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Mbebe S, Rabie S, Coetzee BJ. Factors influencing the transition from paediatric to adult HIV care in the Western Cape, South Africa: perspectives of health care providers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:175-184. [PMID: 37905477 DOI: 10.2989/16085906.2023.2246435] [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: 11/01/2022] [Accepted: 08/01/2023] [Indexed: 11/02/2023]
Abstract
Transitioning to adult care for HIV-infected adolescents is a critical process in determining long-term health outcomes. Poor transitioning to adult care can lead to several adverse HIV-related outcomes for adolescents living with HIV, including disruption of care, non-adherence to ART and virological failure. In this qualitative study, we explore the barriers to and facilitators of the transition to adult care among HIV-infected youth from the perspectives of health care workers and allied staff. We enrolled 24 health care workers and allied staff from two infectious diseases clinics in the Western Cape of South Africa. Participants took part in a once-off, semi-structured interview that was conducted face-to-face at the respective clinics. Interviews were audio-recorded and transcribed verbatim for thematic analysis using ATLAS.ti. Two superordinate themes and seven subthemes emerged from the data. We found that barriers to the transition process were related to a lack of preparedness and readiness to transition at both an institutional level and at the level of the caregiver and adolescent. At the institutional level, a lack of a transition policy and limited time and resources available for the transition process were salient barriers. At the caregiver-adolescent level, adolescents' desire for normality and caregivers' reluctance to devolve responsibility of care to their children were important barriers to the transition process. Facilitators prepare adolescents and caregivers for transition from an early age. Our findings highlight the importance of considering both adolescent, caregiver and institutional factors when preparing for the transition process. Our findings also show that pressure on the health care system precludes the time required for this process. However, counselling for transition from an early age might be an important way to negate these issues.
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Affiliation(s)
- Sylvie Mbebe
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Stephan Rabie
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bronwyne J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Prevalence of Physical Health, Mental Health, and Disability Comorbidities among Women Living with HIV in Canada. J Pers Med 2022; 12:jpm12081294. [PMID: 36013243 PMCID: PMC9409885 DOI: 10.3390/jpm12081294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Life expectancy for people living with HIV has increased, but management of HIV is now more complex due to comorbidities. This study aimed to measure the prevalence of comorbidities among women living with HIV in Canada. We conducted a cross-sectional analysis using data from the 18-months survey (2014−2016) of the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). Self-report of diagnosed conditions was used to measure lifetime prevalence of chronic physical conditions, current mental health conditions, and disabilities. We examined frequency of overlapping conditions and prevalence stratified by gender identity, ethnicity, and age. Among 1039 participants, 70.1% reported a physical health diagnosis, 57.4% reported a current mental health diagnosis, 19.9% reported a disability, and 47.1% reported both physical and mental health comorbidities. The most prevalent comorbidities were depression (32.3%), anxiety (29.5%), obesity (26.7%, defined as body mass index >30 kg/m2), asthma/chronic obstructive pulmonary disease (23.3%), sleep disorder (22.0%), drug addiction (21.9%), and arthritis/osteoarthritis (20.9%). These results highlight the complexity of HIV care and the important prevalence of comorbidities. Personalized health care that integrates care and prevention of all comorbidities with HIV, with attention to social determinants of health, is necessary to optimize health and well-being of women living with HIV.
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Levy ME, Waters A, Sen S, Castel AD, Plankey M, Molock S, Asch F, Goparaju L, Kassaye S. Psychosocial stress and neuroendocrine biomarker concentrations among women living with or without HIV. PLoS One 2021; 16:e0261746. [PMID: 34941922 PMCID: PMC8699620 DOI: 10.1371/journal.pone.0261746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Women living with HIV (WLWH) experience psychosocial stress related to social-structural vulnerabilities. To investigate neuroendocrine pathways linking stress and increased cardiovascular disease risk among WLWH, we evaluated associations between psychosocial stress (i.e., perceived stress, posttraumatic stress, and experiences of race- and gender-based harassment) and a composite neuroendocrine biomarker index among WLWH and women without HIV. METHODS In 2019-2020, Women's Interagency HIV Study participants in Washington, DC completed a questionnaire and provided blood and 12-hour overnight urine samples for testing of serum dehydroepiandrosterone sulfate (DHEA-S) and urinary free cortisol, epinephrine, and norepinephrine. Psychosocial stress was measured using the Perceived Stress Scale, PTSD Checklist-Civilian Version, and Racialized Sexual Harassment Scale. Latent profile analysis was used to classify participants into low (38%), moderate (44%), and high (18%) stress groups. Composite biomarker index scores between 0-4 were assigned based on participants' number of neuroendocrine biomarkers in high-risk quartiles (≥75th percentile for cortisol, epinephrine, and norepinephrine and ≤25th percentile for DHEA-S). We evaluated associations between latent profile and composite biomarker index values using multivariable linear regression, adjusting for socio-demographic, behavioral, metabolic, and HIV-related factors. RESULTS Among 90 women, 62% were WLWH, 53% were non-Hispanic Black, and median age was 55 years. In full multivariable models, there was no statistically significant association between psychosocial stress and composite biomarker index values among all women independent of HIV status. High (vs. low) psychosocial stress was positively associated with higher mean composite biomarker index values among all monoracial Black women (adjusted β = 1.32; 95% CI: 0.20-2.43), Black WLWH (adjusted β = 1.93; 95% CI: 0.02-3.83) and Black HIV-negative women (adjusted β = 2.54; 95% CI: 0.41-4.67). CONCLUSIONS Despite a null association in the overall sample, greater psychosocial stress was positively associated with higher neuroendocrine biomarker concentrations among Black women, highlighting a plausible mechanism by which psychosocial stress could contribute to cardiovascular disease risk.
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Affiliation(s)
- Matthew E. Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Westat, Rockville, Maryland, United States of America
- * E-mail:
| | - Ansley Waters
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Division of Clinical Epidemiology, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia, United States of America
| | - Sabyasachi Sen
- Division of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC, United States of America
| | - Federico Asch
- Cardiovascular Core Laboratories and Cardiac Imaging Research, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Washington, DC, United States of America
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
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Zalazar V, Aristegui I, Socías ME, Cardozo N, Sued O, Shannon K, Duff P. Ethics and the treatment as prevention strategy among transgender women living with HIV in Argentina. CULTURE, HEALTH & SEXUALITY 2021; 23:674-689. [PMID: 32213129 DOI: 10.1080/13691058.2020.1720821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
While numerous ethical concerns have been voiced regarding HIV service scale-up strategies targeting key populations, few studies have examined these from the perspective of affected groups. This study therefore sought to understand transgender women's experiences and perspectives of targeted HIV services scale-up in the context of Argentina's Treatment as Prevention strategy. In 2016, 25 purposively selected transgender women living with HIV were interviewed by a peer research associate. Interviews were audio recorded, transcribed verbatim and analysed using participatory coding techniques. Findings suggest that procedures around informed consent, including the provision of full information in lay language and voluntariness, were lacking both pre- and post-HIV test. Further, many transgender women felt disrespected and disregarded by healthcare workers. While the majority of participants were unaware of Treatment as Prevention, once explained, most felt the approach was ethical overall, and helped improve equity in HIV service access. Study findings offer several community-driven suggestions to support patient rights and the ethical scale-up of HIV services for transgender women in Buenos Aires, including the need for training in and the provision of non-judgemental, gender-affirmative care and the inclusion of peer-navigators.
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Affiliation(s)
| | - Ines Aristegui
- Fundación Huésped, Buenos Aires, Argentina
- Department of Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | - M Eugenia Socías
- British Columbia Centre of Substance Use (BCCSU), Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadir Cardozo
- Fundación Huésped, Buenos Aires, Argentina
- Asociación de Travestis, Transexuales y Transgeneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina
- REDLACTRANS, Buenos Aires, Argentina
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Kate Shannon
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, BC, Canada
| | - Putu Duff
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, BC, Canada
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Akinwunmi B, Buchenberger D, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries. Sex Transm Infect 2021; 97:566-573. [PMID: 33632889 DOI: 10.1136/sextrans-2020-054648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES A novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why. METHODS 688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying ('very'/'highly') and physicians' willingness to offer ('definitely'/'probably') this LAR in different situations, with perceived benefits/concerns was measured. RESULTS Of people living with HIV, 65.8% were interested in trying LAR. The majority (~80%-90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch. CONCLUSION Providers and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.
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Balogun M, Meloni ST, Igwilo UU, Roberts A, Okafor I, Sekoni A, Ogunsola F, Kanki PJ, Akanmu S. Status of HIV-infected patients classified as lost to follow up from a large antiretroviral program in southwest Nigeria. PLoS One 2019; 14:e0219903. [PMID: 31344057 PMCID: PMC6657856 DOI: 10.1371/journal.pone.0219903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/04/2019] [Indexed: 11/19/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a term used to classify patients no longer being seen in a clinical care program, including HIV treatment programs. It is unclear if these patients have transferred their care services elsewhere, died, or if there are other reasons for their LTFU. To better understand the status of patients meeting the criteria of LTFU, we traced a sample of HIV-infected patients that were LTFU from the Lagos University Teaching Hospital (LUTH) antiretroviral program. Methods We conducted a cross-sectional study of HIV-infected adult patients who enrolled for care between 2010 and 2014 at LUTH and were considered LTFU. Patients with locator information were traced using phone calls. Face-to-face interviews were used to collect data from successfully traced and consenting participants. Predictors of LTFU from LUTH, disengagement from care and willingness to re-engage in care in LUTH were assessed. Results Of 6108 registered patients, 3397 (56%) were LTFU and being unmarried was a predictor of being LTFU from LUTH. Of 425 patients that were traced, 355 (84%) were alive and 70 (16%) were dead. Two hundred and sixty-eight patients consented to interviews; 96 (35.8%) of these had transferred to another clinic for care while 172 (64.2%) were disengaged from care. More than half (149/268; 55.6%) were not on antiretroviral therapy (ART). Some of the primary reasons for LTFU were; long distance to clinic (56%) and feeling healthy (6.7%). Predictor of disengagement from care within the interviewed cohort was not having started ART. The predictors of willingness to re-engage in care included, not having started ART, male sex and longer duration in HIV care prior to LTFU. Conclusion Most of the interviewed cohort that was LTFU were truly disengaged from care and not on ART. Interventions are required to address processes of re-engagement of patients that are LTFU.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
- * E-mail:
| | - Seema Thakore Meloni
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | | | - Alero Roberts
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Ifeoma Okafor
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Folasade Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Phyllis J. Kanki
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Sulaimon Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine of the University of Lagos, Lagos, Nigeria
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Adimora AA. Implementing National HIV/AIDS Strategy 2015 Treatment Targets Is Cost-effective and Would Save Lives: What Other Evidence Do We Need? J Infect Dis 2018; 216:787-789. [PMID: 29029229 DOI: 10.1093/infdis/jix351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adaora A Adimora
- UNC School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Peterson B, Gordon C, Boehm J, Inhorn M, Patrizio P. Initiating patient discussions about oocyte cryopreservation: Attitudes of obstetrics and gynaecology resident physicians. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 6:72-79. [PMID: 30519650 PMCID: PMC6259041 DOI: 10.1016/j.rbms.2018.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/02/2018] [Accepted: 10/04/2018] [Indexed: 05/04/2023]
Abstract
This study examined the attitudes of obstetrics and gynaecology (OB/GYN) resident physicians to initiating patient discussions regarding medical and elective oocyte cryopreservation (OC). The study used a cross-sectional online survey of OB/GYN medical residents in the USA, sampled from residency programmes approved by the American Council for Graduate Medical Education. In total, 208 medical residents, distributed evenly between postgraduate years 1-4, participated in the study. Residents' fertility knowledge and attitudes to initiating discussions about OC were gathered. Forty percent (n = 83) believed that OB/GYN residents should initiate discussions about OC with patients (initiators), while 60% (n = 125) did not (non-initiators). Initiators were less likely to overestimate the age at which a woman's fertility begins to decline, and were more likely to believe that discussions about OC and age-related fertility decline should take place during a well-woman annual examination. Initiators and non-initiators did not differ in their attitudes towards discussing OC with patients undergoing cancer treatments; however, initiators were significantly more likely to discuss elective OC with patients who were currently unpartnered or who wished to delay childbearing to pursue a career. Given the increasing age of childbearing among women, and the fact that women prefer to receive reproductive information from their healthcare providers, it is critical that such topics are discussed in consultations to assist patients in making more informed reproductive decisions. Further research is needed to assess the existing barriers to these discussions from both physician and patient perspectives.
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Affiliation(s)
- B. Peterson
- Chapman University, Crean College of Health and Behavioral Sciences, Marriage and Family Therapy Program, One University Drive, Orange, CA 92688, USA
- Corresponding author.
| | - C. Gordon
- University of California Irvine Obstetrics and Gynecology Residency Program, Orange, CA, USA
| | - J.K. Boehm
- Chapman University, Crean College of Health and Behavioral Sciences, Department of Psychology, Orange, CA, USA
| | - M.C. Inhorn
- Yale University, Department of Anthropology, New Haven, CT, USA
| | - P. Patrizio
- Yale University, Fertility Center, New Haven, CT, USA
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Wohl DA, Panter AT, Kirby C, Magnus BE, Hudgens MG, Allmon AG, Mollan KR. Estimating HIV Medication Adherence and Persistence: Two Instruments for Clinical and Research Use. AIDS Behav 2018; 22:948-960. [PMID: 28447269 DOI: 10.1007/s10461-017-1772-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes ( www.med.unc.edu/ncaidstraining/adherence/for-providers ) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence.
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Affiliation(s)
- David A Wohl
- Division of Infectious Diseases, The University of North Carolina, Campus Box 7215, Chapel Hill, NC, 27599, USA.
| | - A T Panter
- Department of Psychology and Neuroscience, The University of North Carolina, Chapel Hill, NC, USA
| | - Christine Kirby
- Division of Infectious Diseases, The University of North Carolina, Campus Box 7215, Chapel Hill, NC, 27599, USA
| | - Brooke E Magnus
- Psychology Department, Marquette University, Milwaukee, WI, USA
| | - Michael G Hudgens
- Department of Biostatistics, The University of North Carolina, Chapel Hill, NC, USA
| | - Andrew G Allmon
- Department of Biostatistics, The University of North Carolina, Chapel Hill, NC, USA
| | - Katie R Mollan
- The University of North Carolina Center for AIDS Research, Chapel Hill, NC, USA
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Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. ACTA ACUST UNITED AC 2017; 8. [PMID: 29201531 PMCID: PMC5708581 DOI: 10.4172/2155-6113.1000730] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access. Conclusion Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.
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Yager J, Faragon J, McGuey L, Hoye-Simek A, Hecox Z, Sullivan S, Neubert S, Patel N. Relationship Between Single Tablet Antiretroviral Regimen and Adherence to Antiretroviral and Non-Antiretroviral Medications Among Veterans' Affairs Patients with Human Immunodeficiency Virus. AIDS Patient Care STDS 2017; 31:370-376. [PMID: 28771023 DOI: 10.1089/apc.2017.0081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several antiretrovirals (ART) have been coformulated as single tablet regimens (STR). Study objectives were to compare ART and non-ART adherence between STR and multiple tablet regimens (MTR) recipients, determine whether STR independently predicts ART adherence, and determine whether ART adherence influences non-ART adherence. A retrospective cohort study was performed among Upstate New York Veterans' Healthcare Administration (VISN-2) patients from 2000 to 2013. Inclusion criteria were age ≥18 years, human immunodeficiency virus (HIV) infection, receipt of ≥3 ART medications for ≥3 months, and available pharmacy refill records. The two study outcomes were adherence to ART medications and non-ART medications. Adherence was determined with pharmacy refill records that were used to calculate medication possession ratios. Among the 1202 subjects, there were 165 (13.7%) STR and 1037 (86.3%) MTR recipients. Mean ± standard deviation (SD) ART adherence was significantly higher for STR recipients (81.5% ± 15.3%) than MTR recipients (66.1% ± 21.1%), p < 0.001. Use of STR [adjusted odds ratio (aOR): 5.76, 95% confidence interval (CI): 3.84-8.65, p < 0.001] was independently associated with optimal (≥90%) adherence to ART. Mean ± SD non-ART adherence did not differ between STR (78.8% ± 15.6%) and MTR recipients (80.8% ± 16.0%), p = 0.17. Optimal adherence to ART medications (aOR: 2.30, 95% CI: 1.57-3.38, p < 0.001) was independently associated with optimal adherence to non-ART medications. The use of STRs are associated with optimal adherence to ART medications, but not directly associated with adherence to non-ART medications.
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Affiliation(s)
- Jenna Yager
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - John Faragon
- Departments of Pharmacy and Medicine, Albany Medical Center Hospital, Albany, New York
| | - Liam McGuey
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Adam Hoye-Simek
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Zachary Hecox
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Steven Sullivan
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Stefanie Neubert
- Division of Infectious Diseases, Samuel S. Stratton Veterans' Affairs Medical Center, Albany, New York
| | - Nimish Patel
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
- Division of Infectious Diseases, Samuel S. Stratton Veterans' Affairs Medical Center, Albany, New York
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Toupin I, Engler K, Lessard D, Wong L, Lènàrt A, Raffi F, Spire B, Lebouché B. Patient profiles as organizing HIV clinicians' ART adherence management: a qualitative analysis. AIDS Care 2017; 30:207-210. [PMID: 28764563 DOI: 10.1080/09540121.2017.1360995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The effectiveness of antiretroviral therapy (ART) depends on optimal clinical management and patient adherence. Little is known about patient characteristics that clinicians consider in the management of ART adherence. Exploring this issue, five focus groups were conducted with 31 HIV-clinicians from across France. A qualitative typological analysis suggests that clinician management of patient adherence is based on characteristics that coalesce into seven patient profiles. For the "passive" patient, described as taking ART exactly as prescribed without questioning their doctor's expertise, a directive and simple management style was preferred. The "misleading" patient is characterized as concerned with social desirability and as reporting no adherence difficulties for fear of displeasing their doctor. If clinical outcomes are suboptimal, the clinicians' strategy is to remind them of the importance of open patient-clinician communication. The "stoic" patient is described as requesting and adequately taking the most potent ART available. Here, clinicians emphasize assessment of side effects, which the patient may minimize. The "hedonistic" patient's festive lifestyle and sexual risk-taking are seen as compromising adherence; with them, clinicians stress the patient's responsibility for their own health and that of their sexual partners. The "obsessive" patient is portrayed as having an irrational fear of ART failure and an inability to distinguish illusory from genuine adherence barriers. With this patient, clinicians seek to identify the latter. The "overburdened" patient is recognized as coping with life priorities that interfere with adherence and, with them, a forgiving ART is favored. The "underprivileged" patient is presented as having limited education, income and housing. In this case, clinicians seek to improve the patient's living conditions and access to care. These results shed light on HIV clinicians' ART adherence management. The value of these profiles for HIV care and patients should be investigated.
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Affiliation(s)
- Isabelle Toupin
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - Kim Engler
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - David Lessard
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - Leo Wong
- b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada
| | - Andràs Lènàrt
- a Department of Family Medicine , McGill University , Montreal , Canada
| | - Francois Raffi
- e Department of Infectious Diseases , CHU de Nantes and CIC 1413, INSERM , Nantes , France
| | - Bruno Spire
- f SESSTIM , Université Aix-Marseille , Marseille , France
| | - Bertrand Lebouché
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
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13
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van den Berg JJ, Neilands TB, Johnson MO, Chen B, Saberi P. Using Path Analysis to Evaluate the Healthcare Empowerment Model Among Persons Living with HIV for Antiretroviral Therapy Adherence. AIDS Patient Care STDS 2016; 30:497-505. [PMID: 27849372 DOI: 10.1089/apc.2016.0159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Healthcare empowerment (HCE) is patient controlled and includes the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty. Understanding psychosocial factors that impact HCE for persons living with HIV is critical for their treatment and care. A sample of 1494 male and female participants living with HIV in the United States with a mean age of 45.6 (standard deviation = 11.4) completed a one-time online survey about their demographic characteristics, social support, healthcare provider relationship, HIV treatment knowledge, perceived HIV-related stigma, lifetime trauma, depressive symptoms, HCE, and antiretroviral therapy (ART) adherence. A path analysis was conducted using structural equation modeling software to fit a theory-based model of HCE. Results included statistically significant direct pathways between depressive symptoms, healthcare provider relationship, lifetime trauma, and ART adherence, as well as between healthcare provider relationship, HIV treatment knowledge, and HCE. Specifically, ART adherence was positively linked to healthcare provider relationship and negatively linked to depressive symptoms and lifetime trauma. In addition, healthcare provider relationship and HIV treatment knowledge were positively associated with HCE. The indirect effects of healthcare provider relationship and HIV treatment knowledge on adherence through HCE were also significant. In particular, ART adherence was indirectly and positively affected by healthcare provider relationship and HIV treatment knowledge through HCE. Multi-level interventions are urgently needed to address the effects of these psychosocial factors on ART adherence.
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Affiliation(s)
- Jacob J. van den Berg
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, Rhode Island
| | | | - Mallory O. Johnson
- Department of Medicine, University of California, San Francisco, California
| | - Bing Chen
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Parya Saberi
- Department of Medicine, University of California, San Francisco, California
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14
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Hanna DB, Jung M, Xue X, Anastos K, Cocohoba JM, Cohen MH, Golub ET, Hessol NA, Levine AM, Wilson TE, Young MA, Kaplan RC. Trends in Nonlipid Cardiovascular Disease Risk Factor Management in the Women's Interagency HIV Study and Association with Adherence to Antiretroviral Therapy. AIDS Patient Care STDS 2016; 30:445-454. [PMID: 27749112 DOI: 10.1089/apc.2016.0143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is increasingly common among women with HIV, but literature on nonlipid CVD risk factor management is lacking. We examined semiannual trends from 2006 to 2014 in hypertension treatment and control (blood pressure <140/90 mmHg), diabetes treatment and control (fasting glucose <130 mg/dL), and smoking quit rates in the Women's Interagency HIV Study. Unadjusted and adjusted Poisson regression models tested time trends and differences between HIV+ and HIV- women. Among antiretroviral therapy (ART) users, we examined the association of ART adherence and virologic suppression with each outcome. We evaluated 1636 HIV+ and 683 HIV- women, with a hypertension prevalence of 40% and 38%, respectively; diabetes prevalence of 21% and 22%; and smoking prevalence of 37% and 48%. Hypertension treatment was higher among HIV+ than HIV- women (77% vs. 67%, p < 0.001) and increased over time with no difference in trend by HIV status. Hypertension control was greater among HIV+ women (56% vs. 43%, p < 0.001) and increased over time among HIV+ but not HIV- women. Diabetes treatment was similar among HIV+ and HIV- women (48% vs. 49%) and increased over time in both groups. Diabetes control was greater among HIV+ women (73% vs. 64%, p = 0.03) and did not change over time. The percent of recent smokers who reported no longer smoking was similar between HIV+ and HIV- women (10% vs. 9%), with no differences over time. Virologic suppression was significantly associated with increased hypertension treatment and greater control. HIV+ women have better control of hypertension and diabetes than HIV- women, but many are still not at target levels.
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Affiliation(s)
- David B. Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Molly Jung
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Anastos
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jennifer M. Cocohoba
- Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, California
| | - Mardge H. Cohen
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nancy A. Hessol
- Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, California
| | | | - Tracey E. Wilson
- Department of Community Health Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Mary A. Young
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Robert C. Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
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15
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Gwadz M, de Guzman R, Freeman R, Kutnick A, Silverman E, Leonard NR, Ritchie AS, Muñoz-Plaza C, Salomon N, Wolfe H, Hilliard C, Cleland CM, Honig S. Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study. Front Public Health 2016; 4:62. [PMID: 27092300 PMCID: PMC4824754 DOI: 10.3389/fpubh.2016.00062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1-2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider-patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff, participants commonly reduced substance use and initiated or reinitiated ART. The present study highlights a number of addressable barriers to ART initiation and engagement in HIV care for this vulnerable population, as well as gaps in current practice and potential junctures for intervention efforts.
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Affiliation(s)
- Marya Gwadz
- New York University College of Nursing, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | | | - Robert Freeman
- New York University College of Nursing , New York, NY , USA
| | | | | | - Noelle R Leonard
- New York University College of Nursing, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | | | | | - Nadim Salomon
- Peter Krueger Center for Immunological Disorders, Mount Sinai Beth Israel , New York, NY , USA
| | - Hannah Wolfe
- Mount Sinai St. Luke's-Roosevelt Hospital Center, Spencer Cox Center for Health , New York, NY , USA
| | - Christopher Hilliard
- New York University College of Nursing, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | - Charles M Cleland
- New York University College of Nursing, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | - Sylvie Honig
- New York University College of Nursing, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
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16
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Carlsson-Lalloo E, Rusner M, Mellgren Å, Berg M. Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis. AIDS Patient Care STDS 2016; 30:56-69. [PMID: 26741804 PMCID: PMC4753620 DOI: 10.1089/apc.2015.0260] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Research, Södra Älvsborg Hospital, Borås, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
- Department of Research, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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