1
|
Fee C, Fuller J, Guss CE, Woods ER, Cooper ER, Bhaumik U, Graham D, Burchett S, Dumont O, Marty E, Narvaez M, Haberer JE, Swendeman D, Mulvaney SA, Kumar VS, Jackson JL, Ho YX. A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study (Preprint). JMIR Form Res 2022; 6:e39357. [DOI: 10.2196/39357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/24/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
|
2
|
Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
Collapse
Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
| |
Collapse
|
3
|
Frieson Bonaparte KS, Graves CC, Farber EW, Gillespie SE, Hussen SA, Thomas-Seaton L, Chakraborty R, Camacho-Gonzalez AF. Metropolitan Atlanta Community Adolescent Rapid Testing Initiative: The impact of motivational interviewing and intensive case management on the psychosocial and clinical care outcomes of adolescents and young adults with HIV. ACTA ACUST UNITED AC 2019; 57:97-106. [PMID: 31647261 DOI: 10.1037/pst0000256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Early diagnosis and treatment are critical to preventing HIV-related complications and transmission for adolescents and young adults with HIV. The Metropolitan Atlanta Community Adolescent Rapid Testing Initiative (MACARTI) was a single-center, prospective, nonrandomized, interventional control group study incorporating motivational interviewing psychotherapy strategies with community outreach, HIV testing, and intensive case management. This substudy of MACARTI examined how the motivational interviewing and case management components influenced psychological distress, proactive coping, HIV/AIDS stress, and HIV stigma in association with HIV disease markers (HIV viral load and CD4+ T-cell counts). Ninety-eight adolescents and young adults with HIV (Mage = 21.5 ± 1.8, range 18-24) were allocated to either the standard of care (n = 49) or MACARTI (n = 49) arms, and results were compared between these two groups. Baseline and follow-up surveys measured psychological distress, proactive coping, HIV/AIDS stress, and HIV stigma. MACARTI arm assignment was associated with statistically significant reductions in psychological distress (p = .016), HIV/AIDS stress (p = .023), and the use of more reflective coping (p = .016) and strategic planning strategies (p = .001) during the first 6 months. These results did not remain significant at 1-year follow-up but may still provide support for the integration of psychotherapy strategies into HIV identification, linkage, and retention efforts in the future. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
|
4
|
Mizuno Y, Higa DH, Leighton CA, Mullins M, Crepaz N. Is co-location of services with HIV care associated with improved HIV care outcomes? A systematic review. AIDS Care 2019; 31:1323-1331. [PMID: 30773038 DOI: 10.1080/09540121.2019.1576847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This systematic review identifies models of service co-location, a structural intervention strategy to remove barriers to HIV care and services, and examines their associations with HIV care outcomes. A cumulative database (e.g., MEDLINE, EMBASE) of HIV, AIDS, and STI literature was systematically searched and manual searches were conducted to identify relevant studies. Thirty-six studies were classified into six models of co-location: HIV care co-located with multiple ancillary services, tuberculosis (TB) care, non-HIV specific primary care, drug abuse treatment, prevention of mother to child transmission programs (PMTCT), and mental health care. More evidence of a positive association was seen for linkage to care and antiretroviral therapy (ART) uptake than for retention and viral suppression. Models of co-location that addressed HIV and non-HIV medical care issues (i.e., co-location with non-HIV specific primary care, PMTCT, and TB) had more positive associations, particularly for linkage to care and ART uptake, than other co-location models. While some findings are encouraging, more research with rigorous study designs is needed to strengthen the evaluation of, and evidence for, service co-location.
Collapse
Affiliation(s)
- Yuko Mizuno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Darrel H Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Carolyn A Leighton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Mary Mullins
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| |
Collapse
|
5
|
Palmer A, Gabler K, Rachlis B, Ding E, Chia J, Bacani N, Bayoumi AM, Closson K, Klein M, Cooper C, Burchell A, Walmsley S, Kaida A, Hogg R. Viral suppression and viral rebound among young adults living with HIV in Canada. Medicine (Baltimore) 2018; 97:e10562. [PMID: 29851775 PMCID: PMC6392935 DOI: 10.1097/md.0000000000010562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
Collapse
Affiliation(s)
- Alexis Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, QB
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto
- St. Michael's Hospital, Toronto, ON
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON
| | - Angela Kaida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| |
Collapse
|
6
|
Tucker JD, Tso LS, Hall B, Ma Q, Beanland R, Best J, Li H, Lackey M, Marley G, Rich ZC, Sou KL, Doherty M. Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention. EBioMedicine 2017; 17:163-171. [PMID: 28161401 PMCID: PMC5360566 DOI: 10.1016/j.ebiom.2017.01.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/21/2022] Open
Abstract
Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.
Collapse
Affiliation(s)
- Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China; Institute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, USA.
| | - Lai Sze Tso
- University of North Carolina Project-China, Guangzhou, China.
| | - Brian Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA.
| | - Qingyan Ma
- University of North Carolina Project-China, Guangzhou, China.
| | - Rachel Beanland
- HIV Department, World Health Organization, Geneva, Switzerland.
| | - John Best
- School of Medicine, University of California, San Francisco, San Francisco, USA.
| | - Haochu Li
- University of North Carolina Project-China, Guangzhou, China
| | - Mellanye Lackey
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA.
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China.
| | - Zachary C Rich
- University of North Carolina Project-China, Guangzhou, China.
| | - Ka-Lon Sou
- University of North Carolina Project-China, Guangzhou, China.
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland.
| |
Collapse
|
7
|
Tso LS, Best J, Beanland R, Doherty M, Lackey M, Ma Q, Hall BJ, Yang B, Tucker JD. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS 2016; 30:1639-53. [PMID: 27058350 PMCID: PMC4889545 DOI: 10.1097/qad.0000000000001101] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To synthesize qualitative evidence on linkage to care interventions for people living with HIV. DESIGN Systematic literature review. METHODS We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. RESULTS Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions. CONCLUSION Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.
Collapse
Affiliation(s)
- Lai Sze Tso
- aUniversity of North Carolina Project-China, Guangzhou, ChinabInstitute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, North Carolina, USAcGuangdong Provincial Center for STD Control, Guangzhou, ChinadSchool of Medicine, University of California, San Francisco, California, USAeHIV/AIDS Department World Health Organization, Geneva SwitzerlandfUniversity of Utah, Salt Lake City, Utah, USAgGuangzhou Eighth People's Hospital, Guangzhou, ChinahDepartment of Psychology, Global and Community Mental Health Research Group, University of Macau, Macau, ChinaiDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Farmer C, Yehia BR, Fleishman JA, Rutstein R, Mathews WC, Nijhawan A, Moore RD, Gebo KA, Agwu AL. Factors Associated With Retention Among Non-Perinatally HIV-Infected Youth in the HIV Research Network. J Pediatric Infect Dis Soc 2016; 5:39-46. [PMID: 26908490 PMCID: PMC4765490 DOI: 10.1093/jpids/piu102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/23/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND The transmission of human immunodeficiency virus (HIV) among youth through high-risk behaviors continues to increase. Retention in Care is associated with positive clinical outcomes and a decrease in HIV transmission risk behaviors. We evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention 1 year after initiating care and in the 2 years thereafter. We also assessed the impact retention in year 1 had on retention in years 2 and 3. METHODS This was a retrospective analysis of treatment-naive nPHIV-infected 12- to 24-year-old youth presenting for care in 16 US HIV clinical sites within the HIV Research Network between 2002 and 2008. Multivariate logistic regression identified factors associated with retention. RESULTS Of 1160 nPHIV-infected youth, 44.6% were retained in care during the first year, and 22.4% were retained in all 3 years. Retention in the first year was associated with starting antiretroviral therapy in the first year (adjusted odds ratio [AOR], 3.47 [95% confidence interval (CI), 2.57-4.67]), Hispanic ethnicity (AOR, 1.66 [95% CI, 1.08-2.56]), men who have sex with men (AOR, 1.59 [95% CI, 1.07-2.36]), and receiving care at a pediatric site (AOR, 5.37 [95% CI, 3.20-9.01]). Retention in years 2 and 3 was associated with being retained 1 year after initiating care (AOR, 7.44 [95% CI, 5.11-10.83]). CONCLUSION A high proportion of newly enrolled nPHIV-infected youth were not retained for 1 year, and only 1 in 4 were retained for 3 years. Patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care. Interventions that target those at risk of being lost to follow up are essential for this high-risk population.
Collapse
Affiliation(s)
| | - Baligh R. Yehia
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - John A. Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania
| | | | - Ank Nijhawan
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kelly A. Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison L. Agwu
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
9
|
Lewis JV, Abramowitz S, Koenig LJ, Chandwani S, Orban L. Negative life events and depression in adolescents with HIV: a stress and coping analysis. AIDS Care 2015; 27:1265-74. [PMID: 26313848 DOI: 10.1080/09540121.2015.1050984] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prevalence of negative life events (NLE) and daily hassles, and their direct and moderated associations with depression, were examined among HIV-infected adolescents. Specifically, we examined whether the negative association with depression of NLE, daily hassles, and/or passive coping were moderated by social support or active coping strategies. Demographic characteristics, depression, coping, social support, NLE, and daily hassles were collected at baseline as part of the Adolescent Impact intervention via face-to-face and computer-assisted interviews. Of 166 HIV-infected adolescents, 53% were female, 72.9% black, 59.6% with perinatally acquired HIV (PIY), the most commonly reported NLE were death in family (81%), violence exposure (68%), school relocation (67%), and hospitalization (61%); and for daily hassles "not having enough money (65%)". Behaviorally infected youth (BIY--acquired HIV later in life) were significantly more likely to experience extensive (14-21) lifetime NLE (38.8% vs. 16.3%, p < .012) than PIY. In multiple stepwise regression analysis, the model accounting for the greatest variability in depression scores (32%) included (in order of entry): daily hassles, low social support, behaviorally acquired HIV, minority sexual orientation, and passive coping. A significant passive coping-by-social support interaction revealed that the association between passive coping and depression was exacerbated when social support was low. Social support moderated the effect of NLE, such that NLE were associated with greater depression when social support was low, although the effect did not remain statistically significant when main effects of other variables were accounted for. Daily hassles, poor coping, and limited social support can adversely affect the psychological well-being of HIV-infected adolescents, particularly sexual minority youth with behaviorally acquired HIV. Multimodal interventions that enhance social support and teach adaptive coping skills may help youth cope with environmental stresses and improve mental health outcomes.
Collapse
Affiliation(s)
- Jennifer V Lewis
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Susan Abramowitz
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Linda J Koenig
- b Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Sulachni Chandwani
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Lisa Orban
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| |
Collapse
|
10
|
Newman C, Persson A, Miller A, Cama E. Bridging worlds, breaking rules: Clinician perspectives on transitioning young people with perinatally acquired HIV into adult care in a low prevalence setting. AIDS Patient Care STDS 2014; 28:381-93. [PMID: 24749770 DOI: 10.1089/apc.2013.0346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The first generation of young people with perinatally acquired HIV is moving into adulthood, precipitating a transition from pediatric to adult care. As the first research appraisal of Australian clinician perspectives on this process, this article makes a unique contribution by examining the particular challenges associated with transitioning this population into adult care in regions of low HIV prevalence among young people. Qualitative interviews were conducted with twelve pediatric and adult care clinicians and analyzed for dominant and diverging themes. Clinicians anticipated significant client vulnerabilities during transition and worked beyond the boundaries of their roles and service parameters to keep clients engaged as they moved between pediatric and adult care. Strategies to strengthen the transition process focused on communication and teamwork, informed by and responsive to the needs of individual young people and their families. Clinicians working in settings with very small numbers of young people with HIV must advocate for a hidden minority with little potential for gaining large scale recognition or system changes. New conversations are needed to design a stronger and more sustainable transition process for both young people living with HIV, and their clinicians who care for them, in low prevalence settings.
Collapse
Affiliation(s)
- Christy Newman
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Asha Persson
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Miller
- Paediatric HIV Service, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Elena Cama
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Abstract
Engagement of HIV-positive persons into care and achieving optimal antiretroviral treatment outcomes is a fundamental HIV prevention strategy. Case management model was recommended as a beneficial model of care for patients with a new HIV diagnosis, focusing on individuals with unmet needs, and linking them with the coordinated health and social services to achieve desired outcomes. HIV case management is population-driven and programs are designed to respond to the unique needs of the client population they serve, such as substance users, homeless, youth, and prison inmates. This view found 28 studies addressing effectiveness and impacts of case management intervention for people living with or at risk of HIV/AIDS. Effectiveness of case management intervention was categorized as follows: decreased mortality and improve health outcomes, linkage to and retention in care, decreased unmet needs, and reducing risky behaviors.
Collapse
|
12
|
Nyabigambo A, Muliira JK, Atuyambe L, Babikako HM, Kambugu A, Ndoleriire C. Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:89-99. [PMID: 24966709 PMCID: PMC4043429 DOI: 10.2147/ahmt.s57950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is minimal research that has been conducted among young adults to understand the determinants of the utilization of human immunodeficiency virus (HIV) health services in this population. The purpose of this study was to explore the levels and determinants of HIV transition clinic (HTC) services utilization by young adults living with HIV/acquired immunodeficiency syndrome (YALHA). The study used a cross-sectional design and quantitative methods to collect data from a sample of 379 YALHA between the ages of 15–24 years who were registered clients of an HTC in Uganda. During data analysis, utilization was categorized into two levels: regular (kept all appointment visits) and irregular (missed one or more appointment visits) utilization. Univariable, bivariable, and multivariable logistic regression analyses were used to examine the determinants associated with HTC utilization. The HTC services that were most utilized by the YALHA were those based at the clinic and provided by professional health care providers and these were: clinical examination (96%); laboratory services (87.1%); and counseling (69.7%). The services that were least utilized were home visiting (5.8%) and peer support services (19.8%). Of the 379 YALHA, only 32.4% regularly utilized the HTC. Multivariable analysis showed that the main determinants of HTC utilization were CD4 count category of ≥251/μL (adjusted odds ratio [AOR] =0.58, 95% confidence interval [CI] =0.36–0.95); not being on antiretroviral therapy (AOR =0.27, 95% CI =0.15–0.47); and not receiving counseling services (AOR =0.47, 95% CI =0.27–0.83). Regular utilization of the HTC by YALHA was low and utilization seems to be influenced by HIV infection stage and HIV counseling services, but not sociodemographic factors or community factors.
Collapse
Affiliation(s)
- Agnes Nyabigambo
- School of Public Health, Makerere University, Kampala, Uganda ; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Lynn Atuyambe
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | |
Collapse
|
13
|
Abstract
This clinical report provides guidance for the pediatrician in addressing the psychosocial needs of adolescents and young adults living with HIV, which can improve linkage to care and adherence to life-saving antiretroviral (ARV) therapy. Recent national case surveillance data for youth (defined here as adolescents and young adults 13 to 24 years of age) revealed that the burden of HIV/AIDS fell most heavily and disproportionately on African American youth, particularly males having sex with males. To effectively increase linkage to care and sustain adherence to therapy, interventions should address the immediate drivers of ARV compliance and also address factors that provide broader social and structural support for HIV-infected adolescents and young adults. Interventions should address psychosocial development, including lack of future orientation, inadequate educational attainment and limited health literacy, failure to focus on the long-term consequences of near-term risk behaviors, and coping ability. Associated challenges are closely linked to the structural environment. Individual case management is essential to linkage to and retention in care, ARV adherence, and management of associated comorbidities. Integrating these skills into pediatric and adolescent HIV practice in a medical home setting is critical, given the alarming increase in new HIV infections in youth in the United States.
Collapse
|
14
|
Ellis J, Norrish G, Elgalib A. Development of a young persons’ HIV clinic in a District General Hospital: a case note review resulting in informed change. Int J STD AIDS 2013; 24:899-901. [DOI: 10.1177/0956462413486453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recognition of the increasing number of HIV-infected young people attending the HIV department at a district general hospital, a case note review was conducted. There was a high prevalence of psychosocial problems and medical complexity among this cohort. As a result, tailored young persons’ services were developed. Effective utilisation of the existing skill-mix and resources were key to success.
Collapse
|
15
|
HIV health center affiliation networks of black men who have sex with men: disentangling fragmented patterns of HIV prevention service utilization. Sex Transm Dis 2012; 39:598-604. [PMID: 22801341 DOI: 10.1097/olq.0b013e3182515cee] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. METHODS The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. RESULTS High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. CONCLUSIONS Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.
Collapse
|
16
|
Determination of optimized multidisciplinary care team for maximal antiretroviral therapy adherence. J Acquir Immune Defic Syndr 2012; 60:183-90. [PMID: 22293551 DOI: 10.1097/qai.0b013e31824bd605] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We seek to determine the optimized multidisciplinary care team (MDCT) composition for antiretroviral therapy (ART) adherence. METHODS We analyzed all new regimen starts (n = 10,801; 7071 ART naive, 3730 ART experienced) among HIV-positive patients in Kaiser Permanente California from 1996 to 2006. We measured 12-month adherence to ART (pharmacy refill methodology) and medical center-specific patient exposure to HIV/infectious disease specialist (reference group), non-HIV primary care provider, clinical pharmacist, nurse case manager, non-nurse care coordinator, dietician, social worker/benefits coordinator, health educator, and mental health worker. We used recursive partitioning to ascertain potential MDCT compositions associated with maximal mean ART adherence. We then employed mixed linear regression with clustering by provider and medical center (adjusting for ART experience, age, gender, race/ethnicity, HIV risk, hepatitis C virus coinfection, ART regimen class, and calendar year) to test which potential MDCT combination identified had statistically significant association with ART adherence. RESULTS We found maximal increase in adherence with pharmacist plus coordinator plus primary care provider combination (8.1% ART adherence difference compared with reference; 95% confidence interval: 2.7% to 13.5%). Other MDCT teams with significantly (P < 0.05) improved adherence compared with specialist only were nurse plus social worker with primary care provider (7.5%; 5.4% to 9.7%), specialist plus mental health worker (6.5%; 2.6% to 10.4%), pharmacist plus social worker plus primary care provider (5.7%; 4.1% to 7.4%), and pharmacist plus primary care provider (3.3%; 0.8% to 5.8%). Among these MDCTs, there were no significant differences in mean adherence, odds of maximal viral control, or CD4+ changes at 12 months (except pharmacist plus primary care provider). CONCLUSIONS Various MDCTs were associated with improved adherence, including ones that did not include the HIV specialist but included primary care plus other health professionals. These findings have application to the HIV care team design.
Collapse
|
17
|
Agwu AL, Siberry GK, Ellen J, Fleishman JA, Rutstein R, Gaur AH, Korthuis PT, Warford R, Spector SA, Gebo KA. Predictors of highly active antiretroviral therapy utilization for behaviorally HIV-1-infected youth: impact of adult versus pediatric clinical care site. J Adolesc Health 2012; 50:471-7. [PMID: 22525110 PMCID: PMC3338204 DOI: 10.1016/j.jadohealth.2011.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/30/2011] [Accepted: 09/01/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVES We evaluated highly active antiretroviral therapy (HAART) utilization in youth infected with HIV through risk behaviors who met treatment criteria for HAART. We assessed the impact of receiving care at an adult or pediatric HIV clinical site on initiation and discontinuation of the first HAART regimen in behaviorally infected youth (BIY). METHODS This was a retrospective analysis of treatment-naive BIY, aged 12-24 years, who enrolled in the HIV Research Network between 2002 and 2008 and who met criteria for HAART. The outcomes were time from meeting criteria to initiation of HAART and time to discontinuation of the first HAART regimen. Analyses were conducted using Cox proportional hazards regression. RESULTS Of 287 treatment-eligible youth, 198 (69%) received HAART; of these 198 youth, 58 (29.3%) subsequently discontinued HAART. In multivariable analyses, there was no significant difference in the time between meeting treatment criteria and initiating HAART for BIY followed at adult or pediatric HIV clinical sites. However, BIY followed at adult sites discontinued HAART sooner than BIY followed at pediatric HIV clinical sites (adjusted hazard ratio [AHR]: 3.19 [1.26-8.06]). CONCLUSIONS Two-thirds of treatment-eligible BIY in the HIV Research Network cohort initiated HAART; however, one-third who initiated HAART discontinued it during the study period. Identifying factors associated with earlier HAART initiation and sustainability can inform interventions to enhance HAART utilization among treatment-eligible youth. The finding of earlier HAART discontinuation for youth at adult care sites deserves further study.
Collapse
Affiliation(s)
- Allison L. Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - George K. Siberry
- Pediatric, Adolescent, and Maternal AIDS Branch, Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Jonathan Ellen
- Division of Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - John A. Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Health Care Research and Quality, Rockville, MD
| | - Richard Rutstein
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude’s Children’s Research Hospital, Memphis TN
| | - P. Todd Korthuis
- Departments of Internal Medicine and Public Health & Preventive Medicine, Oregon Health and Science University, Portland, OR
| | | | - Stephen A. Spector
- Division of Pediatric Infectious Diseases, University of California San Diego, La Jolla, CA and Rady Children’s Hospital, San Diego, CA
| | - Kelly A. Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
18
|
Wohl AR, Garland WH, Wu J, Au CW, Boger A, Dierst-Davies R, Carter J, Carpio F, Jordan W. A youth-focused case management intervention to engage and retain young gay men of color in HIV care. AIDS Care 2011; 23:988-97. [PMID: 21390879 DOI: 10.1080/09540121.2010.542125] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM) designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages 18-24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles County, California. Participants met weekly with a case manager for the first two months and monthly for the next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing, nutrition support, substance abuse treatment, or mental health services. Among intervention participants (n=61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had previously been in intermittent care (n=33), the proportion attending all HIV primary care visits in the previous six months increased from 7% to 73% following participation in the intervention (p<0.0001). Retention in HIV care at six months was associated with increased number of intervention visits (p=0.05), more hours in the intervention (p=0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing hard-to-reach clients and retaining them in consistent HIV care.
Collapse
Affiliation(s)
- Amy Rock Wohl
- Los Angeles County Department of Public Health, HIV Epidemiology Program, CA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr 2010; 53:529-36. [PMID: 19755914 DOI: 10.1097/qai.0b013e3181b56404] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surveillance points to an urgent public health need for HIV prevention, access, and retention among young men of color who have sex with men (YMSM). The purpose of this multisite study was to evaluate the association between organizational- and individual-level characteristics and retention in HIV care among HIV-positive YMSM of color. METHODS Data were collected quarterly via face-to-face interviews and chart abstraction between June 2006 and September 2008. Participants were aged 16-24 years, enrolled at 1 of 8 participating youth-specific demonstration sites, and engaged or reengaged in HIV care within the last 30 days. Generalized estimating equations were used to examine factors associated with missing research and care visits. Stata v.9.0se was used for analysis. RESULTS Of 224 participants, the majority were African American (72.7%), 19-22 years old (66.5%), had graduated high school or equivalent (71.8%), identified as gay or homosexual (80.8%), and disclosed having had sex with a man before HIV diagnosis (98.2%). Over the first 2(1/4) years of the study, only 11.4% of visits were missed without explanation or patient contact. Characteristics associated with retention included being <21 years old, a history of depression, receipt of program services, and feeling respected at clinic; those associated with poorer retention included having a CD4 count <200 at baseline and being Latino. CONCLUSIONS Special Projects of National Significance programs were able to achieve a high level of retention over time, and individual and program characteristics were associated with retention. Latino YMSM, those not receiving services, and those not perceiving respect at the clinic were at increased risk of falling out of care. Retention is essential to providing HIV+ adolescents with treatment, including reducing antiretroviral resistance development. Innovative programs that address the needs of the YMSM of color population may result in improved retention.
Collapse
|
20
|
Dietz E, Clum GA, Chung SE, Leonard L, Murphy DA, Perez LV, Harper GW, Ellen JM. Adherence to scheduled appointments among HIV-infected female youth in five U.S. cities. J Adolesc Health 2010; 46:278-83. [PMID: 20159506 PMCID: PMC2824596 DOI: 10.1016/j.jadohealth.2009.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 06/16/2009] [Accepted: 06/16/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults. METHODS HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping. RESULTS Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior. CONCLUSIONS Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.
Collapse
Affiliation(s)
- Edith Dietz
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gretchen A. Clum
- Community Health Sciences Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Shang-en Chung
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lori Leonard
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Debra A. Murphy
- Department of Psychiatry, University of California at Los Angeles, California
| | | | - Gary W. Harper
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Jonathan M. Ellen
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
21
|
Ding H, Wilson CM, Modjarrad K, McGwin G, Tang J, Vermund SH. Predictors of suboptimal virologic response to highly active antiretroviral therapy among human immunodeficiency virus-infected adolescents: analyses of the reaching for excellence in adolescent care and health (REACH) project. ACTA ACUST UNITED AC 2010; 163:1100-5. [PMID: 19996046 DOI: 10.1001/archpediatrics.2009.204] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the prevalence and biopsychosocial predictors of suboptimal virologic response to highly active antiretroviral therapy (HAART) among human immunodeficiency virus-infected adolescents. DESIGN Population-based cohort study. SETTING Sixteen academic medical centers across 13 cities in the United States. PARTICIPANTS One hundred fifty-four human immunodeficiency virus-infected adolescents who presented for at least 2 consecutive visits after initiation of HAART. MAIN OUTCOME MEASURES Viral load (plasma concentration of human immunodeficiency virus RNA) and CD4(+) lymphocyte count. RESULTS Of the 154 adolescents enrolled in the study, 50 (32.5%) demonstrated early and sustained virologic suppression while receiving HAART. The remaining 104 adolescents (67.5%) had a poor virologic response. Adequate adherence (>50%)-reported by 70.8% of respondents-was associated with 60% reduced odds of suboptimal virologic suppression in a multivariable logistic regression model (adjusted odds ratio = 0.4; 95% confidence interval, 0.2-1.0). Exposure to suboptimal antiretroviral therapy prior to HAART, on the other hand, was associated with more than 2-fold increased odds of suboptimal virologic response (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-5.7). CONCLUSIONS Fully two-thirds of human immunodeficiency virus-infected adolescents in the current study demonstrated a suboptimal virologic response to HAART. Nonadherence and prior single or dual antiretroviral therapy were associated with subsequent poor virologic responses to HAART. These predictors of HAART failure echo findings in pediatric and adult populations. Given the unique developmental stage of adolescence, age-specific interventions are indicated to address high rates of nonadherence and therapeutic failure.
Collapse
Affiliation(s)
- Helen Ding
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | |
Collapse
|
22
|
Psychiatric diagnosis and antiretroviral adherence among adolescent Medicaid beneficiaries diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome. J Nerv Ment Dis 2009; 197:354-61. [PMID: 19440109 DOI: 10.1097/nmd.0b013e3181a208af] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research on adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has suggested that psychiatric and substance abuse comorbidities are prevalent in this population, and that these may sometimes be associated with use of antiretroviral therapy (ART) and adherence. For adolescents with HIV/AIDS, much less is known about patterns of mental health comorbidity, and even fewer data are available that compare them to socioeconomically comparable youth without HIV/AIDS. Using medical and pharmacy data from 1999 to 2000 Medicaid claims (Medicaid Analytic Extract) from 4 states for beneficiaries aged 12 to 17 years, we identified 833 youth under care for HIV/AIDS meeting study criteria within the HIV/AIDS group, receipt of ART was less likely for youth who had diagnoses of substance abuse, conduct disorders, or emotional disorders than for others. Once ART was initiated, adherence did not significantly differ between adolescents living with a psychiatric condition, and those who were not, with the exception of an association between conduct disorder and lower adherence. Among those with HIV/AIDS, ART use and adherence were more common among youth with higher rates of service use, regardless of psychiatric status. Associations between race and adherence varied by gender: compared with their white counterparts, minority girls had lower, and minority boys had higher adherence.
Collapse
|
23
|
To say or not to say: a qualitative study on the disclosure of their condition by human immunodeficiency virus-positive adolescents. J Adolesc Health 2009; 44:356-62. [PMID: 19306794 DOI: 10.1016/j.jadohealth.2008.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 07/29/2008] [Accepted: 08/06/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV)-positive adolescents face a number of challenges in dealing with their disease, treatment, and developmental tasks. This qualitative study describes some of the reasons why, and the extent to which, adolescents may or may not disclose their condition to others. METHODS A semistructured interview lasting 40-110 minutes was conducted with each of 29 adolescents 12-20 years old, 22 female and seven male) living in Switzerland. Interviews were tape recorded and transcribed verbatim. The analysis of the content of interviews allowed us to identify salient topics (e.g., disclosure), which were then explored in detail. RESULTS Of 29 participants, eight had not disclosed their condition to anyone outside the family, 19 had disclosed it to good friends, and 16 had disclosed it to some teachers. Four participants had engaged in public disclosure, and six of 10 sexually active teenagers disclosed their status to their partners. The attitudes toward disclosure among younger adolescents were mostly related to those of the parents, particularly the mother. Older adolescents, engaged in their search for autonomy, tended to decide independently what to say and to whom. Although foster/adoptive parents would often encourage disclosure, biological parents, especially HIV-positive mothers, insisted on not disclosing the adolescent's status for fear of stigma. CONCLUSION The health care team should systematically address the issue of disclosure with the adolescent and his family (or foster parents), the aim being to balance the right of the adolescent and that adolescent's family to maintain privacy against the concerns of sexual partners, as well as the adolescent's interest in divulging HIV status to relatives, school staff, and friends.
Collapse
|
24
|
Eastwood EA, Birnbaum JM. Physical and sexual abuse and unstable housing among adolescents with HIV. AIDS Behav 2007; 11:116-27. [PMID: 17492501 DOI: 10.1007/s10461-007-9236-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 04/16/2007] [Indexed: 10/23/2022]
Abstract
Stable housing is a necessary component of treatment of adolescents with HIV. This study examines the housing status at two points in time of a sample of 224 adolescents with HIV seen at an adolescent medicine clinic in New York City. It addresses whether unstable housing is associated with several forms of abuse, and what factors predict continued instability. 38.6% (n = 86) had a prior history of unstable housing, reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting current and prior unstable housing revealed two variables related to both outcomes: physical abuse and referral from youth/social services entities. Continued unstable housing was associated with all abuse variables and adolescent history of arrest. When adolescents in abusive situations come to the attention of programs for youth, they have a positive impact on transitioning most adolescents to safer households, potentially improving adolescents' accessing of health care services.
Collapse
Affiliation(s)
- Elizabeth A Eastwood
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY 11210, USA.
| | | |
Collapse
|
25
|
Abstract
After the introduction of antiretroviral therapy, HIV infection in children has been transformed from an acute to a chronic illness. The number of HIV-infected children has also increased in recent years. The routes of transmission and clinical manifestation of HIV infection in children are unique and different from those of adults. There are a number of biological, psychological and social factors associated with HIV-infected child that may predispose him/her to develop psychiatric illness. However, there are very few studies on psychiatric morbidity in HIV-infected children. In the existing studies, a number of psychiatric illnesses including: depression, anxiety, disruptive disorders and hyperactive disorders have been observed in HIV-infected children. A number of variables have a bearing on psychiatric morbidity, including experience and expression of physical illness as well as adherence to medications. The physician dealing with HIV-infected children should be aware of the psychological manifestations so that appropriate interventions and referral may be made as needed.
Collapse
Affiliation(s)
- R Rao
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | |
Collapse
|
26
|
Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007; 369:1565-1573. [PMID: 17482988 DOI: 10.1016/s0140-6736(07)60371-7] [Citation(s) in RCA: 387] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For developmental as well as epidemiological reasons, young people need youth-friendly models of primary care. Over the past two decades, much has been written about barriers faced by young people in accessing health care. Worldwide, initiatives are emerging that attempt to remove these barriers and help reach young people with the health services they need. In this paper, we present key models of youth-friendly health provision and review the evidence for the effect of such models on young people's health. Unfortunately, little evidence is available, since many of these initiatives have not been appropriately assessed. Appropriate controlled assessments of the effect of youth-friendly health-service models on young people's health outcomes should be the focus of future research agendas. Enough is known to recommend that a priority for the future is to ensure that each country, state, and locality has a policy and support to encourage provision of innovative and well assessed youth-friendly services.
Collapse
Affiliation(s)
- Andre Tylee
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK.
| | - Dagmar M Haller
- Department of Community and Primary Care Medicine, Geneva University Hospital, Switzerland
| | - Tanya Graham
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK
| | - Rachel Churchill
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK
| | - Lena A Sanci
- Department of General Practice, University of Melbourne, Victoria, Australia
| |
Collapse
|
27
|
Pearson CR, Simoni JM, Hoff P, Kurth AE, Martin DP. Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues. AIDS Behav 2007; 11:161-73. [PMID: 16804749 PMCID: PMC5096443 DOI: 10.1007/s10461-006-9133-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R (2) = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1-3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.
Collapse
Affiliation(s)
- Cynthia R Pearson
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98105-1525, USA.
| | | | | | | | | |
Collapse
|
28
|
Vourlekis B, Ell K. Best practice case management for improved medical adherence. SOCIAL WORK IN HEALTH CARE 2007; 44:161-77. [PMID: 17548273 DOI: 10.1300/j010v44n03_03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Less than optimal treatment adherence for many health conditions impedes clinical progress, leading to increased morbidity, mortality and health care costs, particularly for low-income and racial and ethnic minority patients. When properly understood as a complex phenomenon involving patient, provider, and health system interacting factors, adherence improvement is a natural target for social work's multi-system model of case management. We present five key elements for a generic "best practice" case management blueprint applicable to a range of medical settings. The theory and evidence base for the elements are discussed and illustrated with SAFe, a tested social work case management program to improve adherence following abnormal cancer screens.
Collapse
|
29
|
Sankar A, Golin C, Simoni JM, Luborsky M, Pearson C. How qualitative methods contribute to understanding combination antiretroviral therapy adherence. J Acquir Immune Defic Syndr 2006; 43 Suppl 1:S54-68. [PMID: 17133205 PMCID: PMC4216722 DOI: 10.1097/01.qai.0000248341.28309.79] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance.
Collapse
Affiliation(s)
- Andrea Sankar
- Department of Anthropology, Wayne State University, Detroit, Michigan 48202, USA.
| | | | | | | | | |
Collapse
|
30
|
Sarrazin MV, Hall JA. Impact of Iowa case management on provisions of social support for substance abuse clients. CARE MANAGEMENT JOURNALS : JOURNAL OF CASE MANAGEMENT ; THE JOURNAL OF LONG TERM HOME HEALTH CARE 2005; 5:3-11. [PMID: 15792325 DOI: 10.1891/cmaj.5.1.3.61266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substance abuse can have a devastating effect on the social support networks of individuals. This article describes the impact of a comprehensive model of case management on substance abuse treatment clients'perceptions of social support. Social support was defined using a well-documented typology identifying six provisions for social support. The Iowa Case Management Project (ICMP) for Rural Drug Abuse was a randomized clinical trial using a longitudinal design. Clients were recruited from the residential treatment program of one rural Midwestern substance abuse treatment agency and were randomly assigned to one of three experimental conditions that received case management according to a strengths-based model or to a control group. Client perceptions of social support were measured up to 12 months after treatment initiation. Results indicated that case management positively impacted overall perceptions of social support subsequent to treatment admission, as well as perceptions of support in two of the six provisions of support. Reassurances of worth, which is the recognition of one's competence, skills, and value by others, and attachment, which reflects close emotional bonds with others, were both significantly improved for clients who received case management. However, the effectiveness of case management in improving social support appears to be limited to clients who are married or have significant partners.
Collapse
|
31
|
Abstract
This article reviews the evidence base for community-based interventions from a systems of care perspective. The article summarizes previous reviews and provides updates and current directions for recent and ongoing studies. As expected, the evidence base is strongest for multisystemic therapy and treatment foster care. A relatively well-developed evidence base is also revealed for case management. The article concludes with recommendations for future directions within each of the designated types of interventions.
Collapse
Affiliation(s)
- Elizabeth M Z Farmer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3454, Durham, NC 27710-3454, USA.
| | | | | |
Collapse
|