saberi P, Neilands TB, Pollack LM, Tan JY. Acceptability of the LetSync App Wireframes for an mHealth Intervention to Improve HIV Care Engagement and Treatment Among Black Partnered Sexual Minority Men: Findings from In-Depth Qualitative Interviews. JMIR Form Res 2023; 7:e43676. [PMID: 37624634 PMCID: PMC10492169 DOI: 10.2196/43676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care. OBJECTIVE We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app. METHODS We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement. RESULTS Participants indicated interest in the future LetSync app and noted that the wireframes' features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users' engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner's health needs, including access to and use of health care services; and facilitate participants' ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV. CONCLUSIONS Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services.
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Affiliation(s)
- Nozipho Becker
- Office for Inclusive Excellence, Colorado State University, Fort Collins, CO, United States
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Hyunjin C Kim
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Darius J Bright
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Robert Williams Iii
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Joaquin A Anguera
- Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Emily A Arnold
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Parya Saberi
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Judy Y Tan
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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2
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Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, Safren S, Golub SA, Patel VV. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care 2023; 35:572-580. [PMID: 35819879 PMCID: PMC9834431 DOI: 10.1080/09540121.2022.2099511] [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: 04/02/2021] [Accepted: 07/04/2022] [Indexed: 01/14/2023]
Abstract
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.
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Affiliation(s)
| | | | | | | | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
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3
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Owczarzak J, Fuller S, Coyle C, Davey-Rothwell M, Kiriazova T, Tobin K. The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine. AIDS Behav 2022;:1-12. [PMID: 36441406 DOI: 10.1007/s10461-022-03925-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.
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Sterrett-Hong EM, Crosby R, Johnson M, Jennings Mayo-Wilson L, Arroyo C, Machinga R, Brewer R, Srivastava A, Smith A, Arnold E. Socio-Ecological Influences on HIV Care Engagement: Perspectives of Young Black Men Who Have Sex with Men Living with HIV in the Southern US. J Racial Ethn Health Disparities 2022;:1-11. [PMID: 35976604 DOI: 10.1007/s40615-022-01364-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
Young Black men who have sex with men (MSM) living with HIV evidence the lowest rates of linkage to care and viral suppression of all US MSM. Kentucky, identified by the US Department of Health and Human Services as a "hot spot" state with elevated HIV incidence compared to the rest of the country, exhibits similar racialized outcomes. Structural, interpersonal, and individual drivers of engagement along the HIV care continuum among people living with HIV have been identified, primarily through quantitative designs. However, the mechanisms by which these factors shape HIV care engagement, and the ways they may combine or reinforce each other, as well as from the lived experience of young Black MSM living with HIV, have been studied to a lesser extent. In this study, a purposive sample of n = 29 HIV-positive young Black MSM (age M = 25 years old; 38% retained in care) residing in Kentucky participated in in-depth interviews. Factors that were most influential on engagement varied along the continuum, with health insurance status and knowledge of HIV being relatively more influential to diagnosis, and housing stability, psychological processes, and interpersonal relationships being more influential on retention. For some participants, barriers to care at multiple levels had a mutually influencing and intensifying impact on care engagement. Additional efforts to center the voices of young Black MSM living with HIV will help illuminate acceptable and sustainable interventions for increasing their care engagement and narrowing persistent racial disparities in HIV morbidity and mortality.
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Padilla M, Carter B, Gutierrez M, Fagan J. The Boundary of HIV Care: Barriers and Facilitators to Care Engagement Among People with HIV in the United States. AIDS Patient Care STDS 2022; 36:321-331. [PMID: 35951449 PMCID: PMC10123534 DOI: 10.1089/apc.2022.0062] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/12/2022] Open
Abstract
Treating people with HIV (PWH) quickly and effectively to achieve viral suppression is a key strategy for Ending the HIV Epidemic. Understanding barriers and facilitators to HIV care engagement could improve outcomes among PWH and reduce HIV infections. We sampled PWH who participated in the Medical Monitoring Project from June 2018 to May 2019 and were not engaged in HIV care to participate in 60-min semistructured telephone interviews on barriers and facilitators to HIV care engagement. We used applied thematic analysis and placed codes into themes based on their frequency and salience. Participants reported various intrapersonal, health system, and structural barriers to care. We conceptualize the boundary of care as the space between the stages of the HIV care continuum, where PWH may find themselves when they lack intrapersonal, health system, and structural support. Research and interventions tackling these barriers are needed to improve outcomes among PWH and reduce HIV infections.
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Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brittani Carter
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Jennifer Fagan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Sileo KM, Wanyenze RK, Mukasa B, Musoke W, Kiene SM. The Intersection of Inequitable Gender Norm Endorsement and HIV Stigma: Implications for HIV Care Engagement for Men in Ugandan Fishing Communities. AIDS Behav 2021; 25:2863-2874. [PMID: 33566214 DOI: 10.1007/s10461-021-03176-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Men's engagement in the HIV care continuum may be negatively affected by adherence to inequitable gender norms, which may be exacerbated by HIV stigma. This cross-sectional study with 300 male fisherfolk in Uganda examined the independent and interacting effects of inequitable gender norm endorsement and HIV stigma on men's missed HIV care appointments and missed antiretroviral (ARV) doses. Greater gender inequitable norm endorsement was associated with increased odds of missed HIV clinic visits (adjusted odds ratio [AOR)] 1.44, 95% CI 1.16-1.78) and a statistically significant interaction between internalized HIV stigma and inequitable gender norms on missed ARV doses was identified (AOR 5.32, 95% CI 2.60-10.86). Adherence to traditional gender norms reduces men's HIV appointment attendance, and among men with high internalized stigma, increases the likelihood of poor treatment adherence. These findings point to the need for HIV interventions that reconfigure harmful gender norms with a focus on stigma reduction.
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Affiliation(s)
- K M Sileo
- Department of Public Health, University of Texas At San Antonio, One UTSA Circle, MB 3.472, San Antonio, TX, 78249, USA.
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA.
| | - R K Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | | | - S M Kiene
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA
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Kuhns LM, Hotton AL, Perloff J, Paul J, Parker C, Muldoon AL, Johnson AK, Garofalo R. Evaluation of Translife Care: An Intervention to Address Social Determinants of Engagement in HIV Care Among Transgender Women of Color. AIDS Behav 2021; 25:13-9. [PMID: 31165937 DOI: 10.1007/s10461-019-02548-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The TransLife Care (TLC) project was developed to address the structural factors that act as barriers to HIV care among transgender women of color. The purpose of this study was to evaluate the feasibility and initial efficacy of the TLC project; primary HIV care outcomes included linkage to HIV care, engagement in care, retention in care, use of ART and viral suppression among N = 120 participants. In multivariable analysis, receipt of the intervention (versus none), was associated with any HIV care visit (aOR 2.05; 95% CI 1.25-3.37; p = 0.005), more total HIV care visits (aRR 1.45; 95% CI 1.09-1.94; p = 0.011), being retained in care (aOR 1.58; 95% CI 1.03-2.44; p = 0.038), and having a viral load test done (aOR 1.95; 95% CI 1.23-3.09; p = 0.004). We conclude that a structural intervention, designed and delivered by the focus population, that directly addresses social determinants, is feasible and efficacious to promote HIV care engagement among transgender women of color.
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8
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Cohn WF, Canan CE, Knight S, Waldman AL, Dillingham R, Ingersoll K, Schexnayder J, Flickinger TE. An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research. JMIR Mhealth Uhealth 2021; 9:e19163. [PMID: 33908893 PMCID: PMC8116995 DOI: 10.2196/19163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/25/2020] [Accepted: 03/23/2021] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites.
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Affiliation(s)
- Wendy F Cohn
- Department of Public Health Sciences, University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, United States
| | - Chelsea E Canan
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Sarah Knight
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Ava Lena Waldman
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Julie Schexnayder
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Tabor E Flickinger
- Division of General, Geriatric, Palliative and Hospital Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2020; 73:e3572-e3605. [PMID: 33225349 DOI: 10.1093/cid/ciaa1391] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.
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Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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Amirkhanian YA, Kelly JA, Kuznetsova AV, DiFranceisco WJ, Tarima SS, McAuliffe TL, Pirogov DG, Yakovlev AA, Musatov VB, Chaika NA. Mobilizing individual social capital resources for HIV care support: results of a pilot intervention in St. Petersburg, Russia. AIDS Care 2020; 32:99-106. [PMID: 32162527 DOI: 10.1080/09540121.2020.1739206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Half of HIV-positive persons in Russia are on antiretroviral therapy (ART), and only 27% are virally suppressed. A feasibility pilot intervention to mobilize social capital resources for HIV care support was conducted in St. Petersburg. Out-of-care or ART-nonadherent HIV-positive persons (n = 24) attended a five-session intervention to increase access social capital resources (i.e., family, friends, or providers) to mobilize supports for entering care, initiating care, and adhering to ART. HIV care indicators were assessed at baseline, an immediate followup (FU-1), and 6-month followup (FU-2) points. At FU-1, participants more frequently discussed their care experiences with others, verifying the intervention's mechanism of action. Participants increased in scales of medication taking adherence (p = 0.002, FU-1; p = 0.011, FU-2), self-efficacy (p = 0.042; FU-1), and outcome expectancies (p = 0.016, FU-2). Among persons not on ART, HIV Medication Readiness scale scores increased at FU-1 (p = 0.032) but became attenuated at FU-2. Participants tended to more frequently keep care appointments (79%, baseline to 90%, FU-1, p = 0.077); to have undetectable viral load (54%, baseline to 74%, FU-2; p = 0.063); and to have fewer past-month days with delayed or incomplete medication doses (7.8, baseline to 4.2, FU-1; p = 0.084). This novel social capital intervention is promising for improving HIV care-related outcomes and warrants a full-scale evaluation.
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Affiliation(s)
- Yuri A Amirkhanian
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna V Kuznetsova
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Wayne J DiFranceisco
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergey S Tarima
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dmitry G Pirogov
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.,Faculty of Clinical Psychology, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Alexey A Yakovlev
- Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia.,Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Vladimir B Musatov
- Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia.,Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Nikolay A Chaika
- Pasteur Institute of Epidemiology and Microbiology, St. Petersburg, Russia
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Amirkhanian YA, Kelly JA, Tarima SS, Kuznetsova AV, DiFranceisco WJ, Musatov VB, Yakovlev AA, McAuliffe TL. Prevalence of Alcohol Use and Factors Associated With Problem Drinking in Social Networks of People Living With HIV Infection in St. Petersburg, Russia. AIDS Educ Prev 2019; 31:380-393. [PMID: 31361515 PMCID: PMC6668921 DOI: 10.1521/aeap.2019.31.4.380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/10/2023]
Abstract
Russia has over 1.2 million HIV infections and Europe's highest HIV incidence. Although its HIV epidemic is intertwined with high alcohol consumption rates, the interaction between alcohol use and HIV care in Russia is understudied. Five hundred eighty-six HIV-positive persons were recruited using social network methods in St. Petersburg. Fifty-nine percent of males, and 45% of females, drank regularly. Thirty percent of alcohol users reported binge drinking (males: ≥ 5 drinks; females ≥ 4 drinks) in the past week. Alcohol use was associated with lower HIV care engagement and having a detectable viral load. Multivariate analyses showed that any alcohol consumption, number of alcohol drinks consumed, and having a binge drinking day in the past week were associated with male gender, use of illicit drugs, drug injection, smaller social network size, lower social supports, being unmarried, and reporting condomless intercourse with non-main partners. Interventions to improve HIV care in Russia must comprehensively address the use of alcohol and substances that interfere with care engagement.
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Affiliation(s)
- Yuri A. Amirkhanian
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia
| | - Jeffrey A. Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia
| | - Sergey S. Tarima
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna V. Kuznetsova
- Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia
| | - Wayne J. DiFranceisco
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vladimir B. Musatov
- Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia
- Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Alexey A. Yakovlev
- Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Clinical Hospital of Infectious Diseases Named after S.P. Botkin, St. Petersburg, Russia
- Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Knettel BA, Mulawa MI, Knippler ET, Ciya N, Robertson C, Joska JA, Sikkema KJ. Women's perspectives on ImpACT: a coping intervention to address sexual trauma and improve HIV care engagement in Cape Town, South Africa. AIDS Care 2019; 31:1389-1396. [PMID: 30821168 DOI: 10.1080/09540121.2019.1587368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-infected women who have experienced sexual violence face unique challenges in their HIV care engagement and adherence to antiretroviral medications (ARVs). Improving AIDS Care after Trauma (ImpACT) is a brief counseling intervention aimed at reducing the negative impact of sexual trauma and HIV, building coping skills, and improving long-term HIV care engagement. We conducted a randomized controlled pilot trial of ImpACT with 64 women initiating ARVs in Cape Town, South Africa, with results suggesting the intervention can reduce PTSD symptoms and increase motivation to adhere to ARVs. For the current study, we abstracted data from ImpACT worksheets completed by 31 participants during intervention sessions, and qualitative responses from post-intervention surveys, to examine mechanisms, facilitators, and barriers to change in the intervention. Data included participant descriptions of the values informing their care, barriers to participation, and perceived benefits of the intervention related to coping with trauma and improving care engagement. During the first session, women reported feelings of shame, sadness, and anger that led to social isolation, mistrust, and damaged relationships. Barriers to participation included work and school demands, issues with transportation, finances, and discomfort in talking about HIV and trauma, particularly in group sessions. Despite these challenges, several women stated they developed more positive thinking, felt more confident, and improved their interpersonal relationships. Participants also reported substantial positive impact on symptoms of sexual trauma and motivation to continue with long-term HIV care, and clearer understanding of barriers and facilitators to ARV adherence. ImpACT is a promising intervention model for building adaptive coping skills and adherence to HIV treatment, informed by personal values, among women with a history of trauma in this high-risk setting. The data also offer insights into strategies to strengthen the intervention, overcome barriers to participation, encourage the practical application of skills, and promote long-term HIV care engagement.
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Affiliation(s)
| | - Marta I Mulawa
- Duke Global Health Institute, Duke University , Durham , NC , USA
| | | | - Nonceba Ciya
- Department of Psychiatry and Mental Health, University of Cape Town , Cape Town , South Africa
| | - Corné Robertson
- Department of Psychiatry and Mental Health, University of Cape Town , Cape Town , South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town , Cape Town , South Africa
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University , Durham , NC , USA.,Department of Psychiatry and Mental Health, University of Cape Town , Cape Town , South Africa.,Department of Psychology and Neuroscience, Duke University , Durham , NC , USA
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Sileo KM, Wanyenze RK, Kizito W, Reed E, Brodine SK, Chemusto H, Musoke W, Mukasa B, Kiene SM. Multi-level Determinants of Clinic Attendance and Antiretroviral Treatment Adherence Among Fishermen Living with HIV/AIDS in Communities on Lake Victoria, Uganda. AIDS Behav 2019; 23:406-417. [PMID: 29959718 PMCID: PMC6492274 DOI: 10.1007/s10461-018-2207-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/28/2022]
Abstract
This cross-sectional study assessed determinants of HIV clinic appointment attendance and antiretroviral treatment (ART) adherence among 300 male fisherfolk on ART in Wakiso District, Uganda. Multi-level factors associated with missed HIV clinic visits included those at the individual (age, AOR = 0.98, 95% CI 0.97-0.99), interpersonal (being single/separated from partner, AOR: 1.25, 95% CI 1.01-1.54), normative (anticipated HIV stigma, AOR: 1.55, 95% CI 1.05-2.29) and physical/built environment-level (travel time to the HIV clinic, AOR: 1.11, 95% CI 1.02-1.20; structural-barriers to ART adherence, AOR: 1.27, 95% CI 1.04-1.56; accessing care on a landing site vs. an island, AOR: 1.35, 95% CI 1.08-1.67). Factors associated with ART non-adherence included those at the individual (age, β: - 0.01, η2 = 0.03; monthly income, β: - 0.01, η2 = 0.02) and normative levels (anticipated HIV stigma, β: 0.10, η2 = 0.02; enacted HIV stigma, β: 0.11, η2 = 0.02). Differentiated models of HIV care that integrate stigma reduction and social support, and reduce the number of clinic visits needed, should be explored in this setting to reduce multi-level barriers to accessing HIV care and ART adherence.
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Affiliation(s)
- K M Sileo
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, CT, USA.
| | - R K Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | - E Reed
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - S K Brodine
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | | | | | - S M Kiene
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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Tan JY, Campbell CK, Tabrisky AP, Siedle-Khan R, Conroy AA. A Conceptual Model of Dyadic Coordination in HIV Care Engagement Among Couples of Black Men Who Have Sex with Men: A Qualitative Dyadic Analysis. AIDS Behav 2018; 22:2584-2592. [PMID: 29464429 DOI: 10.1007/s10461-018-2070-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Among Black men who have sex with men (MSM), HIV incidence is disproportionately high and HIV care engagement is disproportionately low. There may be important opportunities to leverage the primary relationship to improve engagement in HIV care and treatment among Black MSM couples. Using dyadic qualitative analysis of semi-structured, one-on-one interviews, we explored dyadic aspects of HIV care engagement among 14 Black MSM couples in which at least one partner was HIV-positive and identified as a Black cisgender man. Findings showed that men varied in how involved they were in their HIV-positive partner's care and treatment, and in how they reciprocated their partner's involvement. Patterns of dyadic HIV care engagement supported a conceptual model of dyadic coordination that describes Black MSM relationships in terms of two conceptual dimensions of dyadic HIV care engagement, and guides future intervention designs with Black MSM couples.
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Tan JY, Pollack L, Rebchook G, Peterson J, Huebner D, Eke A, Johnson W, Kegeles S. The Role of the Primary Romantic Relationship in HIV Care Engagement Outcomes Among Young HIV-Positive Black Men Who Have Sex with Men. AIDS Behav 2018; 22:774-790. [PMID: 27844296 PMCID: PMC5839634 DOI: 10.1007/s10461-016-1601-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.
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Affiliation(s)
- Judy Y Tan
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA.
| | - Lance Pollack
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - Greg Rebchook
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - John Peterson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - David Huebner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Agatha Eke
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Kegeles
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
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Kutnick AH, Gwadz MV, Cleland CM, Leonard NR, Freeman R, Ritchie AS, McCright-Gill T, Ha K, Martinez BY. It's a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals. Front Public Health 2017; 5:100. [PMID: 28540287 PMCID: PMC5423945 DOI: 10.3389/fpubh.2017.00100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
After HIV diagnosis, heterosexuals in high-poverty urban areas evidence delays in linkage to care and antiretroviral therapy initiation compared to other groups. Yet barriers to/facilitators of HIV care among these high-risk heterosexuals are understudied. Under the theory of triadic influence, putative barriers to HIV care engagement include individual/attitudinal-level (e.g., fear, medical distrust), social-level (e.g., stigma), and structural-level influences (e.g., poor access). Participants were African-American/Black and Hispanic adults found newly diagnosed with HIV (N = 25) as part of a community-based HIV testing study with heterosexuals in a high-poverty, high-HIV-incidence urban area. A sequential explanatory mixed-methods design was used. We described linkage to HIV care and clinical outcomes [CD4 counts, viral load (VL) levels] over 1 year, and then addressed qualitative research questions about the experience of receiving a new HIV diagnosis, its effects on timely engagement in HIV care, and other barriers and facilitators. Participants were assessed five times, receiving a structured interview battery, laboratory tests, data extraction from the medical record, a post-test counseling session, and in-person/phone contacts to foster linkage to care. Participants were randomly selected for qualitative interviews (N = 15/25) that were recorded and transcribed, then analyzed using systematic content analysis. Participants were 50 years old, on average (SD = 7.2 years), mostly male (80%), primarily African-American/Black (88%), and low socioeconomic status. At the first follow-up, rates of engagement in care were high (78%), but viral suppression was modest (39%). Rates improved by the final follow-up (96% engaged, 62% virally suppressed). Two-thirds (69%) were adequately retained in care over 1 year. Qualitative results revealed multi-faceted responses to receiving an HIV diagnosis. Problems accepting and internalizing one’s HIV status were common. Reaching acceptance of one’s HIV-infected status was frequently a protracted and circuitous process, but acceptance is vital for engagement in HIV care. Fear of stigma and loss of important relationships were potent barriers to acceptance. Thus, partially as a result of difficulties accepting HIV status, delays in achieving an undetectable VL are common in this population, with serious potential negative consequences for individual and public health. Interventions to foster acceptance of HIV status are needed.
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Affiliation(s)
- Alexandra H Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Marya Viorst Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Charles M Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Robert Freeman
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Kathy Ha
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Belkis Y Martinez
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
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Abstract
High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007-2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = -1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = -0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Mûnene E, Ekman B. Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care center in Kenya. AIDS Care 2014; 27:378-86. [PMID: 25298265 DOI: 10.1080/09540121.2014.963020] [Citation(s) in RCA: 17] [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: 10/24/2022]
Abstract
Consistent individual effort in engagement in HIV medical services has been associated with positive health outcomes in people living with HIV (PLHIV). However, whether these benefits are facilitated by improved medication adherence has not been widely studied. This study aimed to investigate the marginal effect of engagement in HIV care on medication adherence at a public health facility in Kenya. Between February and April 2013, 392 patients on HIV care at Nyeri Provincial General Hospital participated in this study. Data were collected using a self-administered health survey questionnaire assessing health and sociodemographic statuses. A manual stepwise general linear model was specified to measure the effect of engagement in HIV and other associated predictors on medication adherence. Engagement in HIV care was significantly associated with log-transformed medication adherence in the sample (100·β = 9.2%, 95% CI 3.2-15.1) irrespective of gender and other selected predictors. Longer duration on antiretroviral therapy was also a significant predictor of better medication adherence (100·β = 3.2%, 95% CI 2.3-4.1). Despite inter-gender differences in adherence and engagement determinants, gender's independent effect on medication adherence and engagement in care were not statistically significant. Poor medication adherence was associated with lower patient engagement in HIV care services, suggesting that interventions which remove obstacles to regular observance of scheduled clinic appointments and eventual retention may have a beneficial impact on medication adherence and, accordingly, health outcomes in PLHIV.
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Affiliation(s)
- Edwin Mûnene
- a Department of Pharmacy , Nyeri Provincial General Hospital , Nyeri , Nyeri County , Kenya
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