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da Cunha GH, Fontenele MSM, Galvão MTG, Dantas MB, Gomes MEC, Fechine FV, de Sousa Paiva S. Factors Associated With Symptoms of Anxiety and Depression in People Living With HIV in Northeast Brazil. J Acquir Immune Defic Syndr 2024; 97:87-98. [PMID: 39116335 DOI: 10.1097/qai.0000000000003468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/21/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The diagnosis of HIV infection can cause mental disorders or exacerbate existing symptoms because of the stigma, psychological stress, and need for the self-management of the illness. The aim of this study was to determine the prevalence of anxiety and depression symptoms in people with HIV and to identify the associated factors. METHODS This is a cross-sectional study. A sample of 385 people living with HIV (PLWH) was interviewed using the Sociodemographic, Epidemiological, and Clinical Form; the Beck Anxiety Inventory; the Beck Depression Inventory; and Pittsburgh Sleep Quality Index. Univariate and multivariate logistic regression analysis were performed. The odds ratio and 95% confidence interval were calculated. RESULTS The prevalence of anxiety was 27.1% and depression was 39.8%. Being female (P = 0.0227), antiretroviral therapy (ART) for 8 years or less (P = 0.0042), and having depression (P < 0.0001) were associated with the occurrence of anxiety. Having a detectable viral load (P = 0.0476), not exercising regularly (P = 0.0070), and having sleep disorders (P = 0.0001) and anxiety (P < 0.0001) were associated with depression. Retired and on leave or sick pay were, respectively, 2.67 and 3.90 times more likely to have depression than those who were employed. CONCLUSIONS A considerable percentage of PLWH have anxiety and depression symptoms. Being female, less than 8 years of ART, and depression are associated with anxiety, while detectable viral load, not practicing physical exercise, having sleep disorders, anxiety, and being retired or on leave or sick pay are associated with depression. The study showed important data for health interventions by members of the multidisciplinary team for PLWH.
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Martins N, Soares D, Gusmao C, Nunes M, Abrantes L, Valadares D, Marcal S, Mali M, Alves L, Martins J, da Silva V, Ward PR, Fauk NK. A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste. PLoS One 2024; 19:e0306106. [PMID: 39133682 PMCID: PMC11318865 DOI: 10.1371/journal.pone.0306106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024] Open
Abstract
Violence against women or gender-based violence (GBV) is a significant public health issue facing women and girls in different settings. It is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n = 19) or TB (n = 23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one, in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer's analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The women's experience of GBV during the pandemic also led to various negative psychological impacts. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended.
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Affiliation(s)
- Nelson Martins
- Daslo Research and Development, Timor Leste
- Universidade da Paz (UNPAZ), Timor Leste
- Menzies School of Health Research, Darwin, NT, Australia
| | - Domingos Soares
- Instituto Nacional de Saúde Publica Timor-Leste (INSP-TL), Ministry of Health Timor-Leste
- Instituto Superior Cristal, Timor Leste
| | - Caetano Gusmao
- Instituto Nacional de Saúde Publica Timor-Leste (INSP-TL), Ministry of Health Timor-Leste
| | | | | | | | | | | | - Luis Alves
- Daslo Research and Development, Timor Leste
| | | | - Valente da Silva
- Daslo Research and Development, Timor Leste
- Universidade da Paz (UNPAZ), Timor Leste
| | - Paul Russell Ward
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Melbourne, Australia
| | - Nelsensius Klau Fauk
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Melbourne, Australia
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Kim Y, Park E, Jung Y, Kim K, Kim T, Kim HS. Impact of COVID-19 on human immunodeficiency virus tests, new diagnoses, and healthcare visits in the Republic of Korea: a retrospective study from 2016 to 2021. Osong Public Health Res Perspect 2024; 15:340-352. [PMID: 39091166 PMCID: PMC11391373 DOI: 10.24171/j.phrp.2024.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Public health workers have been at the forefront of treating patients with coronavirus disease 2019 (COVID-19) and managing the pandemic. The redeployment of this workforce has limited or interrupted other public health services, including testing for human immunodeficiency virus (HIV). This study aims to examine the impact of COVID-19 on HIV testing and diagnosis in the Republic of Korea from 2016 to 2021, comparing data before and after the onset of COVID-19. METHODS Annual HIV testing data were collected from each institution through direct communication or from open-source databases. The annual number of new HIV cases was obtained from the official report of the Korea Disease Control and Prevention Agency. Data on healthcare visits for HIV diagnosis or treatment were extracted from the open-source database of the National Insurance Health Service of Korea. Interrupted time series regression was conducted, stratified by institution type. RESULTS In 2020, HIV tests, diagnoses, and visits decreased. Notably, public health centers experienced a substantial reduction in 2020-2021 compared to previous years. The annual percentage change in HIV tests was -53.0%, while for HIV diagnoses, it was -31.6%. The decrease in visits for HIV was also most pronounced for public facilities: -33.3% in 2020 and -45.6% in 2021 relative to 2019. CONCLUSION The numbers of tests, diagnoses, and healthcare visits for HIV at public health centers in the Republic of Korea substantially decreased in 2020 and 2021. The impacts of these changes on the early diagnosis and treatment of HIV necessitate further monitoring.
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Affiliation(s)
- Yeonju Kim
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Eonjoo Park
- Division of Infectious Disease Response, Capital Regional Center for Disease Control and Prevention, Seoul, Republic of Korea
| | - Yoonhee Jung
- Division of HIV/AIDS Prevention, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Koun Kim
- Division of HIV/AIDS Prevention, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Taeyoung Kim
- Division of HIV/AIDS Prevention, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Hwa Su Kim
- Division of HIV/AIDS Prevention, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
- Division of Bacterial Disease, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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Wang L, Slaughter F, Nguyen AT, Smith S, Prabhu S, Beima-Sofie K, Wallace S, Crane HM, Simoni JM, Graham SM. Impact of the COVID-19 pandemic on mental health and viral suppression among persons living with HIV in western Washington. AIDS Care 2024; 36:885-898. [PMID: 38623592 DOI: 10.1080/09540121.2024.2341220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
The COVID-19 pandemic and social distancing measures elevated stress levels globally, exacerbating mental health challenges for people with HIV (PWH). We examined the effect of COVID-19-related stress on mental health among PWH in western Washington, exploring whether social support and coping self-efficacy were protective. Data on COVID-19-related stress, mental health, social support, and coping self-efficacy were collected using online surveys during the pandemic. Pre-COVID-19 mental health data were available for a subset of participants and were linked with the survey data. In the total sample (N = 373), COVID-19-stress was associated with elevated depression (PHQ-8, β = 0.21, 95%CI [0.10, 0.32]) and anxiety (GAD-7, β = 0.28, 95%CI [0.17, 0.39]). Among the subset of respondents with pre-pandemic mental health data (N = 103), COVID-19-related stress was associated with elevated PHQ-8 scores (β = 0.35, 95%CI [0.15, 0.56]) and GAD-7 scores (β = 0.35, 95%CI [0.16, 0.54]), adjusted for baseline mental health and other confounders. Coping self-efficacy was negatively associated with GAD-7 scores (β = -0.01, 95%CI [-0.01, 0.00]), while social support was negatively associated with PHQ-8 scores (β = -0.06, 95%CI [-0.12, -0.01]). Viral suppression before and during the pandemic did not differ among participants with available data. While COVID-19-related stress predicted elevated depression and anxiety symptoms among PWH, social support and coping self-efficacy were protective.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Francis Slaughter
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Anh T Nguyen
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Smith
- Center on Gender Equity and Health (GEH), University of California, San Diego, USA
| | - Sandeep Prabhu
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stephaun Wallace
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Susan M Graham
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Poku OB, Ahmed A, Liotta L, Kluisza L, Robbins RN, Abrams EJ, Mellins CA. "We did more than survive": lessons learned from studies of risk and resilience of young people growing up with HIV and mental health needs. AIDS Care 2024; 36:24-35. [PMID: 38446048 PMCID: PMC11283975 DOI: 10.1080/09540121.2024.2308745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024]
Abstract
Despite advances in HIV-treatment, adolescents and young adults (AYA) with HIV (AYAHIV) face myriad challenges. They are less likely than children and older adults to be virally suppressed and are at higher risk for mental health conditions compared to their peers who do not have HIV. AYA are also developing in the context of numerous biomedical, neurocognitive, and psychosocial developmental changes. Normative challenges during this time can be exacerbated by HIV and can result in significant physical and mental health problems. Yet, many AYAHIV have shown resilience with positive assets and resources and few health or mental health problems. Historically research has had a risk-focused approach to understanding AYAHIV needs. This paper discusses the rationale for a shift from a risk-focused only approach to one that examines AYAHIV needs from both a risk and resilience perspective. This paper presents: (1) epidemiological data on AYAHIV; (2) conceptual models for understanding both risk (e.g., poverty, stress, trauma, limited resources) and resilience/protective factors (e.g., family and peer support, future orientation, problem-solving skills); (3) global data examining risk and protective factors for physical and mental health challenges; and (4) promising interventions that incorporate elements of resilience to improve overall outcomes among AYAHIV.
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Affiliation(s)
- Ohemaa B. Poku
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Afifa Ahmed
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Reuben N. Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Jung M. Assessing COVID-19 Vulnerability Among HIV-positive Men Who Have Sex With Men in Korea: The Role of Vaccination and Sexual Behaviors. J Prev Med Public Health 2024; 57:370-378. [PMID: 38938044 PMCID: PMC11309833 DOI: 10.3961/jpmph.24.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV. METHODS Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables. RESULTS Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35). CONCLUSIONS The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.
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Affiliation(s)
- Minsoo Jung
- Department of Health Science, Dongduk Women’s University College of Natural Science, Seoul, Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Gizaw AT, Abayneh M. Exploring how stay-at-home orders during the COVID-19 pandemic impedes engagement along the HIV/AIDS care continuum in public hospitals of Southwest Ethiopia: a qualitative study. Front Public Health 2024; 12:1273448. [PMID: 38952732 PMCID: PMC11215968 DOI: 10.3389/fpubh.2024.1273448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/08/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction COVID-19 has rapidly spread across the world. In March 2020, shortly after the first confirmed case of COVID-19 in Ethiopia in March 2020, the government of Ethiopia took several measures. Purpose This study aims to explore how stay-at-home orders during the COVID-19 pandemic hinder engagement with HIV/AIDS care in public hospitals in Southwest Ethiopia. Additionally, we aim to explore the psychosocial challenges faced in accessing services during stay-at-home orders. Methods A descriptive qualitative study was conducted from 20 May to 3 June 2020, using semi-structured, in-depth interviews. In total, 27 study participants were recruited from purposively selected people living with HIV/AIDS (PLWHA) who had experienced delays, declines, or discontinuation of care after COVID-19 was confirmed in Ethiopia on 13 March 2020. The participants were interviewed over the phone and their responses were audio-recorded. Data were transcribed verbatim, translated, and analyzed using inductive thematic analysis in the Atlas ti.7.1 software package. Results The main themes and sub-themes that emerged were psychosocial issues (such as depression, hopelessness, and fear), risk perception (including high risk, susceptibility, and severity), forceful enforcement of stay-at-home orders (such as police beatings, community leaders disgracing, and influence of families and relatives), socioeconomic factors (such as stigma, religion, and transportation costs), misinformation about COVID-19 (such as lockdowns and ART stock-outs), and healthcare factors (such as inadequate health information and long distances to healthcare facilities). Conclusion Overall, these findings were similar to the challenges experienced by PLWHA in adhering to the recommended continuum of care. However, there are additional factors due to COVID-19, such as misinformation and the forceful implementation of the stay-at-home-orders, that impede the continuum of care. Therefore, it is important to strengthen information, education, and communication.
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Affiliation(s)
- Abraham Tamirat Gizaw
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mengistu Abayneh
- School of Medical Laboratory Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
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Agor D, Knettel BA, Daici K, Meanley S. The Intersection of Mental Health and Sexual and Gender Minority Identities for Older Adults Living with Human Immunodeficiency Virus: A Narrative Review. Nurs Clin North Am 2024; 59:253-271. [PMID: 38670693 DOI: 10.1016/j.cnur.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The transition of HIV into a chronic illness has brought to the forefront the pressing need to address the complex web of social determinants of HIV outcomes. A structured literature search and narrative review of studies describing intervention strategies for mental health among sexual/gender minority (SGM) older adults living with HIV (OALWH) published in the last decade identified 2 studies for inclusion. This narrative review identifies age-sensitive and culturally adapted therapies, mindfulness and meditation-based stress reduction, group therapy, digital mental health resources, and psilocybin-assisted group therapy as emerging intervention models tailored to meet the unique needs of SGM OALWH.
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Affiliation(s)
- David Agor
- Department of Family and Community Health, University of Pennsylvania, School of Nursing, 418 Curie Boulevard, 218L E, Philadelphia, PA 19104, USA; University of Pennsylvania Eidos Center, Philadelphia, PA, USA.
| | - Brandon A Knettel
- Duke School of Nursing, 307 Trent Drive, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Global Mental Health Program, Duke University, Durham, NC, USA
| | - Kenneth Daici
- Brown University, 69 Brown Street, Box 9734, Providence, RI 02912, USA
| | - Steven Meanley
- University of Pennsylvania Eidos Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing, 418 Curie Boulevard, 231L, Philadelphia, PA 19104, USA
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Tedaldi E, Hou Q, Armon C, Mahnken JD, Palella F FJ, Simoncini G, Fuhrer J, Mayer C, Ewing A, Chagaris K, Carlson KJ, Li J, Buchacz K. Emerging from the shadows: Trends in HIV ambulatory care, viral load testing, and viral suppression in a U.S. HIV cohort, 2019-2022: Impact of COVID-19 pandemic. J Investig Med 2024:10815589241252592. [PMID: 38666457 DOI: 10.1177/10815589241252592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
This article aimed at analyzing the acute impact and the longer-term recovery of COVID-19 pandemic effects on clinical encounter types, HIV viral load (VL) testing, and suppression (HIV VL < 200 copies/mL). This study was a longitudinal cohort study of participants seen during 2019-2022 at nine HIV Outpatient Study (HOPS) sites. Generalized linear mixed models (GLMMs) estimated monthly rates of all encounters, office and telemedicine visits, and HIV VL tests using 2010-2022 data. We examined factors associated with nonsuppressed VL (VL ≥ 200 copies/mL) and not having ambulatory care visits during the pandemic using GLMM for logistic regression with 2017-2022 and 2019-2022 data, respectively. Of 2351 active participants, 76.0% were male, 57.6% aged ≥ 50 years, 40.7% non-Hispanic White, 38.2% non-Hispanic Black, 17.3% Hispanic/Latino, and 51.0% publicly insured. The monthly rates of in-person and telemedicine visits varied during 2020 through mid-year 2022. Multivariable logistic regression showed that persons with no encounters were more likely to be male or have VL ≥ 200 copies/mL. For participants with ≥1 VL test, the prevalence rate of HIV VL ≥ 200 copies/mL during 2020 was close to the rates from 2014 to 2019. The change in probability of viral suppression was not associated with participant's age, sex, race/ethnicity, or insurance type. In the HOPS, overall patient encounters declined over 2 years during the pandemic with variations in telemedicine and in-person events, with relative maintenance of viral suppression. Ongoing recovery from the impact of COVID-19 on ambulatory care will require continued efforts to improve retention and patient access to medical services.
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Affiliation(s)
- Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | | | - Frank J Palella F
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jack Fuhrer
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cynthia Mayer
- St. Joseph's Comprehensive Research Institute, Tampa, FL, USA
- Department of Medicine, Anschutz Medical Center, Aurora, CO, USA
| | - Alexander Ewing
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Jun Li
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ojukwu E, Hirani S, Sotindjo T, McKay E, Okedo-Alex I, Magagula P, Pashaei A, Agudosi GM. The Impact of Intersectional Discrimination and Stigma on HIV Care for African, Caribbean, and Black Women Living With HIV During the COVID-19 Pandemic in British Columbia: A Descriptive Study. J Assoc Nurses AIDS Care 2024; 35:175-188. [PMID: 38427789 PMCID: PMC11037459 DOI: 10.1097/jnc.0000000000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
ABSTRACT African, Caribbean, and Black women living with HIV (ACB WWH) in British Columbia experience discrimination on the basis of their race, sex, gender identity, sexual orientation, and HIV status. The various forms of stigma that ACB WWH experience intersect to create a uniquely marginalized experience that has negative consequences for quality of life and overall well-being. Eighteen semistructured interviews were completed with ACB WWH in British Columbia. Interviews were conducted by phone, Zoom, or in-person at the participant's request. Participants consistently reported experiences of various forms of discrimination. There was additional stigmatization due to COVID-19 pandemic that negatively influenced the lives of ACB WWH. Interventions and resources are needed to support ACB WWH in navigating how to work through the multifaceted impacts of intersectional stigmatization. Efforts are needed to identify ways to continue the delivery of resources like social support groups throughout future pandemics.
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Affiliation(s)
| | - Saima Hirani
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Tatiana Sotindjo
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Emily McKay
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ijeoma Okedo-Alex
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Patience Magagula
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ava Pashaei
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ginikachukwu Marylinda Agudosi
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
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11
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Harsono D, Deng Y, Chung S, Barakat LA, Friedland G, Villanueva M, Yager JE, Justen M, Edelman EJ. Prevalence and Correlates of Physical Inactivity Among Individuals with HIV During the First COVID-19 Wave: A Cross-sectional Survey. AIDS Behav 2024; 28:1531-1545. [PMID: 37824037 PMCID: PMC11349050 DOI: 10.1007/s10461-023-04170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Physical activity is associated with improved health outcomes among people with HIV (PWH). In the recent pandemic context, policies designed to mitigate COVID-19 transmission may result in an increase in sedentary lifestyle and decreased physical activity. In this study, we aimed to characterize self-reported physical activity and factors associated with physical inactivity during the first wave of the COVID-19 pandemic among a sample of PWH engaged in care. We also described whether psychological coping strategies measured by the Brief COPE differed based on physical activity levels. Among 260 surveyed PWH in two HIV clinics in the US Northeast, 28.5% (n = 74) met the criteria for being physically active according to the Centers for Disease Control and Prevention (CDC)'s physical activity guidelines. Receiving care in New Haven, CT, presence of a detectable HIV viral load, every day tobacco use, and unhealthy alcohol use were associated with physical inactivity. Problem-focused coping, emotion-focused coping, and avoidance-focused coping strategies were found to be protective against physical inactivity. In adjusted analysis, only problem-focused coping continued to be significantly associated with lower odds of reporting physical inactivity. Efforts are urgently needed to promote physical activity among PWH, including among those without problem-focused coping strategies.
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Affiliation(s)
- Dini Harsono
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA.
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Sangyun Chung
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Lydia A Barakat
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gerald Friedland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Merceditas Villanueva
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica E Yager
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - E Jennifer Edelman
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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12
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Amura CR, Thorne J, Bean M, Avery LK, Sylla LN, Liss HK, Cook PF. Evolution of HIV Health Care Workforce Needs in the U.S. Mountain West During the COVID-19 Pandemic: A Mixed Method Study. J Assoc Nurses AIDS Care 2024; 35:78-90. [PMID: 38949905 PMCID: PMC11217585 DOI: 10.1097/jnc.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
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Affiliation(s)
- Claudia R Amura
- Claudia R. Amura, PhD, MPH, is an Assistant Professor of Research, University of Colorado College of Nursing, and is a Director of the Latino Health Certificate, Latino Research of Policy Center, Colorado School of Public University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Julia Thorne, is an MPH Graduate, Colorado School of Public Health, Aurora, Colorado, USA. Meagan Bean, is a Latino Health Certificate and MPH Candidate, Colorado School of Public Health, Aurora, Colorado, USA. Lisa Krug Avery, MSW, is a Professional Research Assistant, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Laurie N. Sylla, MHSA, is the Director, Mountain West AIDS Training Education Center, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA. Hillary K. Liss, MD, is a Clinical Associate Professor, Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. Paul F. Cook, PhD, is a Professor and Chair, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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14
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Wang Y, Lai Y. The Interrelationship between HIV Infection and COVID-19: A Review of the Literature. Curr HIV Res 2024; 22:6-15. [PMID: 38151836 DOI: 10.2174/011570162x282739231222062830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
The Corona Virus Disease 2019 (COVID-19) pandemic resulting from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to significant morbidity and mortality in patients and put a strain on healthcare systems worldwide. The clinical characteristics and results of COVID-19 in immunosuppressed patients, such as people living with human immunodeficiency virus (PLWH), considered at higher risk of severe disease, are not well-characterized. Accumulated evidence indicates that COVID-19 and the human immunodeficiency virus (HIV) can interact in various ways. This review explored the similarities and differences in virology between SARS-CoV-2 and HIV, the effect of the COVID-19 vaccine on PLWH, the impact of the COVID-19 pandemic on PLWH care and prevention, and the influence of HIV-related factors on COVID-19. Discovering the potential link between HIV and COVID-19 may provide a novel way to avoid the factors of HIV and SARS-CoV-2 co-infection and advance future research.
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Affiliation(s)
- Yiyu Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Yu Lai
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
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15
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Bulled N, Singer M. Conceptualizing COVID-19 syndemics: A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241249835. [PMID: 38682155 PMCID: PMC11055430 DOI: 10.1177/26335565241249835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Background COVID-19's heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions. Objective To review how the term 'syndemic' is defined and applied within peer-reviewed literature in relation to COVID-19. Design A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed. Results Content analysis revealed that COVID-19 has varied clustered configurations of communicable-non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept. Conclusion This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses.
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Affiliation(s)
| | - Merrill Singer
- Anthropology, University of Connecticut, Storrs, CT, USA
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16
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Neduzhko O, Kiriazova T, Zeziulin O, Legkostup L, Riabokon S, DeHovitz JA, Dumchev K. The Effects of COVID-19 Pandemic on HIV Service Provision in Ukraine. J Int Assoc Provid AIDS Care 2024; 23:23259582241277649. [PMID: 39252523 PMCID: PMC11384520 DOI: 10.1177/23259582241277649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Ukraine faced significant fluctuations in COVID-19 morbidity and mortality, alongside an escalating HIV epidemic. This mixed-methods study, conducted between February and August 2022, employed a sequential explanatory design combining a quantitative analysis of national data and qualitative interviews to investigate the pandemic's effects on HIV services in Ukraine. The observed trends confirmed that the pandemic significantly disrupted facility-based HIV testing due to logistical challenges, an increased burden on healthcare workers, and supply shortages. Meanwhile, community-based testing showed resilience, largely attributed to programmatic adjustments rather than the pandemic itself. The initiation of antiretroviral therapy declined, especially during initial lockdowns, reflecting diminished treatment capacities. Despite these challenges, telemedicine and home medication delivery innovations supported antiretroviral therapy adherence. Furthermore, improvements in viral load testing and suppression rates showed healthcare resilience. The study highlights the critical need for adaptable, sustainable healthcare strategies in crises, emphasized during the war with Russia.
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Affiliation(s)
| | | | | | - Liudmyla Legkostup
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Serhii Riabokon
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Jack A DeHovitz
- Department of Medicine, SUNY Downstate Health Sciences University, New York, USA
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17
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Shi F, Zhang J, Yang X, Gao H, Chen S, Weissman S, Olatosi B, Li X. COVID-19 Testing Among People with HIV: A Population Level Analysis Based on Statewide Data in South Carolina. AIDS Behav 2023:10.1007/s10461-023-04244-4. [PMID: 38109020 DOI: 10.1007/s10461-023-04244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
People with HIV (PWH) are at an elevated risk of developing severe COVID-19 outcomes because of compromised immunity and more comorbidities. However, existing literature suggests a lower rate of COVID-testing among PWH. This study aimed to explore the temporal trend of county-level COVID-19 testing rate and multi-level predictors of COVID-19 ever-testing among PWH in South Carolina (SC). Leveraging linked statewide HIV and COVID-19 datasets, we defined the study population as all adult (18 + years) PWH who were alive on March 2020 and living in SC. PWH with a COVID-19 testing record between March 2020 and October 2021 were defined as COVID-19 ever-testers. Logistic regression and generalized mixed models were used to investigate the association of PWH's demographic profile, HIV clinical characteristics (e.g., CD4 count, viral load), comorbidities, and social factors with COVID-19 testing among PWH. Among 15,660 adult PWH, 8,005 (51.12%) had ever tested for COVID-19 during the study period (March 2020-October 2021). PWH with older age, being male, and Hispanics were less likely to take COVID-19 testing, while men who have sex with men or injection drug users were more likely to take COVID-19 testing. PWH with higher recent viral load (10,000-100,000 copies/ml vs. <200 copies/ml: adjusted odds ratio [AOR]: 0.64, 95%CI: 0.55-0.75) and lower CD4 counts (> 350 cells/mm3 vs. <200 cells/mm3: AOR: 1.25, 95%CI: 1.09-1.45) had lower odds for COVID-19 testing. Additionally, PWH with lower comorbidity burden and those living in rural areas were less likely to be tested for COVID-19. Differences in COVID-19 test-seeking behaviors were observed among PWH in the current study, which could help provide empirical evidence to inform the prioritization of further disease monitoring and targeted intervention. More efforts on building effective surveillance and screening systems are needed to allow early case detection and curbing disease transmission among older, male, Hispanic, and immune-suppressed PWH, especially in rural areas.
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Affiliation(s)
- Fanghui Shi
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US.
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US.
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US.
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
| | - Haoyuan Gao
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Sharon Weissman
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- School of Medicine, University of South Carolina, Columbia, SC, US
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
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18
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Suarez E, Bartholomew TS, Plesons M, Ciraldo K, Ostrer L, Serota DP, Chueng TA, Frederick M, Onugha J, Tookes HE. Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study. Ann Med 2023; 55:733-743. [PMID: 36856571 PMCID: PMC9980015 DOI: 10.1080/07853890.2023.2182908] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP.Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy.Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program settingUsing telehealth was associated with increased three-month buprenorphine retentionBaseline stimulant use was negatively associated with three-month buprenorphine retention.
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Affiliation(s)
- Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marina Plesons
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lily Ostrer
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A. Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan Frederick
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Onugha
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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19
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Dawe J, Cassano D, Keane R, Ruth S, Wilkinson AL, Elsum I, Gunn J, Brown G, West M, Hoy J, Power J, Stoové M. Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing. HIV Med 2023; 24:1253-1267. [PMID: 37990812 DOI: 10.1111/hiv.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions. METHODS In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services. RESULTS Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β -0.49; 95% CI -0.74 to -0.24), stigma (β -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (β -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (β -0.50; 95% CI -0.71 to -0.30). CONCLUSIONS Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.
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Affiliation(s)
- Joshua Dawe
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Dean Cassano
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Richard Keane
- Living Positive Victoria, Melbourne, Victoria, Australia
| | - Simon Ruth
- Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Anna Lee Wilkinson
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- University of Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Imogen Elsum
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Jack Gunn
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Michael West
- Department of Health, Melbourne, Victoria, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Mark Stoové
- Burnet Institute, Public Health Discipline, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
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20
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Braunstein SL, Wahnich A, Lazar R. COVID-19 Outcomes Among People With HIV and COVID-19 in New York City. J Infect Dis 2023; 228:1571-1582. [PMID: 37534822 DOI: 10.1093/infdis/jiad311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Literature on the impact of human immunodeficiency virus (HIV) on coronavirus disease 2019 (COVID-19)-related outcomes remains mixed. Few studies have evaluated COVID-19 outcomes by HIV status using population-based data. METHODS Using data from New York City COVID-19 surveillance and HIV surveillance systems prior to the widespread availability of COVID-19 vaccines, we conducted a retrospective cohort study comparing the risk of COVID-19 hospitalization and mortality by HIV status among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnoses from 29 February to 17 October 2020. RESULTS Risk of hospitalization and death among people with HIV (PWH) withCOVID-19 were both nearly 30% higher compared with people without HIV. In crude models, incidence of adverse COVID-19 outcomes among PWH compared to people without HIV was elevated in certain groups, including women, and black, Hispanic/Latino, Native American, and multiracial people. CD4 cell count at SARS-CoV-2 diagnosis and presence of an underlying, non-HIV-related condition were independently and strongly associated with risk for COVID-19 hospitalization and death among PWH. CONCLUSIONS New Yorkers with HIV experienced elevated risk for poor COVID-19 outcomes compared to those without HIV during 2020. PWH, particularly those with low CD4 counts or underlying conditions, should be an ongoing focus for COVID-19 vaccination and rigorous identification and treatment of SARS-CoV-2 infections to prevent adverse outcomes.
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Affiliation(s)
- Sarah L Braunstein
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Amanda Wahnich
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Rachael Lazar
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
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21
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Penot P, Chateauneuf J, Auperin I, Cordel H, Letembet VA, Bottero J, Cailhol J. Socioeconomic impact of the COVID-19 crisis and early perceptions of COVID-19 vaccines among immigrant and nonimmigrant people living with HIV followed up in public hospitals in Seine-Saint-Denis, France. PLoS One 2023; 18:e0276038. [PMID: 37862300 PMCID: PMC10588853 DOI: 10.1371/journal.pone.0276038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/08/2023] [Indexed: 10/22/2023] Open
Abstract
The burden of the first year of the coronavirus disease 2019 (COVID-19) pandemic was greater for vulnerable populations, such as immigrants, people living in disadvantaged urban areas, and people with chronic illnesses whose usual follow-up may have been disrupted. Immigrants receiving care for HIV in Seine-Saint-Denis' hospitals have a combination of such vulnerabilities, while nonimmigrant people living with HIV (PLWHIV) have more heterogeneous vulnerability profiles. The ICOVIH study aimed to compare the socioeconomic effects of the COVID-19 crisis as well as attitudes toward COVID-19 vaccination among immigrant and nonimmigrant PLWHIV. A questionnaire assessed vulnerabilities prior to the COVID-19 epidemic and the impact of the early epidemic on administrative, residential, professional, and financial fields. We surveyed 296 adults living with HIV at four hospitals in Seine-Saint-Denis, the poorest metropolitan French department, between January and May 2021. Administrative barriers affected 9% of French-born versus 26.3% of immigrant participants. Immigrants experienced financial insecurity and hunger more often than nonimmigrant participants (21.8% versus 7.1% and 6.6% versus 3%, respectively). Spontaneous acceptance of vaccination was higher among nonimmigrant than among immigrant participants (56.7% versus 32.1%), while immigrants were more likely to wait for their doctor's recommendation or for their doctor to convince them than their French-born counterparts (34.2% versus 19.6%). The trust-based doctor‒patient relationship established through HIV follow-up appeared to be a determining factor in the high acceptance of the COVID-19 vaccine among immigrant participants.
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Affiliation(s)
- Pauline Penot
- CEGIDD (Sexual Health and Infectious Disease Clinic), Centre Hospitalier André Grégoire, Montreuil, France
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) et Université de Paris, Paris, France
| | - Julie Chateauneuf
- CEGIDD (Sexual Health and Infectious Disease Clinic), Centre Hospitalier André Grégoire, Montreuil, France
- Perinatal Network “Naître dans l’Est Francilien”, Centre Hospitalier André Grégoire, Montreuil, France
| | - Isabelle Auperin
- Addictology and Infectious Disease Unit, Centre Hospitalier André Grégoire, Montreuil, France
| | - Hugues Cordel
- Infectious and Tropical Disease Ward, Avicenne Hospital, Bobigny, France
| | - Valerie-Anne Letembet
- CEGIDD (Sexual Health and Infectious Disease Clinic), Centre Hospitalier André Grégoire, Montreuil, France
| | - Julie Bottero
- Infectious and Tropical Disease Ward, Avicenne Hospital, Bobigny, France
| | - Johann Cailhol
- Infectious and Tropical Disease Ward, Avicenne Hospital, Bobigny, France
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22
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Qiao S, Zhang J, Liang C, Li X. Using All of Us data to examine the mental health change during COVID-19 pandemic among people living with HIV: A longitudinal study protocol. BMJ Open 2023; 13:e071285. [PMID: 37788923 PMCID: PMC10551941 DOI: 10.1136/bmjopen-2022-071285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has negatively affected people's mental health around the globe. Such effects may be especially compounded among some vulnerable populations such as people living with HIV (PLWH). However, large-scale data on mental health outcomes among PLWH are limited. Few studies have also identified potential protective factors for mental health outcomes. METHODS AND ANALYSIS Guided by theories of resilience and socioecology, we will leverage multiple datasets from National Institutes of Health's Cloud-based All of Us Programme including electronic health records (EHRs), a series of COVID-19 Participant Experience (COPE) Surveys conducted from May 2020 to February 2021, and other self-reported survey data to achieve two specific aims: (1) to examine the mental health outcome changes during COVID-19 pandemic among PLWH by employing both EHR data (2018-2022) and survey data (2020-2021) in the All of Us Programme; and (2) to identify potential protective factors based on COPE Survey data for mental health outcomes at multiple socioecological levels including individual level (eg, coping strategy), interpersonal level (eg, social support) and health institutional level (eg, health service accessibility), adjusting for pre-existing health conditions including psychiatric disorders and other relevant factors (eg, COVID-19 infection). Interaction terms will be included in the multivariable analysis to identify different socially disadvantaged or stigmatised subgroups. ETHICS AND DISSEMINATION The study has been approved by the institutional review board at the University of South Carolina (Pro00124044). Study findings will be disseminated through presentations at academic conferences and publications in peer-reviewed journals.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Chen Liang
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
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23
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Assaf RD, Javanbakht M, Gorbach PM, Cooper ZD. Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic. LGBT Health 2023; 10:514-525. [PMID: 37252794 PMCID: PMC10552144 DOI: 10.1089/lgbt.2022.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.
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Affiliation(s)
- Ryan D. Assaf
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Pamina M. Gorbach
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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24
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Kalichman SC, Kalichman MO, Shkembi B, Eaton LA. COVID-19 health information trust and prejudicial attitudes predict healthcare disruptions in the first year of COVID-19 among people living with HIV. J Behav Med 2023; 46:812-820. [PMID: 36881251 PMCID: PMC9989585 DOI: 10.1007/s10865-023-00399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Cross-sectional studies have reported that people living with HIV experienced disruptions to social relationships and healthcare during the first year of the COVID-19 pandemic. Furthermore, individuals with less trust in public health sources of COVID-19 information as well as those who held greater COVID-19 prejudicial attitudes experienced greater healthcare disruptions in the early months of COVID-19. To examine changes in trust and prejudicial attitudes in relation to healthcare disruptions during the first year of COVID-19, we followed a closed cohort of 115 men and 26 women ages 18 to 36 living with HIV over the first year of the COVID-19 pandemic. Findings confirmed that a majority of individuals continued to experience disruptions to their social relationships and healthcare over the course of the first year of COVID-19. In addition, trust in COVID-19 information from the CDC and state health department diminished over the year as did COVID-19 prejudicial attitudes. Regression models showed that lower trust in the CDC and health department and greater prejudicial attitudes toward COVID-19 early in the pandemic predicted greater healthcare disruptions over the year. In addition, greater trust in the CDC and health department early in COVID-19 predicted better antiretroviral therapy adherence later in the year. Results support an urgent need to regain and sustain trust in public health authorities among vulnerable populations.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA.
| | - Moira O Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
| | - Bruno Shkembi
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
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25
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Brown MT, Wikiera J, Albarran M, Partap A, Ahmed C, Brock V, Beard S, Siegler EL. Using Community-Based Participatory Research to Develop Care Recommendations for People Aging With HIV. Innov Aging 2023; 7:igad107. [PMID: 37941828 PMCID: PMC10629937 DOI: 10.1093/geroni/igad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 11/10/2023] Open
Abstract
Background and Objectives Over 50% of New Yorkers living with human immunodeficiency virus (HIV) are 50 years old or older, and the emotional and physical consequences of being a long-term survivor are significant. This study aimed to identify the practical needs of long-term survivors and older people with HIV (consumers) in New York State and develop recommendations addressing those needs. Research Design and Methods The HIV + Aging/LTS/Perinatally Diagnosed Subcommittee of the Consumer Advisory and Quality Advisory committees in the New York State AIDS Institute used community-based participatory research (CBPR) methods to design a statewide survey about the care needs of consumers in New York State. This survey, open to consumers, clinicians, and supportive services providers, was launched in June 2021 using Qualtrics. Participants provided demographic data and chose the 3 most important barriers and recommendations from each of 10 categories of issues affecting health care and supportive services. Consumers provided information about their HIV diagnosis and other health conditions. Responses were characterized using basic descriptive statistics. Results Participants included 124 consumers from 26 counties, 20 clinicians, and 24 supportive service providers. Among consumers, 67% were cisgender men, 27% were African American, and 65% were both long-term survivors and older people with HIV. On average consumers had been diagnosed with HIV for 27 years. Participants were concerned with clinical care coordination, housing needs, cultural representation in mental health services, and financial support of consumers. Discussion and Implications CBPR is an effective approach to developing consumer-generated recommendations to improve HIV care for long-term survivors and older people with HIV. Town hall formats informed survey design, enabled broad coverage of topics, and ensured that focus remained on priorities most important to consumers. The first quality initiative arising from the study was a routine screening of long-term survivors of HIV to identify functional decline and enhance referral pathways and care linkages.
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Affiliation(s)
- Maria T Brown
- School of Social Work, Syracuse University, Syracuse, New York, USA
| | - John Wikiera
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | | | - Angie Partap
- Stony Brook Medical University, Stony Brook, New York, USA
| | - Courtney Ahmed
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | | | - Sheriden Beard
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | - Eugenia L Siegler
- The Center on Aging, Weill Cornell Medicine, New York, New York, USA
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26
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Allison WE, Choi AN, Kawasaki K, Desai A, Melhado TV. Accessing Care During the COVID-19 Pandemic Using Telemedicine: Perspectives From People With HIV. Health Promot Pract 2023; 24:982-989. [PMID: 37440447 PMCID: PMC10345820 DOI: 10.1177/15248399231169925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The COVID-19 pandemic has resulted in a steep increase in telemedicine implementation and use. Data are lacking on telemedicine use in marginalized and underserved groups including people with HIV (PWH). The Ryan White HIV/AIDS Program (RWHAP) is the largest single provider of HIV care in the United States (U.S.) and the southern part of the country remains the epicenter of the HIV epidemic. This study recruited PWH from RWHAP clinics across South Texas. To ascertain their perspectives on utilizing telemedicine for HIV care during the COVID-19 pandemic, a survey instrument derived from validated instruments was used. Descriptive statistics were used for client characteristics, quality of telemedicine care, and COVID-19 impact. Wilcoxon Rank Sum and Kruskal-Wallis tests were assessed associations of telemedicine care quality and COVID-19 impact between client groups. Among 246 eligible PWH, 122 clients completed the survey with a response rate of 50%. Clients were predominantly Hispanic males. Significant differences in perception of telemedicine care and the impact of COVID-19 by gender, age, language, and race/ethnicity were observed. Older PWHIV used telemedicine more than younger clients (p = .01). English speakers indicated more impact of the COVID-19 pandemic on daily life than Spanish speakers (p = .02). Worry about the pandemic was most evident among non-Hispanic Black and Hispanic PWH (p = .03). Overall, telemedicine was found to be a favorable and acceptable mechanism of HIV care delivery by PWH in a Southern state during the COVID-19 pandemic.
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Affiliation(s)
- Waridibo E. Allison
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aro N. Choi
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Keito Kawasaki
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anmol Desai
- The University of Texas at Austin, Austin, TX, USA
| | - Trisha V. Melhado
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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27
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Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
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Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
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28
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Piran CMG, Cargnin AVE, Shibukawa BMC, de Oliveira NN, da Silva M, Furtado MD. Antiretroviral therapy abandonment among adolescents and young people with HIV/AIDS during COVID-19: A case-control study. Rev Lat Am Enfermagem 2023; 31:e3947. [PMID: 37341259 PMCID: PMC10306057 DOI: 10.1590/1518-8345.6497.3947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/08/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE to identify the factors associated with antiretroviral therapy abandonment among adolescents and young people living with HIV/AIDS during the COVID-19 pandemic. METHOD a case-control study carried out between 2020 and 2021 in Maringá, Paraná. The cases corresponded to the following: adolescents and young people (aged from 10 to 24 years old) diagnosed with HIV/AIDS and who abandoned treatment, while the Control Group consisted of people with similar sociodemographic characteristics, diagnosed with HIV/AIDS and with no history of treatment abandonment. Pairing of the cases and controls was by convenience, with four controls for each case. The research instrument presented sociodemographic variables, clinical characteristics and others, whose association with treatment abandonment was analyzed by means of logistic regression. RESULTS a total of 27 cases and 109 controls were included in the study (1/4 ratio). The variable associated with an increased chance of abandonment was age close to 22.8 years old (ORadj: 1.47; 95% CI: 1.07-2.13; p=0.024). Sporadic condom use (ORadj: 0.22; 95% CI: 0.07-0.59; p=0.003) and having an opportunistic infection (OR: 0.31; 95% CI: 0.10-0.90; p=0.030) were protective factors. CONCLUSION age close to 23 years old at the last consultation was associated with antiretroviral therapy abandonment. The presence of opportunistic infections and condom use are determining factors for treatment continuity during COVID-19.
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Affiliation(s)
| | | | | | | | - Marcelo da Silva
- Universidade Estadual de Maringá, Maringá, PR, Brasil
- Prefeitura do Município de Maringá, Ambulatório Municipal de IST/HIV/AIDS, Maringá, PR, Brasil
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Gutiérrez-Velilla E, Barrientos-Casarrubias V, Gómez-Palacio Schjetnan M, Perrusquia-Ortiz LE, Cruz-Maycott R, Alvarado-de la Barrera C, Ávila-Ríos S, Caballero-Suárez NP. Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic. AIDS Res Ther 2023; 20:34. [PMID: 37287023 PMCID: PMC10245356 DOI: 10.1186/s12981-023-00532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The mental health and medical follow-up of people living with HIV (PLWH) have been disrupted by the COVID-19 pandemic. The objectives of this study were to assess anxiety, depression and substance use in Mexican PLWH during the pandemic; to explore the association of these symptoms with adherence to antiretroviral therapy (ART), and to compare patients with and without vulnerability factors (low socioeconomic level, previous psychological and/or psychiatric treatment). METHODS We studied 1259 participants in a cross-sectional study, PLWH receiving care at the HIV clinic in Mexico City were contacted by telephone and invited to participate in the study. We included PLWH were receiving ART; answered a structured interview on sociodemographic data and adherence to ART; and completed the psychological instruments to assess depressive and anxiety symptoms and substance use risk. Data collection was performed from June 2020 to October 2021. RESULTS 84.7% were men, 8% had inadequate ART adherence, 11% had moderate-severe symptoms of depression, and 13% had moderate-severe symptoms of anxiety. Adherence was related to psychological symptoms (p < 0.001). Vulnerable patients were more likely to be women, with low educational level and unemployed (p < 0.001). CONCLUSIONS It is important to address mental health of PLWH during the COVID-19 pandemic, with special attention to the most vulnerable individuals. Future studies are needed to understand the relationship between mental health and ART adherence.
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Affiliation(s)
- Ester Gutiérrez-Velilla
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Vania Barrientos-Casarrubias
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - María Gómez-Palacio Schjetnan
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Lydia E Perrusquia-Ortiz
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Rosa Cruz-Maycott
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México
| | - Nancy Patricia Caballero-Suárez
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México.
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30
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McKay E, Ojukwu E, Hirani S, Sotindjo T, Okedo-Alex I, Magagula P. How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6051. [PMID: 37297655 PMCID: PMC10252676 DOI: 10.3390/ijerph20116051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic resulted in disruption in healthcare delivery for people living with human immunodeficiency virus (HIV). African, Caribbean, and Black women living with HIV (ACB WLWH) in British Columbia (BC) faced barriers to engage with HIV care services prior to the COVID-19 pandemic that were intensified by the transition to virtual care during the pandemic. This paper aims to assess which factors influenced ACB WLWH's access to, utilization and affordability of, and motivation to engage with HIV care services. This study utilized a qualitative descriptive approach using in-depth interviews. Eighteen participants were recruited from relevant women's health, HIV, and ACB organizations in BC. Participants felt dismissed by healthcare providers delivering services only in virtual formats and suggested that services be performed in a hybrid model to increase access and utilization. Mental health supports, such as support groups, dissolved during the pandemic and overall utilization decreased for many participants. The affordability of services pertained primarily to expenses not covered by the provincial healthcare plan. Resources should be directed to covering supplements, healthy food, and extended health services. The primary factor decreasing motivation to engage with HIV services was fear, which emerged due to the unknown impact of the COVID-19 virus on immunocompromised participants.
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Affiliation(s)
- Emily McKay
- School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (E.M.); (S.H.)
| | - Emmanuela Ojukwu
- School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (E.M.); (S.H.)
| | - Saima Hirani
- School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (E.M.); (S.H.)
| | - Tatiana Sotindjo
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- B.C. Women’s Hospital & Health Centre, Vancouver, BC V6H 2N9, Canada
| | - Ijeoma Okedo-Alex
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
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Dutta D, Liu J, Xiong H. The Impact of COVID-19 on People Living with HIV-1 and HIV-1-Associated Neurological Complications. Viruses 2023; 15:1117. [PMID: 37243203 PMCID: PMC10223371 DOI: 10.3390/v15051117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.
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Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Fauk NK, Gesesew HA, Seran AL, Ward PR. Barriers to access to antiretroviral therapy by people living with HIV in an indonesian remote district during the COVID-19 pandemic: a qualitative study. BMC Infect Dis 2023; 23:296. [PMID: 37147599 PMCID: PMC10161978 DOI: 10.1186/s12879-023-08221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/04/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) pandemic has a significant influence on the access to healthcare services. This study aimed to understand the views and experiences of people living with HIV (PLHIV) about barriers to their access to antiretroviral therapy (ART) service in Belu district, Indonesia, during the COVID-19 pandemic. METHODS This qualitative inquiry employed in-depth interviews to collect data from 21 participants who were recruited using a snowball sampling technique. Data analysis was guided by a thematic framework analysis. RESULTS The findings showed that fear of contracting COVID-19 was a barrier that impeded participants' access to ART service. Such fear was influenced by their awareness of their vulnerability to the infection, the possibility of unavoidable physical contact in public transport during a travelling to HIV clinic and the widespread COVID-19 infection in healthcare facilities. Lockdowns, COVID-19 restrictions and lack of information about the provision of ART service during the pandemic were also barriers that impeded their access to the service. Other barriers included the mandatory regulation for travellers to provide their COVID-19 vaccine certificate, financial difficulty, and long-distance travel to the HIV clinic. CONCLUSIONS The findings indicate the need for dissemination of information about the provision of ART service during the pandemic and the benefits of COVID-19 vaccination for the health of PLHIV. The findings also indicate the need for new strategies to bring ART service closer to PLHIV during the pandemic such as a community-based delivery system. Future large-scale studies exploring views and experiences of PLHIV about barriers to their access to ART service during the COVID-19 pandemic and new intervention strategies are recommended.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, 85227, Kupang, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia.
- College of Health Sciences, Mekelle University, P.O. Box 231, Mekelle, Tigray, Ethiopia.
| | - Alfonsa Liquory Seran
- Health Department of Belu District, Atapupu Public Health Centre, 85752, Atambua, Belu, Indonesia
| | - Paul Russell Ward
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
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Jaafari Z, Mirzaei H, Moradi Y, Nasiri N, Mehmandoost S, Khezri M, Tavakoli F, Abbaszadeh S, Sharifi H. The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study. BMC Health Serv Res 2023; 23:430. [PMID: 37138294 PMCID: PMC10155158 DOI: 10.1186/s12913-023-09407-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.
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Affiliation(s)
- Zahra Jaafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Mirzaei
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Yousef Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samaneh Abbaszadeh
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Krishnan A, Woreta TA, Sims OT, Hamilton JP, Potter JJ, Alqahtani SA. Impact of nonalcoholic fatty liver disease on clinical outcomes in patients with COVID-19 among persons living with HIV: A multicenter research network study. J Infect Public Health 2023; 16:673-679. [PMID: 36931143 PMCID: PMC9922673 DOI: 10.1016/j.jiph.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/22/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (PLWH) are at an increased risk of nonalcoholic fatty liver disease (NAFLD) but how these patients react to COVID-19 infection is unclear. We examined the clinical characteristics and outcomes of patients with and without nonalcoholic fatty liver disease (NAFLD) among people living with human immunodeficiency virus (PLWH) diagnosed with COVID-19. METHODS A multicenter, retrospective cohort study was conducted using TriNetX. Participants diagnosed with COVID-19 between January 20, 2020, and October 31, 2021, in PLWH were identified and divided into cohorts based on preexisting NAFLD. The primary outcome was all-cause mortality, and secondary outcomes were hospitalization, severe disease, critical care, need for mechanical ventilation, and acute kidney injury(AKI). Propensity score matching (PSM) mitigated the imbalance among group covariates. Risk ratios (RR) with 95 % confidence intervals (CI) were calculated. RESULTS Of the 5012 PLWH identified with confirmed COVID-19 during the study period, 563 had a diagnosis of NAFLD. After PSM, both groups were well-matched with 561 patients. The primary outcome did not differ between the cohorts at 30-days, even after a fully adjusted analysis, and the risk of all-cause mortality did not differ at 60 and 90 days. NAFLD had a significantly higher risk for hospitalization rates (RR 1.32; 95 % CI, 1.06-1.63) and AKI (RR 2.55; 95 % CI 1.42-4.57) than the non-NAFLD group at 30 days. No other differences were detected in other secondary outcome measures. CONCLUSIONS Preexisting NAFLD is associated with an increased risk for hospitalization and AKI among PLWH infected with COVID-19. The potential role of NAFLD in developing severe COVID-19 among PLWH remains to be elucidated in future studies. Still, this study indicates the need for careful monitoring of this at-risk population.
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Affiliation(s)
- Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
| | - Tinsay A Woreta
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Omar T Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - James J Potter
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia.
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Abbasi SAA, Noor T, Mylavarapu M, Sahotra M, Bashir HA, Bhat RR, Jindal U, Amin U, V A, Siddiqui HF. Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses. Cureus 2023; 15:e38678. [PMID: 37288215 PMCID: PMC10243673 DOI: 10.7759/cureus.38678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/09/2023] Open
Abstract
A global outbreak of coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mounted a substantial threat to public health worldwide. It initially emerged as a mere outbreak in Wuhan, China, in December 2019 and quickly engulfed the entire world, evolving into a global pandemic, consuming millions of lives and leaving a catastrophic effect on our lives in ways unimaginable. The entire healthcare system was significantly impacted and HIV healthcare was not spared. In this article, we reviewed the effect of HIV on COVID-19 disease and the ramifications of the recent COVID-19 pandemic over HIV management strategies. Our review highlights that contrary to the instinctive belief that HIV should render patients susceptible to COVID-19 infection, the studies depicted mixed results, although comorbidities and other confounders greatly affected the results. Few studies showed a higher rate of in-hospital mortality due to COVID-19 among HIV patients; however, the use of antiretroviral therapy had no consequential effect. COVID-19 vaccination was deemed safe among HIV patients in general. The recent pandemic can destabilize the HIV epidemic control as it hugely impacted access to care and preventive services and led to a marked reduction in HIV testing. The collision of these two disastrous pandemics warrants the need to materialize rigorous epidemiological measures and health policies, but most importantly, brisk research in prevention strategies to mitigate the combined burden of the two viruses and to battle similar future pandemics.
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Affiliation(s)
| | - Tarika Noor
- Department of Medicine, Government Medical College, Patiala, Ludhiana, IND
| | | | - Monika Sahotra
- Department of Medicine, Bukovinian State Medical University, Chernivtsi, UKR
| | - Hunmble A Bashir
- Forensic Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Rakshita Ramesh Bhat
- Medical Oncology, Mangalore Institute of Oncology, Mangalore, IND
- Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Urmi Jindal
- Department of Medicine, Karamshi Jethabhai Somaiya Medical College, Mumbai, IND
| | - Uzma Amin
- Pathology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Anushree V
- Department of Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Humza F Siddiqui
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Krause KD, Pérez-Figueroa RE, Halkitis PN. Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV. Curr Opin HIV AIDS 2023; 18:142-147. [PMID: 36943471 DOI: 10.1097/coh.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review reports on the myriad barriers and facilitators related to COVID-19 vaccine hesitancy and factors contribution to uptake among people living with HIV (PLWH) globally published over the past year (2021-2022). RECENT FINDINGS Across the literature, participants indicated concerns about the safety, efficacy and overall rapid development of the COVID-19 vaccine as a reason for delaying or not being vaccinated. Medical mistrust and perceptions about the risk of COVID-19 immune response and severity also played a role in COVID-19 vaccine hesitancy among PLWH. Almost every study examined different sociodemographic characteristics associated with COVID-19 vaccination acceptance and uptake, and although strong themes emerged around race/ethnicity, sex and educational attainment, the results were mixed across other characteristics, including age. Some studies also examined medical factors specifically related to PLWH including CD4 + cell count and adherence to antiretroviral therapy. SUMMARY The findings highlight individual, structural and social differences in COVID-19 vaccine acceptance and uptake among PLWH, which are varied throughout the world. We call on researchers and interventionists to not just consider the role of medical mistrust and disinformation, but also how emotional, financial and political vulnerability plays into making decisions around COVID-19 vaccine uptake and overall healthcare.
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Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Rafael E Pérez-Figueroa
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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Montgomerie EK, Michel C, Sanchez-Covarrubias AP, Duthely LM. Stress, Support, and Length of Diagnosis Among Women Living with HIV/AIDS in the Southern USA, During the COVID-19 Pandemic. HIV AIDS (Auckl) 2023; 15:95-103. [PMID: 36922991 PMCID: PMC10010129 DOI: 10.2147/hiv.s388307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/22/2023] [Indexed: 03/11/2023] Open
Abstract
Background Health-related challenges caused and worsened by the global COVID-19 pandemic have proven broad and multifaceted, particularly for racial/ethnic minority women living with HIV (WLWH). The 2020 pandemic has affected the wellbeing and access to care for WLWH in Southeastern Florida, a region that experienced simultaneous high rates of COVID-19 and HIV. WLWH, over a short- or long-term period, likely utilize different coping mechanisms as they face these challenges. Methods This analysis compared pandemic-related stress and support endorsed by participants attending an urban clinic in South Florida, from January through May 2021. Participants completed an adapted version of the Pandemic Stress Index (PSI). The items in the PSI assessed emotional distress, stigma, and support, and were dichotomized, as either "stress" or "support". Mann-Whitney U-test assessed differences in distributions of PSI scores (stress and support) comparing long-term survivors (≥10 years with an HIV diagnosis) to those more recently diagnosed (<10 years). Results The cohort consisted of 63 WLWH, aged 21-71 (Mean = 42 years±12.95). The group of WLWH were almost evenly split, with 50.8% having been diagnosed in the last 10 years (short-term survivors). The high-stress group endorsed lower levels of support, compared to the low-stress group. There was a non-significant trend of higher stress scores for short-term survivors, compared to long-term survivors; and, higher support scores for long-term survivors, compared to short-term survivors. Conclusion Results suggest a trend in long-term survivor WLWH endorsing lower stress and higher support; the contrary was found for their short-term survivor counterparts. Patterns in COVID-19 related stressors and maladaptive behaviors need further exploration to establish suitable interventions that address disparities within groups of WLWH.
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Affiliation(s)
- Emily K Montgomerie
- Department of Neurology, Stroke Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cassandra Michel
- School of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - Alex P Sanchez-Covarrubias
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lunthita M Duthely
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Hong C, Queiroz A, Hoskin J. The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review. J Int AIDS Soc 2023; 26:e26060. [PMID: 36912238 PMCID: PMC10009802 DOI: 10.1002/jia2.26060] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/19/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic and associated measures implemented by authorities have created additional stressors and increased the risk of psychological illnesses among people living with HIV (PLWH). Yet, there is no collective evidence on the mental health status of this population during the global pandemic and associated factors. This scoping review aimed to synthesize the evidence in the current literature related to the mental health outcomes and challenges faced by PLWH during the COVID-19 pandemic, identify the associated factors with psychological distress and summarize various coping strategies to ease these psychological distresses used by this population. METHODS We conducted a scoping review following the PRISMA-ScR guideline and a literature search in four electronic databases in August 2022. Three reviewers independently screened all the search records and extracted the data from studies that met the inclusion criteria. Factors associated with worsened mental health outcomes were synthesized according to the socio-ecological framework. RESULTS Among 1100 research records, 45 articles met the eligibility criteria and were included in the final review and data extraction, most of which were quantitative analyses. PLWH reported high rates of mental health problems during the pandemic. Multi-level factors were associated with increased psychological distress, including substance use, antiretroviral adherence, social support, financial hardship and economic vulnerability during the pandemic. PLWH used social media as a coping strategy to foster social support to deal with growing mental distress. Increased mental health illnesses were associated with increased substance use, it was also found associated with suboptimal medication adherence and antiretroviral therapy (ART) care engagement. DISCUSSION PLWH experienced high rates of mental health illnesses, such as depression during the global COVID-19 pandemic. There is an urgent need to provide comprehensive HIV treatment and mental health services as the pandemic continues to evolve. CONCLUSIONS The review summarized how the mental health of PLWH was affected during the COVID-19 pandemic. Future work in the implementation of effective interventions to promote mental health in this population is needed, not only to ensure their quality of life but also to help them maintain ART adherence and healthcare during more unprecedented times.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Jordan Hoskin
- State of California Department of Rehabilitation, Los Angeles, California, USA
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Wang L, Zhao N, Wang Y, Sun K, Wang Y, Huang S, Yao F, Guo X, Yang Y, Ma C, Liu S. Impact of the COVID-19 pandemic and the dynamic COVID-zero strategy on HIV incidence and mortality in China. BMC Public Health 2023; 23:361. [PMID: 36800946 PMCID: PMC9938685 DOI: 10.1186/s12889-023-15268-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/13/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND In response to the coronavirus disease 2019 (COVID-19) pandemic, the Chinese government implemented the dynamic COVID-zero strategy. We hypothesized that pandemic mitigation measures might have reduced the incidence, mortality rates, and case fatality ratios (CFRs) of the human immunodeficiency virus (HIV) in 2020-2022. METHOD We collected HIV incidence and mortality data from the website of the National Health Commission of the People's Republic of China from January 2015 to December 2022. We compared the observed and predicted HIV values in 2020-2022 with those in 2015-2019 using a two-ratio Z-test. RESULTS From January 1, 2015, to December 31, 2022, a total of 480,747 HIV incident cases were reported in mainland China, of which 60,906 (per year) and 58,739 (per year) were reported in 2015-2019 (pre-COVID-19 stage) and 2020-2022 (post-COVID-19 stage), respectively. The average yearly HIV incidence decreased by 5.2450% (from 4.4143 to 4.1827 per 100,000 people, p < 0.001) in 2020-2022 compared with that in 2015-2019. However, the average yearly HIV mortality rates and CFRs increased by 14.1076 and 20.4238%, respectively (all p < 0.001), in 2020-2022 compared with those in 2015-2019. During the emergency phase in January 2020 to April 2020, the monthly incidence was significantly lower (23.7158%) than that during the corresponding period in 2015-2019, while the incidence during the routine stage in May 2020-December 2022 increased by 27.4334%, (all p < 0.001). The observed incidence and mortality rates for HIV decreased by 16.55 and 18.1052% in 2020, by 25.1274 and 20.2136% in 2021, and by 39.7921 and 31.7535% in 2022, respectively, compared with the predicted values, (all p < 0.001). CONCLUSIONS The findings suggest that China's dynamic COVID-zero strategy may have partly disrupted HIV transmission and further slowed down its growth. Without China's dynamic COVID-zero strategy, HIV incidence and deaths in the country would have likely remained high in 2020-2022. There is an urgent need to expand and improve HIV prevention, care, and treatment, as well as surveillance in the future.
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Affiliation(s)
- Lan Wang
- Department of Geriatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Key Laboratory of Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China
| | - Na Zhao
- School of Ecology and Environment, Anhui Normal University, Wuhu, 241002, Anhui Province, China
| | - Yuliang Wang
- Department of Immunology, Basic Medical School, Nanjing Medical University, Nanjing, 211166, China
| | - Kaili Sun
- College of Statistics and Data Science, Faculty of Science, Beijing University of Technology, Beijing, 100124, China
| | - Yike Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510315, Guangdong Province, China
| | - Shufang Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510315, Guangdong Province, China
| | - Feng Yao
- Peking University Health Science Center, Beijing, 100191, China
| | - Xiangyu Guo
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Yunmei Yang
- Department of Geriatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Key Laboratory of Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China.
| | - Chenjin Ma
- College of Statistics and Data Science, Faculty of Science, Beijing University of Technology, Beijing, 100124, China.
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang Province, China.
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Yilmaz G, Bulut H, Ozden Omaygenc D, Akca A, Can E, Tuten N, Bestel A, Erdem B, Atmaca UO, Kara Y, Kaya E, Unsel M, Sahin AS, Salihoglu Z. Baseline serum vitamin A and vitamin C levels and their association with disease severity in COVID-19 patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023007. [PMID: 36786260 PMCID: PMC9987489 DOI: 10.23750/abm.v94i1.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/20/2022] [Indexed: 02/15/2023]
Abstract
AIM We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19. Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed. Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001). CONCLUSION COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.
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Affiliation(s)
- Gulseren Yilmaz
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Anesthesiology, Istanbul, Turkey.
| | - Huri Bulut
- Istinye University, Faculty of Medicine, Department of Biochemistry, Istanbul, Turkey.
| | | | - Aysu Akca
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Esra Can
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Nevin Tuten
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Aysegul Bestel
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Baki Erdem
- Acıbadem University, Faculty of Medicine, Department of Gynecologic Oncology, Istanbul, Turkey.
| | - Uygar Ozan Atmaca
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Anesthesiology, Istanbul, Turkey.
| | - Yasin Kara
- Kanuni Sultan Suleyman Training & Research Hospital, Department of General Surgery, Istanbul, Turkey.
| | - Ebru Kaya
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Critical Care, Istanbul, Turkey.
| | - Murat Unsel
- Basaksehir Cam ve Sakura City Hospital, Department of Anesthesiology and Critical Care, Istanbul, Turkey.
| | - Ayca Sultan Sahin
- Kanuni Sultan Suleyman Training & Research Hospital, Department of Anesthesiology, Istanbul, Turkey.
| | - Ziya Salihoglu
- Istanbul University - Cerrahpasa, Faculty of Medicine, Department of Anesthesiology, Istanbul, Turkey.
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Saqib K, Qureshi AS, Butt ZA. COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3262. [PMID: 36833955 PMCID: PMC9962717 DOI: 10.3390/ijerph20043262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an epidemiological and psychological crisis; what it does to the body is quite well known by now, and more research is underway, but the syndemic impact of COVID-19 and mental health on underlying chronic illnesses among the general population is not completely understood. METHODS We carried out a literature review to identify the potential impact of COVID-19 and related mental health issues on underlying comorbidities that could affect the overall health of the population. RESULTS Many available studies have highlighted the impact of COVID-19 on mental health only, but how complex their interaction is in patients with comorbidities and COVID-19, the absolute risks, and how they connect with the interrelated risks in the general population, remain unknown. The COVID-19 pandemic can be recognized as a syndemic due to; synergistic interactions among different diseases and other health conditions, increasing overall illness burden, emergence, spread, and interactions between infectious zoonotic diseases leading to new infectious zoonotic diseases; this is together with social and health interactions leading to increased risks in vulnerable populations and exacerbating clustering of multiple diseases. CONCLUSION There is a need to develop evidence to support appropriate and effective interventions for the overall improvement of health and psychosocial wellbeing of at-risk populations during this pandemic. The syndemic framework is an important framework that can be used to investigate and examine the potential benefits and impact of codesigning COVID-19/non-communicable diseases (NCDs)/mental health programming services which can tackle these epidemics concurrently.
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Affiliation(s)
- Kiran Saqib
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Afaf Saqib Qureshi
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zahid Ahmad Butt
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Tookes HE, Oxner A, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, McCollister K, Rodriguez A, Kolber MA, Chueng TA, Zayas S, McCoy B, Sutherland K, Archer C, Bartholomew TS. Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs. Trials 2023; 24:96. [PMID: 36750867 PMCID: PMC9904271 DOI: 10.1186/s13063-023-07074-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. METHODS The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. DISCUSSION The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022.
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Affiliation(s)
- Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Asa Oxner
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Kathryn McCollister
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bernice McCoy
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kyle Sutherland
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chetwyn Archer
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Gravesteijn BY, van Hof KS, Krijkamp E, Asselman F, Leemans CR, van Alphen AM, van der Horst H, Widdershoven G, de Jong LB, Lingsma H, Busschbach J, de Jong RB. Minimizing population health loss due to scarcity in OR capacity: validation of quality of life input. BMC Med Res Methodol 2023; 23:31. [PMID: 36721106 PMCID: PMC9887555 DOI: 10.1186/s12874-022-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES A previously developed decision model to prioritize surgical procedures in times of scarce surgical capacity used quality of life (QoL) primarily derived from experts in one center. These estimates are key input of the model, and might be more context-dependent than the other input parameters (age, survival). The aim of this study was to validate our model by replicating these QoL estimates. METHODS The original study estimated QoL of patients in need of commonly performed procedures in live expert-panel meetings. This study replicated this procedure using a web-based Delphi approach in a different hospital. The new QoL scores were compared with the original scores using mixed effects linear regression. The ranking of surgical procedures based on combined QoL values from the validation and original study was compared to the ranking based solely on the original QoL values. RESULTS The overall mean difference in QoL estimates between the validation study and the original study was - 0.11 (95% CI: -0.12 - -0.10). The model output (DALY/month delay) based on QoL data from both studies was similar to the model output based on the original data only: The Spearman's correlation coefficient between the ranking of all procedures before and after including the new QoL estimates was 0.988. DISCUSSION Even though the new QoL estimates were systematically lower than the values from the original study, the ranking for urgency based on health loss per unit of time delay of procedures was consistent. This underscores the robustness and generalizability of the decision model for prioritization of surgical procedures.
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Affiliation(s)
- Benjamin Y. Gravesteijn
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands ,Department of Obstetrics & Gynaecology, OLVG, Amsterdam, Netherlands
| | - Kira S. van Hof
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline Krijkamp
- grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus University Medical Center, currently employed by the Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Franck Asselman
- grid.509540.d0000 0004 6880 3010Strategy & Innovation department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - C. René Leemans
- grid.12380.380000 0004 1754 9227Department of Otolaryngology – Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Anouk M.I.A. van Alphen
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henriëtte van der Horst
- grid.509540.d0000 0004 6880 3010Department of general practice, Amsterdam University Medical Centers Vrije Universiteit, Amsterdam, Netherlands
| | - Guy Widdershoven
- grid.12380.380000 0004 1754 9227Department of Ethics, Law and Humanities, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Hester Lingsma
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan Busschbach
- grid.5645.2000000040459992XDepartment of Medical Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rob Baatenburg de Jong
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
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AlShurman BA, Butt ZA. Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1561. [PMID: 36674314 PMCID: PMC9864682 DOI: 10.3390/ijerph20021561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.
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Affiliation(s)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Folayan MO, Abeldaño Zuñiga RA, Virtanen JI, Ezechi OC, Yousaf MA, Al-Tammemi AB, Jafer M, Ellakany P, Ara E, Ayanore MA, Ishabiyi AO, Gaffar B, Aly NM, Lusher J, El Tantawi M, Nguyen AL. A multi-country survey on access to healthcare and treatment services among individuals with critical medical care needs during the first wave of the pandemic. BMC Public Health 2023; 23:90. [PMID: 36635677 PMCID: PMC9834675 DOI: 10.1186/s12889-023-15007-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Healthcare services were significantly interrupted during the early phase of the COVID-19 pandemic. The aim of the present study was to determine the associations between sociodemographic factors and healthcare access during the first wave of the COVID-19 pandemic among individuals with critical care needs. METHODS This was a secondary analysis of the data of 5,156 participants recruited from 152 countries during the first wave of the COVID-19 pandemic. The dependent variables were self-reported difficulty of access to health care, challenges with obtaining medication, and the use of alternative medical services. The independent variables were age at last birthday; sex at birth, level of education, employment status and the macro-social vulnerability status. The confounding variable was the country income level. Three multivariable logistic regression analyses were conducted to determine the associations between the dependent variables and the independent variables after adjusting for the confounder. RESULTS Difficulty accessing health care services and obtaining medications was experienced by 1922 (37.3%) and 3746 (72.7%) participants respectively. Also, 1433 (27.8%) used alternative medical care. Retirees (AOR:1.59), unemployed (AOR:1.198), people living with HIV (AOR:2.36) and at increased risk of COVID-19 (AOR:2.10), people who used drugs (AOR:1.83) and transacted sex (AOR:1.971) had significantly higher odds for reporting difficulty with access to health care. Males (AOR:1.23), respondents with secondary level of education (AOR:1.39), retirees (AOR:2.19), unemployed (AOR:1.47), people living with HIV (AOR:2.46), people who used drugs (AOR:1.79), transacted sex (AOR:2.71) and those who might be (AOR: 1.66) and were at (AOR: 2.3) increased risk of severe COVID-19 had significantly higher odds for reporting difficulty with access to medications. People who used drugs (AOR:2.093) transacted sex (AOR:1.639), who might be (AOR: 1.211) and were at (AOR: 1.511) increased risk of severe COVID-19, and who had difficulty accessing usual healthcare (AOR: 9.047) and obtaining medications (AOR:2.16) had significantly higher odds of reporting alternative medical care use. People living with HIV (AOR:0.562) had significantly lower odds of using alternative medical care. CONCLUSION We identified populations who had challenges with access to healthcare and obtaining medications used alternative medical care except for people living with HIV. Priority attention should be given to alternative medical care use during future health pandemics.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Postgraduate Department, University of Sierra Sur, Oaxaca, Mexico
| | - Jorma I Virtanen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Oliver C Ezechi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- The Centre for Reproductive and Population Health Studies, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Biology, Faculty of Science and Technology, Virtual University of Pakistan, Lahore, Pakistan
| | - Ala'a B Al-Tammemi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Migration Health Division, International Organization for Migration (IOM), Amman, Jordan
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Faculty of Dentistry, Dental Public Health Division, Jazan University, Jizan, Saudi Arabia
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Government College for Women, J&K, MA Road Srinagar, Srinagar, India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Sociology, Florida Atlantic University, Florida, USA
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Provost's Group, Regent's University London, London, UK
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Annie L Nguyen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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46
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Wu S, Zhu S, Yan X, Xu Y, Xu H, Yang F, Han Z, Gu Y, Zhou Y, Yang Z, Yang H, Shu B, Tang W, Liang K. Willingness to receive the COVID-19 vaccine among HIV positive men who have sex with men in China: a cross-sectional study. BMC Public Health 2023; 23:64. [PMID: 36627582 PMCID: PMC9830605 DOI: 10.1186/s12889-022-14961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND People living with HIV(PLWH) are deemed more vulnerable to the SARS-CoV-2 infection than the uninfected population. Vaccination is an effective measure for COVID-19 control, yet, little knowledge exists about the willingness of men who have sex with men (MSM) living with HIV in China to be vaccinated. METHODS This cross-sectional study evaluated the willingness of MSM living with HIV to receive COVID-19 vaccination in six cities of Guangdong, China, from July to September 2020. Factors associated with willingness to receive COVID-19 vaccination using multivariable logistic regression. RESULTS In total, we recruited 944 HIV-positive MSM with a mean age of 29.2 ± 7.7 years. Of all participants, 92.4% of them were willing to receive the COVID-19 vaccine. Participants who were separated, divorced, or widowed (adjusted OR: 5.29, 95%CI: 1.02-27.48), had an annual income higher than 9,000 USD (adjusted OR: 1.70, 95%CI: 1.01-2.86), had ever taken an HIV self-test (adjusted OR: 1.78, 95%CI: 1.07-2.95), had ever disclosed sexual orientation to a doctor/nurse (adjusted OR: 3.16, 95%CI: 1.33-7.50), had ever disclosed sexual orientation to others besides their male partners (adjusted OR: 2.18, 95%CI: 1.29-3.69) were more willing to receive the vaccine. Sex with a female partner in the past six months decreased the likelihood of willingness to receive the vaccine (adjusted OR: 0.40, 95%CI: 0.17-0.95). Economic burden, worry that my health condition could not bear the risk of receiving COVID-19 vaccines, and concern that the vaccination would affect the immune status and antiretroviral therapy were the main reasons for unwillingness to receive vaccination. CONCLUSION Our study showed that HIV-positive MSM had a high willingness to receive the COVID-19 vaccination. Targeted interventions such as health education should be conducted among MSM with HIV infection to enhance COVID-19 vaccine uptake.
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Affiliation(s)
- Songjie Wu
- grid.413247.70000 0004 1808 0969Department of Nosocomial Infection, Zhongnan Hospital of Wuhan University, Wuhan, China ,grid.506261.60000 0001 0706 7839Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, 430071 China
| | - Shanhui Zhu
- grid.413247.70000 0004 1808 0969Medical Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xumeng Yan
- grid.10698.360000000122483208University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yongshi Xu
- grid.10698.360000000122483208University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Huifang Xu
- grid.10698.360000000122483208University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Fang Yang
- grid.508326.a0000 0004 1754 9032Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zhigang Han
- grid.508371.80000 0004 1774 3337Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuzhou Gu
- grid.508371.80000 0004 1774 3337Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yi Zhou
- Department of HIV/AIDS Control and Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Zhengrong Yang
- grid.464443.50000 0004 8511 7645Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Huake Yang
- Department of HIV/AIDS Control and Prevention, Dongguan Center for Disease Control and Prevention, Dongguan, China
| | - Bo Shu
- Department of HIV/AIDS Control and Prevention, Zhongshan Center for Disease Control and Prevention, Zhongshan, China
| | - Weiming Tang
- grid.10698.360000000122483208University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Ke Liang
- grid.413247.70000 0004 1808 0969Department of Nosocomial Infection, Zhongnan Hospital of Wuhan University, Wuhan, China ,grid.506261.60000 0001 0706 7839Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, 430071 China ,grid.49470.3e0000 0001 2331 6153Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China ,Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China
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SeyedAlinaghi S, Mirzapour P, Pashaei Z, Afzalian A, Tantuoyir MM, Salmani R, Maroufi SF, Paranjkhoo P, Maroufi SP, Badri H, Varshochi S, Vahedi F, Mehraeen E, Dadras O. The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review. AIDS Res Ther 2023; 20:4. [PMID: 36609313 PMCID: PMC9821373 DOI: 10.1186/s12981-022-00496-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The COVID-19 epidemic and various control and mitigation measures to combat the widespread outbreak of the disease may affect other parts of health care systems. There is a concern that the COVID-19 pandemic could disrupt HIV services. Therefore, this study aimed to systematically evaluate the effect of the COVID-19 pandemic on service delivery and treatment outcomes in people with HIV. METHODS In this study, a systematic search was conducted using the keywords in the online databases including Scopus, PubMed, Web of Science, and Cochrane databases. The retrieved articles underwent a two-step title/abstract and full-text review process, and the eligible papers were selected and included in the qualitative synthesis. RESULT We selected 16 studies out of 529 retrieved records that met the inclusion criteria for this review. Study populations of the selected studies were either HIV-positive patients or HIV clinics and healthcare providers. Most studies were focused on adhering to and obtaining medication and attending clinical appointments and their decrement during the pandemic. Other aspects of HIV care (alternative healthcare settings, viral suppression, psychological care, etc.) were discussed to a lesser extent by the included studies. CONCLUSION Interruption in in-person visits and medical follow-up services, loss of adherence to treatment, and subsequent increase in mortality due to the COVID-19 pandemic complications in PLHIV have led to growing concerns. Other challenges were psychological disorders such as anxiety and depression, an increase in substance abuse, and a rise in experienced stigma and discrimination. However, the use of telemedicine in some countries helps to alleviate the situation to some extent and is recommended in similar settings in the future.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Mirzapour
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pashaei
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Arian Afzalian
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marcarious M. Tantuoyir
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,grid.8652.90000 0004 1937 1485Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana
| | - Roghayeh Salmani
- Department of Midwifery, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Seyed Farzad Maroufi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Paranjkhoo
- grid.78780.300000 0004 0613 1044Turpanjian College of Health Sciences, American University of Armenia, 0019 Yerevan, Armenia
| | - Seyede Parmis Maroufi
- grid.486769.20000 0004 0384 8779Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hajar Badri
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, 5681761351 Iran
| | - Sanaz Varshochi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Vahedi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, 5681761351 Iran
| | - Omid Dadras
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Carson H, Wang KH, Paek H, Hoffman P, Arakaki A, Gonzalez-Colaso R, Barakat LA, Villanueva M, Womack JA. Equity and use of telehealth modalities among people living with HIV during the COVID-19 pandemic. Digit Health 2023; 9:20552076231218840. [PMID: 38107977 PMCID: PMC10722925 DOI: 10.1177/20552076231218840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background COVID-19 forced a rapid transition to telehealth. Little is known about the use of telephone versus video visits among people living with or at risk for HIV (PWH). Setting We studied electronic health record data from an urban HIV clinic. Our sample included visit- and person-level data. Visit-level data came from appointments scheduled from 30 March 2020 to 31 May 2020. Person-level data came from patients 18+ years of age who completed at least one telephone or video visit during the period of interest. Methods We performed a cross-sectional analysis. Our primary outcome was telehealth modality (telephone or video). We compared visit completion status by telehealth modality. We evaluated associations between patient characteristics and telehealth modality using logistic regression. Results In total, 1742 visits included information on telehealth modality: 1432 telephone (82%) and 310 (18%) video visits. 77% of telephone visits were completed compared to 75% of video visits (p = 0.449). The clinic recorded 643 completed telehealth visits in April and 623 in May 2020. The proportion of telephone visits decreased from 84% in April to 79% in May (p = 0.031). Most patients participated in telephone versus video visits (415 vs. 88 patients). Older age (adjusted odds ratio [AOR] 3.28; 95% confidence interval [CI], 1.37-7.82) and Black race (AOR 2.42; 95% CI, 1.20-4.49) were positively associated with telephone visits. Patient portal enrollment (AOR 0.06; 95% CI, 0.02-0.16) was negatively associated with telephone visits. Conclusion PWH used telephone more than video visits, suggesting that telephone visits are a vital healthcare resource for this population.
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Affiliation(s)
- Hannah Carson
- Yale School of Medicine and Yale Physician Associate Program, New Haven, CT, USA
| | - Karen H. Wang
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Hyung Paek
- Yale School of Medicine and Yale School of Public Health, Department of Biostatistics, New Haven, CT, USA
| | - Pamela Hoffman
- Yale School of Medicine, Child Study Center, New Haven, CT, USA
| | - Andrew Arakaki
- Yale School of Public Health, Department of Chronic Disease Epidemiology New Haven, CT, USA
| | | | - Lydia A Barakat
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Julie A Womack
- VA Connecticut Healthcare System and Yale School of Nursing, West Haven, CT, USA
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Meyer D, Slone SE, Ogungbe O, Duroseau B, Farley JE. Impact of the COVID-19 Pandemic on HIV Healthcare Service Engagement, Treatment Adherence, and Viral Suppression in the United States: A Systematic Literature Review. AIDS Behav 2023; 27:344-357. [PMID: 35916951 PMCID: PMC9344234 DOI: 10.1007/s10461-022-03771-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
The COVID-19 pandemic has necessitated adaptations in how healthcare services are rendered. However, it is unclear how these adaptations have impacted HIV healthcare services across the United States. We conducted a systematic review to assess the impacts of the pandemic on service engagement, treatment adherence, and viral suppression. We identified 26 total studies spanning the beginning of the pandemic (March 11, 2020) up until November 5, 2021. Studies were conducted at the national, state, and city levels and included representation from all four CDC HIV surveillance regions. Studies revealed varying impacts of the pandemic on HIV healthcare retention/engagement, medication adherence, and viral suppression rates, including decreases in HIV healthcare visits, provider cancellations, and inability to get prescription refills. Telehealth was critical to ensuring continued access to care and contributed to improved retention and engagement in some studies. Disparities existed in who had access to the resources needed for telehealth, as well as among populations living with HIV whose care was impacted by the pandemic.
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Affiliation(s)
- Diane Meyer
- Center for Health Security, Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA 621 East Pratt Street, Suite 210, 21202 ,Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Sarah E. Slone
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Oluwabunmi Ogungbe
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
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Lyons N, Bhagwandeen B, Edwards J. Factors Affecting COVID-19 Vaccination Intentions among Patients Attending a Large HIV Treatment Clinic in Trinidad Using Constructs of the Health Belief Model. Vaccines (Basel) 2022; 11:vaccines11010004. [PMID: 36679849 PMCID: PMC9861852 DOI: 10.3390/vaccines11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Persons living with HIV are particularly vulnerable to COVID-19 and understanding the factors influencing their decision to take the COVID-19 vaccine are crucial. Using the Health Belief Model (HBM), our study examined the role of psychological factors in predicting vaccine intention in patients with HIV. The underlying concept of the HBM is that behaviour is determined by personal beliefs about a disease, and access to strategies to decrease its occurrence. A cross-sectional survey using a structured questionnaire was conducted between August and September 2021 at an HIV clinic in Trinidad. Data on the HBM constructs, namely patient's beliefs about the perceived severity and susceptibility to COVID-19, their perceived benefits of taking the vaccine, and external cues to action, i.e., factors that may motivate them to take the vaccine, were collected. Univariate and multivariable logistic regression analyses were used to examine associations and whether the HBM components were predictors of vaccination intention. In this study, 59.9% of patients indicated their intentions to take the vaccine. Females (OR 0.49, 95% CI 0.30-0.81) were less inclined to take the COVID-19 vaccine compared to males, while Indo-Trinidadian patients with HIV (OR 4.40, 95% CI 1.26-15.3) were more inclined to take the vaccine compared to Afro-Trinidadians. Health beliefs such as having confidence in the vaccine (p = 0.001) and believing in its perceived benefits (p = 0.001) were significant predictors of vaccination intention. Patients who were confident about the vaccine were six times more likely to take the vaccine (OR 6.45, 95% CI 2.13-19.5) than persons who were not confident in it. Having adequate information about the vaccine or the knowledge of others who received the vaccine (OR 1.48, 95% CI 1.03-2.11) were significant cues to action influencing their decision. Guided by the HBM, understanding patient's health beliefs is important in the design of tailored interventions to improve vaccine outcomes. The HBM may also be useful in the design of approaches to increase the uptake of critical HIV prevention, and treatment services.
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Affiliation(s)
- Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
- Correspondence:
| | - Brendon Bhagwandeen
- School of Mathematical and Computer Sciences, Heriot Watt University Malaysia, 1 Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
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