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Weiss SM, Rodriguez VJ, Cook RR, Bowa K, Zulu R, Mweemba O, Kamboyi R, Castro J, Dunleavy VO, Alcaide ML, Jones DL. Increasing early infant male circumcision uptake in Zambia: Like father like son. PLoS One 2023; 18:e0289819. [PMID: 37561707 PMCID: PMC10414584 DOI: 10.1371/journal.pone.0289819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, "Like Father, Like Son" (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples' older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son "bonding" by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples' older sons and is a novel leverage point for promotion of this HIV prevention strategy.
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Affiliation(s)
- Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Psychology, University of Georgia, Athens, Georgia, United States of America
| | - Ryan R. Cook
- Medicine, General Internal Medicine, and Geriatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Kasonde Bowa
- University of Lusaka School of Medicine, Lusaka, Zambia
| | - Robert Zulu
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Jose Castro
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | - Maria L. Alcaide
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Lier AJ, Seval N, Vander Wyk B, Di Paola A, Springer SA. Maintenance on extended-release naltrexone is associated with reduced injection opioid use among justice-involved persons with opioid use disorder. J Subst Abuse Treat 2022; 142:108852. [PMID: 35988513 PMCID: PMC9509444 DOI: 10.1016/j.jsat.2022.108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) and injection drug use (IDU) place justice-involved individuals at increased risk for acquiring or transmitting HIV or hepatitis C virus (HCV). Methadone and buprenorphine have been associated with reduced opioid IDU; however, the effect of extended-release naltrexone (XR-NTX) on this behavior is incompletely studied. METHODS This study examined injection opioid use and shared injection equipment behavior from a completed double-blind placebo-controlled trial of XR-NTX among 88 justice-involved participants with HIV and OUD. Changes in participants' self-reported daily injection opioid use and shared injection equipment was evaluated pre-incarceration, during incarceration, and monthly post-release for 6 months. The study also assessed differences in time to first opioid injection post-release. The research team performed intention to treat and "as treated" (high treatment versus low treatment) analyses. RESULTS Fifty-eight of 88 participants (69.5 %) endorsed IDU and 26 (29.5 %) reported sharing injection equipment in the 30 days pre-incarceration; 2 participants (2.2 %) reported IDU during incarceration; 19 (21.6 %) reported IDU one month post-release from prison or jail. Fifty-four (61.4 %) participants had an HIV RNA below 200 copies/mL and 62 (70.5 %) were baseline HCV antibody positive. The 6-month follow-up rate was 49.5 % and 50.5 % for those who received XR-NTX and placebo, respectively, which was not significantly different (p = 0.822). Participants in the XR-NTX and placebo groups had similar low mean opioid injection use post-release and time to first injection opioid use in the Intention-to-treat analysis. In the as-treated analysis, participants in the high treatment group had significantly lower mean proportion of days injecting opioids (13.8 % high treatment versus 22.8 % low treatment, p = 0.02) by month 1, which persisted up to 5 months post-release (0 % high treatment vs 24.3 % low treatment, p < 0.001) and experienced a longer time to first opioid injection post-release (143.8 days high treatment vs 67.4 days low treatment, p < 0.001). CONCLUSIONS Injection opioid use was low during incarceration and remained low post-release in this justice-involved population. Retention on XR-NTX was associated with reduced intravenous opioid use, which has important implications for reducing transmission of HIV and HCV.
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Affiliation(s)
- Audun J Lier
- Department of Internal Medicine, Division of Infectious Diseases, Northport VA Medical Center, Northport, NY, USA
| | - Nikhil Seval
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Angela Di Paola
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
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Meyer JP, Price CR, Ye Y, Qin Y, Tracey D, Demidont AC, Melbourne K, Altice FL. A PrEP Demonstration Project Using eHealth and Community Outreach to Justice-Involved Cisgender Women and Their Risk Networks. AIDS Behav 2022; 26:3807-3817. [PMID: 35672552 DOI: 10.1007/s10461-022-03709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
| | - Carolina R Price
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - Yiwen Ye
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States
| | - Yilu Qin
- Primary Care Program, Yale New Haven Health, HIV Training Track, New Haven, CT, United States
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - A C Demidont
- Gilead Sciences, Inc, Foster City, CA, United States
| | | | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
- Yale School of Public Health, Epidemiology of Microbial Diseases, New Haven, CT, United States
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Cedillo G, George MC, Deshpande R, Benn EKT, Navis A, Nmashie A, Siddiqui A, Mueller BR, Chikamoto Y, Weiss L, Scherer M, Kamler A, Aberg JA, Vickrey BG, Bryan A, Horn B, Starkweather A, Fisher J, Robinson-Papp J. Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial. Addict Sci Clin Pract 2022; 17:28. [PMID: 35578356 PMCID: PMC9108346 DOI: 10.1186/s13722-022-00311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 2016 U.S. Centers for Disease Control Opioid Prescribing Guideline (CDC Guideline) is currently being revised amid concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). However, a methodology to faithfully implement the CDC guideline, measure prescriber adherence, and systematically test its effect on patient and public health outcomes is lacking. We developed and tested a CDC Guideline implementation strategy (termed TOWER), focusing on an outpatient HIV-focused primary care setting. METHODS TOWER was developed in a stakeholder-engaged, multi-step iterative process within an Information, Motivation and Behavioral Skills (IMB) framework of behavior change. TOWER consists of: 1) a patient-facing opioid management app (OM-App); 2) a progress note template (OM-Note) to guide the office visit; and 3) a primary care provider (PCP) training. TOWER was evaluated in a 9-month, randomized-controlled trial of HIV-PCPs (N = 11) and their patients with HIV and CP-LTOT (N = 40). The primary outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the validated Safer Opioid Prescribing Evaluation Tool (SOPET). Qualitative data including one-on-one PCP interviews were collected. We also piloted patient-reported outcome measures (PROMs) reflective of domains identified as important by stakeholders (pain intensity and function; mood; substance use; medication use and adherence; relationship with provider; stigma and discrimination). RESULTS PCPs randomized to TOWER were 48% more CDC Guideline adherent (p < 0.0001) with significant improvements in use of: non-pharmacologic treatments, functional treatment goals, opioid agreements, prescription drug monitoring programs (PDMPs), opioid benefit/harm assessment, and naloxone prescribing. Qualitative data demonstrated high levels of confidence in conducting these care processes among intervention providers, and that OM-Note supported these efforts while experience with OM-App was mixed. There were no intervention-associated safety concerns (defined as worsening of any of the PROMs). CONCLUSIONS CDC-guideline adherence can be promoted and measured, and is not associated with worsening of outcomes for people with HIV receiving LTOT for CP. Future work would be needed to document scalability of these results and to determine whether CDC-guideline adherence results in a positive effect on public health. Trial registration https://clinicaltrials.gov/ct2/show/NCT03669939 . Registration date: 9/13/2018.
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Affiliation(s)
- Gabriela Cedillo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Mary Catherine George
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Richa Deshpande
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA.,Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA.,Caring Accent (Consultancy), San Jose, CA, USA.,Department of Economics and the Center On Alcoholism, Substance Use and Addictions, University of New Mexico, Albuquerque, USA.,Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA.,School of Nursing, University of Connecticut, Storrs, CT, USA.,Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Emma K T Benn
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Alexandra Nmashie
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Alina Siddiqui
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Bridget R Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | | | - Linda Weiss
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Maya Scherer
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Alexandra Kamler
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, USA
| | - Judith A Aberg
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA
| | - Angela Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
| | - Brady Horn
- Department of Economics and the Center On Alcoholism, Substance Use and Addictions, University of New Mexico, Albuquerque, USA
| | | | - Jeffrey Fisher
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1052, New York, NY, 10029, USA.
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Walter AW, Morocho C. HIV Related Knowledge, HIV Testing Decision-Making, and Perceptions of Alcohol Use as a Risk Factor for HIV among Black and African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4535. [PMID: 33923339 PMCID: PMC8123126 DOI: 10.3390/ijerph18094535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
The HIV/AIDS epidemic disproportionately affects Black and African American women in the United States. This study examined the extent of HIV related knowledge, HIV testing decision-making, and perceptions of alcohol use as a risk factor for HIV among Black and African American women in urban and suburban communities. Seven focus groups were conducted with 37 women aged 18 to 49 residing in the Commonwealth of Massachusetts. Women participating in focus groups had a wide breadth of HIV related knowledge. Findings suggest the influence of interpersonal relationships and provider-patient interactions on HIV testing, the need for building community capacity and leveraging community resources towards HIV prevention, and the influence of alcohol outlet density on HIV vulnerability and exposure in communities of color. Comprehensive multifaceted evidence informed interventions that are culturally relevant and gender responsive are needed to reduce HIV/AIDS disparities.
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Cesar Morocho
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA;
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6
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Kuhns LM, Hereth J, Garofalo R, Hidalgo M, Johnson AK, Schnall R, Reisner SL, Belzer M, Mimiaga MJ. A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study. J Med Internet Res 2021; 23:e21839. [PMID: 33787503 PMCID: PMC8047777 DOI: 10.2196/21839] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/28/2020] [Accepted: 02/08/2021] [Indexed: 01/26/2023] Open
Abstract
Background Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW.
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Affiliation(s)
- Lisa M Kuhns
- Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jane Hereth
- Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, IL, United States.,Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Robert Garofalo
- Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Marco Hidalgo
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Amy K Johnson
- Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, United States
| | - Sari L Reisner
- Fenway Institute, Boston, MA, United States.,Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Marvin Belzer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Matthew J Mimiaga
- Fenway Institute, Boston, MA, United States.,Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States.,Center for Health Equity Research, Brown University, Providence, RI, United States.,Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States
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Meyer J, Price C, Tracey D, Sharpless L, Song Y, Madden L, Elwyn G, Altice F. Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders. Patient Prefer Adherence 2021; 15:1913-1927. [PMID: 34511887 PMCID: PMC8420782 DOI: 10.2147/ppa.s315543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
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Affiliation(s)
- Jaimie Meyer
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- Correspondence: Jaimie Meyer Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USATel +203 737 6233Fax +203 737 4051 Email
| | - Carolina Price
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | | | - Yue Song
- Yale School of Public Health, New Haven, CT, USA
- Oregon Health Sciences University, Portland, OR, USA
| | - Lynn Madden
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- Scientific Institute for Quality of Healthcare, University Nijmegen Medical Centre, Nijmegen, Netherlands
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Frederick Altice
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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8
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Lee NY, Chen YC, Liu HY, Li CY, Li CW, Ko WC, Ko NY. Increased repeat syphilis among HIV-infected patients: A nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 2020; 99:e21132. [PMID: 32664143 PMCID: PMC7360277 DOI: 10.1097/md.0000000000021132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (β = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61-0.98; P < .001) were associated with a reduced risk of repeat syphilis.The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.
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Affiliation(s)
- Nan-Yao Lee
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Ying Liu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Nai-Ying Ko
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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9
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Robinson-Papp J, Aberg J, Benn EK, Bryan A, Cedillo G, Chikamoto Y, George MC, Horn B, Kamler A, Navis A, Nmashie A, Scherer M, Starkweather A, Vickrey B, Weiss L, Yang Q, Fisher J. Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers. Contemp Clin Trials Commun 2019; 16:100468. [PMID: 31701042 PMCID: PMC6831717 DOI: 10.1016/j.conctc.2019.100468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafER Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.
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Affiliation(s)
| | - Judith Aberg
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases, USA
| | - Emma K.T. Benn
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Angela Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, USA
| | - Gabriela Cedillo
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | | | | | - Brady Horn
- University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, USA
| | - Alexandra Kamler
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Allison Navis
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Alexandra Nmashie
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Maya Scherer
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Linda Weiss
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Qiuchen Yang
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Jeffrey Fisher
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), USA
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10
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Ruben MA, Livingston NA, Berke DS, Matza AR, Shipherd JC. Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication. Health Equity 2019; 3:480-488. [PMID: 31559377 PMCID: PMC6761590 DOI: 10.1089/heq.2019.0069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: Lesbian, gay, bisexual, and transgender (LGBT) veterans report discrimination in health care, which may be associated with negative health outcomes/behaviors and has implications for LGBT identity disclosure to providers. Quality provider communication may serve to offset some of the deleterious effects of discrimination; however, no research to date has examined provider communication with respect to health among LGBT patients. Methods: Participants were 47 LGBT veterans who completed measures related to past health care experiences, experiences of discrimination in health care, perceptions of provider communication, and measures of anxiety, depression, post-traumatic stress disorder symptoms, and alcohol/tobacco use. Results: The majority of LGBT veterans reported experiencing LGBT-based discrimination in health care, which was associated with higher rates of tobacco use and less comfort in disclosing their LGBT identity to providers. We also found evidence of moderation, such that high-quality provider communication appeared to buffer these associations. Conclusion: LGBT veterans face unique challenges with respect to receiving appropriate health care. The high frequencies of reported discrimination in health care is problematic and warrants further research and intervention. These results highlight the important role of provider communication, and the potential for quality communication to buffer against certain effects, particularly with respect to tobacco use and LGBT identity disclosure, which is an important protective factor.
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Affiliation(s)
- Mollie A Ruben
- Department of Psychology, University of Maine, Orono, Maine.,Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Danielle S Berke
- Department of Psychology, Hunter College of the City University of New York, New York.,The Graduate Center of the City University of New York, New York
| | - Alexis R Matza
- LGBT Health Program, Veterans Health Administration, Washington, District of Columbia
| | - Jillian C Shipherd
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,LGBT Health Program, Veterans Health Administration, Washington, District of Columbia.,National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts
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11
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Llewellyn CD, Abraham C, Pollard A, Jones CI, Bremner S, Miners A, Smith H. A randomised controlled trial of a telephone administered brief HIV risk reduction intervention amongst men who have sex with men prescribed post-exposure prophylaxis for HIV after sexual exposure in the UK: Project PEPSE. PLoS One 2019; 14:e0216855. [PMID: 31120898 PMCID: PMC6532860 DOI: 10.1371/journal.pone.0216855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 12/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In western countries, men who have sex with men (MSM) are most affected by HIV and increasingly likely to engage in risky sexual behaviour. MSM who experience a potential sexual exposure to HIV (PEPSE) and receive a preventative regimen of anti-HIV treatment are at particularly high risk of acquiring HIV and could potentially benefit from targeted risk reduction behavioural interventions such as motivational interviewing (MI). PURPOSE The aim of this trial was to examine the impact of augmented MI (MI plus information provision and behavioural skills building), over and above routine care, on reducing risky sexual behaviour in MSM prescribed PEPSE. Secondary aims of the research were to examine whether the intervention reduced sexually transmitted infections (STI) and further requests for PEP. METHODS A parallel-group pragmatic randomised controlled trial was conducted with 175 MSM recruited from five sexual health (SH) clinics in the south east of England. The intervention was two fixed-duration sessions of telephone administered augmented MI. A manual guided the selection of individualised persuasive communication strategies based on underlying change mechanisms specified by the Information, Motivation and Behavioural Skills (IMB) model. Primary outcomes were the number of receptive and active anal intercourse (AI) partners, the use of condoms every time during receptive and active AI and the use of condoms sometimes during receptive and active AI. RESULTS There were no significant impacts on sexual risk behaviour or any of the psychological measures, and no discernible reduction in requests for repeat PEP or rates of STIs within a year. CONCLUSION Our behavioural intervention of augmented MI did not affect risky sexual behaviour, rates of further PEP and STIs, and psychological factors, in MSM prescribed PEPSE. TRIAL REGISTRATION NUMBERS UKCRN ID:11436; ISRCTN00746242.
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Affiliation(s)
| | - Charles Abraham
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Alex Pollard
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alec Miners
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Smith
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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12
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High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems. AIDS Behav 2019; 23:835-846. [PMID: 30737609 DOI: 10.1007/s10461-019-02413-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.
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13
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Shafii T, Benson SK, Morrison DM, Hughes JP, Golden MR, Holmes KK. Results from e-KISS: electronic-KIOSK Intervention for Safer Sex: A pilot randomized controlled trial of an interactive computer-based intervention for sexual health in adolescents and young adults. PLoS One 2019; 14:e0209064. [PMID: 30673710 PMCID: PMC6343886 DOI: 10.1371/journal.pone.0209064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/27/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Interactive computer-based interventions (ICBI) are potentially scalable tools for use in real-world settings to promote sexual health and prevent sexually transmitted infections (STIs) and unintended pregnancies. We developed and assessed the feasibility and acceptability of an ICBI for promoting adolescent and young adult sexual health, and the effectiveness of the intervention in reducing unprotected sex, STIs, and unintended pregnancy. METHODS This pilot randomized controlled trial enrolled STI Clinic patients, in Seattle, Washington, who were 14-24 years old and reported unprotected vaginal sex during the last 2 months. Both the control and intervention group used a computerized survey to enter their sexual health and only the intervention group received the ICBI. The ICBI included personalized sexual health feedback from a physician avatar; instructive video modules advocating sexual health; and identification of one behavior to change. At 3-month follow-up, participants reported on interim sexual and pregnancy histories and underwent repeat STI testing. We assessed intervention impact on unprotected vaginal sex, number of sexual partners, incident STIs, and unintended pregnancy. RESULTS Of 272 participants, 242 (89%) completed the study, of whom 65% were female. While these findings did not reach statistical significance, at 3-month follow-up, the intervention group reported a 33% lower rate of unprotected vaginal sex (no condom use) [IRR = 0.67, 95% CI: 0.44-1.02]; 29% fewer sex partners [IRR = 0.71, 95% CI: 0.50-1.03]; and 48% fewer STIs [IRR = 0.52, 95% CI: 0.25-1.08] when compared to the control group. Similarly, as compared to the control group, intervention females reported a lower rate of unprotected vaginal sex (no birth control) [IRR = 0.80, 95% CI: 0.47-1.35] and half as many unintended pregnancies (n = 5) versus control females (n = 10) [IRR = 0.51, 95% CI: 0.17-1.58]. In exploratory analyses, intervention females reported fewer partners [IRR = 0.71, 95% CI: 0.50-1.00] and a significantly lower rate of vaginal sex without condoms [IRR = 0.50, 95% CI: 0.30-0.85]. CONCLUSION The intervention was acceptable to both males and females, and at 3-month follow-up, there were non-significant reductions in risk behavior for all outcomes. Among females, exploratory analysis showed a significant reduction in vaginal sex without condoms.
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Affiliation(s)
- Taraneh Shafii
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Samantha K. Benson
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Diane M. Morrison
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Matthew R. Golden
- Department of Medicine, University of Washington School of Medicine, Public Health Seattle & King County HIV/STD Program, Seattle, WA, United States of America
| | - King K. Holmes
- Departments of Global Health and Medicine, University of Washington Schools of Medicine and Public Health; and Center for AIDS & STD, Seattle, WA, United States of America
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14
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Norris AL, Rich C, Krieger N, Guthrie KM, Kaplan C, Carey KB, Carey MP. Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic. BMC Womens Health 2019; 19:15. [PMID: 30665343 PMCID: PMC6341714 DOI: 10.1186/s12905-019-0709-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity. METHODS Women 18-29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%). RESULTS One-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms. CONCLUSIONS Reproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.
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Affiliation(s)
- Alyssa L. Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
| | - Naomi Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
| | - Kate M. Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
| | - Clair Kaplan
- Department of Clinical Research, Planned Parenthood of Southern New England, 345 Whitney Avenue, New Haven, CT 06511 USA
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510 USA
| | - Kate B. Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903 USA
- Center for Alcohol and Addiction Studies, Brown University, 121 S. Main Street, Box G-S121-5, Providence, RI 02912 USA
| | - Michael P. Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903 USA
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15
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Miller WC, Rutstein SE, Phiri S, Kamanga G, Nsona D, Pasquale DK, Rucinski KB, Chen JS, Golin CE, Powers KA, Dennis AM, Hosseinipour MC, Eron JJ, Chege W, Hoffman IF, Pettifor AE. Randomized Controlled Pilot Study of Antiretrovirals and a Behavioral Intervention for Persons With Acute HIV Infection: Opportunity for Interrupting Transmission. Open Forum Infect Dis 2018; 6:ofy341. [PMID: 30648131 PMCID: PMC6329906 DOI: 10.1093/ofid/ofy341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Persons with acute HIV infection (AHI) have heightened transmission risk. We evaluated potential transmission reduction using behavioral and biomedical interventions in a randomized controlled pilot study in Malawi. Methods Persons were randomized 1:2:2 to standard counseling (SC), 5-session behavioral intervention (BI), or behavioral intervention plus 12 weeks of antiretrovirals (ARVs; BIA). All were followed for 26–52 weeks and, regardless of arm, referred for treatment according to Malawi-ARV guidelines. Participants were asked to refer partners for testing. Results Among 46 persons (9 SC, 18 BI, 19 BIA), the average age was 28; 61% were male. The median viral load (VL) was 5.9 log copies/mL at enrollment. 67% (10/15) of BIA participants were suppressed (<1000 copies/mL) at week 12 vs 25% BI and 50% SC (P = .07). Although the mean number of reported condomless sexual acts in the past week decreased from baseline across all arms (1.5 vs 0.3 acts), 36% experienced incident sexually transmitted infection by 52 weeks (12% SC, 28% BI, 18% BIA). Forty-one percent (19/46) of participants referred partners (44% SC, 44% BI, 37% BIA); 15 of the partners were HIV-infected. Conclusions Diagnosis of AHI facilitates behavioral and biomedical risk reduction strategies during a high-transmission period that begins years before people are typically identified and started on ARVs. Sexually transmitted infection incidence in this cohort suggests ongoing risk behaviors, reinforcing the importance of early intervention with ARVs to reduce transmission. Early diagnosis coupled with standard AHI counseling and early ARV referral quickly suppresses viremia, may effectively change behavior, and could have tremendous public health benefit in reducing onward transmission.
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Affiliation(s)
- William C Miller
- Division of Epidemiology, The Ohio State University, Columbus, Ohio.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah E Rutstein
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Dana K Pasquale
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine B Rucinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jane S Chen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carol E Golin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly A Powers
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ann M Dennis
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mina C Hosseinipour
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J Eron
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Irving F Hoffman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Cook CL, Staras SAS, Zhou Z, Chichetto N, Cook RL. Disclosure of HIV serostatus and condomless sex among men living with HIV/AIDS in Florida. PLoS One 2018; 13:e0207838. [PMID: 30557362 PMCID: PMC6296664 DOI: 10.1371/journal.pone.0207838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
Despite campaigns to increase safer sex practices, there are people living with HIV/AIDS (PLWH) who do not disclose their HIV status to sexual partners and engage in condomless sex. The purpose of this research was to: 1) describe factors associated with disclosure of HIV status to sexual partners; and 2) determine if disclosure and/or receipt of prevention counseling are independently associated with condomless sex. We used the Florida Medical Monitoring Project to analyze data from 376 HIV positive men with more than one sexual partner. Results indicated that 55% consistently disclosed their HIV status to sexual partners, 30% inconsistently disclosed, 15% did not disclose, and 48% reported any condomless sex. The odds of having condomless sex was 3.3 (CI = 1.5, 7.3) times greater in men who disclosed to all partners. Results suggest that men who disclose are also those who are more likely to have condomless sex. More research is needed to better understand the complex nature of disclosure and sexual risk behaviors and how disclosure impacts sexual risk.
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Affiliation(s)
- Christa L. Cook
- Department of Nursing Systems, College of Nursing, University of Central Florida, Orlando, FL, United States of America
| | - Stephanie A. S. Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Zhi Zhou
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Natalie Chichetto
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Robert L. Cook
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
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17
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Circumstances Surrounding High-risk Sexual Experiences Among Primary Care Patients Living With and Without HIV. J Gen Intern Med 2018; 33:2163-2170. [PMID: 30251213 PMCID: PMC6258602 DOI: 10.1007/s11606-018-4675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/12/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk. METHODS We conducted semi-structured 1:1 interviews with patients living with and without HIV reporting ≥ 1 sex partner and varying STI exposure risk in the past 12 months from four geographically diverse US HIV and primary care clinics. We audio-recorded, transcribed, and coded interviews by circumstance type, using double-coding to ensure inter-coder reliability. We used Fisher's exact and T tests to determine associations with demographic/risk factors. RESULTS Patients (n = 91) identified a mean of 3 of 11 circumstances. These included substance use (54%), desire for physical/emotional intimacy (48%), lack of HIV/STI status disclosure (44%), psychological drivers (i.e., coping, depression; 38%), personal dislike of condoms (22%), partner condom dislike/refusal (19%), receiving payment for sex (13%), and condom unavailability (9%). Higher proportions of those who were high STI-exposure risk patients, defined as those with ≥ 2 sex partners in the past 3 months reporting never or sometimes using condoms, reported disliking condoms (p = .006); higher proportions of the high-risk and moderate-risk (≥ 2 partners and condom use "most of the time") groups reported substance use as a circumstance (p = .04). CONCLUSION Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
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18
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Fredericksen RJ, Mayer KH, Gibbons LE, Edwards TC, Yang FM, Walcott M, Brown S, Dant L, Loo S, Gutierrez C, Paez E, Fitzsimmons E, Wu AW, Mugavero MJ, Mathews WC, Lober WB, Kitahata MM, Patrick DL, Crane PK, Crane HM. Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care. J Gen Intern Med 2018; 33:1661-1668. [PMID: 29845470 PMCID: PMC6153230 DOI: 10.1007/s11606-018-4496-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/21/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. OBJECTIVE To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. DESIGN Qualitative item development/quantitative instrument validation. PARTICIPANTS We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422). APPROACH We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients. KEY RESULTS Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP. CONCLUSION The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.
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Affiliation(s)
| | | | - Laura E Gibbons
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Todd C Edwards
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | | | | | - Sharon Brown
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Lydia Dant
- Fenway Community Health, Boston, MA, USA
| | | | | | - Edgar Paez
- University of California, San Diego, CA, USA
| | - Emma Fitzsimmons
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Albert W Wu
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | - William B Lober
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Mari M Kitahata
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Donald L Patrick
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Heidi M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
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De Vasconcelos S, Toskin I, Cooper B, Chollier M, Stephenson R, Blondeel K, Troussier T, Kiarie J. Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies: A systematic review. PLoS One 2018; 13:e0204088. [PMID: 30260991 PMCID: PMC6159869 DOI: 10.1371/journal.pone.0204088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behaviour-change interventions have been consistently considered an essential part of comprehensive HIV, STI and unintended pregnancy prevention. In 2015, the World Health Organization reviewed and assessed existing evidence on brief behavioural interventions, leading to the publication of Brief sexuality-related communication: recommendations for a public health approach. This guideline recommends the use of brief behaviour intervention and communication programmes to promote sexual health and to prevent HIV, STIs, and unintended pregnancies in primary health services, particularly sexual and reproductive health services. OBJECTIVE With the purpose of informing the development of a brief behaviour intervention in sexual and reproductive health, we conducted a systematic review of brief intervention to prevent HIV, STI and unintended pregnancies, to identify behaviour change techniques (BCTs) used in health care settings. METHODS Participants from all ages and genders were included. Brief interventions delivered in ≤ 60 minutes were included. Data was extracted, and interventions were coded following the Behaviour Change Techniques Taxonomy (BCTTv1) guidelines. RESULTS Of the 6.687 articles identified, 355 were reviewed and 37 studies were included. In effective interventions, we identified 48 behaviour change techniques (BCTs). A core set of 8 frequently used behaviour change techniques was identified: "Problem solving", "Feedback on behaviour", "Social support (unspecified)", "Instructions on how to perform the behaviour", "Information about health consequences", "Information about social and environmental consequences", "Demonstration of the behaviour" and "Credible source". CONCLUSIONS The technical content of brief behaviour interventions was identified in a reliable and standardized way providing preliminary indications on potentially effective techniques to achieve behaviour change.
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Affiliation(s)
- Sofia De Vasconcelos
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bergen Cooper
- Center for Health and Gender Equity (CHANGE), Washington, D.C., United States of America
| | - Marie Chollier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Troussier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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De P, Downing MJ, Hirshfield S. Cost Analysis of Implementing a Video-Based eHealth Intervention for HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:301-308. [PMID: 30148673 DOI: 10.1521/aeap.2018.30.4.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Clinician-delivered HIV prevention interventions are common and often effective but have small reach, particularly in remote, rural, or sparsely populated areas. Electronic health (eHealth) interventions may be an efficient alternative to providing HIV prevention to geographically dispersed or traditionally hard-to-reach populations, though eHealth interventions tend to have high start-up costs. We present cost data from a video-based eHealth intervention, Sex Positive!, among 1,208 U.S. gay, bisexual, and other men who have sex with men living with HIV. Specifically, we provide estimates for the cost of the intervention, overall, and per participant based on funding amounts. The total average cost per participant was $1,021. Sensitivity analyses demonstrated that reaching more participants would greatly reduce the average cost per participant. Findings indicate that the cost per person engaged in an eHealth HIV intervention is consistent with previous studies, and that further scaling up would greatly reduce the cost while increasing reach.
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Affiliation(s)
- Prabal De
- Colin Powell School, City College, and the Graduate Center, City University of New York, New York City
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21
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Grodensky CA, Golin CE, Pack AP, Pettifor A, Demers M, Massa C, Kamanga G, McKenna K, Corneli A. Adaptation and delivery of a motivational interviewing-based counseling program for persons acutely infected with HIV in Malawi: Implementation and lessons learned. PATIENT EDUCATION AND COUNSELING 2018. [PMID: 29519656 PMCID: PMC6003622 DOI: 10.1016/j.pec.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Individuals diagnosed with acute HIV infection (AHI) are highly infectious and require immediate HIV prevention efforts to minimize their likelihood of transmitting HIV to others. We sought to explore the relevance of Motivational Interviewing (MI), an evidence-based counseling method, for Malawians with AHI. METHODS We designed a MI-based intervention called "Uphungu Wanga" to support risk reduction efforts immediately after AHI diagnosis. It was adapted from Options and SafeTalk interventions, and refined through formative research and input from Malawian team members and training participants. We conducted qualitative interviews with counselors and participants to explore the relevance of MI in this context. RESULTS Intervention adaptation required careful consideration of Malawian cultural context and the needs of people with AHI. Uphungu Wanga's content was relevant and key MI techniques of topic selection and goal setting were viewed positively by counselors and participants. However, rating levels of importance and confidence did not appear to help participants to explore behavior change as intended. CONCLUSION Uphungu Wanga may have provided some added benefits beyond "brief education" standard of care counseling for Malawians with AHI. PRACTICE IMPLICATIONS MI techniques of topic selection and goal setting may enhance prevention education and counseling for Malawians with AHI.
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Affiliation(s)
- Catherine A Grodensky
- Department of Medicine, Institute of Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carol E Golin
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Allison P Pack
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michele Demers
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Kevin McKenna
- Department of Social, Behavioral, and Health Sciences, FHI 360, Durham, NC, United States(1); Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Amy Corneli
- Department of Social, Behavioral, and Health Sciences, FHI 360, Durham, NC, United States(1); Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
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Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004-2014. J Acquir Immune Defic Syndr 2018; 76:409-416. [PMID: 28777262 DOI: 10.1097/qai.0000000000001514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Annual screening for gonorrhea [Neisseria gonorrhoeae (NG)] and chlamydia [Chlamydia trachomatis (CT)] is recommended for all sexually active persons living with HIV but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004-2014, a period of expanding testing. METHODS We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women, and women. RESULTS Among 15,614 patients (50% MSM, 26% men who have sex exclusively with women, and 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 [adjusted odds ratio (AOR) per year 1.22 (1.21-1.22)]. Despite the increase in testing, test positivity also increased [AOR per year 1.10 (1.07-1.12)], and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 [AOR per year 1.20 (1.17-1.22)]. Case detection was highest among MSM but increased over time among all 3 groups. CONCLUSIONS NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among persons living with HIV to decrease transmission and complications of NG/CT and of HIV.
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Loeliger KB, Biggs ML, Young R, Seal DW, Beckwith CG, Kuo I, Gordon MS, Altice FL, Ouellet LJ, Cunningham WE, Young JD, Springer SA. Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium. AIDS Behav 2017; 21:2945-2957. [PMID: 28188460 DOI: 10.1007/s10461-017-1722-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.
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Fongkaew W, Udomkhamsuk W, Viseskul N, Guptaruk M. Developing a program for enhancing youth HIV treatment adherence and risk reduction. Nurs Health Sci 2017; 19:427-435. [PMID: 28799688 DOI: 10.1111/nhs.12360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Abstract
Youth living with HIV face difficult and challenging situations that decrease their adherence to antiretroviral medications. In this study, we developed a pilot program to enhance HIV treatment adherence and risk reduction among youth living with HIV based on collaboration with a community hospital involving a multi-disciplinary healthcare team. Participants were 25 youth living with HIV/AIDS, 18 caregivers, and 12 healthcare providers. The action research process comprised a preliminary stage and four phases of assessment, planning, implementation, and evaluation. This program used "edutainment", participatory learning, and multi-disciplinary collaboration to improve HIV treatment adherence and HIV risk behavior knowledge, motivation, and behavior. Education aimed to improve knowledge of antiretroviral drugs and HIV risk-taking behaviors. Motivation was directed at reframing beliefs and increasing positive attitudes of youth toward treatment adherence and raising awareness about safer sex behaviors. The behavioral skills focused on medication management in daily life activities, problem-solving, refusal and negotiation, and condom use. Findings provided preliminary evidence that the program was practical in a clinical context in a community hospital.
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Affiliation(s)
- Warunee Fongkaew
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nongkran Viseskul
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
| | - Marisa Guptaruk
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
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25
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Emlet CA, Fredriksen-Goldsen KI, Kim HJ, Hoy-Ellis C. The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men. J Appl Gerontol 2017; 36:931-952. [PMID: 26100507 PMCID: PMC4704987 DOI: 10.1177/0733464815591210] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men.
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Toskin I, Cooper B, Troussier T, Klugman B, Kulier R, Chandra-Mouli V, Temmerman M. WHO guideline for brief sexuality-related communication: implications for STI/HIV policy and practice. REPRODUCTIVE HEALTH MATTERS 2017; 23:177-84. [PMID: 26719009 DOI: 10.1016/j.rhm.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/06/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
Brief sexuality-related communication (BSC) aims to identify current and potential sexual concerns and motivate those at risk to change their sexual behaviour or maintain safe sexual behaviour. BSC in primary health care can range from 5 to 60 minutes and takes into account biological, psychological and social dimensions of sexual health and wellbeing. It focuses on opportunistic rather than systematic or continuous communication and can be used in conjunction with already established prevention programs. The informational and motivational techniques of BSC enable health care providers to communicate more effectively with their patients, encouraging them to take steps to avoid HIV and sexually transmitted infections. The WHO Department of Reproductive Health and Research, following a review and assessment of existing evidence with regards to BSC, has recently published the guideline on Brief Sexuality-Related Communication: Recommendations for a Public Health Approach.
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Affiliation(s)
- Igor Toskin
- Scientist, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Bergen Cooper
- Consultant, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Barbara Klugman
- Visiting Professor, School of Public Health, Faculty of Health Sciences, University of the Witwatersrandd
| | | | | | - Marleen Temmerman
- Director, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Baipluthong B, Anekthananon T, Munsakul W, Jirajariyavej S, Asavapiriyanont S, Hancharoenkit U, Roongpisuthipong A, Pattanasin S, Martin M, Guntamala L, Lolekha R. Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand. PLoS One 2017; 12:e0170558. [PMID: 28158210 PMCID: PMC5291364 DOI: 10.1371/journal.pone.0170558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/07/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. METHODS From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. RESULTS A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ≥ two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor). CONCLUSION Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.
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Affiliation(s)
- Benjamas Baipluthong
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | | | - Warangkana Munsakul
- Faculty of Medicine, Vajira Hospital, Navamindharadhiraj University, Bangkok, Thailand
| | | | | | | | | | - Sarika Pattanasin
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Michael Martin
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Lisa Guntamala
- Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Rangsima Lolekha
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
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Gonçalves TR, Faria ER, Carvalho FTD, Piccinini CA, Shoveller JA. Behavioral interventions to promote condom use among women living with HIV: a systematic review update. CAD SAUDE PUBLICA 2017; 33:e00202515. [PMID: 28125130 DOI: 10.1590/0102-311x00202515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 10/25/2016] [Indexed: 12/30/2022] Open
Abstract
Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.
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Affiliation(s)
| | | | - Fernanda Torres de Carvalho
- Ambulatório de Dermatologia Sanitária, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, Brasil
| | - Cesar Augusto Piccinini
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Jean Anne Shoveller
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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HIV transmission risk behaviors among people living with HIV/AIDS: the need to integrate HIV prevention interventions and public health strategies into HIV care. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:E1-E10. [PMID: 24335609 DOI: 10.1097/phh.0000000000000038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) who continue high-risk behaviors may represent an important source for transmitting HIV infections. OBJECTIVE To identify factors associated with high-risk behaviors among PLWHA and to plan better HIV prevention intervention strategies in HIV care. DESIGN A cross-sectional survey to assess HIV transmission risk behaviors including sexual practices, disclosure of HIV infection status to sexual partner(s), and injection drug use. SETTING Five HIV outpatient clinics serving diverse PLWHA in south central Pennsylvania. PARTICIPANTS A total of 519 HIV-infected patients. MAIN OUTCOME MEASURES Two high-risk behaviors that may increase HIV transmission risk: (1) any unsafe sexual behavior and (2) nondisclosure of HIV infection status to sexual partner(s). An unsafe sexual behavior was defined as inconsistent condom use, sex under the influence of alcohol or drugs, or exchange of sex for money. A subgroup analysis was performed to examine factors related to unprotected anal intercourse among sexually active men who have sex with men. RESULTS About two-thirds of 519 HIV patients (65.7%) were sexually active, and nearly 50% of sexually active patients reported at least 1 unsafe sexual behavior. Nondisclosure of HIV infection status was reported by about 15% of the patients. Partners' characteristics including HIV infection status and the perceived partner behavior (ie, partner may have sex with other people) were significantly associated with unsafe sexual behaviors and with nondisclosure of HIV infection status. Non-Hispanic black males were more likely to withhold their HIV infection status from their sexual partner(s) (adjusted odds ratio = 4.51) than their white counterparts. In addition, the perceived partner sexual behavior was significantly related to unprotected anal intercourse among men who have sex with men (adjusted odds ratio = 2.00). CONCLUSIONS High-risk sexual behaviors are commonly reported by PLWHA, and these behaviors may be influenced by their partners' characteristics. HIV prevention interventions and public health strategies need to be incorporated into HIV care.
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Operario D, Wang D, Zaller ND, Yang MF, Blaney K, Cheng J, Hong Q, Zhang H, Chai J, Szekeres G, Galea J, Coates TJ. Effect of a knowledge-based and skills-based programme for physicians on risk of sexually transmitted reinfections among high-risk patients in China: a cluster randomised trial. LANCET GLOBAL HEALTH 2016; 4:e29-36. [PMID: 26718807 DOI: 10.1016/s2214-109x(15)00249-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 09/22/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND China is experiencing growing epidemics of HIV and sexually transmitted infections (STIs). Programmes to train physicians in China on HIV and STI knowledge, diagnosis, treatment, and risk reduction counselling can potentially reduce HIV and STI risk among high-risk patients. We aimed to assess a knowledge-based and skills-based programme for physicians in China to reduce patients' STI risk. METHODS In this cluster randomised trial, we block randomised counties in two provinces in eastern China to intervention or control groups. In the intervention group, physicians from county general hospitals participated in a structured HIV and STI training programme and received opportunities to enhance their clinical and counselling skills, whereas in the control group, physicians from county hospitals received the training after the intervention group completed final assessments. We recruited STI patients from physicians in both groups, treated baseline gonorrhoea and chlamydia infections, and assessed 9-month gonorrhoea and chlamydia reinfection as the primary outcome. Statistical comparisons between intervention and delayed-control patients used multilevel analyses to account for cluster effects at county and physician levels. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, NCT00644150. FINDINGS Between April 1, 2007, and Sept 1, 2008, 51 counties were randomly assigned; 27 to receive immediate intervention and 24 to receive delayed intervention. 249 physicians from the 51 county-level hospitals were enrolled, 121 physicians in the intervention group and 128 in the control group. From these physicians, we enrolled 633 and 491 patients, respectively, of whom 508 (80%) and 402 (82%) were available for reassessment at 9 months. Intervention patients at follow-up had significantly lower odds of combined gonorrhoea or chlamydia reinfection than did control patients (58/508 [11%] vs 123/402 [31%]; adjusted odds ratio 0·62 [95% CI 0·46-0·84]). INTERPRETATION Integrating HIV and STI training into medical education in China could be an effective strategy to reduce the country's growing HIV risk and STI epidemics. FUNDING US National Institutes of Health.
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Affiliation(s)
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, China
| | - Nickolas D Zaller
- Fay Boozman College of Public Health, University of Arkansas, Fayetteville, AR, USA
| | | | | | - Jing Cheng
- School of Health Service Management, Anhui Medical University, China
| | - Qian Hong
- School of Health Service Management, Anhui Medical University, China
| | - Hongbo Zhang
- School of Public Health, Anhui Medical University, China
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, China
| | - Gregory Szekeres
- Center for World Health, University of California Los Angeles, USA
| | - Jerome Galea
- Center for World Health, University of California Los Angeles, USA
| | - Thomas J Coates
- Center for World Health, University of California Los Angeles, USA.
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Kiene SM, Bateganya MH, Lule H, Wanyenze RK. The Effect of Motivational Interviewing-Based Counseling During Outpatient Provider Initiated HIV Testing on High-Risk Sexual Behavior in Rural Uganda. AIDS Behav 2016; 20:1928-36. [PMID: 27037546 DOI: 10.1007/s10461-016-1377-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Provider-initiated HIV testing and counseling (PITC) has rapidly expanded in many countries including Uganda. However, because it provides HIV prevention information without individualized risk assessment and risk reduction counseling it may create missed opportunities for effective HIV prevention counseling. Our objective was to assess the effect of a brief motivational interviewing-based intervention during outpatient PITC in rural Uganda compared to Uganda's standard-of-care PITC at reducing HIV transmission-relevant sexual risk behavior. We enrolled 333 (160 control, 173 intervention) participants in a historical control trial to test the intervention vs. standard-of-care. Participants received PITC and standard-of-care or the intervention counseling and we assessed sexual risk behavior at baseline and 3 and 6 months follow-up. The intervention condition showed 1.5-2.4 times greater decreases in high risk sexual behavior over time compared to standard-of-care (p = 0.015 and p = 0.004). These data suggest that motivational interviewing based counseling during PITC may be a promising intervention to reduce high-risk sexual behavior and potentially reduce risk of HIV infection.
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Affiliation(s)
- Susan M Kiene
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | - Moses H Bateganya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Kalibala S, Woelk GB, Gloyd S, Jani N, Kay L, Sarna A, Okal J, Ndwiga C, Haberland N, Sinai I. Experiences in implementation and publication of operations research interventions: gaps and a way forward. J Int AIDS Soc 2016; 19:20842. [PMID: 27443272 PMCID: PMC4956737 DOI: 10.7448/ias.19.5.20842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION According to UNAIDS, the world currently has an adequate collection of proven HIV prevention, treatment and diagnostic tools, which, if scaled up, can lay the foundation for ending the AIDS epidemic. HIV operations research (OR) tests and promotes the use of interventions that can increase the demand for and supply of these tools. However, current publications of OR mainly focus on outcomes, leaving gaps in reporting of intervention characteristics, which are essential to address for the utilization of OR findings. This has prompted WHO and other international public health agencies to issue reporting requirements for OR studies. The objective of this commentary is to review experiences in HIV OR intervention design, implementation, process data collection and publication in order to identify gaps, contribute to the body of knowledge and propose a way forward to improve the focus on "implementation" in implementation research. DISCUSSION Interventions in OR, like ordinary service delivery programmes, are subject to the programme cycle, which continually uses insights from implementation and the local context to modify service delivery modalities. Given that some of these modifications in the intervention may influence study outcomes, the documentation of process data becomes vital in OR. However, a key challenge is that study resources tend to be skewed towards documentation and the reporting of study outcomes to the detriment of process data, even though process data is vital for understanding factors influencing the outcomes. CONCLUSIONS Interventions in OR should be viewed using the lens of programme evaluation, which includes formative assessment (to determine concept and design), followed by process evaluation (to monitor inputs and outputs) and effectiveness evaluation (to assess outcomes and effectiveness). Study resources should be equitably used between process evaluation and outcome measurement to facilitate inclusion of data about fidelity and dose in publications in order to enable explanation of the relationship between dosing and study outcomes for purposes of scaling up and further refinement through research.
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Affiliation(s)
| | - Godfrey B Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nrupa Jani
- HIVCore/Population Council, Washington, DC, USA
| | | | - Avina Sarna
- HIVCore/Population Council, Washington, DC, USA
| | - Jerry Okal
- HIVCore/Population Council, Washington, DC, USA
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Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bradley-Springer LA, Everett MR, Rotach EG, Vojir CP. Changes in Clinician Ability to Assess Risk and Help Patients Determine the Need for Hiv Testing. Eval Health Prof 2016; 29:367-93. [PMID: 17102061 DOI: 10.1177/0163278706293404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An estimated one of four people with HIV in the United States do not know they have the infection. The Centers for Disease Control and Prevention encourages HIV testing in clinical settings, but there is evidence that this is not done on a regular basis. The purposes of this study were to (a) compare two less traditional teaching methods with a classroom method to determine whether the less traditional methods resulted in greater improvement of clinician knowledge, skill, and willingness to perform HIV risk assessment as the basis for recommending HIV testing; and (b) find out whether there were significant differences in convenience, cost, learner preference, or learner acceptance that would make one method more desirable than the others. Findings from participants in the standardized patient interaction with facilitator feedback (FB) and the case-based self-study module (SSM) were not different from those of participants in the interactive classroom education method (CL). Generally, there were positive changes in knowledge, attitudes, and behaviors over time. Participants preferred standardized patient interaction (FB) and interactive classes (CL) to self-study modules (SSM).
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Karoly HC, Callahan T, Schmiege SJ, Ewing SWF. Evaluating the Hispanic Paradox in the Context of Adolescent Risky Sexual Behavior: The Role of Parent Monitoring. J Pediatr Psychol 2016; 41:429-40. [PMID: 25972373 PMCID: PMC4829736 DOI: 10.1093/jpepsy/jsv039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In the United States, Hispanic adolescents are at elevated risk for negative outcomes related to risky sexual behavior. To evaluate potential protective factors for this group, we examined the fit of the Hispanic Paradox for sexual behavior among high-risk youth and the moderating role of parent monitoring. METHOD We enrolled 323 justice-involved Hispanic youth (73% male; mean age 16 years), and measured generational status, parent monitoring (monitoring location, who children spend time with outside of school, family dinner frequency), and sexual risk behavior. RESULTS There were no main effects for generational status on sexual behavior. Parent monitoring of location moderated the relationship between generational status and sexual behavior, such that greater monitoring of location was associated with less risky sexual behavior, but only for youth second generation and above. CONCLUSIONS Rather than direct evidence supporting the Hispanic Paradox, we found a more nuanced relationship for generational status in this sample.
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Affiliation(s)
- Hollis C Karoly
- Department of Psychology and Neuroscience, University of Colorado,
| | - Tiffany Callahan
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, and
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, and
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Spohr SA, Suzuki S, Marshall B, Taxman FS, Walters ST. Social support quality and availability affects risk behaviors in offenders. HEALTH & JUSTICE 2016; 4:2. [PMID: 27054059 PMCID: PMC4766225 DOI: 10.1186/s40352-016-0033-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/10/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND People involved in the justice system are at 2.5 times the risk of HIV infection compared to the general population, which is further complicated by substance abuse. The purpose of this study was to evaluate the role of social network quality and quantity on unprotected sex, criminal risk, and substance use. METHODS We used data from 330 drug-involved offenders. Structural equation modeling (SEM) was used to model and test path directionality and magnitude between the latent constructs of social support quality and quantity on risky behaviors. RESULTS The SEM indicated the latent construct of social support quality was significantly associated with reduced sexual risk behavior (β = -0.27), criminal risk (β = -0.26), and reduced substance use (β = -0.33). Additionally, the proposed model found that social support quantity was significantly positively associated with increased sexual risk behavior (β = 0.40) and substance use (β = 0.20). CONCLUSIONS Social support quality is an important predictor of risky behaviors; as the quality of an offender's social support increases, engagement in risky behaviors decreases. Probationers who had broader social support availability also had increased substance use and unprotected sex. Probation systems may be able to reduce substance use and STD/HIV infection risk in offenders by strengthening the quality of social support networks.
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Affiliation(s)
| | - Sumihiro Suzuki
- University of North Texas Health Science Center, Fort Worth, USA
| | | | | | - Scott T Walters
- University of North Texas Health Science Center, Fort Worth, USA
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Jaiantilal P, Gutin SA, Cummings B, Mbofana F, Rose CD. Acceptability, feasibility and challenges of implementing an HIV prevention intervention for people living with HIV/AIDS among healthcare providers in Mozambique: results of a qualitative study. SAHARA J 2015; 12:2-9. [PMID: 25778860 PMCID: PMC4396498 DOI: 10.1080/17290376.2015.1016999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges such as gender inequalities, stigma and discrimination which hinder the full impact of PP interventions in this context.
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Affiliation(s)
- Prafulta Jaiantilal
- a MSS, is a HIV Prevention Specialist affiliated to Global AIDS Program, Center for Global Health, Centers for Disease Control and Prevention , Maputo , Mozambique
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Berry SA, Ghanem KG, Mathews WC, Korthuis PT, Yehia BR, Agwu AL, Lehmann CU, Moore RD, Allen SL, Gebo KA. Brief Report: Gonorrhea and Chlamydia Testing Increasing but Still Lagging in HIV Clinics in the United States. J Acquir Immune Defic Syndr 2015; 70:275-9. [PMID: 26068721 PMCID: PMC4607588 DOI: 10.1097/qai.0000000000000711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Screening persons living with HIV for gonorrhea and chlamydia has been recommended since 2003. We compared annual gonorrhea/chlamydia testing to syphilis and lipid testing among 19,368 adults (41% men who have sex with men, 30% heterosexual men, and 29% women) engaged in HIV care. In 2004, 22%, 62%, and 70% of all patients were tested for gonorrhea/chlamydia, syphilis, and lipid levels, respectively. Despite increasing steadily [odds ratio per year (95% confidence interval): 1.14 (1.13 to 1.15)], gonorrhea/chlamydia testing in 2010 remained lower than syphilis and lipid testing (39%, 77%, 76%, respectively). Interventions to improve gonorrhea/chlamydia screening are needed. A more targeted screening approach may be warranted.
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Affiliation(s)
| | | | | | | | - Baligh R. Yehia
- University of Pennsylvania School of Medicine, Philadelphia PA
| | | | | | | | - Sara L. Allen
- Drexel University School of Medicine, Philadelphia PA
| | - Kelly A. Gebo
- Johns Hopkins University School of Medicine, Baltimore MD
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Vernon LT, Howard AR. Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting. ACTA ACUST UNITED AC 2015; 2:111-122. [PMID: 26457237 DOI: 10.1007/s40496-015-0056-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients' oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients' knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned.
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Affiliation(s)
- Lance T Vernon
- School of Dental Medicine, Department of Pediatric Dentistry and Community Dentistry, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4905, USA
| | - Anita R Howard
- Weatherhead School of Management, Department of Organizational Behavior, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4905, USA
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Audet CM, Gutin SA, Blevins M, Chiau E, Alvim F, Jose E, Vaz LME, Shepherd BE, Dawson Rose C. The Impact of Visual Aids and Enhanced Training on the Delivery of Positive Health, Dignity, and Prevention Messages to Adult Patients Living with HIV in Rural North Central Mozambique. PLoS One 2015; 10:e0130676. [PMID: 26147115 PMCID: PMC4493138 DOI: 10.1371/journal.pone.0130676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/24/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Positive health, dignity, and prevention (PHDP) interventions target people living with HIV and AIDS (PLHIV) to promote well-being and prevent onward transmission. Concern that increased life expectancy and improved well-being would lead to increased risky sexual behaviour and subsequent HIV transmission motivated researchers to test novel strategies to support treatment adherence, encourage safer sex, STI treatment and partner testing, prevention of mother to child transmission, and support uptake of family planning. Methods We assessed the number and type of PHDP messages delivered to PLHIV before and after the implementation of an educational intervention for health providers combined with the distribution of visual job aids and monthly technical assistance. Results From April 21, 2013 to March 20, 2014, we documented 54,731 clinical encounters at three rural health centres in Zambézia province, Mozambique from 9,248 unique patients. The percentage of patients who received all seven PHDP messages during their last three visits was 1.9% pre-intervention vs. 13.6% post- intervention (p=<0.001). Younger patients (25 years vs. 35) and those with a recent HIV diagnosis (two weeks vs. two years) had higher odds of receiving any PHDP message (Odds Ratio [OR]: 1.22 and 2.79, respectively). Patients >59 days late collecting medications were not more likely to receive adherence messages than adherent patients (p=0.17). Discussion Targeting HIV prevention efforts to PLHIV is an effective HIV prevention approach to eliminate HIV transmission. Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique. Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed. Conclusions We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Departments of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
| | - Sarah A. Gutin
- Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Meridith Blevins
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Elvino Chiau
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Fernanda Alvim
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Eurico Jose
- Friends in Global Health, Maputo and Quelimane, Mozambique
| | - Lara M. E. Vaz
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Bryan E Shepherd
- Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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Poudel KC, Buchanan DR, Poudel-Tandukar K. Effects of a Community-Based HIV Risk Reduction Intervention Among HIV-Positive Individuals: Results of a Quasi-Experimental Study in Nepal. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:240-256. [PMID: 26010315 DOI: 10.1521/aeap.2015.27.3.240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We evaluated the efficacy of a sexual risk reduction intervention utilizing protection motivation and social cognitive theories to address knowledge, threat and coping appraisals, and condom use intentions among HIV-positive individuals in Nepal. Using a quasi-experimental research design, we assigned 277 participants to intervention (n=146) and control (n=131) groups. The intervention group received six sessions on sexual risk reduction strategies and the control group six sessions on medication adherence, smoking, and mental health. Data were collected at baseline and immediately after the intervention. Results indicate that the sexual risk reduction intervention produced a significant increase in HIV transmission knowledge, perceived threat and coping appraisals, and intentions to use condoms with regular, HIV-positive, and HIV-negative partners. The positive effects of the intervention remained significant after adjusting for baseline scores and other potential confounders. In conclusion, our theory-based sexual risk reduction intervention was effective in improving HIV transmission knowledge, perceived threat and coping appraisals, and condom use intentions. Further studies are needed to evaluate the long-term efficacy of the intervention in increasing protection motivation and maintaining preventive behaviors.
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Pettifor A, Corneli A, Kamanga G, McKenna K, Rosenberg NE, Yu X, Ou SS, Massa C, Wiyo P, Lynn D, Tharaldson J, Golin C, Hoffman I. HPTN 062: A Pilot Randomized Controlled Trial Exploring the Effect of a Motivational-Interviewing Intervention on Sexual Behavior among Individuals with Acute HIV Infection in Lilongwe, Malawi. PLoS One 2015; 10:e0124452. [PMID: 25962118 PMCID: PMC4427322 DOI: 10.1371/journal.pone.0124452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 02/11/2015] [Indexed: 12/24/2022] Open
Abstract
Objective We pilot tested a Motivational Interviewing (MI) –based counseling intervention for individuals with Acute HIV Infection (AHI) to reduce risky sexual behavior in Lilongwe, Malawi. Methods Twenty-eight individuals diagnosed with AHI were randomized to receive either brief education alone, or the brief education plus the MI-based intervention, called Uphungu Wanga. Participants in Uphungu Wanga received four sessions delivered on the day of diagnosis, three days later and at weeks 1 and 2 with a booster session at week 8; participants were followed for 24 weeks from diagnosis. An interviewer administered quantitative questionnaire was conducted at baseline and at weeks 2, 4, 8, 12, 16, 20 and 24. Semi-structured qualitative interviews (SSI) were conducted at weeks 2, 8, 12, and 24. Results The majority of participants in both arms reported rapid and sustained behavior change following diagnosis with AHI. Very few participants reported having sex without a condom after diagnosis. Participants reported a trend towards fewer sex partners and abstaining from sex during study follow-up. Participants in the MI-based arm provided concrete examples of risk reduction strategies in the SSIs while those in the brief education arm primarily described reducing risk behavior, suggesting that the MI-based group may have acquired more risk reduction skills. Conclusions Individuals in both study arms reduced risky sexual behaviors after diagnosis with AHI. We found few major differences between study arms during the 6-month follow up period in self-reported sexual behaviors therefore a MI-based intervention may not be needed to trigger behavior change following AHI. However, comparing the MI-based intervention to repeated brief education sessions made it difficult to assess the potential benefit of an MI-based intervention in a setting where standard counseling often consists of one post-test session. Nevertheless, provision of counseling immediately following diagnosis with HIV to support behavior change should remain a priority. Trial Registration ClinicalTrials.gov NCT01197027
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Affiliation(s)
- Audrey Pettifor
- University of North Carolina at Chapel Hill, NC, United States of America
- * E-mail:
| | - Amy Corneli
- FHI 360; Durham, NC, United States of America
| | | | | | - Nora E. Rosenberg
- University of North Carolina at Chapel Hill, NC, United States of America
| | - Xuesong Yu
- The Statistical Center for HIV/AIDS Research & Prevention, Seattle, WA, United States of America
| | - San-San Ou
- The Statistical Center for HIV/AIDS Research & Prevention, Seattle, WA, United States of America
| | | | | | - Diana Lynn
- The Statistical Center for HIV/AIDS Research & Prevention, Seattle, WA, United States of America
| | | | - Carol Golin
- University of North Carolina at Chapel Hill, NC, United States of America
| | - Irving Hoffman
- University of North Carolina at Chapel Hill, NC, United States of America
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Tufano CS, do Amaral RA, Cardoso LRD, Malbergier A. The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study. SAO PAULO MED J 2015; 133:179-86. [PMID: 25250800 PMCID: PMC10876366 DOI: 10.1590/1516-3180.2013.7450010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 07/30/2013] [Accepted: 02/17/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms. DESIGN AND SETTING This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007. METHODS 438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ). RESULTS The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV. CONCLUSION ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms.
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Affiliation(s)
| | | | | | - André Malbergier
- MD, MSc, PhD. Lecturer at Medical School, Universidade de São Paulo (USP), São Paulo, Brazil.
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Laisaar KT, Raag M, Rosenthal M, Uusküla A. Behavioral Interventions to Reduce Sexual Risk Behavior in Adults with HIV/AIDS Receiving HIV Care: A Systematic Review. AIDS Patient Care STDS 2015; 29:288-98. [PMID: 25844941 PMCID: PMC4410762 DOI: 10.1089/apc.2014.0240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV.
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Affiliation(s)
| | - Mait Raag
- Department of Public Health, University of Tartu, Tartu, Estonia
| | - Marika Rosenthal
- Centre for Continuing Medical Education, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Department of Public Health, University of Tartu, Tartu, Estonia
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Konkle-Parker DJ. Nurses can facilitate safer sexual behavior counseling for persons living with HIV: strategies for success. J Assoc Nurses AIDS Care 2015; 26:229-34. [PMID: 25769756 DOI: 10.1016/j.jana.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/27/2014] [Indexed: 11/18/2022]
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HIV prevention counseling intervention delivered during routine clinical care reduces HIV risk behavior in HIV-infected South Africans receiving antiretroviral therapy: the Izindlela Zokuphila/Options for Health randomized trial. J Acquir Immune Defic Syndr 2015; 67:499-507. [PMID: 25230288 DOI: 10.1097/qai.0000000000000348] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. OBJECTIVE To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. DESIGN Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care. SETTING Publicly funded HIV clinical care sites. PATIENTS One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). INTERVENTION Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care. MAIN OUTCOME MEASURES Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. RESULTS Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared with standard-of-care participants. Differences in sexually transmitted infection incidence between arms were not observed. CONCLUSIONS Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. TRIAL REGISTRATION Not applicable.
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Song DL, Altice FL, Copenhaver MM, Long EF. Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States. PLoS One 2015; 10:e0116694. [PMID: 25658949 PMCID: PMC4320073 DOI: 10.1371/journal.pone.0116694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/14/2014] [Indexed: 02/05/2023] Open
Abstract
AIMS Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. METHODS A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. RESULTS Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. CONCLUSIONS Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.
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Affiliation(s)
- Dahye L. Song
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
| | - Frederick L. Altice
- AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michael M. Copenhaver
- Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, United States of America
| | - Elisa F. Long
- UCLA Anderson School of Management, Los Angeles, California, United States of America
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van Loggerenberg F, Grant AD, Naidoo K, Murrman M, Gengiah S, Gengiah TN, Fielding K, Abdool Karim SS. Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: findings of the CAPRISA 058 randomised controlled trial. AIDS Behav 2015; 19:145-56. [PMID: 24696226 DOI: 10.1007/s10461-014-0763-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n = 150), or an intensive motivational adherence intervention after initiating ART (n = 147). Study arms were similar for age (mean 35.8 years), sex (43.1 % male), CD4+ cell count (median 121.5 cells/μl) and viral load (median 119,000 copies/ml). Virologic suppression at 9 months was achieved in 89.8 % of didactic and 87.9 % of motivational counselling participants (risk ratio [RR] 0.98, 95 % confidence interval [CI] 0.90-1.07, p = 0.62). 82.9 % of didactic and 79.5 % of motivational counselling participants achieved >95 % adherence by pill count at 6 months (RR 0.96, 95 % CI 0.85-1.09, p = 0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting.
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Hogben M, Ford J, Becasen JS, Brown KF. A systematic review of sexual health interventions for adults: narrative evidence. JOURNAL OF SEX RESEARCH 2014; 52:444-69. [PMID: 25406027 PMCID: PMC4578698 DOI: 10.1080/00224499.2014.973100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.
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Affiliation(s)
- Matthew Hogben
- a Division of STD Prevention , Centers for Disease Control and Prevention
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Mayer KH, Skeer MR, O'Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers. Ann Behav Med 2014; 47:165-71. [PMID: 23873338 DOI: 10.1007/s12160-013-9527-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The HIV epidemic continues unabated in the USA, with men who have sex with men (MSM) being most frequently infected. PURPOSE The purpose of this study is to understand the biological and behavioral risk factors associated with increased HIV transmission efficiency, which is HIV transmission risk behavior in the context of uncontrolled HIV replication or intercurrent sexually transmitted infections. METHODS Participants were 201 HIV-infected MSM who received their primary care at an HIV ambulatory care center in Boston. Logistic regression models were conducted to determine factors associated with engaging in behavior associated with potentially amplified transmission. RESULTS In the final model, heavy alcohol use (AOR, 3.27; 95 % CI 1.37-7.79), as well as stimulant drug use (crystal meth, crack, or other cocaine; AOR, 3.00; CI 1.32-6.84), having at least a college degree (OR, 2.74; CI, 1.15-6.54), and decreased duration of HIV infection (OR, 0.91; CI, 0.85-0.97) were each uniquely associated with enhanced HIV transmission behavior. CONCLUSIONS HIV primary care providers should routinely assess patients for potential HIV transmission behaviors, particularly those who are younger and more recently diagnosed with HIV, who drink alcohol heavily, and who use any nonprescription drugs, particularly stimulants, in order to decrease the spread of HIV.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA,
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