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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Deaterly C, Richards V, Weaver M, Villalba K, Varma D, Payton I, Cook R. Associations of Intimate Partner Violence and Drug Use on Viral Suppression Among Women Living With HIV in South Florida: A Secondary Analysis. J Assoc Nurses AIDS Care 2024; 35:00001782-990000000-00085. [PMID: 38417080 DOI: 10.1097/jnc.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
ABSTRACT Suboptimal viral suppression is associated with worse outcomes and increased HIV transmission among women with HIV (WWH). Based on syndemic theory, we hypothesized that women exposed to recent intimate partner violence (IPV) and current drug use would be most likely to have suboptimal HIV viral suppression. We analyzed baseline data from a longitudinal clinical trial (WHAT-IF? Will Having Alcohol Treatment Improve My Functioning?) that enrolled WWH from Miami, FL, who reported heavy drinking. Bivariate logistic regression was done, mean age was 48 years ( n = 194; SD : 8.7), 40% had current drug use (other than alcohol), and 14% reported recent IPV. WWH who reported both IPV and drug use had the highest rate of suboptimal viral suppression (45%), but these differences were not statistically significant. The high rates of suboptimal viral suppression, drug use, and IPV suggest a need to include screening for IPV in clinical guidelines related to HIV care in women.
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Affiliation(s)
- Caroline Deaterly
- Caroline Deaterly, PhD, BSN, RN, is a Postdoctoral Student, University of Alabama at Birmingham, Birmingham, Alabama, USA. Veronica Richards, PhD, MPH, is a Postdoctoral Fellow, Pennsylvania State University, University Park, Pennsylvania, USA. Michael Weaver, PhD, RN, FAAN, is a Professor, University of Florida College of Nursing, Gainesville, Florida, USA. Karina Villalba, PhD, MPH, is an Assistant Professor, University of Central Florida College of Medicine, Orlando, Florida, USA. Deepthi Varma, PhD, MSW, MPhil, is an Assistant Professor, University of Florida Department of Epidemiology, Gainesville, Florida, USA. Isaac Payton, MSN, MBA, APRN, PMHNP-BC, is a PhD Student at the University of Florida College of Nursing, and is a Pre-doctoral Student, Southern HIV and Alcohol Research Consortium, Gainesville, Florida, USA. Robert Cook, MD, MPH, is a Professor, University of Florida Department of Epidemiology, Gainesville, Florida, USA
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Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
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Parisi CE, Gracy HR, Bush NJ, Cook RL, Wang Y, Chichetto N. Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone? ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1917-1925. [PMID: 37864537 PMCID: PMC10662960 DOI: 10.1111/acer.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Many women living with HIV (WLWH) experience pain. Alcohol use with the intent to treat pain could lead to hazardous drinking and difficulty in reducing drinking. Naltrexone acts on opioid receptors important for pain regulation and is an approved treatment for alcohol use disorder. In this secondary analysis of a randomized double-blind placebo-controlled naltrexone clinical trial, the goals were to (1) compare alcohol reduction between women who drank to treat pain and those who did not and (2) examine differences in alcohol reduction by both drinking intention and treatment arm. METHODS Women living with HIV (N = 194, mean age 48.3 years, 83% non-Hispanic Black, 11% Hispanic) with hazardous drinking (>7 drinks/week) were randomized to receive daily treatment with naltrexone 50 mg or placebo for 4 months. Study visits occurred at baseline and 2, 4, and 7 months (posttreatment). The number of drinks/week was measured using the Timeline Follow Back. Use of alcohol to treat pain was self-reported. Participants were categorized as using alcohol to treat pain or not and in the naltrexone or placebo group. Chi-square, t-test, MANOVA, and sequential mixed effects models were used to determine group differences in demographic factors, mean/drinks per week, and percent change in mean drinks/week at baseline and each follow-up visit. RESULTS There was a consistent decrease in drinking throughout the study. There was not a significant difference in mean drinks/week at any point in the study between women who used alcohol to treat pain and those who did not. When considering treatment arm, at 2 months only those who did not use alcohol to treat pain in the naltrexone group had a significantly lower mean drinks/week than the other groups (p = 0.007); all groups had similar decreases in drinking from 4 months onward. CONCLUSION In the naltrexone group, WLWH who drank to treat pain reduced their alcohol consumption more slowly than WLWH who did not drink to treat pain. Replication of these findings would suggest that alcohol treatment guidelines should address pain as a factor in drinking outcomes.
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Affiliation(s)
- Christina E. Parisi
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Hannah R. Gracy
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Nicholas J. Bush
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Natalie Chichetto
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Sterling SA, Chi FW, Palzes VA, Luu MN, Flamm JA, Hare CB, Williams EC, Bryant KJ, Weisner CM, Silverberg MJ, Satre DD. Characterizing Unhealthy Alcohol Use Patterns and Their Association with Alcohol Use Reduction and Alcohol Use Disorder During Follow-Up in HIV Care. AIDS Behav 2023; 27:1380-1391. [PMID: 36169779 PMCID: PMC10043049 DOI: 10.1007/s10461-022-03873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Outcomes of PWH with unhealthy alcohol use, such as alcohol use reduction or progression to AUD, are not well-known and may differ by baseline patterns of unhealthy alcohol use. Among 1299 PWH screening positive for NIAAA-defined unhealthy alcohol use in Kaiser Permanente Northern California, 2013-2017, we compared 2-year probabilities of reduction to low-risk/no alcohol use and rates of new AUD diagnoses by baseline use patterns, categorized as exceeding: only daily limits (72% of included PWH), only weekly limits (17%), or both (11%), based on NIAAA recommendations. Overall, 73.2% (95% CI 70.5-75.9%) of re-screened PWH reduced to low-risk/no alcohol use over 2 years, and there were 3.1 (95% CI 2.5-3.8%) new AUD diagnoses per 100 person-years. Compared with PWH only exceeding daily limits at baseline, those only exceeding weekly limits and those exceeding both limits were less likely to reduce and likelier to be diagnosed with AUD during follow-up. PWH exceeding weekly drinking limits, with or without exceeding daily limits, may have a potential need for targeted interventions to address unhealthy alcohol use.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd., CB #7030, Chapel Hill, NC, 27599, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mitchell N Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, USA
| | - C Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Emily C Williams
- Center of Innovation for Veteran Centered and Value-Driven Care, Veterans Affairs Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Santos GM, Ikeda J, Coffin P, Walker J, Matheson T, Ali A, McLaughlin M, Jain J, Arenander J, Vittinghoff E, Batki S. Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men: A Randomized Trial. Am J Psychiatry 2022; 179:915-926. [PMID: 36285404 PMCID: PMC10072332 DOI: 10.1176/appi.ajp.20220335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine the efficacy of targeted naltrexone in sexual and gender minority men (SGM) who binge drink and have mild to moderate alcohol use disorder. METHODS In a double-blind placebo-controlled trial, a total of 120 SGM who binge drink and have mild to moderate alcohol use disorder were randomized in a 1:1 ratio to receive targeted oral naltrexone (50 mg) or placebo with weekly counseling for 12 weeks. The study's primary endpoints were binge-drinking intensity, defined as 1) number of drinks in the past 30 days; 2) any binge drinking in the past week; 3) number of binge-drinking days in the past week; and 4) number of drinking days in the past week. The study also measured changes in alcohol use with two alcohol biomarker measures: ethyl glucuronide in urine samples and phosphatidylethanol (PEth) in dried blood spot samples. RESULTS Ninety-three percent completed the trial, with 85% of weekly follow-up visits completed. In intention-to-treat analyses, naltrexone was associated with a significantly reduced reported number of binge-drinking days (incidence rate ratio [IRR]=0.74, 95% CI=0.56, 0.98; number needed to treat [NNT]=2), weeks with any binge drinking (IRR=0.83, 95% CI=0.72, 0.96; NNT=7.4), number of drinks per month (IRR=0.69, 95% CI=0.52, 0.91; NNT=5.7 for 10 drinks), and alcohol craving scores (coefficient=-9.25, 95% CI=-17.20, -1.31). In as-treated analyses among those who took their medication on average at least 2.5 days per week (the median frequency in the study), naltrexone reduced any binge drinking (IRR=0.84, 95% CI=0.71, 0.99), number of binge-drinking days (IRR=0.67, 95% CI=0.47, 0.96), and PEth concentrations (coefficient=-55.47, 95% CI=-110.75, -0.20). At 6 months posttreatment, naltrexone had sustained effects in number of drinks per month (IRR=0.69, 95% CI=0.50, 0.97), number of binge-drinking days (IRR=0.67, 95% CI=0.47, 0.95), and any binge drinking in the past week (IRR=0.79, 95% CI=0.63, 0.99). CONCLUSIONS Targeted naltrexone significantly reduced drinking outcomes among SGM with mild to moderate alcohol use disorder during treatment, with sustained effects at 6 months posttreatment. Naltrexone may be an important pharmacotherapy to address binge drinking in populations with mild to moderate alcohol use disorder.
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Affiliation(s)
- Glenn-Milo Santos
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Janet Ikeda
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Phillip Coffin
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - John Walker
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Tim Matheson
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Arsheen Ali
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Matthew McLaughlin
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Jennifer Jain
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Justine Arenander
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Eric Vittinghoff
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
| | - Steven Batki
- Department of Community Health Systems (Santos, Jain), Division of HIV, Infectious Disease, and Global Medicine (Coffin), Department of Psychiatry and Behavioral Sciences (Jain, Batki), and Department of Epidemiology and Biostatistics (Vittinghoff), University of California, San Francisco; Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco (Santos, Ikeda, Coffin, Walker, Matheson, Ali, McLaughlin); Human Services Department, County of Sonoma, Sonoma, California (Arenander); San Francisco VA Health Care System, San Francisco (Batki)
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Richards VL, Leeman RF, Wang Y, Cook C, Prins C, Ennis N, Spencer EC, Cook RL. Identifying the best measures of alcohol consumption to predict future HIV viral suppression trajectories. AIDS Behav 2022; 26:3242-3253. [PMID: 35380289 PMCID: PMC9474662 DOI: 10.1007/s10461-022-03674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
Alcohol use is associated with poor outcomes among people living with HIV (PLWH), but it remains unclear which alcohol use measures best predict future HIV viral non-suppression over time. This study aimed to compare the ability of five alcohol use measures to predict risk of suboptimal HIV viral load trajectories over 36 months. We analyzed data from a cohort of PLWH in Florida including survey data linked to the state HIV surveillance system on prospective HIV viral loads over 36 months (n = 783; 66% male; 55% Black; Mage=46, SD = 11). Four trajectory patterns for HIV viral load were identified: consistently low (65.1%), decreasing (15.9%), increasing (10.6%), and consistently high (8.4%). Past year alcohol use frequency (OR = 2.1, CI:1.0-4.4), drinks consumed on a typical drinking day (OR = 2.2, CI:1.2-4.1), frequency of binge drinking (OR = 2.6, CI:1.3-5.2), and alcohol-related problems score (OR = 1.7, CI:1.1-2.7) were the measures predictive of the risk of future viral non-suppression above specific thresholds.
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Affiliation(s)
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Cindy Prins
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Gordon KS, Becker WC, Bryant KJ, Crystal S, Maisto SA, Marshall BDL, McInnes DK, Satre DD, Williams EC, Edelman EJ, Justice AC. Patient-Reported Bothersome Symptoms Attributed to Alcohol Use Among People With and Without HIV. AIDS Behav 2022; 26:3589-3596. [PMID: 35553287 PMCID: PMC10084471 DOI: 10.1007/s10461-022-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Analyses were restricted to current alcohol users (AUDIT-C > 0). We applied generalized estimating equations. The outcome was having any Symptoms Attributed to Alcohol use (SxAA). Primary independent variables were each of the 20 symptoms and HIV status. Compared to PWoH, PWH had increased odds of SxAA (OR 1.54; 95% CI 1.27, 1.88). Increased AUDIT-C score was also associated with SxAA (OR 1.32; 95% CI 1.28, 1.36), as were trouble remembering, anxiety, and weight loss/wasting. Evidence that specific symptoms are attributed to alcohol use may help motive people with and without HIV decrease their alcohol use.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - William C Becker
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Stephen Crystal
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Stephen A Maisto
- Syracuse University College of Arts and Sciences, Syracuse, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - D Keith McInnes
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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9
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Canidate SS, Schrimshaw EW, Schaefer N, Gebru NM, Powers N, Maisto S, Parisi C, Leeman RF, Fields S, Cook RL. The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South? AIDS Behav 2021; 25:302-313. [PMID: 34741688 PMCID: PMC8610946 DOI: 10.1007/s10461-021-03479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.-particularly in the southern U.S.-despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population's unique risks and needs to inform the development of tailored interventions.
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Affiliation(s)
- Shantrel S Canidate
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA.
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Nancy Schaefer
- UF Health Science Center Libraries, University of Florida, Gainesville, FL, 32610, USA
| | - Nioud Mulugeta Gebru
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
| | - Noelani Powers
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Stephen Maisto
- Department of Psychiatry, College of Arts and Sciences, Syracuse University, Syracuse, NY, 13244, USA
| | - Christina Parisi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Sheldon Fields
- College of Nursing, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
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10
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Wechsberg WM, Browne FA, Bonner CP, Washio Y, Howard BN, van der Drift I. Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters. Curr HIV/AIDS Rep 2021; 18:351-364. [PMID: 34110591 PMCID: PMC8190977 DOI: 10.1007/s11904-021-00558-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH examines how these studies considered gender in the samples, design, and analyses. RECENT FINDINGS Three searches were conducted initially, and 13 intervention studies fit our criteria with alcohol outcomes. In general, most studies did not consider gender and had used small samples, and few demonstrated significant efficacy/effectiveness outcomes. Five studies considered gender in their samples or analyses and/or were woman-focused with larger samples and demonstrated significant outcomes. It is essential for women who misuse alcohol to not only be well represented in alcohol and HIV research but also for studies to consider the barriers to reaching them and their contextual demands and/or co-occurring issues that may affect participation and outcomes in intervention research.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Department of Psychology, North Carolina State University, Raleigh, NC, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yukiko Washio
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Brittni N Howard
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Isa van der Drift
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
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11
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Fisk RJ, Richards VL, Leeman RF, Brumback B, Cook C, Cook RL. Negative Consequences of Alcohol Use among People Living with HIV. Subst Use Misuse 2021; 56:871-878. [PMID: 33769201 PMCID: PMC8988930 DOI: 10.1080/10826084.2021.1899232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Among people living with HIV (PLWH), alcohol use can have negative impacts beyond HIV-related outcomes. The objectives of this study are to identify the most common alcohol-related consequences among PLWH in Florida and describe factors associated with experiencing more alcohol-related consequences. Methods: Data were collected from PLWH in the Florida Cohort study who drank at least monthly in the past year (n=397). Self-reported consequences were assessed by the 15-item Short Inventory of Problems Revised (SIP-2R). Nonparametric tests and a generalized estimating equation model with inverse probability of exposure weighting were used to evaluate associations between the total SIP-2R score and socio-demographics, mental health, and substance use while controlling for alcohol use. Results: Over half (56%) endorsed at least one consequence and 29% endorsed 5 or more consequences. The most common consequences were doing something they regretted and taking foolish risks (both endorsed by 37% of participants), both in the impulse control domain. After controlling for alcohol use and other covariates, homelessness and injection drug use remained significantly associated with greater SIP-2R scores. Conclusion: PLWH who are experiencing homelessness or injecting drugs could benefit from receiving additional screening for alcohol-related consequences if they report any alcohol use.
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Affiliation(s)
- Rebecca J Fisk
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | | | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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12
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
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13
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Richards VL, Sajdeya R, Villalba K, Wang Y, Bryant V, Brumback B, Bryant K, Hahn JA, Cook RL. Secondary Analysis of a Randomized Clinical Trial of Naltrexone Among Women Living With HIV: Correlations Between Reductions in Self-Reported Alcohol Use and Changes in Phosphatidylethanol. Alcohol Clin Exp Res 2020; 45:174-180. [PMID: 33190242 DOI: 10.1111/acer.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Direct biomarkers such as phosphatidylethanol (PEth) have the capability to detect heavy alcohol use, but it is unclear how strongly self-reported reduction in alcohol use correlates with reduction in PEth. We sought to explore the strength of correlation between reductions in self-reported alcohol use and change in PEth among a sample of women living with HIV (WLWH) who participated in a clinical trial to reduce heavy alcohol use. We also sought to determine whether this correlation was stronger in women with lower body mass index (BMI) and women without an alcohol use disorder (AUD). METHODS 81 WLWH (mean age = 48.7, 80% Black) engaging in a randomized trial of naltrexone versus placebo with a positive baseline PEth (≥8 ng/ml), and alcohol use data at baseline, 2, and 7 months were included in this analysis. Spearman correlation coefficients were compared to measure the correlation between baseline PEth and number of drinks per week by demographic, biological, and alcohol use factors. Mini-International Neuropsychiatric Interview was used to screen for AUD. Further analyses were stratified by BMI and AUD. Spearman correlation coefficients were calculated for the change in PEth and the change in number of drinks per week over 7 months, including 3 time-points: baseline, 2, and 7 months. RESULTS At baseline, the correlation between baseline PEth and the number of drinks per week was significantly stronger for those with a BMI ≤25 compared to those with a BMI > 25 (r = 0.66; r = 0.26, respectively). Similarly, the correlation between baseline PEth and number of drinks was stronger for those who did not screen positive for AUD compared with those who did (r = 0.66; r = 0.25, respectively). When stratifying by BMI, a low-to-moderate correlation (r = 0.32, p = 0.02) was present for persons with a BMI > 25; when stratifying by AUD, a moderate correlation (r = 0.50, p < 0.01) was present for persons without an AUD between 0 and 2 months only. CONCLUSIONS In this sample of WLWH, BMI and AUD affected the strength of correlation between PEth and drinks per week. Future work examining changes in PEth over time in broader populations is needed, particularly to understand the sex differences in PEth levels.
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Affiliation(s)
- Veronica L Richards
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Ruba Sajdeya
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Karina Villalba
- Robert Stempel College of Public Health and Social Work, (KV), Florida International University, Miami, Florida
| | - Yan Wang
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Vaughn Bryant
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, (BB), University of Florida, Gainesville, Florida
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, (KB), Bethesda, Maryland
| | - Judith A Hahn
- Department of Medicine, (JAH), University of California, San Francisco, California
| | - Robert L Cook
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
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14
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Chichetto NE, Polanka BM, So-Armah KA, Sung M, Stewart JC, Koethe JR, Edelman EJ, Tindle HA, Freiberg MS. Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review. Curr HIV/AIDS Rep 2020; 17:354-372. [PMID: 32314325 PMCID: PMC7363585 DOI: 10.1007/s11904-020-00498-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW We summarize recent literature on the contribution of substance use and depression to non-AIDS-related comorbidities. Discussion of recent randomized clinical trials and implementation research to curtail risk attributed to each behavioral health issue is provided. RECENT FINDINGS Smoking, unhealthy alcohol use, opioid use, and depression are common among PWH and individually contribute to increased risk for non-AIDS-related comorbidities. The concurrence of these conditions is notable, yet understudied, and provides opportunity for linked-screening and potential treatment of more than one behavioral health factor. Current results from randomized clinical trials are inconsistent. Investigating interventions to reduce the impact of these behavioral health conditions with a focus on implementation into clinical care is important. Non-AIDS-defining cancers, cardiovascular disease, liver disease, and diabetes are leading causes of morbidity in people with HIV. Behavioral health factors including substance use and mental health issues, often co-occurring, likely contribute to the excess risk of non-AIDS-related comorbidities.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Minhee Sung
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
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15
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Canidate SS, Cook CL, Varma D, Carnaby GD, Ennis N, Stetten NE, Cook RL. Recruitment, experience, and retention among women with HIV and hazardous drinking participating in a clinical trial. BMC Public Health 2020; 20:1169. [PMID: 32718308 PMCID: PMC7385856 DOI: 10.1186/s12889-020-09233-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite efforts by the NIH to enhance the participation of women and minorities in clinical research, women with HIV continue to remain underrepresented in alcohol intervention research. The purpose of this study is to better understand the reasons why women with HIV and hazardous drinking participated in the WHAT-IF? study and to discuss their experience (positive or negative) in the study. The WHAT-IF? study was a randomized clinical trial that evaluated pharmacotherapy for a reduction in drinking among women with HIV. METHODS Convenience and theoretical sampling were used to recruit women with HIV and hazardous drinking to complete qualitative interviews. These women had previously completed a clinical alcohol intervention trial and had consented to be contacted in the future for study-related purposes. The biopsychosocial model was used to frame the interview questions that assessed multiple determinants of drinking behavior and helped explain linkages to broader health constructs. RESULTS A total of 20 women with HIV and hazardous drinking completed the qualitative interview. Several factors were identified by the women as influential in their decision to participate in the WHAT-IF? study, such as the ability to quit or reduce their drinking to nonhazardous levels (biological), the ability to gain knowledge or a greater understanding of the negative effects of hazardous drinking on HIV disease progression (psychological), and peer pressure and monetary compensation (social). Also, the women identified factors (positive or negative) associated with their clinical trial experience, such as the effects of the study medication on the woman's body (biological), thoughts and feelings toward study procedures (i.e. medication, lab work, study assessments) and the length of the study (psychological), and the interactions with the WHAT-IF? study staff (social). CONCLUSION Recruiting and retaining women with HIV in alcohol intervention research remains a challenge. Findings from this study suggest that women with HIV who are hazardous drinkers may benefit from participating in research studies that could help them to reduce or quit their drinking, increase their knowledge about specific behavior changes, and earn monetary compensation. Also, positive staff interactions may be instrumental in retaining minority women in alcohol intervention research.
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Affiliation(s)
- Shantrel S Canidate
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA.
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA.
| | - Christa L Cook
- College of Nursing, University of Central Florida, Orlando, FL, 32816, USA
| | - Deepthi Varma
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Giselle D Carnaby
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, 32816, USA
| | - Nicole Ennis
- College of Medicine, Florida State University, Tallahassee, FL, 32304, USA
| | - Nichole E Stetten
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Robert L Cook
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
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16
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Satre DD, Sarovar V, Leyden W, Hare CB, Catz SL, Bryant KJ, Williams EC, Hojilla JC, Horberg MA, Silverberg MJ. Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data. AIDS Behav 2020; 24:1784-1792. [PMID: 31773444 DOI: 10.1007/s10461-019-02742-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a sample of people with HIV (PWH) enrolled in an alcohol intervention trial and followed for 12 months, we examined the association of changes in days (i.e., decrease, increase, no change [reference]) of unhealthy drinking (consuming ≥ 4/≥ 5 drinks for women/men) with antiretroviral therapy adherence (≥ 95% adherent), viral suppression (HIV RNA < 75 copies/mL), condomless sex with HIV-negative/unknown status partners, and dual-risk outcome (HIV RNA ≥ 75 copies/mL plus condomless sex). The sample included 566 PWH (96.8% male; 63.1% White; 93.9% HIV RNA < 75 copies/mL) who completed baseline, 6-, and 12-month assessments. Decrease in days of unhealthy drinking was associated with increased likelihood of viral suppression (odds ratio [OR] 3.78; 95% confidence interval [CI] 1.06, 13.51, P = .04) versus no change. Increase in days of unhealthy drinking was associated with increased likelihood of condomless sex (OR 3.13; 95% CI 1.60, 6.12, P < .001). Neither increase nor decrease were associated with adherence or dual-risk outcome. On a continuous scale, for each increase by 1 day of unhealthy drinking in the prior month, the odds of being 95% adherent decreased by 6% (OR 0.94, 95% CI 0.88, 1.00, P = 0.04).
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Affiliation(s)
- Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Charles B Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
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