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Bazazi AR, Thomas M, Vittinghoff E, Walkup J, Hermida R, Arnold EA, Cournos F, Crystal S, Dawson L, Dahiya P, Alonso-Fraire P, Dilley J, Olfson M, Mangurian C. Schizophrenia and Retention in HIV Care Among Adults Insured Through Medicaid in the United States: A Population-Based Retrospective Cohort Study. J Acquir Immune Defic Syndr 2025; 99:20-30. [PMID: 39847446 DOI: 10.1097/qai.0000000000003606] [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: 05/10/2024] [Accepted: 12/18/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND People with schizophrenia spectrum disorders are at elevated risk of HIV, and people with both HIV and schizophrenia are at elevated risk of death compared with individuals with either diagnosis alone. Limited research has assessed the HIV care cascade, and in particular retention in care, among people with HIV (PWH) and schizophrenia in the United States. METHODS This population-based retrospective cohort study used Medicaid claims data to compare retention in HIV care between PWH with schizophrenia (n = 38,217) and matched controls without schizophrenia (n = 29,455) from 2001 to 2012. The primary outcome of annual retention in HIV care was at least 2 tests for CD4 + T-cell count or HIV viral load at least 90 days apart per year. Unadjusted and covariate-adjusted differences in period prevalence of retention among cases and controls were estimated. FINDINGS Annual retention in HIV care was 29.9% (95% CI: 29.4 to 30.4%) among people with schizophrenia and 38.5% (95% CI: 37.9 to 39.1%) among controls, representing 8.5% (95% CI: 9.3 to 7.7) lower retention in unadjusted and 9.0% (95% CI: 9.9 to 8.2) lower retention in adjusted estimates for people with HIV and schizophrenia. This disparity varied across states. Over time, retention increased and the disparity between people with and without schizophrenia diminished. INTERPRETATION PWH in the United States insured through Medicaid and diagnosed with schizophrenia experience lower retention in HIV care than controls. Suboptimal retention likely drives disparities in HIV-related morbidity and mortality for PWH with schizophrenia, and targeted individual and structural interventions are merited to improve the health of this population.
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Affiliation(s)
- Alexander R Bazazi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, CA
| | - James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA
| | - Francine Cournos
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | | | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Paola Alonso-Fraire
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Mark Olfson
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA; and
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
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Chikuse E, Hagstrom C, Smith D, Banda T, Chimbaka H, Nkhoma Z, Samuko M, Lichenya J, Hoffman R, Njala J, Phiri S, Phiri K, van Oosterhout JJ. Early Outcomes of Mental Health Screening Integrated Into Routine HIV Care in Malawi. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300517. [PMID: 39578095 DOI: 10.9745/ghsp-d-23-00517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 10/29/2024] [Indexed: 11/24/2024]
Abstract
Mental health (MH) disorders are highly prevalent among people living with HIV and can have a negative impact on antiretroviral therapy (ART) outcomes. Malawi's Ministry of Health introduced MH screening in national HIV management guidelines in 2022. We describe early experience with integrated MH screening at ART clinics that have scarce human resources and limited capacity of specialist MH units. ART staff in 15 facilities were trained to use the Patient Health Questionnaire-9 (depression) and the Alcohol Use Disorders Identification Test (harmful alcohol use) screening instruments, MH registers were developed for tracking screening results and referrals, and existing MH referral units were engaged. Based on screening results, ART clients received counseling by lay cadre staff (for mild symptoms) or intensive counseling by trained psychosocial counselors and referrals to specialist MH units (for moderate to severe symptoms). From October 2022 through July 2023, 9,826 ART clients were screened from the following priority groups: returning to care after an interruption in treatment (50%), newly diagnosed (38%), and viral load ≥1,000 copies/mL (12%). Of those screened, 59% were female and 14% were aged 12-19 years. Screening coverage was 85% (9,826/11,553) among the 3 priority groups. All of the individuals who screened positive for moderate/severe depression (1.1%; n=106) or high risk for harmful alcohol use (2.3%; n=227) were referred to specialist MH units. In conclusion, thorough preparation led to high MH screening coverage among ART priority groups, and the number of referrals to specialist MH units was low. MH screening was feasible at Malawi ART clinics. Next steps include studying the clinical impact of integrated MH screening on MH outcomes and ART outcomes (retention in care and viral suppression) and scaling up integrated MH screening to all ART clinics.
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Affiliation(s)
| | - Christine Hagstrom
- University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
| | - Deanna Smith
- Partners in Hope, Lilongwe, Malawi
- University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
| | | | | | | | | | | | - Risa Hoffman
- University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
| | | | - Sam Phiri
- Partners in Hope, Lilongwe, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | | | - Joep J van Oosterhout
- Partners in Hope, Lilongwe, Malawi.
- University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
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Rtbey G, Mihertabe M, Andualem F, Melkam M, Takelle GM, Tinsae T, Fentahun S. Anxiety and associated factors among medical and surgical patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0306413. [PMID: 39046996 PMCID: PMC11268606 DOI: 10.1371/journal.pone.0306413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Individuals diagnosed with chronic medical conditions and patients appointed to undergo surgery face various degrees of anxiety as a result of doubts related to the outcome of surgery, and the psycho-socioeconomic costs of the medical illness. This can affect the treatment process and even the outcome of patients with medical and surgical cases. Though different studies were conducted on anxiety and associated factors among medical and surgical patients in Ethiopia, the findings were found to be inconsistent and had a wide discrepancy. So, this systematic review and meta-analysis estimated the pooled effect size of anxiety among this population and guides to plan appropriate intervention at a national level. METHODS Studies conducted on anxiety and associated factors among medical and surgical patients in Ethiopia were included. Data was extracted using Microsoft Excel and analyzed using STATA version 11. The random-effects model was used to estimate the pooled effect size of anxiety and its determinants with 95% confidence intervals. Funnel plots and Egger's regression tests were employed to check publication bias. Sub-group and sensitivity analyses were also conducted. RESULTS The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be 48.82% with a 95% CI (42.66, 54.99). Being female[OR = 2.84(2.02, 4.01)], fear of death [OR = 2.93(1.57, 5.50)], and history of surgery[OR = 0.42(0.27, 0.065)], among surgical patients and being female[OR = 2.35(1.94, 2.850], having poor social support[OR = 2.22(1.62, 3.05)], perceived stigma[OR = 4.25(1.97, 9.18)] and family history of mental illness[OR = 1.86(1.21, 2.86)] among medical patients were significantly associated with anxiety in this systematic review and meta-analysis. CONCLUSION AND RECOMMENDATION The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be high. Therefore, it would be good for professionals to screen patients for anxiety besides managing their medical or surgical cases to detect them early and address them.
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Affiliation(s)
- Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Milen Mihertabe
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Alinaitwe R, Elyanu PJ, Kanywa JB, Akena D. Use of computer-assisted self-interview in detection of and referral for depression among adolescents living with HIV at an urban HIV treatment clinic in Uganda: a quasi-experimental study. BMJ Paediatr Open 2024; 8:e002383. [PMID: 38886110 PMCID: PMC11184185 DOI: 10.1136/bmjpo-2023-002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Depression is common among adolescents living with HIV (ALHIV) and impacts their quality of life. However, it is not routinely detected and treated due to a lack of screening tools, coupled with large numbers of clients in the HIV clinics and limited staff. Enabling adolescents to do a self-assessment for depression on a tablet computer could possibly improve the detection of depression in this population. We set out to assess the detection and referral of depression among ALHIV in care in Uganda. METHODS This was a quasi-experimental study design with a historical control at Baylor College of Medicine of Children's Foundation. We conducted a retrospective chart review of 425 adolescents covering a 3-month period and documented the proportion screened for depression and referred to the clinic counsellors. From July to September 2022, eligible adolescents aged 10-19 years who had assented and consented self-assessed for depression using a Patient Health Questionnaire-Adolescent on a tablet computer-assisted self-interview (CASI). Adolescents who screened positive had a prompt on the tablet computers referring them to the counsellor for mental healthcare. We compared the proportions of participants screened for depression and referred to counsellors from clinic chart review and on the CASI using paired t-tests. RESULTS Out of 425 medical records reviewed, 54% (231/425) were females and the median age was 15 years. Of the participants who self-assessed on the CASI, 52% (222/425) were males and the median age of all participants was 16 years. Self-assessment on the CASI increased the rate of detection of depression from 0% to 23.3%. Of those referred on the CASI, 15% accessed care at the referral point. CONCLUSION The use of CASI improves the rate of detection of depression among ALHIV; however, there is a need to address the barriers to effective referral for mental health services.
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Affiliation(s)
| | | | | | - Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda
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Dahiya P, Riano NS, Dilley JW, Olfson M, Cournos F, Mangurian C, Arnold EA. Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2024; 24:690. [PMID: 38822307 PMCID: PMC11143645 DOI: 10.1186/s12913-024-11146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic. METHODS We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis. RESULTS Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices. CONCLUSIONS Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
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Affiliation(s)
- Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Nicholas S Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine. 4220 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - James W Dilley
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Mark Olfson
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th Street, Suite 350, San Francisco, CA, 94110, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, Box 0886, San Francisco, CA, 94143, USA.
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Ndagire R, Wangi RN, Ojiambo KO, Nangendo J, Nakku J, Muyinda H, Semitala FC. HIV viral load suppression among people with mental disorders at two urban HIV clinics in Uganda: a parallel convergent mixed methods study using the social ecological model. AIDS Res Ther 2023; 20:68. [PMID: 37726822 PMCID: PMC10510257 DOI: 10.1186/s12981-023-00567-3] [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: 05/05/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. METHODS We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. RESULTS Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0 - 92.2%) achieved VLS. Age (aPR = 1.00, 95%Cl = 1.00-1.00), male gender (aPR = 0.90, 95%Cl = 0.82-0.98), divorced (aPR = 0.88, 95%Cl = 0.82-0.94), widowed (aPR = 0.84, 95%Cl = 0.83-0.86), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.85-0.94), psychotic mental disorders (aPR = 1.11; 95%CI = 1.08-1.13) and fair (85-94%) ART adherence level (aPR = 0.69, 95%Cl = 0.55-0.87) and TDF/3TC/DTG (aPR = 0.92; 95%CI = 0.91-0.94) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. CONCLUSION AND RECOMMENDATIONS HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.
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Affiliation(s)
- Regina Ndagire
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
- Clarke International University, Kampala, Uganda.
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Mental Referral Hospital, Kampala, Uganda
| | | | - Fred C Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program (MJAP), Makerere University, Kampala, Uganda
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Ndagire R, Wangi RN, Ojiambo KO, Nangendo J, Nakku J, Muyinda H, Semitala FC. HIV viral load suppression among people with mental disorders at two urban HIV Clinics in Uganda: a parallel convergent mixed methods study using the Social Ecological Model. RESEARCH SQUARE 2023:rs.3.rs-2897447. [PMID: 37214962 PMCID: PMC10197750 DOI: 10.21203/rs.3.rs-2897447/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. Methods We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. Results Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0% - 92.2%) achieved VLS. Age (aPR = 1.01, 95%Cl = 1.00-1.01), male gender (aPR = 0.95, 95%Cl = 0.95-0.95), divorced (aPR = 0.89, 95%Cl = 0.87-0.91), widowed (aPR = 0.84, 95%Cl = 0.79-0.90), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.82-0.95), and fair (85-94%) ART adherence level (aPR = 0.68, (95%Cl = 0.54-0.87) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. Conclusion and recommendations HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.
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Affiliation(s)
- Regina Ndagire
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Joanita Nangendo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
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Health Related Quality of Life and Psychopathological Symptoms in People with Hemophilia, Bloodborne Co-Infections and Comorbidities: An Italian Multicenter Observational Study. Mediterr J Hematol Infect Dis 2023; 15:e2023005. [PMID: 36660351 PMCID: PMC9833307 DOI: 10.4084/mjhid.2023.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
Background The health-related quality of life (HRQoL) of people with hemophilia (PWH) is an important issue, especially considering people suffering from chronic diseases beyond hemophilia. The principal aim of this study was to investigate the presence and relevance of psychological symptoms, both internalizing and externalizing, lifestyle, and HRQoL in a group of Italian PWH with chronic bloodborne co-infections and comorbidities. Furthermore, the research describes the association between psychological aspects and the impact of disease-related characteristics (type of hemophilia, presence of co-infections, and comorbidities) on them. Methods Seventy patients (mean age 46.77±11.3), 64 with severe hemophilia A (Factor VIII: C < 1 IU/dL) and 6 with severe hemophilia B (Factor IX <1 IU/dL), were consecutively recruited from seven Hemophilia Centers in Italy of Italian Association of Hemophilia Centers (AICE). In order to assess psychological symptoms, HRQoL, and lifestyle, three psychological questionnaires were administered (the SCL-90-R, SF-36, and PSQ, respectively). Results A general decline in the quality of life and an increase in the tendency to adopt a lifestyle characterized by hyperactivity emerged. Inverse correlations were found between HRQoL and psychological distress. Although the SCL-90-R did not reveal symptoms above the clinical cut-off, co-infections significantly increased anxiety, depression, somatizations, paranoia, and social withdrawal. Lastly, HRQoL is impaired by co-infections as well as comorbidities. Conclusion Our preliminary results must be confirmed to deepen the findings between mental health and hemophilia.
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Kang CR, Yang SJ. Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea. AIDS Care 2022; 34:1522-1529. [PMID: 34612099 DOI: 10.1080/09540121.2021.1981225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.
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Affiliation(s)
- Cho Ryok Kang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea.,Infectious Disease Control Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sook Ja Yang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
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10
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Riano NS, Borowsky HM, Arnold EA, Olfson M, Walkup JT, Vittinghoff E, Cournos F, Dawson L, Bazazi AR, Crystal S, Mangurian C. HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification. Psychiatr Serv 2021; 72:1385-1391. [PMID: 34126780 PMCID: PMC8639611 DOI: 10.1176/appi.ps.202000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States. METHODS Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics. RESULTS Among U.S. substance use treatment facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. Across states, the proportions of facilities offering HIV testing ranged from 9.0% to 62.8%, and the proportion offering counseling ranged from 19.2% to 83.3%. In only three states was HIV testing offered by at least 50% of facilities. HIV testing was significantly more likely to be offered in facilities that offered medication for opioid use disorder (48.0% versus 16.0% in those not offering such medication) or mental health services (31.2% versus 24.1% in those not offering such services). Higher state-level HIV incidence was related to an increased proportion of facilities offering HIV testing. CONCLUSIONS Only three in 10 substance use treatment facilities offered HIV testing in 2018. This finding represents a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.
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Affiliation(s)
- Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Hannah M Borowsky
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - James T Walkup
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Francine Cournos
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Alexander R Bazazi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
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11
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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12
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Bassett SM, Brody LR, Jack DC, Weber KM, Cohen MH, Clark TM, Dale SK, Moskowitz JT. Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV. AIDS Behav 2021; 25:1737-1750. [PMID: 33389322 PMCID: PMC7778488 DOI: 10.1007/s10461-020-03103-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
While programs and interventions intended to increase positive affect among people living with HIV (PLWH) and other chronic diseases have been associated with improved health outcomes, including decreased depression, programs have not been tailored specifically for Black women. We tailored a program designed to increase positive affect and to decrease depressive symptoms in PLWH to a group format for Black WLWH. We also added skills to increase gender empowerment. We then tested the acceptability and feasibility of this program with 8 Black WLWH. The program was acceptable and relatively feasible, as assessed by women’s participation and feedback about program clarity and helpfulness, which women rated above 9 on a 10-point scale. A few women suggested that optimal delivery point for some skills taught would be shortly after HIV diagnosis. A proof-of-concept program intended to bolster positive emotions and gender empowerment and decrease depression can be tailored for Black WLWH and is relatively feasible and acceptable. A randomized controlled trial is needed to assess the preliminary efficacy of this program on positive affect, depression, and other health outcomes for WLWH.
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Affiliation(s)
- S M Bassett
- Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - L R Brody
- Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - D C Jack
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, WA, USA
| | - K M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - M H Cohen
- Department of Medicine, Rush University and Stroger Hospital of Cook County, Chicago, IL, USA
| | - T M Clark
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - S K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - J T Moskowitz
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
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13
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Sullivan PS, Knox J, Jones J, Taussig J, Valentine Graves M, Millett G, Luisi N, Hall E, Sanchez TH, Del Rio C, Kelley C, Rosenberg ES, Guest JL. Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia. J Int AIDS Soc 2021; 24:e25689. [PMID: 33821554 PMCID: PMC8022103 DOI: 10.1002/jia2.25689] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community-based cohort of Black and white MSM living with HIV in Atlanta, GA. METHODS We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. RESULTS Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age-adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). CONCLUSIONS Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual-level interventions to reduce racial disparities.
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Affiliation(s)
- Patrick S Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Justin Knox
- Department of PsychiatryColumbia UniversityNew YorkNYUSA
| | - Jeb Jones
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Jennifer Taussig
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Greg Millett
- American Foundation for AIDS ResearchWashingtonDCUSA
| | - Nicole Luisi
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Eric Hall
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Travis H Sanchez
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Carlos Del Rio
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | - Colleen Kelley
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | | | - Jodie L Guest
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
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14
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Momenzadeh A, Shumway M, Dong BJ, Dilley J, Nye J, Mangurian C. Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital. Ann Pharmacother 2020; 55:452-458. [PMID: 32885983 DOI: 10.1177/1060028020954924] [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: 11/16/2022] Open
Abstract
BACKGROUND HIV infection is more prevalent among people with severe mental illness (SMI) than in the general population. People with SMI may lack access to recommended antiretroviral therapy (ART), and inpatient psychiatric admissions may be opportunities to ensure that individuals receive recommended treatment. OBJECTIVE To evaluate ART prescription patterns on an inpatient psychiatry service. METHODS In this retrospective, observational study, patient and admission characteristics and ART prescriptions were obtained for 248 HIV-positive inpatients between 2006 and 2012. Receipt of any ART, any recommended ART regimen, and ART with potentially harmful adverse events and drug interactions were examined. General estimating equation models were used to evaluate prescription patterns in relation to patient and admission characteristics. RESULTS ART was prescribed at 39% of discharges and increased by 51% during the study. Prescription was more common in admissions with an AIDS diagnosis and age greater than 29 years and less common in admissions associated with a psychotic diagnosis and shorter inpatient stays. When ART was prescribed, regimens were consistent with guideline recommendations 91% of the time. Prescription of potentially harmful regimens was limited. CONCLUSION AND RELEVANCE In an acute inpatient psychiatry setting in an urban HIV/AIDS epicenter, where psychotic disorders and brief and involuntary admissions were the norm, guideline-recommended ART regimens were prescribed at almost 60% of discharges by the end of the study. Future studies should explore interventions to increase ART for high-risk subpopulations with SMI, including younger individuals or those with brief inpatient psychiatry hospitalizations.
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Affiliation(s)
- Amanda Momenzadeh
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Martha Shumway
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Betty J Dong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - James Dilley
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jonathan Nye
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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15
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Abstract
Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.
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Affiliation(s)
- Arleen A. Leibowitz
- Department of Public Policy, UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Box 951656, Los Angeles, CA 90095-1656 USA
| | - Katherine A. Desmond
- Department of Public Policy, UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Box 951656, Los Angeles, CA 90095-1656 USA
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16
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Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009-2014. AIDS Behav 2019; 23:3452-3459. [PMID: 31367965 DOI: 10.1007/s10461-019-02613-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous research indicates a high burden of depression among adults living with HIV and an association between depression and poor HIV clinical outcomes. National estimates of diagnosed depression, depression treatment status, and association with HIV clinical outcomes are lacking. We used 2009-2014 data from the Medical Monitoring Project to estimate diagnosed depression, antidepressant treatment status, and associations with sustained viral suppression (all viral loads in past year < 200 copies/mL). Data were obtained through interview and medical record abstraction and were weighted to account for unequal selection probabilities and non-response. Of adults receiving HIV medical care in the U.S. and prescribed ART, 27% (95% confidence interval [CI] 25-29%) had diagnosed depression during the surveillance period; the majority (65%) were prescribed antidepressants. The percentage with sustained viral suppression was highest among those without depression (72%, CI 71-73%) and lowest among those with untreated depression (66%, CI 64-69%). Compared to those without depression, those with a depression diagnosis were less likely to achieve sustained viral suppression (aPR 0.95, CI 0.93-0.97); this association held for persons with treated depression compared to no depression (aPR 0.96, CI 0.94-0.99) and untreated depression compared to no depression (aPR 0.92, CI 0.89-0.96). The burden of depression among adults living with HIV in care is high. While in our study depression was only minimally associated with a lower prevalence of sustained viral suppression, diagnosing and treating depression in persons living with HIV remains crucial in order to improve mental health and avoid other poor health outcomes.
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17
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Stimulant Use and Viral Suppression in the Era of Universal Antiretroviral Therapy. J Acquir Immune Defic Syndr 2019; 80:89-93. [PMID: 30272634 DOI: 10.1097/qai.0000000000001867] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-positive persons who use stimulants such as methamphetamine experience difficulties navigating the HIV care continuum that undermine the benefits of antiretroviral therapy (ART). However, few studies have examined the association of stimulant use with viral suppression in the era of universal ART. SETTING Zuckerberg San Francisco General Hospital. METHODS HIV-positive persons participating in a clinical cohort study and taking ART completed assessments every 4-6 months. The exposure was the cumulative, time-varying proportion of assessments with any self-reported stimulant use. The time-varying outcome, HIV viral suppression (ie, <200 copies/mL), was measured at assessments or extracted from the clinical record. RESULTS In total, 1635 HIV-positive participants on ART contributed 17,610 person-visits over a median of 2.3 [interquartile range (IQR) = 1.0-5.3] years of follow-up. Participants were middle-aged (median = 45.0; IQR = 38.0-52.0), predominantly white (57%), sexual minority men (78%), with a median CD4 T-cell count of 409 (IQR = 225-640) cells/mm at enrollment. Significant increases in odds of viral suppression over time were less pronounced among stimulant users compared with nonusers, particularly before the advent of universal ART. Increasing odds of viral suppression were paralleled by declining stimulant use over time. In the universal ART era, increasing odds of viral suppression were observed at lower levels of stimulant use, but not when participants reported using stimulants at every visit. CONCLUSIONS Although ART benefits are still not achieved as rapidly in stimulant users, this disparity is not as large in the era of universal ART.
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18
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Riley ED, Vittinghoff E, Koss CA, Christopoulos KA, Clemenzi-Allen A, Dilworth SE, Carrico AW. Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco. AIDS Behav 2019; 23:2326-2336. [PMID: 31324996 PMCID: PMC7478361 DOI: 10.1007/s10461-019-02601-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine A Koss
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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19
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Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women. AIDS Behav 2019; 23:802-812. [PMID: 30267368 DOI: 10.1007/s10461-018-2280-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV-). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges.
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Digital depression screening in HIV primary care in South Africa: mood in retroviral + application monitoring [MIR + IAM]. Glob Ment Health (Camb) 2019; 6:e2. [PMID: 30854218 PMCID: PMC6401371 DOI: 10.1017/gmh.2018.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/26/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Integrating mental health care into HIV services is critical to addressing the high unmet treatment needs for people living with HIV and comorbid major depressive disorder. Introducing routine mental health screening at the primary health care level is a much needed diagonal approach to enhancing HIV care. In low-resource settings with a shortage of mental health care providers, eMental Health may provide a novel opportunity to attenuate this treatment gap and strengthen the health system. OBJECTIVE To conduct formative health systems research on the implementation of routine depression screening using a digital tool - Mood in Retroviral Positive Individuals Application Monitoring (MIR + IAM) - in an HIV primary care setting in South Africa. METHODS A Theory of Change (ToC) approach was utilised through individual and group session interviews to design an intervention that is embedded in the local context. Ten experts and local stakeholders were selected from the UK and South Africa. Data were analysed thematically using Atlas.ti to identify interventions, assumptions, barriers and facilitators of implementation. FINDINGS The participants considered digital depression screening in HIV care services relevant for the improvement of mental health in this population. The six main themes identified from the ToC process were: (1) user experience including acceptability by patients, issues of patient privacy and digital literacy, and the need for a patient-centred tool; (2) benefits of the digital tool for data collection and health promotion; (3) availability of treatment after diagnosis; (4) human and physical resource capacity of primary health care; (5) training for lay health care workers; and (6) demonstration of the intervention's usefulness to generate interest from decision-makers. CONCLUSION Digital depression screening coupled with routine mental health data collection and analysis in HIV care is an applicable service that could improve the mental and physical health outcomes of this population. Careful consideration of the local health system capacity, including both workers and patients, is required. Future research to refine this intervention should focus on service users, government stakeholders and funders.
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Duko B, Toma A, Asnake S, Abraham Y. Depression, Anxiety and Their Correlates Among Patients With HIV in South Ethiopia: An Institution-Based Cross-Sectional Study. Front Psychiatry 2019; 10:290. [PMID: 31133893 PMCID: PMC6514188 DOI: 10.3389/fpsyt.2019.00290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Depressive and anxious symptoms are more regularly seen in HIV-infected people than in the general population. This investigation planned to evaluate the magnitude and factors related to depressive and anxiety symptoms among HIV patients in South Ethiopia, 2018. Methods: This was an institution-based cross-sectional study directed among 363 HIV-infected individuals who had a customary visit at Hawassa University Comprehensive Specialized Hospital and Yirgalem Hospital, Ethiopia, who were incorporated into the study through systematic sampling techniques. The hospital anxiety and depression scale (HADS) was utilized to take a look at anxious and depressive symptoms. Results: The mean age of the respondents was 37.66 years (SD ±10.03). The prevalence of depression and anxiety were 32.0% and 34.4%, respectively. Patients who were living alone [AOR = 1.94, (95% CI: 1.06, 3.56)], had poor social support [AOR = 5.57, (95% CI: 1.20, 10.84)] or had HIV-related perceived stigma [AOR = 2.35, (95% CI: 1.44, 3.84)] were more likely to have depression as compared to their counterparts. Those with a previous history of mental illness [AOR = 3.36, (95% CI: 1.31, 8.61)] and poor social support [AOR = 6.67, (95% CI: 1.47, 10.33)] were more likely to have anxiety symptoms. Conclusion: The prevalence of anxiety and depression in the current study was high. Concerned health departments of the country should create guidelines to screen and treat depression and anxiety among HIV patients. Further research on hazard factors of depression and anxiety ought to be examined to strengthen and expand these findings.
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Affiliation(s)
- Bereket Duko
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alemayehu Toma
- Faculty of Medical Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Solomon Asnake
- Faculty of Medical Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yacob Abraham
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Jin H, Ogunbajo A, Mimiaga MJ, Duncan DT, Boyer E, Chai P, Dilworth SE, Carrico AW. Over the influence: The HIV care continuum among methamphetamine-using men who have sex with men. Drug Alcohol Depend 2018; 192:125-128. [PMID: 30248558 PMCID: PMC6612057 DOI: 10.1016/j.drugalcdep.2018.07.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND HIV-positive persons who use stimulants such as methamphetamine experience greater difficulties in navigating the HIV care continuum. In the era of HIV treatment as prevention (TasP), little is known about the prevalence and correlates of success along the HIV care continuum among people who use stimulants. SETTING San Francisco, California USA METHODS: Cross-sectional study that enrolled 129 HIV-positive men who have sex with men (MSM) from 2013 through 2017 who had biologically confirmed, recent methamphetamine use. Multivariable logistic regressions were built to identify correlates of success across the HIV care continuum. RESULTS Although two-thirds (87/129) of participants had undetectable HIV viral load (<40 copies/mL), only one-in-four (32/129) reported taking at least 90% of their antiretroviral therapy (ART). Those who were homeless in the past year (adjusted odds ratio [aOR] = 0.20; 95% CI = 0.06-0.65) had 80% lower odds of being undetectable and adherent to ART. Substance use disorder treatment was associated with 77% lower odds of being engaged in HIV care (aOR = 0.23; 95% CI = 0.06-0.84) but also close to 3-fold greater odds of being adherent to ART (aOR = 2.91; 95% CI = 1.12-7.60). CONCLUSION Despite the fact that many HIV-positive, methamphetamine-using MSM are able to achieve undetectable viral load in this sample, difficulties with ART adherence threaten to undermine the clinical and public health benefits of TasP. Expanded efforts to boost the effectiveness of TasP in this population should focus on meeting the unique needs of homeless individuals, optimizing ART adherence, and facilitating the integration of HIV care with substance use disorder treatment.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA
| | - Matthew J. Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA,Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA
| | - Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016 USA
| | - Edward Boyer
- Brigham and Women’s Hospital, Division of Medical Toxicology, Department of Emergency Medicine, 75 Francis Street, Boston Ma 02115 USA
| | - Peter Chai
- Brigham and Women’s Hospital, Division of Medical Toxicology, Department of Emergency Medicine, 75 Francis Street, Boston Ma 02115 USA
| | - Samantha E. Dilworth
- School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA
| | - Adam W. Carrico
- School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA,Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Office 1005, Miami, FL 33136 USA,Correspondence: Adam W. Carrico, Department of Public Health Sciences, University of Miami, 1120 NW 14 St., Office 1005, Miami, FL 33136, Tel: 305-243-6947,
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23
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Aralis HJ, Shoptaw S, Brookmeyer R, Ragsdale A, Bolan R, Gorbach PM. Psychiatric Illness, Substance Use, and Viral Suppression Among HIV-Positive Men of Color Who Have Sex with Men in Los Angeles. AIDS Behav 2018; 22:3117-3129. [PMID: 29478146 DOI: 10.1007/s10461-018-2055-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For individuals living with human immunodeficiency virus (HIV), viral suppression positively affects quality and length of life and reduces risks for HIV transmission. Men of color who have sex with men (MoCSM) who have been diagnosed with HIV have disproportionately low rates of viral suppression, with concomitant increases in incidence. We identified specific social, structural, and psychiatric factors associated with viral suppression among a sample of 155 HIV-positive MoCSM. Cigarette smoking and biological markers of recent drug use were significantly associated with detectable viral load. In contrast, individuals reporting a history of psychiatric illness during medical examination were more likely to be virally suppressed. Further analyses demonstrated that psychiatric illness may affect virologic outcomes through increased probability of being prescribed HIV medications. Alternatively, cigarette smoking and drug use appear to negatively affect subsequent HIV Care Continuum milestones such as medication adherence. Findings provide support for comprehensive intervention programs that emphasize prevention and treatment of cigarette, methamphetamine, and other drug use, and promote improved connection to psychiatric care. Continual achievement of this goal may be a crucial step to increase rates of viral suppression and slow HIV incidence in communities of MoCSM in Los Angeles and other urban areas.
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Affiliation(s)
- Hilary J Aralis
- Department of Biostatistics, University of California Los Angeles (UCLA) Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095-1772, USA.
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
- University of California Los Angeles (UCLA) Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA
| | - Ron Brookmeyer
- Department of Biostatistics, University of California Los Angeles (UCLA) Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095-1772, USA
| | - Amy Ragsdale
- University of California Los Angeles (UCLA) Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA
| | | | - Pamina M Gorbach
- Department of Epidemiology, University of California Los Angeles (UCLA) Fielding School of Public Health, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Wang T, Fu H, Kaminga AC, Li Z, Guo G, Chen L, Li Q. Prevalence of depression or depressive symptoms among people living with HIV/AIDS in China: a systematic review and meta-analysis. BMC Psychiatry 2018; 18:160. [PMID: 29855289 PMCID: PMC5984474 DOI: 10.1186/s12888-018-1741-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/11/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The number of people living with HIV/AIDS (PLHA) in China continues to increase. Depression, a common mental disorder in this population, may confer a higher likelihood of worse health outcomes. An estimate of the prevalence of this disorder among PLHA is required to guide public health policy, but the published results vary widely and lack accuracy in China. The goal of this study was to estimate the pooled prevalence of depression or depressive symptoms among PLHA in China. METHODS A systematic literature search of several databases was conducted from inception to June 2017, focusing on studies reporting on depression or depressive symptoms among PLHA in China. The risk of bias of individual studies was assessed using a modified version of the Newcastle-Ottawa scale. The overall prevalence estimates were pooled using random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis and meta-regression. RESULTS Seventy-four observational studies including a total of 20,635 PLHA were included. The pooled prevalence of depression or depressive symptoms was 50.8% (95% CI: 46.0-55.5%) among general PLHA, 43.9% (95% CI: 36.2-51.9%) among HIV-positive men who have sex with men, 85.6% (95% CI: 64.1-95.2%) among HIV-positive former blood/plasma donors, and 51.6% (95% CI: 31.9-70.8%) among other HIV-positive populations. Significant heterogeneity was detected across studies regarding these prevalence estimates. Heterogeneity in the prevalence of depression among the general population of PLHA was partially explained by the geographic location and baseline survey year. CONCLUSIONS Because of the significant heterogeneity detected across studies regarding these prevalence estimates of depression or depressive symptoms, the results must be interpreted with caution. Our findings suggest that the estimates of depression or depressive symptoms among PLHA in China are considerable, which highlights the need to integrate screening and providing treatment for mental disorders in the treatment package offered to PLHA, which would ultimately lead to better health outcomes in PLHA.
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Affiliation(s)
- Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province China
| | - Hanlin Fu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province China
- Department of Mathematics, Mzuzu University, Mzuzu 2, Malawi
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province China
| | - Guiping Guo
- Department of Medical Psychology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province China
| | - Qiongxuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province China
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Yellin H, Beckwith C, Kurth A, Liu T, Castonguay B, Patrick R, Trezza C, Bazerman L, Kuo I. Syndemic effect of mental illness and substance use on viral suppression among recently-incarcerated, HIV-infected individuals in the CARE+ Corrections study. AIDS Care 2018; 30:1252-1256. [PMID: 29607658 DOI: 10.1080/09540121.2018.1455961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Few studies on HIV-related syndemics of co-occurring and mutually reinforcing psychosocial conditions have assessed clinical outcomes in criminal justice (CJ)-involved populations. Baseline data from the CARE+ Corrections study were used to quantify co-occurring mental illness and substance use and examine syndemic effects on viral suppression among 106 CJ-involved HIV-infected individuals. Ninety-one (86%) reported a mental illness diagnosis, 30 (28%) reported hazardous alcohol use, and 61 (58%) were drug dependent. Eighteen (17%) experienced all three conditions. Drug dependence was clustered with mental illness (prevalence odds ratio [POR] 3.20, 95% CI 1.01-10.14) and hazardous alcohol use (POR 2.61, 95% CI 1.03-6.56). The association between syndemic score, representing the number of conditions reported by each individual, and viral suppression was not statistically significant, although 86% of participants with none of these conditions were virally suppressed, compared to 56% of those with all three (p = 0.56). Mental illness and substance use were concentrated in this sample, indicating a need for integrated care services.
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Affiliation(s)
- Hannah Yellin
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Curt Beckwith
- b Division of Infectious Diseases , The Miriam Hospital , Providence , RI , USA.,c Division of Infectious Diseases , Brown University Alpert School of Medicine , Providence , RI , USA
| | - Ann Kurth
- d Yale University School of Nursing , New Haven , CT , USA
| | - Tao Liu
- e Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Breana Castonguay
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Rudy Patrick
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Claudia Trezza
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Lauri Bazerman
- b Division of Infectious Diseases , The Miriam Hospital , Providence , RI , USA
| | - Irene Kuo
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
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Jimenez-Torres GJ, Wojna V, Rosario E, Hechevarría R, Alemán-Batista AM, Matos MR, Madan A, Skolasky RL, Acevedo SF. Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings. PLoS One 2017; 12:e0181253. [PMID: 28723939 PMCID: PMC5517021 DOI: 10.1371/journal.pone.0181253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale. METHODS AND DESIGN The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version. RESULTS The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003). CONCLUSION Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.
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Affiliation(s)
- Gladys J. Jimenez-Torres
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Valerie Wojna
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Department of Internal Medicine, Neurology Division, University of Puerto Rico, San Juan, PR, United States of America
| | - Ernesto Rosario
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Rosa Hechevarría
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, PR, United States of America
| | - Ada M. Alemán-Batista
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
| | - Miriam Ríos Matos
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
| | - Alok Madan
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
| | - Richard L. Skolasky
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
- Department of Orthopedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States of America
| | - Summer F. Acevedo
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Maragh-Bass AC, Denison JA, Thorpe RJ, Knowlton AR. The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs. J Ethn Subst Abuse 2017. [PMID: 28632094 DOI: 10.1080/15332640.2016.1264337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (p<.05). Interaction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.
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Affiliation(s)
| | - Julie A Denison
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Roland J Thorpe
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Amy R Knowlton
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2015; 106:e1-e23. [PMID: 26562123 DOI: 10.2105/ajph.2015.302905] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. OBJECTIVES We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. SEARCH METHODS We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. SELECTION CRITERIA We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. DATA COLLECTION AND ANALYSIS Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. RESULTS Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. CONCLUSIONS Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.
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Affiliation(s)
- Angela A Aidala
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Michael G Wilson
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Virginia Shubert
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - David Gogolishvili
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Jason Globerman
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sergio Rueda
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Anne K Bozack
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Maria Caban
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sean B Rourke
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
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Mitchell MM, Robinson AC, Nguyen TQ, Knowlton AR. Informal Caregiver Characteristics Associated with Viral Load Suppression Among Current or Former Injection Drug Users Living with HIV/AIDS. AIDS Behav 2015; 19:2117-22. [PMID: 25969180 DOI: 10.1007/s10461-015-1090-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Few studies have examined the association between having an informal (unpaid) caregiver and viral suppression among persons living with HIV/AIDS (PLHIV) who are on antiretroviral therapy. The current study examined relationships between caregivers' individual and social network characteristics and care recipient viral suppression. Baseline data were from the BEACON study caregivers and their HIV seropositive former or current drug using care recipients, of whom 89 % were African American (N = 258 dyads). Using adjusted logistic regression, care recipient's undetectable viral load was positively associated with caregiver's limited physical functioning and negatively associated with caregivers having few family members to turn to for problem solving, a greater number of current drug users in their network, and poorer perceptions of the care recipient's mental health. Results further understandings of interpersonal relationship factors important to PLHIV's health outcomes, and the need for caregiving relationship-focused intervention to promote viral suppression among PLHIV.
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Antiretroviral Therapy Use, Medication Adherence, and Viral Suppression Among PLWHA with Panic Symptoms. AIDS Behav 2015; 19:2049-56. [PMID: 25903506 DOI: 10.1007/s10461-015-1064-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Panic symptoms are prevalent among PLWHAs, yet few studies have examined their relationship with HIV outcomes. Using data from an observational cohort study in Baltimore, MD, we examined the association between panic symptoms and antiretroviral therapy (ART) use, medication adherence, and viral suppression. Data were analyzed using generalized estimating equations and adjusted for age, sex, race/ethnicity, cocaine and/or heroin use, clinic enrollment time, alcohol use, and depressive symptoms. Between June 2010 and September 2012, 1195 individuals participated in 2080 audio computer assisted interviews; 9.9 % (n = 118) of individuals endorsed current panic symptoms. In multivariate analysis, panic symptoms were associated with decreased ART use (IRR 0.94; p = 0.05). Panic symptoms were neither associated with medication adherence nor viral suppression. These findings were independent of depressive symptoms and substance use. Panic symptoms are under-recognized in primary care settings and present an important barrier to ART use. Further studies investigating the reasons for this association are needed.
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Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV. AIDS Behav 2015; 19:1527-34. [PMID: 25351185 DOI: 10.1007/s10461-014-0922-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depression and food insecurity are prevalent among people with HIV (PLHIV) and contribute to poor HIV outcomes. Longitudinal data can help clarify the effect of food insecurity on depression among PLHIV in the United States. We assessed the longitudinal association of food insecurity with symptoms of depression using validated measures among participants living with HIV from the Research on Access to Care in the Homeless cohort in San Francisco. We followed 346 participants for a median of 28 months. Over half of participants (55.0 %) were food insecure and 35.8 % had symptoms of depression. In adjusted models, severe food insecurity in the previous period was associated with increased depressive symptom severity (b = 1.22; p < 0.001). The association remained statistically significant in models including participant fixed effects. Severe food insecurity was also longitudinally associated with a binary variable indicating probable depression. Efforts to increase access to and participation in food security safety net programs for PLHIV could improve depression.
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Riley ED, Shumway M, Knight KR, Guzman D, Cohen J, Weiser SD. Risk factors for stimulant use among homeless and unstably housed adult women. Drug Alcohol Depend 2015; 153:173-9. [PMID: 26070454 PMCID: PMC4510017 DOI: 10.1016/j.drugalcdep.2015.05.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND One of the most common causes of death among homeless and unstably housed women is acute intoxication where cocaine is present. While correlates of stimulant use have been determined in prior research, few studies have assessed risk factors of use specifically in this high-risk population. METHODS We sampled biological women with a history of housing instability from community-based venues to participate in a cohort study. Baseline and 6-month follow-up data were used to determine the relative risk of stimulant use (crack cocaine, powder cocaine or methamphetamine) among individuals who did not use at baseline. RESULTS Among 260 study participants, the median age was 47 years, 70% were women of color; 47% reported having unmet subsistence needs and 53% reported abstinence from stimulants at baseline. In analyses adjusting for baseline sociodemographics and drug treatment, the risk of using stimulants within 6 months was significantly higher among women who reported recent sexual violence (Adjusted Relative Risk [ARR]=4.31; 95% CI:1.97-9.45), sleeping in a shelter or public place (ARR=2.75; 95% CI:1.15-6.57), and using unprescribed opioid analgesics (ARR=2.54; 95% CI:1.01-6.38). CONCLUSION We found that almost half of homeless and unstably housed women used stimulants at baseline and 14% of those who did not use began within 6 months. Addressing homelessness and sexual violence is critical to reduce stimulant use among impoverished women.
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Affiliation(s)
- Elise D Riley
- School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Martha Shumway
- School of Medicine, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kelly R Knight
- School of Medicine, Department of Anthropology, History and Social Medicine, University of California, San Francisco, CA, USA
| | - David Guzman
- School of Medicine, Department of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Jennifer Cohen
- School of Medicine, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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Chartier M, Maier M. Engagement Along the HIV Care Continuum and the Potential Role f Mental Health and Substance Use Disorders. Fed Pract 2015; 32:10S-14S. [PMID: 30766106 PMCID: PMC6375506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increasing access to mental health and substance use services, particularly through integrated care models, as well as addressing issues of HIV-related stigma, may positively impact engagement in HIV clinical care.
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Affiliation(s)
- Maggie Chartier
- is a national public health clinical psychologist for the HIV, Hepatitis and Public Health Pathogens Programs in the VHA Office of Public Health, a staff psychologist at the San Francisco VAMC, and assistant clinical professor in the Department of Psychiatry, University of California, San Francisco. is a national public health infectious disease officer for the HIV, Hepatitis, and Public Health Pathogens Program in the VHA Office of Public Health and a staff physician at the Portland VAMC, and is an assistant professor at Oregon Health and Sciences University in Portland
| | - Marissa Maier
- is a national public health clinical psychologist for the HIV, Hepatitis and Public Health Pathogens Programs in the VHA Office of Public Health, a staff psychologist at the San Francisco VAMC, and assistant clinical professor in the Department of Psychiatry, University of California, San Francisco. is a national public health infectious disease officer for the HIV, Hepatitis, and Public Health Pathogens Program in the VHA Office of Public Health and a staff physician at the Portland VAMC, and is an assistant professor at Oregon Health and Sciences University in Portland
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Abstract
Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated with the HIV illness. Evidences exist to support the importance of improving the identification of depressive symptoms and their adequate treatment. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality. By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, Cochrane Library), the review discusses the epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches, including psychosocial interventions, psychopharmacology as well as HIV-specific health psychology health service models.
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Carrico AW, Shoptaw S, Cox C, Stall R, Li X, Ostrow DG, Vlahov D, Plankey MW. Stimulant use and progression to AIDS or mortality after the initiation of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2014; 67:508-13. [PMID: 25271387 PMCID: PMC4232455 DOI: 10.1097/qai.0000000000000364] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND HIV-positive persons who use stimulants (eg, methamphetamine) experience profound health disparities, but it remains unclear whether these persist after highly active antiretroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined whether stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART. METHODS Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (ie, 0%, 1%-49%, 50%-99%, and 100%) was examined as a time-varying predictor of (1) all-cause mortality and (2) AIDS or all-cause mortality. RESULTS Among the 1313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risk analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (adjusted odds ratio = 1.54; 95% confidence interval: 1.02 to 2.33; P < 0.05). CONCLUSIONS HIV-positive stimulant-using MSM receiving HAART seem to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared with nonusers. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.
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Affiliation(s)
- Adam W. Carrico
- University of California, San Francisco School of Nursing, Department of Community Health Systems, San Francisco, CA
| | - Steven Shoptaw
- University of California, Los Angeles David Geffen School of Medicine, Departments of Family Medicine and Psychiatry, Los Angeles, CA
| | - Christopher Cox
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Ronald Stall
- University of Pittsburgh, Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Xiuhong Li
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - David G. Ostrow
- The Chicago MACS and Ostrow & Associates, LLC, Chicago, Chicago, IL
| | - David Vlahov
- University of California, San Francisco School of Nursing, Department of Community Health Systems, San Francisco, CA
| | - Michael W. Plankey
- Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, Washington, DC
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Physical activity and health outcomes among HIV-infected men who have sex with men: a longitudinal mediational analysis. Ann Behav Med 2014; 46:149-56. [PMID: 23483379 DOI: 10.1007/s12160-013-9489-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Low physical activity is associated with depression, which may, in turn, negatively impact antiretroviral therapy (ART) adherence among HIV-infected individuals; however, prior studies have not investigated the relationships between physical inactivity and ART non-adherence. PURPOSE The purpose of this study was to examine the association of physical inactivity, depression, ART non-adherence, and viral load in HIV-infected men who have sex with men. METHODS The sample (N = 860) was from a large, multicenter cohort of HIV-infected patients engaged in clinical care. RESULTS Across time, depression mediated the relationship between physical inactivity and ART non-adherence (γ = 0.075) and the relationship between physical inactivity and viral load (γ = 0.05). ART non-adherence mediated the relationship between depression and viral load (γ = 0.002) and the relationship between physical inactivity and viral load (γ = 0.009). CONCLUSIONS Low levels of physical activity predicted increased depression and poor ART adherence over time, which subsequently predicted higher viral load.
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Blank MB, Himelhoch S, Walkup J, Eisenberg MM. Treatment considerations for HIV-infected individuals with severe mental illness. Curr HIV/AIDS Rep 2013; 10:371-9. [PMID: 24158425 PMCID: PMC3857330 DOI: 10.1007/s11904-013-0179-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others. The pathophysiology and direction of effects between severe mental illness and HIV infection is less clear however, and relatively little work has been done on prevention and treatment for people with these complex, co-occurring conditions. Here we present the most recent work that has been published on HIV and mental illness. Further, we describe the need for better treatments for "triply diagnosed persons"; those with HIV, mental illness, and substance abuse and dependence. Finally, we describe the potential drug-drug interactions between psychotropic medications and anti-retrovirals, and the need for better treatment guidelines in this area. We describe one example of an individually tailored intervention for persons with serious mental illness and HIV (PATH+) that shows that integrated community-based treatments using advanced practice nurses (APNs) as health navigators can be successful in improving health-related quality of life and reducing the burden of disease in these persons.
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Affiliation(s)
- Michael B. Blank
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., room 3020, Philadelphia, PA 19104-3309, (o) 215-746-6717, (f) 215-349-8715
| | - Seth Himelhoch
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 701 W. Pratt Street, 388, Baltimore, MD, (o) 410-706-2490, (f) 410-706-0022
| | - James Walkup
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson, New Brunswick, New Jersey 08504, (o) 848-932-1171, (f) 732/445-4888
| | - Marlene M. Eisenberg
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, 3535 Market St., Suite 4000, Philadelphia, PA 19104, (o) 215-746-5785, (f) 215-746-7377
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Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. PLoS One 2013; 8:e78952. [PMID: 24260137 PMCID: PMC3832515 DOI: 10.1371/journal.pone.0078952] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/25/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes. METHODS We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness) from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility) and virologic suppression (within 1 year) based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU). RESULTS Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60-0.88). Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87-1.45). Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47-0.95). CONCLUSIONS We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed.
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Satre DD, DeLorenze GN, Quesenberry CP, Tsai A, Weisner C. Factors associated with treatment initiation for psychiatric and substance use disorders among persons with HIV. Psychiatr Serv 2013; 64:745-53. [PMID: 23584606 PMCID: PMC4030718 DOI: 10.1176/appi.ps.201200064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Prior studies of individuals with HIV infection have found that accessing psychiatric and substance abuse treatment when needed can improve health and prolong life, yet little is known about factors associated with treatment initiation. METHODS In a retrospective cohort design including individuals with HIV infection (≥14 years old) in an integrated health care system in Northern California, this study included 822 patients with a major psychiatric diagnosis and 1,624 with a substance use disorder diagnosis. Data were extracted from a regional HIV registry and computerized databases. RESULTS Twenty-four percent (N=198) of study patients with psychiatric diagnoses and 15% (N=245) with substance abuse or dependence received one or more specialty care visits within 12 months of diagnosis. Among patients with a psychiatric diagnosis, significant predictors of visiting a psychiatry clinic included not having an AIDS diagnosis at baseline or before the study (p=.049), having a diagnosis of major depression (p=.013), having a diagnosis of bipolar disorder (p<.001), and receiving a psychiatric diagnosis in 1996 versus later years of the study (p<.01). Among patients with a substance use disorder, significant predictors of initiating substance abuse treatment included age <30 (p=.015) and being in the HIV transmission risk group of injection drug use (p<.001). CONCLUSIONS Clinical, diagnostic, and demographic factors were associated with specialty care treatment initiation in this sample of individuals with HIV infection and substance use or psychiatric disorders. Developing strategies to enhance treatment initiation has the potential to improve outcomes for individuals with HIV infection.
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Affiliation(s)
- Derek D Satre
- Division of Research, Kaiser Permanente, Oakland, California, USA.
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Kulkarni SP, Shah KR, Sarma KV, Mahajan AP. Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review. Am J Public Health 2013; 103:e14-23. [PMID: 23597344 PMCID: PMC3670656 DOI: 10.2105/ajph.2013.301273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 12/13/2022]
Abstract
Despite the HIV "test-and-treat" strategy's promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy's success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation.
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Affiliation(s)
- Sonali P Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA 90005, USA.
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Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16:2119-43. [PMID: 22644066 PMCID: PMC3481055 DOI: 10.1007/s10461-012-0212-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
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Badiee J, Riggs PK, Rooney AS, Vaida F, Grant I, Atkinson JH, Moore, and the HIV Neurobehavioral DJ. Approaches to identifying appropriate medication adherence assessments for HIV infected individuals with comorbid bipolar disorder. AIDS Patient Care STDS 2012; 26:388-94. [PMID: 22686169 DOI: 10.1089/apc.2011.0447] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Assessing medication adherence in already difficult-to-treat HIV-infected subpopulations presents a unique challenge. The objective of this study was to compare different approaches to assessing medication adherence: (1) electronic medication monitoring, (2) standardized self-report questionnaire, and (3) self-report visual analogue scale, and to determine whether antiretroviral therapy (ART) adherence measures differed for HIV-infected persons with bipolar disorder (HIV+ /BD+) as compared to HIV-infected persons without bipolar disorder (HIV+ /BD-). ART adherence was assessed for 74 HIV-positive participants using the Medication Event Monitoring System (MEMS), AIDS Clinical Trials Group (ACTG) adherence questionnaire, and visual analogue scale (VAS). Participants were classified as adherent or nonadherent on each measure by previously validated cutscores. Correlations and logistic regressions were used to examine associations between adherence measures and demographic and clinical variables. In the HIV+ /BD- group, significant correlations existed between each self-report measure and the MEMS. Males comprised 81% of the study population. Participants averaged 44 years of age and 13 years of education. No significant correlations were found among adherence measures in the HIV+ /BD+ group. Among participants reporting adherence on either self-report measure but classified as nonadherent based on MEMS, 94% had a diagnosis of bipolar disorder. Bipolar disorder was a significant predictor of adherence classification discordance among self-report measures. Our findings suggest that it remains difficult to assess ART adherence among HIV-positive individuals with bipolar disorder. Combined approaches of self-report and objective measures may be the best way to estimate adherence, and may provide the best basis for interventions designed to improve adherence in difficult-to-treat populations.
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Affiliation(s)
- Jayraan Badiee
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Patricia K. Riggs
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Alexandra S. Rooney
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Florin Vaida
- Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla, California
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - J. Hampton Atkinson
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
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Tsai AC, Karasic DH, Hammer GP, Charlebois ED, Ragland K, Moss AR, Sorensen JL, Dilley JW, Bangsberg DR. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am J Public Health 2012; 103:308-15. [PMID: 22720766 DOI: 10.2105/ajph.2011.300422] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. METHODS We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome. Response was a 50% reduction from baseline and remission a score below 8. Secondary measures were Beck Depression Inventory-II (BDI-II) score, antiretroviral uptake, antiretroviral adherence (measured by unannounced pill count), and HIV-1 RNA viral suppression (< 50 copies/mL). RESULTS The intervention reduced depression symptom severity (b = -1.97; 95% confidence interval [CI] = -0.85, -3.08; P < .001) and increased response (adjusted odds ratio [AOR] = 2.40; 95% CI = 1.86, 3.10; P < .001) and remission (AOR = 2.97; 95% CI = 1.29, 3.87; P < .001). BDI-II results were similar. We observed no statistically significant differences in secondary HIV outcomes. CONCLUSIONS Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults, a vulnerable population with multiple barriers to adherence.
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Affiliation(s)
- Alexander C Tsai
- Langley Porter Psychiatric Institute, University of California, San Francisco, CA, USA.
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Carrico AW, Pollack LM, Stall RD, Shade SB, Neilands TB, Rice TM, Woods WJ, Moskowitz JT. Psychological processes and stimulant use among men who have sex with men. Drug Alcohol Depend 2012; 123:79-83. [PMID: 22088656 PMCID: PMC3494990 DOI: 10.1016/j.drugalcdep.2011.10.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. METHODS A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. RESULTS Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (β(indirect)=0.11, p<.001) and depressed mood (β(indirect)=0.13, p<.001) with stimulant use. CONCLUSIONS Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA 94105, USA.
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Simoni JM, Yard SS, Huh D. Prospective prediction of viral suppression and immune response nine months after ART initiation in Seattle, WA. AIDS Care 2012; 25:181-5. [PMID: 22639986 DOI: 10.1080/09540121.2012.687821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Knowing at antiretroviral therapy (ART) initiation which patients might be at greatest risk for failure to achieve viral suppression would enable providers to target patients most in need and tailor their care appropriately. This study involved multilevel modeling of data from a randomized controlled trial among outpatients in Seattle, WA, USA. The 224 participants initiating or switching ART at baseline were 24% female, 34% heterosexual, and 47% Caucasian. Of 24 baseline demographic and psychosocial patient-level variables modeled in separate generalized estimating equations, only employment predicted changes in HIV-1 RNA viral load or CD4 lymphocyte count over the course of the 9-month trial. Although the findings require replication, they suggest adherence support strategies should emphasize close monitoring and support for all patients initiating ART.
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Affiliation(s)
- Jane M Simoni
- Department of Psychology, University of Washington, Seattle, USA.
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Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med 2012; 74:2012-9. [PMID: 22513248 DOI: 10.1016/j.socscimed.2012.02.033] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 01/03/2012] [Accepted: 02/17/2012] [Indexed: 11/21/2022]
Abstract
Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings.
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