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Wirtz AL, Logie CH, Mbuagbaw L. Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research. Epidemiol Rev 2022; 44:87-109. [PMID: 36124659 PMCID: PMC10362940 DOI: 10.1093/epirev/mxac008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022] Open
Abstract
Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.
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Affiliation(s)
- Andrea L Wirtz
- Correspondence to Dr. Andrea L. Wirtz, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 (e-mail: )
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Amirkhanian YA, Kelly JA, DiFranceisco WJ, Tarima SS, McAuliffe TL, Kuznetsova AV. People Living With HIV in St. Petersburg, Russia: Gender and Exposure Group Differences in HIV Care Engagement, Psychosocial Health, Substance Use, and Transmission Risk Behavior. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:226-244. [PMID: 35647864 DOI: 10.1521/aeap.2022.34.3.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg (N = 872). Samples were recruited between 2014 and 2018 by enrolling a PLWH seed who was either out-of-care or treatment nonadherent as well as network members surrounding each seed, assessing each participant's HIV care, transmission risk, substance use, and mental health characteristics. Almost one-quarter of participants said they were never offered antiretroviral therapy (ART), and-among those offered ART-one-quarter refused or discontinued therapy and 45% were <95% ART-adherent. Almost half of participants had detectable viral load, and many reported continued condomless intercourse with potentially nonconcordant serostatus partners or needle sharing. Over 46% of participants had elevated scores on measures of depression, hopelessness, state anxiety, or poor social support. Study findings illustrate unmet needs of PLWH in Russia.
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Affiliation(s)
- Yuri A Amirkhanian
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wayne J DiFranceisco
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey S Tarima
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna V Kuznetsova
- Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
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Wali N, Renzaho A, Wang X, Atkins B, Bhattacharya D. Do interventions to improve adherence to antiretroviral therapy recognise diversity? A systematic review. AIDS Care 2020; 33:1379-1393. [PMID: 32847386 DOI: 10.1080/09540121.2020.1811198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
People living with HIV (PLWH) are often culturally and linguistically diverse populations; these differences are associated with differing barriers to antiretroviral therapy (ART) adherence. Cultural competence measures the extent to which trial design recognises this diversity. This systematic review aimed to determine whether adherence trial participants represent the diversity of PLWH. Randomised Controlled Trials in Organisation for Economic Co-operation and Development countries to improve ART adherence were eligible. We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. For all included trials, we searched for their development, testing and evaluation studies. We compared trial participant characteristics with nationally reported PLWH data. We appraised trial cultural competence against ten criteria; scoring each criterion as 0, 1 or 2 indicating cultural blindness, pre-competence or competence respectively. For 80 included trials, a further 13 studies presenting development/testing/evaluation data for the included trials were identified. Only one of the 80 included studies reported trial participants representative of the country's population of PLWH. The median (IQ) cultural competence score was 2.5 (1.0, 4.0) out of 20. HIV adherence trial participants are not reflective of the population with HIV, which may be due to limited adoption of culturally competent research methods.
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Affiliation(s)
- Nidhi Wali
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Andre Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Xia Wang
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - Bethany Atkins
- School of Pharmacy, University of East Anglia, Norwich, UK
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Horvath KJ, Lammert S, MacLehose RF, Danh T, Baker JV, Carrico AW. A Pilot Study of a Mobile App to Support HIV Antiretroviral Therapy Adherence Among Men Who Have Sex with Men Who Use Stimulants. AIDS Behav 2019; 23:3184-3198. [PMID: 31309348 PMCID: PMC6803067 DOI: 10.1007/s10461-019-02597-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
APP+ is a theoretically-grounded mobile app intervention to improve antiretroviral (ART) adherence among men who have sex with men (MSM) who use stimulants. We assessed the feasibility and acceptability of APP+ in a six-month randomized controlled trial among a national sample of 90 MSM recruited online; secondarily, we examined changes in self-reported ART adherence by study arm. Retention at the final assessment was 82%, and acceptability ratings were comparable to other technology-based interventions. MSM in the APP+ group reported higher self-reported percentage ART adherence in the past 30 days at the four-month timepoint compared to a no-treatment control group (89.0% vs. 77.2%). However, once access to the app was removed after month four, group differences in ART adherence diminished by month six. APP+ may be a potentially promising intervention approach for MSM living with HIV who use stimulants but would require enhancements to optimize acceptability and demonstrate more sustained effects.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, USA.
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, USA
| | - Thu Danh
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, USA
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Adam W Carrico
- School of Medicine, University of Miami, Coral Gables, USA
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Opioid Misuse Among HIV-Positive Adults in Medical Care: Results From the Medical Monitoring Project, 2009-2014. J Acquir Immune Defic Syndr 2019; 80:127-134. [PMID: 30383590 DOI: 10.1097/qai.0000000000001889] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND People living with HIV are prescribed opioids more often and at higher doses than people who do not have HIV, and disproportionately experience risk factors for substance use disorder, which suggests they could be at increased risk of the misuse of opioids. Researchers also suggest that opioid misuse negatively affects various HIV clinical outcomes, increasing the risk of transmission to partners with an HIV-negative status. METHODS We calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics among a probability sample of 28,162 HIV-positive adults receiving medical care in the United States who misused opioids (n = 975). Then, we used Rao-Scott χ tests to assess bivariate associations between opioid misuse and selected characteristics. RESULTS In all, 3.3% misused opioids. Misuse was more common among young adults, males, and non-Hispanic whites. Persons who misused opioids were less likely to: have been prescribed antiretroviral therapy (ART) (88.7%), report being adherent to ART medications in the past 3 days (78.1%), and have durable viral suppression (54.3%) than persons who did not misuse opioids (92.5%, 87.7%, and 64.7%, respectively). Persons who misused opioids were more likely to report condomless sex with partners of negative or unknown HIV status while not durably virally suppressed (11.7% vs 3.4%) than persons who did not misuse opioids. CONCLUSIONS Opioid misuse among adults receiving HIV medical care is associated with inadequate ART adherence, insufficient durable viral suppression, and higher risk of HIV transmission to sexual partners.
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Kalichman SC. When is Enough, Enough? How the Absence of Dose-Determination Trials Impedes Implementation of HIV Behavioral Interventions. AIDS Behav 2019; 23:2219-2225. [PMID: 31440859 DOI: 10.1007/s10461-019-02650-1] [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: 01/08/2023]
Abstract
Carefully controlled clinical trials have determined that theory-based behavioral interventions delivered by adherence nurses, professional and paraprofessional counselors, and case managers improve ART adherence and viral suppression. However, there are no studies that empirically inform how much intervention is needed for which patient populations and at what cost. This Editorial raises the issue of how a lack of intervention dosing limits interpretation of trial results and impedes implementation, therefore calling for behavioral intervention dose-finding studies.
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Cherenack EM, Sikkema KJ, Watt MH, Hansen NB, Wilson PA. Avoidant Coping Mediates the Relationship Between Self-Efficacy for HIV Disclosure and Depression Symptoms Among Men Who Have Sex with Men Newly Diagnosed with HIV. AIDS Behav 2018; 22:3130-3140. [PMID: 29372454 PMCID: PMC6060017 DOI: 10.1007/s10461-018-2036-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV diagnosis presents a critical opportunity to reduce secondary transmission, improve engagement in care, and enhance overall well-being. To develop relevant interventions, research is needed on the psychosocial experiences of newly diagnosed individuals. This study examined avoidant coping, self-efficacy for HIV disclosure decisions, and depression among 92 newly diagnosed men who have sex with men who reported recent sexual risk behavior. It was hypothesized that avoidant coping would mediate the relationship between self-efficacy and depression. Cross-sectional surveys were collected from participants 3 months after HIV diagnosis. To test for mediation, multiple linear regressions were conducted while controlling for HIV disclosure to sexual partners. Self-efficacy for HIV disclosure decisions showed a negative linear relationship to depression symptoms, and 99% of this relationship was mediated by avoidant coping. The index of mediation of self-efficacy on depression indicated a small-to-medium effect. Higher self-efficacy was related to less avoidant coping, and less avoidant coping was related to decreased depression symptoms, all else held constant. These findings highlight the role of avoidant coping in explaining the relationship between self-efficacy for HIV disclosure decisions and depression.
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Affiliation(s)
- Emily M Cherenack
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC, 27708-0086, USA.
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC, 27708-0086, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway. AIDS Behav 2018; 22:3166-3174. [PMID: 29572762 DOI: 10.1007/s10461-018-2098-1] [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: 01/20/2023]
Abstract
Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.
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Pokhrel KN, Sharma VD, Pokhrel KG, Neupane SR, Mlunde LB, Poudel KC, Jimba M. Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study. BMC Infect Dis 2018; 18:263. [PMID: 29879916 PMCID: PMC5992643 DOI: 10.1186/s12879-018-3170-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-based care intervention; however, the effects of the intervention on health outcomes is not yet known. Therefore, we examined the impact of the intervention on mental health and antiretroviral therapy (ART) adherence. METHODS We conducted an intervention study to identify the effects of a community home-based care intervention on mental health disorders, substance use, and non-adherence to ART among HIV-positive people in Nepal from March to August 2015. In total, 344 participated in the intervention and another 338 were in the control group. The intervention was comprised of home-based psychosocial support and peer counseling, adherence support, basic health care, and referral services. We measured the participants' depression, anxiety, stress, substance use, and non-adherence to ART. We applied a generalized estimating equation to examine the effects of intervention on health outcomes. RESULTS The intervention had positive effects in reducing depressive symptoms [Adjusted Odds Ratio (AOR) = 0.44, p < 0.001)], anxiety (AOR = 0.54, p = 0.014), stress (β = - 3.98, p < 0.001), substance use (AOR = 0.51, p = 0.005), and non-adherence to ART (AOR = 0.62, p = 0.025) among its participants at six-month follow-up. CONCLUSIONS The intervention was effective in reducing mental health disorders, substance use, and non-adherence to ART among HIV-positive people. Community home-based care intervention can be applied in resource limited setting to improve the mental health of the HIV-positive people. Such intervention should be targeted to include more HIV-positive people in order to improve their ART adherence. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03505866 , Released Date: April 20, 2018.
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Affiliation(s)
- Khem N. Pokhrel
- Health Research and Social Development Forum Nepal, P.O. Box 24133, Thapathali, Kathmandu, Nepal
| | - Vidya D. Sharma
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal
| | | | | | - Linda B. Mlunde
- Management and Development for Health, P.O. Box 79810, Dar es Salaam, Tanzania
| | - Krishna C. Poudel
- Department of Public Health Policy, School of Public Health and Health Sciences, University of Massachussets Amherst, Boston, USA
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
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Horvath KJ, Amico KR, Erickson D, Ecklund AM, Martinka A, DeWitt J, McLaughlin J, Parsons JT. Thrive With Me: Protocol for a Randomized Controlled Trial to Test a Peer Support Intervention to Improve Antiretroviral Therapy Adherence Among Men Who Have Sex With Men. JMIR Res Protoc 2018; 7:e10182. [PMID: 29853437 PMCID: PMC6002671 DOI: 10.2196/10182] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The suboptimal rate of viral suppression among persons aged 13 years and older and residing in 37 states and the District of Columbia leaves considerable opportunities for onward transmission and contributes to poor health outcomes. Men who have sex with men (MSM) represent one of the most at-risk groups in the United States. There is a clear and continued need for innovative adherence support programs to optimize viral suppression. To address this gap, we designed and are implementing a randomized controlled trial (RCT) to test the efficacy of the Thrive with Me intervention for MSM living with HIV. Critical components of the protocol are presented. OBJECTIVE The aim of this study is to describe the protocol for rigorously testing the efficacy of Thrive with Me to improve antiretroviral therapy (ART) adherence among HIV-positive MSM residing in New York City. METHODS A community advisory board and beta testing were used to obtain feedback from HIV-positive MSM on the overall look and feel of Thrive with Me and problems with navigation to finalize intervention components and content. We will enroll 400 HIV-positive MSM residing in the New York City area into a two-arm prospective RCT and follow them for 17 months. Men in the Thrive with Me experimental intervention arm will have access to Thrive with Me for 5 months. Thrive with Me has three primary components: (1) a private social networking feature; (2) tailored HIV and ART adherence information; and (3) medication reminders, self-monitoring, and reflection. Gamification components include badges and leveling up to increase intrinsic motivation to engage with the intervention. Men randomized to the control condition will view a weekly newsletter for 5 months. The newsletter will be delivered via email and contains information on topics related to HIV with the exception of ART adherence. Study assessments will occur at enrollment and 5, 11, and 17 months post enrollment. The primary study outcome is HIV viral load, which is considered an objective indicator of ART adherence. RESULTS Participant recruitment for the RCT began in October 2016, and the data collection period is anticipated to end in the Fall of 2019. CONCLUSIONS The efficacy trial of Thrive with Me will help to fill gaps in understanding about the utility of multicomponent, technology-based interventions to improve ART adherence among HIV-positive MSM. Of importance is the ability for the results of the Thrive with Me trial to inform best practices for conducting technology-based interventions that incorporate social media features. TRIAL REGISTRATION ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/ct2/show/NCT02704208 (Archived by WebCite at http://www.webcitation.org/6zQ8WPra6). REGISTERED REPORT IDENTIFIER RR1-10.2196/10182.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Darin Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Alexandra M Ecklund
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Aldona Martinka
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - James DeWitt
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | | | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College, Graduate Center of the City University of New York (CUNY), New York City, NY, United States
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Kalichman SC, Cherry C, Kalichman MO, Eaton LA, Kohler J, Montero C, Schinazi RF. Mobile Health Intervention to Reduce HIV Transmission: A Randomized Trial of Behaviorally Enhanced HIV Treatment as Prevention (B-TasP). J Acquir Immune Defic Syndr 2018; 78:34-42. [PMID: 29406429 PMCID: PMC5889341 DOI: 10.1097/qai.0000000000001637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV. METHODS A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months. RESULTS Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission. CONCLUSIONS Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Moira O. Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - James Kohler
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
| | - Catherine Montero
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
| | - Raymond F. Schinazi
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
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Hightow-Weidman L, Muessig K, Knudtson K, Srivatsa M, Lawrence E, LeGrand S, Hotten A, Hosek S. A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study. JMIR Public Health Surveill 2018; 4:e34. [PMID: 29712626 PMCID: PMC5952121 DOI: 10.2196/publichealth.8923] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/31/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions-particularly mobile health platforms-can provide tailored adherence interventions and allow YMSM to engage and connect with others. OBJECTIVE The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. METHODS AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. RESULTS Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. CONCLUSIONS AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kelly Knudtson
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | | | | | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Anna Hotten
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, United States
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Spaan P, van Luenen S, Garnefski N, Kraaij V. Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis. J Health Psychol 2018; 25:1326-1340. [PMID: 29417851 PMCID: PMC7480021 DOI: 10.1177/1359105318755545] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
About 40 per cent of people living with HIV do not sufficiently adhere to
their medication regimen, which adversely affects their health. The
current meta-analysis investigated the effect of psychosocial
interventions on medication adherence in people living with HIV.
Databases were systematically searched, resulting in 43 included
randomized controlled trials. Study and intervention characteristics
were investigated as moderators. The overall effect size indicates a
small to moderate positive effect (Hedges’ g = 0.37)
of psychosocial interventions on medication adherence in people living
with HIV. No evidence for publication bias was found. This
meta-analysis study concludes that various psychosocial interventions
can improve medication adherence and thereby the health of people
living with HIV.
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Affiliation(s)
- Pascalle Spaan
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne van Luenen
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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16
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Gonçalves TR, Faria ER, Carvalho FTD, Piccinini CA, Shoveller JA. Behavioral interventions to promote condom use among women living with HIV: a systematic review update. CAD SAUDE PUBLICA 2017; 33:e00202515. [PMID: 28125130 DOI: 10.1590/0102-311x00202515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 10/25/2016] [Indexed: 12/30/2022] Open
Abstract
Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.
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Affiliation(s)
| | | | - Fernanda Torres de Carvalho
- Ambulatório de Dermatologia Sanitária, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, Brasil
| | - Cesar Augusto Piccinini
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Jean Anne Shoveller
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Kanters S, Park JJH, Chan K, Socias ME, Ford N, Forrest JI, Thorlund K, Nachega JB, Mills EJ. Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis. Lancet HIV 2016; 4:e31-e40. [PMID: 27863996 DOI: 10.1016/s2352-3018(16)30206-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND High adherence to antiretroviral therapy is crucial to the success of HIV treatment. We evaluated comparative effectiveness of adherence interventions with the aim of informing the WHO's global guidance on interventions to increase adherence. METHODS For this systematic review and network meta-analysis, we searched for randomised controlled trials of interventions that aimed to improve adherence to antiretroviral therapy regimens in populations with HIV. We searched Cochrane Central Register of Controlled Trials, Embase, and MEDLINE for reports published up to July 16, 2015, and searched major conference abstracts from Jan 1, 2013, to July 16, 2015. We extracted data from eligible studies for study characteristics, interventions, patients' characteristics at baseline, and outcomes for the study populations of interest. We used network meta-analyses to compare adherence and viral suppression for all study settings (global network) and for studies in low-income and middle-income countries only (LMIC network). FINDINGS We obtained data from 85 trials with 16 271 participants. Short message service (SMS; text message) interventions were superior to standard of care in improving adherence in both the global network (odds ratio [OR] 1·48, 95% credible interval [CrI] 1·00-2·16) and in the LMIC network (1·49, 1·04-2·09). Multiple interventions showed generally superior adherence to single interventions, indicating additive effects. For viral suppression, only cognitive behavioural therapy (1·46, 1·05-2·12) and supporter interventions (1·28, 1·01-1·71) were superior to standard of care in the global network; none of the interventions improved viral response in the LMIC network. For the global network, the time discrepancy (whether the study outcome was measured during or after intervention was withdrawn) was an effect modifier for both adherence to antiretroviral therapy (coefficient estimate -0·43, 95% CrI -0·75 to -0·11) and viral suppression (-0·48; -0·84 to -0·12), suggesting that the effects of interventions wane over time. INTERPRETATION Several interventions can improve adherence and viral suppression; generally, their estimated effects were modest and waned over time. FUNDING WHO.
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Affiliation(s)
- Steve Kanters
- Precision Global Health, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Keith Chan
- Precision Global Health, Vancouver, BC, Canada
| | - Maria Eugenia Socias
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Jamie I Forrest
- Precision Global Health, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Jean B Nachega
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Departments of Epidemiology, Infectious Diseases, and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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18
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Webb Mazinyo E, Kim L, Masuku S, Lancaster JL, Odendaal R, Uys M, Podewils LJ, Van der Walt ML. Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Treatment among Co-Infected Persons in South Africa, 2008-2010. PLoS One 2016; 11:e0159317. [PMID: 27442440 PMCID: PMC4956242 DOI: 10.1371/journal.pone.0159317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/30/2016] [Indexed: 11/19/2022] Open
Abstract
Background Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa. Methods A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008–31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence. Results Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76). Conclusions The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment.
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Affiliation(s)
- Ernesha Webb Mazinyo
- Tuberculosis HIV/AIDS Treatment Support and Integrated Therapy (THAT’SIT), Johannesburg, South Africa and Foundation for Professional Development, Pretoria, South Africa
- * E-mail:
| | - Lindsay Kim
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sikhethiwe Masuku
- Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Joey L. Lancaster
- Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Ronel Odendaal
- Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Margot Uys
- Tuberculosis HIV/AIDS Treatment Support and Integrated Therapy (THAT’SIT), Johannesburg, South Africa and Foundation for Professional Development, Pretoria, South Africa
| | - Laura Jean Podewils
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martie L. Van der Walt
- Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa
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19
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Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 19 Suppl 2:142-55. [PMID: 25638037 DOI: 10.1007/s10461-014-0983-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This two-phase pilot study aimed to design, pilot, and refine an automated interactive voice response (IVR) intervention to support antiretroviral adherence for people living with HIV (PLH), in Kolkata, India. Mixed-methods formative research included a community advisory board for IVR message development, 1-month pre-post pilot, post-pilot focus groups, and further message development. Two IVR calls are made daily, timed to patients' dosing schedules, with brief messages (<1-min) on strategies for self-management of three domains: medical (adherence, symptoms, co-infections), mental health (social support, stress, positive cognitions), and nutrition and hygiene (per PLH preferences). Three ART appointment reminders are also sent each month. One-month pilot results (n = 46, 80 % women, 60 % sex workers) found significant increases in self-reported ART adherence, both within past three days (p = 0.05) and time since missed last dose (p = 0.015). Depression was common. Messaging content and assessment domains were expanded for testing in a randomized trial currently underway.
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20
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Abstract
BACKGROUND Depression is a risk factor for nonadherence to HIV/AIDS treatment. PURPOSE A meta-analysis was conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence. METHODS PubMed and PsycINFO databases were systematically searched for relevant articles. Studies that reported an association between depression treatment (or an intervention with a component addressing mental health) and antiretroviral adherence were included. RESULTS Across 29 studies of 12,243 persons living with HIV/AIDS, treatment of depression and psychological distress improved antiretroviral adherence (p < 0.001). The odds of a person adhering were 83 % better if he/she was treated for depression. Greater improvements in adherence were found for samples with lower CD4 counts or more severe depression, for interventions specifically targeting depression (versus addressing mental health as a secondary objective), longer treatments, and observational studies. CONCLUSIONS These findings support the need for detection and treatment of depression among persons living with HIV/AIDS.
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21
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SZOMOLAY BARBARA, LUNGU EDWARDM. A MATHEMATICAL MODEL FOR THE TREATMENT OF AIDS-RELATED KAPOSI'S SARCOMA. J BIOL SYST 2014. [DOI: 10.1142/s0218339014500247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We formulate a mathematical model to study the dynamics of HIV-1 related Kaposi's Sarcoma (KS) pathogenesis. KS progression is modeled as a dual process involving the primary infection of B cells, which sustains HHV-8 replication and the secondary infection of progenitor cells by HHV-8, which sustains the KS cell replication. We incorporate the pharmacodynamics of highly active antiretroviral therapy (HAART), or combination therapy (HAART plus KS therapy) and consider how each treatment strategy alters the disease progression. Our results indicate that administration of HAART to individuals co-infected with the HIV-1 and HHV-8 viruses can greatly amplify the therapeutic response of low-dose KS therapies. We have found that adherence levels above 85% can significantly reduce the risk of KS and HIV for a treatment periods under 1 year. For longer treatment periods, however, at least 90% adherence level is recommended.
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Affiliation(s)
- BARBARA SZOMOLAY
- Department of Mathematics, University of Warwick, Coventry, CV4 7AL, UK
| | - EDWARD M. LUNGU
- Department of Mathematics, University of Botswana, P. Bag 00704, Gaborone, Botswana, Southern Africa
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22
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Kurth AE, Spielberg F, Cleland CM, Lambdin B, Bangsberg DR, Frick PA, Severynen AO, Clausen M, Norman RG, Lockhart D, Simoni JM, Holmes KK. Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial. J Acquir Immune Defic Syndr 2014; 65:611-20. [PMID: 24384803 PMCID: PMC3999203 DOI: 10.1097/qai.0000000000000100] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. DESIGN Longitudinal randomized controlled trial. SETTINGS An academic HIV clinic and a community-based organization in Seattle. SUBJECTS In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). INTERVENTION Randomization to computerized counseling or assessment only, 4 sessions over 9 months. MAIN OUTCOME MEASURES HIV-1 viral suppression, and self-reported ART adherence and transmission risks, compared using generalized estimating equations. RESULTS Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (>30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. CONCLUSIONS Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.
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Affiliation(s)
- Ann E Kurth
- *New York University College of Nursing, New York, NY; †School of Nursing, Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA; ‡Research Triangle Institute, San Francisco, CA; Departments of §Global Health; ‖Medicine, University of Washington, Seattle, WA; ¶Pangaea Global AIDS Foundation, Oakland, CA; #University of California, San Francisco, CA; **Harborview Medical Center, HIV-Specialty Clinic Affiliated With UW, Seattle, WA; and ††Department of Psychology, University of Washington, Seattle, WA
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Dawson Rose C, Webel A, Sullivan KM, Cuca YP, Wantland D, Johnson MO, Brion J, Portillo CJ, Corless IB, Voss J, Chen WT, Phillips JC, Tyer-Viola L, Rivero-Méndez M, Nicholas PK, Nokes K, Kemppainen J, Sefcik E, Eller LS, Iipinge S, Kirksey K, Chaiphibalsarisdi P, Davila N, Hamilton MJ, Hickey D, Maryland M, Reid P, Holzemer WL. Self-compassion and risk behavior among people living with HIV/AIDS. Res Nurs Health 2014; 37:98-106. [PMID: 24510757 PMCID: PMC4158433 DOI: 10.1002/nur.21587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 11/12/2022]
Abstract
Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.
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Affiliation(s)
- Carol Dawson Rose
- UCSF School of Nursing, Dept. of Community Health Systems, San Francisco, CA 94143-0608, T: (415) 713-5252, F: (415) 476-4076
| | - Allison Webel
- Case Western Reserve University, Bolten School of Nursing
| | | | | | - Dean Wantland
- Office of Research & Evaluation, Rutgers College of Nursing
| | | | - John Brion
- The Ohio State University College of Nursing
| | | | | | | | | | | | | | | | - Patrice K. Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and MGH Institute of Health Professions
| | | | | | | | | | | | - Kenn Kirksey
- Nursing Strategic Initiatives, Lyndon B. Johnson Hospital – Executive Administration, Harris Health System
| | | | | | | | - Dorothy Hickey
- Momentum AIDS Program & Assistant Adjunct Clinical Professor at New York City College of Technology
| | - Mary Maryland
- Chicago State University College of Health Sciences, Department of Nursing
| | - Paula Reid
- School of Nursing, The University of North Carolina at Wilmington
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Charania MR, Marshall KJ, Lyles CM, Crepaz N, Kay LS, Koenig LJ, Weidle PJ, Purcell DW. Identification of evidence-based interventions for promoting HIV medication adherence: findings from a systematic review of U.S.-based studies, 1996-2011. AIDS Behav 2014; 18:646-60. [PMID: 24043269 DOI: 10.1007/s10461-013-0594-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A systematic review was conducted to identify evidence-based interventions (EBIs) for increasing HIV medication adherence behavior or decreasing HIV viral load among persons living with HIV (PLWH). We conducted automated searches of electronic databases (i.e., MEDLINE, EMBASE, PsycINFO, CINAHL) and manual searches of journals, reference lists, and listservs. Interventions were eligible for the review if they were U.S.-based, published between 1996 and 2011, intended to improve HIV medication adherence behaviors of PLWH, evaluated the intervention using a comparison group, and reported outcome data on adherence behaviors or HIV viral load. Each intervention was evaluated on the quality of study design, implementation, analysis, and strength of findings. Of the 65 eligible interventions, 10 are EBIs. The remaining 55 interventions failed to meet the efficacy criteria primarily due to null findings, small sample sizes, or low retention rates. Research gaps and future directions for development of adherence EBIs are discussed.
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Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults. Int J Behav Med 2014; 22:139-48. [DOI: 10.1007/s12529-014-9404-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
INTRODUCTION Access to antiretroviral treatment (ART) has substantially improved over the past decade. In this new era of HIV as a chronic disease, the continued success of ART will depend critically on sustained high ART adherence. The objective of this review was to systematically review interventions that can improve adherence to ART, including individual-level interventions and changes to the structure of ART delivery, to inform the evidence base for the 2013 WHO consolidated antiretroviral guidelines. DESIGN A rapid systematic review. METHODS We conducted a rapid systematic review of the global evidence on interventions to improve adherence to ART, utilizing pre-existing systematic reviews to identify relevant research evidence complemented by screening of databases for articles published over the past 2 years on evidence from randomized controlled trials (RCTs). We searched five databases for both systematic reviews and primary RCT studies (Cochrane Library, EMBASE, MEDLINE, Web of Science, and WHO Global Health Library); we additionally searched ClinicalTrials.gov for RCT studies. We examined intervention effectiveness by different study characteristics, in particular, the specific populations who received the intervention. RESULTS A total of 124 studies met our selection criteria. Eighty-six studies were RCTs. More than 20 studies have tested the effectiveness of each of the following interventions, either singly or in combination with other interventions: cognitive-behavioural interventions, education, treatment supporters, directly observed therapy, and active adherence reminder devices (such as mobile phone text messages). Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some settings, each intervention has also been found not to produce significant effects in several studies. Almost half (55) of the 124 studies investigated the effectiveness of combination interventions. Combination interventions tended to have effects that were similar to those of single interventions. The evidence base on interventions in key populations was weak, with the exception of interventions for people who inject drugs. CONCLUSION Tested and effective adherence-enhancing interventions should be increasingly moved into implementation in routine programme and care settings, accompanied by rigorous evaluation of implementation impact and performance. Major evidence gaps on adherence-enhancing interventions remain, in particular, on the cost-effectiveness of interventions in different settings, long-term effectiveness, and effectiveness of interventions in specific populations, such as pregnant and breastfeeding women.
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How do we better translate adherence research into improvements in patient care? Int J Clin Pharm 2013; 36:10-4. [DOI: 10.1007/s11096-013-9869-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Parhami I, Fong TW, Siani A, Carlotti C, Khanlou H. Documentation of psychiatric disorders and related factors in a large sample population of HIV-positive patients in California. AIDS Behav 2013; 17:2792-801. [PMID: 23247363 DOI: 10.1007/s10461-012-0386-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This retrospective cohort study examined electronic medical records of HIV-positive patients in California (N = 7,834) to find the prevalence of any psychiatric condition and the associations between several factors and the likelihood of these disorders. Approximately 53 % of the patients in this study had a documented psychiatric condition, including 23 % who had a mood disorder, 19 % who had a substance-related disorder, and 16 % who had an anxiety disorder. After controlling for potential confounders, significant positive associations (p < 0.001) were found between female gender and the presence of any mood disorder (adjusted odds ratio [95 % confidence interval, 95 %CI] = 1.58 [1.26-1.99]) or anxiety disorder (AOR = 1.54 [1.18-2.02]) and between homosexual orientation and the presence of any psychiatric condition (AOR = 1.33 [1.15-1.55]), mood disorder (AOR = 1.71 [1.42-2.07]), or anxiety disorder (AOR = 1.41 [1.22-1.88]). There were also significant negative associations between African-American race and the presence of any psychiatric condition (AOR = 0.68 [0.60-0.77]), mood disorder (AOR = 0.74 [0.64-0.86]), anxiety disorder (AOR = 0.43 [0.36-0.52]), or substance-related disorder (AOR = 0.78 [0.67-0.91]) and between state/federal insurance and the presence of any psychiatric condition (AOR = 0.70 [0.62-0.79]), mood disorder (AOR = 0.71 [0.62-0.80]), or anxiety disorder (AOR = 0.77 [0.66-0.89]).
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Affiliation(s)
- Iman Parhami
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,
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The Complex Nature of Adherence in the Management of HIV/AIDS as a Chronic Medical Condition. Diseases 2013. [DOI: 10.3390/diseases1010018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wang N, Sun X, Yin L, Liu H, Ruan Y, Shao Y, Qian HZ, Vermund SH. Meta-Analysis of Interventions for Reducing Number of Sexual Partners and Drug and Alcohol Abuse among People Living with HIV/AIDS. JOURNAL OF AIDS & CLINICAL RESEARCH 2013; 4:14272. [PMID: 24224118 PMCID: PMC3819193 DOI: 10.4172/2155-6113.1000213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of the efficacy of risk reduction interventions on HIV-related risk behaviors among people living with HIV/AIDS (PLWHA). METHODS Studies included in the meta-analysis were randomized clinical trials (RCTs) of risk reduction interventions, which targeted PLWHA aged 18 year or older and assessed the changes of number of sexual partners, drug use, needle sharing, and/or alcohol abuse between pre- and post-intervention. The standardized mean differences (SMD) between study arms as well as between baseline and post-intervention, defined as the effect sizes (ES), were calculated in random effects models. Heterogeneity of studies was estimated by the I2 statistic. RESULTS Twelve RCTs involving 3993 PLWHA were included in our analysis: seven reported impacts on the number of sexual partners, and three reported impacts on drug use, needle sharing, and alcohol abuse, respectively. There were no statistically significant impacts of risk reduction interventions on the number of total sexual partners (mean ES, -0.10; 95% confidence interval [CI], -0.26, 0.06; P=0.22) or on the subset of HIV-negative or unknown-status sexual partners (mean ES, 0.003; 95% CI, -0.54, 0.54; P=0.99). Overall, risk reduction intervention studies documented a reduction of drug abuse (mean ES: -0.26; 95% CI: -0.51, -0.01; P=0.04) among HIV-infected drug users, but this impact was mainly attributable to one study. Risk reduction interventions did not show a reduction of needle sharing (mean ES, -0.15; 95% CI, -0.43, 0.13; P=0.29) or of alcohol abuse (mean ES, -0.10; 95% CI, -0.36, 0.17; P=0.47). No heterogeneity or publication bias was found across individual studies. CONCLUSIONS Our meta-analysis did not find a positive impacts of risk reduction interventions on number of sexual partners, drug use, needle sharing, or alcohol abuse among PLWHA, but the small number of studies meeting our review criteria limits these findings.
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Affiliation(s)
- Na Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyun Sun
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Yuhua Ruan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Parker L, Maman S, Pettifor A, Chalachala JL, Edmonds A, Golin CE, Moracco K, Behets F. Adaptation of a U.S. evidence-based Positive Prevention intervention for youth living with HIV/AIDS in Kinshasa, Democratic Republic of the Congo. EVALUATION AND PROGRAM PLANNING 2013; 36:124-35. [PMID: 23063699 PMCID: PMC3572542 DOI: 10.1016/j.evalprogplan.2012.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 07/31/2012] [Accepted: 09/09/2012] [Indexed: 05/24/2023]
Abstract
Effective HIV prevention programs for people living with HIV/AIDS (PLWH) are important to reduce new infections and to ensure PLWH remain healthy. This paper describes the systematic adaptation of a U.S.-developed Evidence Based Intervention (EBI) using the Centers for Disease Control and Prevention (CDC) Map of Adaption Process for use at a Pediatric Hospital in Kinshasa, Democratic Republic of the Congo (DRC). The adapted intervention, Supporting Youth and Motivating Positive Action or SYMPA, a six-session risk reduction intervention targeted for youth living with HIV/AIDS (YLWH) in Kinshasa was adapted from the Healthy Living Project and guided by the Social Action Theory. This paper describes the process of implementing the first four steps of the ADAPT framework (Assess, Select, Prepare, and Pilot). Our study has shown that an EBI developed and implemented in the U.S. can be adapted successfully for a different target population in a low-resource context through an iterative process following the CDC ADAPT framework. This process included reviewing existing literature, adapting and adding components, and focusing on increasing staff capacity. This paper provides a rare, detailed description of the adaptation process and may aid organizations seeking to adapt and implement HIV prevention EBIs in sub-Saharan Africa and beyond.
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Affiliation(s)
- L Parker
- Futures Group, Chapel Hill, North Carolina, USA.
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Arroyo MJH, Figueroa SEC, Correa RS, de la Paz Valverde Merino M, Gómez AI, Hurlé ADG, On behalf of the Tormes Team. Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study. Patient Prefer Adherence 2013; 7:729-39. [PMID: 23983457 PMCID: PMC3751466 DOI: 10.2147/ppa.s47519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antiretroviral treatments (ART) form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1) to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2) to detect possible correlations between different adherence evaluation measurements. METHODS A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR). The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR) in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February-May, 2005-2010). RESULTS A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01). Improvement was observed in the mean adherence level (P < 0.001), and there was a considerable decrease in the percentage of patients with CD4+ lymphocytes less than 200 cells/mm(3) (P < 0.001). A relationship was found between the number of patients with optimum adherence levels and the time that plasma viral load remained undetected. The number of interviews and interventions performed in each patient in the first 12 months from the onset of the pharmaceutical care program (month 6), was related to a significant increase in adherence during this same time period. CONCLUSION The results suggest that the establishment and permanence of a pharmaceutical care program may increase ART adherence, increase permanence time of the patient with undetectable plasma viral loads, and improve patients' lymphocyte count.
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Affiliation(s)
| | - Salvador Enrique Cabrera Figueroa
- Pharmacy Institute, University Austral of Chile, Valdivia, Chile
- Correspondence: Salvador Cabrera Figueroa, Servicio de Farmacia, Hospital Universitario de Salamanca, Paseo de San Vicente 58, 37007 Salamanca, Spain, Tel +34 923 291 172, Fax +34 923 291 174, email
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Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial. AIDS Behav 2013; 17:181-92. [PMID: 22527264 PMCID: PMC3548088 DOI: 10.1007/s10461-012-0175-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCT00716040.
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Giordano TP, Rodriguez S, Zhang H, Kallen MA, Jibaja-Weiss M, Buscher AL, Arya M, Suarez-Almazor ME, Ross M. Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection. AIDS Behav 2013; 17:104-12. [PMID: 22983536 DOI: 10.1007/s10461-012-0295-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan "Live the Solution: Take Your Pills Every Day." Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change -2.02 %, paired t test P = 0.39). Among the 39.7 % of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3 %, while it decreased in the other participants by 5.5 % (paired t test P = 0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence.
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Mental disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review. AIDS 2012; 26 Suppl 2:S117-35. [PMID: 23303434 DOI: 10.1097/qad.0b013e32835bde0f] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To conduct a systematic review of the literature to examine the interrelationship between mental health and treatment outcomes in low-income and middle-income settings; to update the work of Collins et al. (2006). DESIGN Systematic review of peer-reviewed articles that examined one of the following: the effects of mental disorders (including cognitive impairment) upon engagement with treatment and/or adherence; their influence upon HIV-related clinical outcomes; and the impact of interventions for mental disorder. METHODS Articles about mental health and HIV/AIDS were included if they were published after 2005 and addressed one of the areas of interest described above. Systematic methods were used for searching, screening, and data extraction. Studies employing quantitative measures of exposures and outcomes wherein all participants had a diagnosis of HIV/AIDS were included. RESULTS This review found ample and moderately consistent evidence that adverse mental health and alcohol consumption are associated with reduced adherence. Variation in measurement and the relative paucity of work meant that interpretation of studies examining engagement with care and other clinical outcomes was difficult. Evidence on the efficacy and effectiveness of mental health interventions in low-income and middle-income settings was very limited. CONCLUSION This review suggests that psychosocial factors, namely, depression and alcohol may have adverse effects upon HIV-related outcomes. However, further large, high-quality studies examining outcomes other than adherence are needed. There is also an urgent need for randomized controlled trials of interventions for mental disorder and a need to investigate their impact upon HIV-related outcomes.
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Kikuchi K, Poudel KC, Muganda J, Majyambere A, Otsuka K, Sato T, Mutabazi V, Nyonsenga SP, Muhayimpundu R, Jimba M, Yasuoka J. High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda. PLoS One 2012; 7:e41998. [PMID: 22860043 PMCID: PMC3408396 DOI: 10.1371/journal.pone.0041998] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/28/2012] [Indexed: 12/15/2022] Open
Abstract
Background To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child’s adherence. Methods A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children’s adherence rate was measured using a pill count method and those who took 85% or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Results Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3%, 44.9%, 46.7%, and 49.7%, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95% CI 0.12–0.80), paternal orphans (AOR 0.35, 95% CI 0.14–0.89), and non-orphans (AOR 0.45, 95% CI 0.21–0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Conclusions Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child’s adherence to ART.
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Affiliation(s)
- Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Krishna C. Poudel
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - John Muganda
- Division of Obstetrics and Gynecology, King Faisal Hospital, Kigali, Rwanda
| | - Adolphe Majyambere
- HIV/AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Keiko Otsuka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Sato
- Department of Psychology, The Meiji Gakuin University, Tokyo, Japan
| | - Vincent Mutabazi
- HIV/AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Simon Pierre Nyonsenga
- HIV/AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Ribakare Muhayimpundu
- HIV/AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
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Informing the dosing of interventions in randomized trials. Contemp Clin Trials 2012; 33:1225-30. [PMID: 22841930 DOI: 10.1016/j.cct.2012.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 06/26/2012] [Accepted: 07/14/2012] [Indexed: 11/21/2022]
Abstract
Dosing is potentially the most important decision that must be made when building or refining behavioral interventions. In this paper, we propose standardized terminology and reporting of dosing information, which would inform intervention development, refinement for dissemination, and systematic reviews of dose-response relationships. Dosing of interventions may be characterized by duration, frequency, and amount. To illustrate the value of operationalizing these three parameters to evaluate dose-response relationships, 31 published reports of behavioral interventions to increase adherence to antiretroviral therapy (ART) were reviewed. The ART literature was characterized by under-reporting of dosing parameters, heterogeneity in dosing schedules, and heterogeneity in type of control group, which complicate analysis of dose-response relationships in systematic review and determination of the optimal dose for intervention dissemination. Improved reporting of the three dosing parameters and comparison of intended to actual delivery can inform the identification of the most effective intervention doses and the efficient implementation of efficacious interventions in clinical practice.
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Lorimer K, Kidd L, Lawrence M, McPherson K, Cayless S, Cornish F. Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men. AIDS Care 2012; 25:133-50. [DOI: 10.1080/09540121.2012.699672] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Karen Lorimer
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Lisa Kidd
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Maggie Lawrence
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Kerri McPherson
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Sandi Cayless
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Flora Cornish
- a School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
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Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, Orrell C, Altice FL, Bangsberg DR, Bartlett JG, Beckwith CG, Dowshen N, Gordon CM, Horn T, Kumar P, Scott JD, Stirratt MJ, Remien RH, Simoni JM, Nachega JB. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med 2012; 156:817-33, W-284, W-285, W-286, W-287, W-288, W-289, W-290, W-291, W-292, W-293, W-294. [PMID: 22393036 PMCID: PMC4044043 DOI: 10.7326/0003-4819-156-11-201206050-00419] [Citation(s) in RCA: 481] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
DESCRIPTION After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). Adherence to ART is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. METHODS A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. RECOMMENDATIONS Recommendations are provided for monitoring entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.
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Leeman J, Chang Y, Voils CI, Crandell JL, Sandelowski M. A mixed-methods approach to synthesizing evidence on mediators of intervention effects. West J Nurs Res 2011; 33:870-900. [PMID: 21415244 PMCID: PMC3155731 DOI: 10.1177/0193945911402365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Greater understanding of the mechanisms (mediators) by which behavioral-change interventions work is critical to developing theory and refining interventions. Although systematic reviews have been advocated as a method for exploring mediators, this is rarely done. One challenge is that intervention researchers typically test only two paths of the mediational model: the effect of the intervention on mediators and on outcomes. The authors addressed this challenge by drawing information not only from intervention studies but also from observational studies that provide data on associations between potential mediators and outcomes. They also reviewed qualitative studies of participants' perceptions of why and how interventions worked. Using data from intervention (n = 37) and quantitative observational studies (n = 55), the authors conducted a meta-analysis of the mediation effects of eight variables. Qualitative findings (n = 6) contributed to more in-depth explanations for findings. The methods used have potential to contribute to understanding of core mechanisms of behavioral-change interventions.
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Carvalho FT, Gonçalves TR, Faria ER, Shoveller JA, Piccinini CA, Ramos MC, Medeiros LRF, Cochrane HIV/AIDS Group. Behavioral interventions to promote condom use among women living with HIV. Cochrane Database Syst Rev 2011; 2011:CD007844. [PMID: 21901711 PMCID: PMC11366414 DOI: 10.1002/14651858.cd007844.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND High rates of HIV infection among women of reproductive age have dramatic consequences for personal and public health. Prophylaxis during sexual intercourse in the form of condoms has been the most effective way to prevent both STI and HIV transmission among people living with HIV. OBJECTIVES To investigate the effectiveness of behavioral interventions in promoting condom use among women living with HIV. SEARCH STRATEGY We conducted a comprehensive literature search in several scientific databases, clinical trials databases, conference proceedings, and conference websites to identify studies produced between 1980 and May 2010 that met our selection criteria. SELECTION CRITERIA Studies were included in the analysis if they conducted a randomized controlled trial that examined the effects of behavioral interventions on condom use among HIV-positive women; considered at least one HIV-related behavioral outcome (e.g., reported protected anal, vaginal, or oral sex) or biological outcome (e.g., acquisition of STIs); and one follow-up assessment three months or more after the intervention. Studies were assessed irregardless of langauge or publication status. DATA COLLECTION AND ANALYSIS We used random effects models to summarize odds ratios (ORs) that compared intervention and control groups with respect to a dichotomous outcome (consistent versus inconsistent condom use). We used funnel plots to examine publication bias and a χ(2) statistic to test for heterogeneity. The methodological and evidence quality was evaluated through risk of bias criteria and the GRADE system, respectively. MAIN RESULTS Five primary studies that collectively researched a total of 725 women living with HIV were analysed. When compared to standard care or minimal HIV support intervention, meta-analysis showed that behavioral interventions had no effect on increasing condom use among HIV-positive women. This finding was consistent at various follow-up meetings (3, 6, and 12-months) as well as over the entire 12-month follow-up period (OR= 0.82; 95% CI 0.65-1.04; p=0.11). Only one study presented adequate data to analyze the relationship between behavioral interventions and STI incidence. Studies included in this analysis demonstrated low risk of bias based on the risk of bias criteria. However, sample size was considered inadequate across all studies. AUTHORS' CONCLUSIONS Meta-analysis shows that behavioral interventions have little effect on increasing condom use among HIV-positive women. However, these findings should be used with caution since results were based on a few small trials that were targeted specifically towards HIV-positive women. To decrease sexual transmission of HIV among this population, we recommend interventions that combine condom promotion, family planning provision and counselling, and efforts to reduce viral loads among HIV-positive women and their partners (e.g., HAART treatment provision). New research is needed to address the needs of HIV-positive women, including an assessment of the impact of interventions that combine safer sexual behavior and harm reduction approaches.
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Affiliation(s)
- Fernanda T Carvalho
- Centro de Estudos de Aids / DST do Rio Grande do Sul (CEARGS)Rua Demétrio Ribeiro, 55/04CentroPorto AlegreRSBrazilCEP 90.010‐312
| | - Tonantzin R Gonçalves
- Universidade Federal do Rio Grande do SulPost‐graduation program in PsychologyPorto AlegreRio Grande do SulBrazil
| | | | - Jean A Shoveller
- University of British Columbia5804 Fairview AvenueVancouverBCCanadaV6T 1Z3
| | - C A Piccinini
- Universidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Mauro C Ramos
- Centro de Estudos de Aids / DST do Rio Grande do Sul (CEARGS)Rua Demétrio Ribeiro, 55/04CentroPorto AlegreRSBrazilCEP 90.010‐312
| | - Lídia RF Medeiros
- Post‐graduation Program in Medical Sciences, Universidade Federal do Rio Grande do SulSocial Medicine/EpidemiologyJose de Alencar 1244, 1009 Menino DeusPorto AlegreRio Grande do SulBrazil90880‐480
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Mirandola P, Gobbi G, Micheloni C, Vaccarezza M, Di Marcantonio D, Ruscitti F, de Panfilis G, Vitale M. Hydrogen sulfide inhibits IL-8 expression in human keratinocytes via MAP kinase signaling. J Transl Med 2011; 91:1188-94. [PMID: 21555999 DOI: 10.1038/labinvest.2011.76] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sulfur is able to penetrate the skin, and a sulfur-rich balneotherapy has been suggested to be effective in the treatment of psoriasis. Psoriasis is now considered a genetically programmed, immune-mediated, inflammatory disease, in which intralesional T lymphocytes trigger keratinocytes to proliferate and perpetuate the disease process. Interleukin (IL)-17 and IL-22 produced by Th1/Th17 lymphocytes induce IL-8 secretion by keratinocytes, a key event in the pathogenesis of the disease. It is now clear that mitogen-activated protein kinase (MAPK) (extracellular signal-regulated kinases (ERK) 1 and 2) activity is required for IL-17-induced IL-8 synthesis by keratinocytes, and, in fact, MAPK activity is increased in lesional psoriatic skin. Here, we demonstrate both in vitro and in vivo on primary psoriatic lesions that pharmacological inhibitors of ERKs as well as hydrogen sulfide not only reduce the basal expression and secretion of IL-8, but also interfere with IL-17- and IL-22-induced IL-8 production. These observations, together with the known anti-inflammatory activity of H₂S, are relevant to understanding some previously unexplained biological effects exerted by sulfur therapy.
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Affiliation(s)
- Prisco Mirandola
- Department of Anatomy, Pharmacology and Forensic Medicine, University of Parma, Parma, Italy
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Wilkerson JM, Smolenski DJ, Morgan R, Rosser BRS. Sexual agreement classifications for gay and bisexual men and implications for harm reduction HIV prevention. HEALTH EDUCATION & BEHAVIOR 2011; 39:303-14. [PMID: 21765058 DOI: 10.1177/1090198111413917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV prevention educators frequently encourage gay and bisexual men (GBM) to negotiate condom use prior to sexual engagement. Identifying groups of GBM based on their presexual agreements can aid efforts to tailor interventions. Using cross-sectional data from 1,188 GBM who reported having sex with a nonprimary sex partner in the 90 days prior to the survey, the authors identified presexual agreement patterns. For both HIV-positive and HIV-negative GBM, two groups existed: men agreeing to no anal sex and men agreeing to anal sex with condoms. Among HIV-negative participants, there was a group agreeing to anal sex without specifying condom use. Among HIV-positive participants, there was a group agreeing to anal sex without condoms; this was the largest group of HIV-positive participants. Despite a presexual agreement to use condoms, substance use during sex increased the risk of unprotected anal sex. Suggestions for applying harm reduction to HIV prevention based on agreement classifications are discussed.
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People with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress. AIDS Behav 2011; 15:767-77. [PMID: 20803063 DOI: 10.1007/s10461-010-9793-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Russia has seen one of the world's fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 58% of participants had partners of HIV-negative or unknown serostatus (mean = 5.8). About 52% reported unprotected intercourse with such partners, with 30% of acts unprotected. Greater perceived discrimination predicted lower condom use. A 47% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. Twenty-five percentage of PLH had been refused general health care, 11% refused employment, 7% fired, and 6% forced from family homes. Thirty-nine percentage of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. Of the 54% of PLH who were offered HAART, 16% refused HAART regimens, and 5% of those on the therapy took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
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Webel AR, Okonsky J. Psychometric properties of a Symptom Management Self-Efficacy Scale for women living with HIV/AIDS. J Pain Symptom Manage 2011; 41:549-57. [PMID: 21145198 PMCID: PMC3062714 DOI: 10.1016/j.jpainsymman.2010.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 05/27/2010] [Accepted: 05/28/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Many people with HIV/AIDS find it difficult to manage the symptoms of the disease, but by adopting effective symptom management behavior, they increase the potential of alleviating the burden of those symptoms. Self-efficacy is a recognized mediator of successful behavior change and is used by many researchers and clinicians when developing symptom management interventions. Despite this, an instrument measuring the self-efficacy of symptom management behavior specifically for people living with HIV/AIDS has not yet been made available. OBJECTIVES To introduce and test the psychometric properties of the HIV Symptom Management Self-Efficacy for Women Scale (HSM-SEWS) for women with HIV/AIDS. This scale, a new nine-item measurement instrument, was modified from the Chronic Disease Self-Efficacy Scale. METHODS In this study, psychometric testing focused on the reliability and validity of the HSM-SEWS instrument. Reliability was assessed using Cronbach's alpha. Exploratory factor analysis with oblique promax rotation was used to examine validity and test hypothetical associations. RESULTS Eighty-nine HIV-positive women were recruited and asked to complete the scale every four weeks for a total of 16 weeks. Factor analysis supported a one-factor solution explaining 93% of the variance among items. Internal consistency of the nine items was found to range from 0.83 to 0.93, with an overall Cronbach's alpha of 0.92. CONCLUSION Psychometric analyses suggest that the HSM-SEWS is a reliable and valid instrument that measures the self-efficacy of symptom management behavior in women with HIV/AIDS and can be used during interventions and in studies targeting this area of health care research.
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA.
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Johnson MO, Dilworth SE, Taylor JM, Neilands TB. Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV. Ann Behav Med 2011; 41:83-91. [PMID: 20922510 PMCID: PMC3030747 DOI: 10.1007/s12160-010-9230-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality. PURPOSE To examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence. METHODS HIV+ men and women (N = 249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment. RESULTS Intent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects. CONCLUSIONS Interventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.
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Affiliation(s)
- Mallory O Johnson
- Center for AIDS Prevention Studies, University of California San Francisco, 94105, USA.
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Kalichman SC, Cherry C, Kalichman MO, Amaral CM, White D, Pope H, Swetzes C, Eaton L, Macy R, Cain D. Integrated behavioral intervention to improve HIV/AIDS treatment adherence and reduce HIV transmission. Am J Public Health 2011; 101:531-8. [PMID: 21233431 DOI: 10.2105/ajph.2010.197608] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a randomized clinical trial to test an integrated behavioral intervention designed to enhance using HIV treatment as prevention by improving medication adherence, reducing risks for other sexually transmitted infections, and minimizing risk compensation beliefs. METHODS Individuals living with HIV/AIDS (n = 436) participated in a randomized clinical trial testing an intensive behavioral intervention aimed at reducing HIV transmission risks compared with an attention control condition. We used unannounced pill counts to monitor antiretroviral therapy adherence and computerized interviews to measure risk behaviors. RESULTS The integrated transmission risk reduction intervention demonstrated increased antiretroviral therapy adherence and less unprotected intercourse with nonseroconcordant partners at 3- and 6-month follow-ups as well as fewer new sexually transmitted infections diagnosed over the 9-month follow-up period (adjusted odds ratio = 3.0; P < .05; 95% confidence interval = 1.01, 9.04). The integrated intervention also reduced behavioral risk compensation beliefs. CONCLUSIONS A theory-based integrated behavioral intervention can improve HIV treatment adherence and reduce HIV transmission risks. HIV treatment as prevention should be bundled with behavioral interventions to maximize effectiveness.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT 06269, USA.
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Rose CD, Courtenay-Quirk C, Knight K, Shade SB, Vittinghoff E, Gomez C, Lum PJ, Bacon O, Colfax G. HIV intervention for providers study: a randomized controlled trial of a clinician-delivered HIV risk-reduction intervention for HIV-positive people. J Acquir Immune Defic Syndr 2010; 55:572-81. [PMID: 20827218 DOI: 10.1097/qai.0b013e3181ee4c62] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinician-delivered prevention interventions offer an opportunity to integrate risk-reduction counseling as a routine part of medical care. The HIV Intervention for Providers study, a randomized controlled trial, developed and tested a medical provider HIV prevention training intervention in 4 northern California HIV care clinics. Providers were assigned to either the intervention or control condition (usual care). The intervention arm received a 4-hour training on assessing sexual risk behavior with HIV-positive patients and delivering risk-reduction-oriented prevention messages to patients who reported risk behaviors with HIV-uninfected or unknown-status partners. To compare the efficacy of the intervention versus control on transmission risk behavior, 386 patients of the randomized providers were enrolled. Over six-months of follow-up, patients whose providers were assigned the intervention reported a relative increase in provider-patient discussions of safer sex (OR = 1.49; 95% CI = 1.06 to 2.09), assessment of sexual activity (OR = 1.60; 95% CI = 1.05 to 2.45), and a significant decrease in the number of sexual partners (OR = 0.49, 95% CI = 0.26 to 0.92). These findings show that a brief intervention to train HIV providers to identify risk and provide a prevention message results in increased prevention conversations and significantly reduced the mean number of sexual partners reported by HIV-positive patients.
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Affiliation(s)
- Carol Dawson Rose
- UCSF, Center for AIDS Prevention Studies, School of Nursing, CA 94105, USA.
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Leeman J, Chang YK, Lee EJ, Voils CI, Crandell J, Sandelowski M. Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence. J Adv Nurs 2010; 66:1915-30. [PMID: 20707822 PMCID: PMC2923750 DOI: 10.1111/j.1365-2648.2010.05360.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy. BACKGROUND Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings. DATA SOURCES Sixty-one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty-two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity. REVIEW METHODS An adaptation of Pawson's realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed. RESULTS The final explanatory model suggests that individuals with HIV will be more likely to enroll in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one-to-one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand-alone interventions. CONCLUSION The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, USA.
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Abstract
OBJECTIVE To test the impact of participation in a peer-based intervention for symptom management for women living with HIV infection on selected outcome measures including, symptom intensity, medication adherence, viral control, and quality of life. DESIGN Randomized clinical trial. METHODS Participants were recruited using a convenient, consecutive sampling method. Those participants randomized to the experimental condition attended seven, peer-led sessions over seven weeks. Participants randomized to the control condition received a copy of HIV Symptom Management Strategies: A Manual for People Living with HIV/AIDS. Participants completed four surveys assessing change over time in the aforementioned outcome variables. RESULTS Eighty-nine HIV-infected women followed over 14 weeks and there were no differences between the two groups on baseline demographic variables. Mixed-effects regression indicated no significant difference between groups across time in total symptom intensity score and medication adherence. There was a significant difference between groups across time for two of the nine quality of life scales - HIV Mastery (chi(2)=25.08; p<0.005) and Disclosure Worries (chi(2)=24.67; p<0.005). CONCLUSIONS In urban-dwelling women living with HIV/AIDS, results suggest that a peer-based symptom management intervention may not decrease symptom intensity or increase medication adherence. There is positive evidence that suggests that the intervention may increase some important aspects of quality of life. However, further research is warranted to elucidate the effect of peer-based interventions in achieving positive self-management outcomes.
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