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White TM, Fuster-RuizdeApodaca MJ, Iniesta C, Prats-Silvestre C, Lazarus JV, Izquierdo R, Jarrín I. Network analysis to prioritize issues for intervention to improve the health-related quality of life of people with HIV in Spain. HIV Med 2024. [PMID: 39126315 DOI: 10.1111/hiv.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES The objective is to assess the interconnectedness of a network of health-related quality of life (HRQoL) variables among people with HIV (PHIV) to identify key areas for which clinical interventions could improve HRQoL for this population. METHODS Between 2021 and 2023, we carried out a cross-sectional study within the Spanish CoRIS cohort. We conducted a weighted and undirected network analysis, which examines complex patterns of relationships and interconnections between variables, to assess a network of eight HRQoL dimensions from the validated Clinic Screening Tool for HIV (CST-HIV): anticipated stigma, psychological distress, sexuality, social support, material deprivation, sleep and fatigue, cognitive problems and physical symptoms. RESULTS A total of 347 participants, predominantly male (93.1%), currently working (79.0%), self-reported homosexual (72.6%) and college-educated (53.9%), were included in the study. Psychological distress showed the highest centrality in the network, indicating its strong connections with sleep and fatigue, cognitive problems and social support within the HRQoL network. CONCLUSIONS Psychological distress, sleep and fatigue, cognitive issues and social support were identified as key factors in an HRQoL network, indicating that interventions focused on these areas could significantly enhance overall well-being.
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Affiliation(s)
- Trenton M White
- ISGlobal, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- The City University of New York Graduate School of Public Health and Policy (CUNY SPH), New York City, New York, USA
| | - María José Fuster-RuizdeApodaca
- The Spanish Interdisciplinary AIDS Society (SEISIDA), Madrid, Spain
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Carlos Iniesta
- The Spanish Interdisciplinary AIDS Society (SEISIDA), Madrid, Spain
- Center of Biomedical Research for Infectious Diseases (CIBERINFEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Jeffrey V Lazarus
- ISGlobal, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- The City University of New York Graduate School of Public Health and Policy (CUNY SPH), New York City, New York, USA
| | - Rebeca Izquierdo
- Center of Biomedical Research for Infectious Diseases (CIBERINFEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Center for Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Inmaculada Jarrín
- Center of Biomedical Research for Infectious Diseases (CIBERINFEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Center for Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
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Verinumbe T, Katomski AS, Turpin G, Syarif O, Looze P, Lalak K, Anoubissi J, Brion S, Dunaway K, Sprague L, Matyushina D, De Leon Moreno CG, Baral SD, Rucinski K, Lyons C. Characterizing the Relationship between HIV Peer Support Groups and Internalized Stigma Among People Living with HIV in Nigeria. AIDS Behav 2024; 28:1068-1076. [PMID: 37889362 PMCID: PMC11234473 DOI: 10.1007/s10461-023-04217-7] [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: 10/14/2023] [Indexed: 10/28/2023]
Abstract
HIV-related stigma remains a significant barrier to implementing effective HIV treatment and prevention strategies in Nigeria. Despite the high uptake of peer support groups among people living with HIV (PLHIV) in Nigeria, the potential role of such peer support on the burden of internalized stigma remains understudied. To address this gap, we conducted a secondary analysis of the PLHIV Stigma Index 2.0, a socio-behavioral survey implemented by PLHIV led-organizations to assess the relationship between group membership and internalized stigma. Internalized stigma was measured using the Internalized AIDS-related Stigma Scale. Multinomial logistic regression was used to measure the association between self-reported engagement in peer support groups and internalized stigma adjusting for age, education, duration since HIV diagnosis, employment, disclosure status, and sex-work engagement. Of the 1,244 respondents in this study, 75.1% were engaged in HIV peer support groups. Over half (55.5%) and about one-fourth (27.3%) demonstrated low/moderate and high levels of internalized stigma, respectively. PLHIV engaged in HIV peer support groups were less likely to report both low/moderate (versus no) (adjusted odds ratio (aOR): 0.47 [95% CI: 0.27 to 0.81]; p = 0.006) and high (versus no) (aOR: 0.30 [95% CI: 0.17 to 0.53]; p < 0.001) levels of internalized stigma compared to those not engaged. In this study, the burden of internalized stigma is high among PLHIV in Nigeria. However, engagement in peer support groups appears to mitigate these stigmas. Stigma mitigation strategies to increase peer support may represent a critical tool in decreasing sustained HIV treatment gaps among PLHIV in Nigeria.
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Affiliation(s)
- Tarfa Verinumbe
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1717 East Monument St., Baltimore, MD, 21205, USA.
| | - Anna-Sophia Katomski
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Pim Looze
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Katarzyna Lalak
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Jean Anoubissi
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Sophie Brion
- The International Community of Women Living with HIV (ICW), London, UK
| | - Keren Dunaway
- The International Community of Women Living with HIV (ICW), London, UK
| | - Laurel Sprague
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Daria Matyushina
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Ratnawati D, Setiawan A, Sahar J, Widyatuti, Nursasi AY, Siregar T. Improving adolescents' HIV/AIDS prevention behavior: A phenomenological study of the experience of planning generation program (GenRe) ambassadors as peer educators. BELITUNG NURSING JOURNAL 2024; 10:56-66. [PMID: 38425688 PMCID: PMC10900061 DOI: 10.33546/bnj.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 12/15/2023] [Indexed: 03/02/2024] Open
Abstract
Background Adolescents face increased vulnerability to HIV/AIDS due to factors such as insufficient knowledge and awareness, stigma, and restricted access to information. The Indonesian government initiated a peer education program through the Planning Generation Program (GenRe) ambassadors. These ambassadors are tasked with educating their peers about HIV/AIDS. However, their experiences are largely underexplored. Objective This study aimed to explore the GenRe ambassadors' experience in improving adolescents' HIV/AIDS prevention behavior. Methods This study employed a qualitative phenomenological approach, with in-depth and semi-structured interviews of GenRe ambassadors who had served for at least three to six months within the South Jakarta Health Sub-Department, Indonesia. Purposive sampling and data saturation techniques were utilized. Data were collected from 13 May to 31 August 2022, and Colaizzi's steps were used to guide the data analysis. Results Nineteen GenRe ambassadors participated, predominantly female university students ages 18-22. Six themes were developed: 1) the impact of GenRe ambassadors' roles in improving HIV/AIDS prevention behavior, 2) activities to improve HIV/AIDS prevention behavior, 3) enhancement of self-concept as GenRe ambassadors, 4) obstacles to activities for improving HIV/AIDS prevention behavior, 5) support for activities to improve HIV/AIDS prevention behavior, and 6) hope for improving the GenRe ambassador program's implementation. Conclusion GenRe ambassadors are influencers who play a critical role in promoting HIV/AIDS prevention behaviors and fostering positive change in the broader youth community. Despite their positive self-concept, they encounter challenges in fulfilling their roles. Utilizing their insights, community health nurses can create effective peer-led HIV/AIDS prevention programs and contribute to a model of health promotion for adolescents. Leveraging the role of GenRe ambassadors as peer educators is recommended to enhance HIV/AIDS prevention efforts among adolescents.
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Affiliation(s)
- Diah Ratnawati
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, 16424 Depok, Indonesia
- Department of Nursing, Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta, 12450 Jakarta, Indonesia
| | - Agus Setiawan
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, 16424 Depok, Indonesia
| | - Junaiti Sahar
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, 16424 Depok, Indonesia
| | - Widyatuti
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, 16424 Depok, Indonesia
| | - Astuti Yuni Nursasi
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, 16424 Depok, Indonesia
| | - Tatiana Siregar
- Department of Nursing, Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta, 12450 Jakarta, Indonesia
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Nyman F. Reshaping the narrative: Tracing the historical trajectory of HIV/AIDS, gay men, and public health in Sweden. PLoS One 2024; 19:e0298630. [PMID: 38386666 PMCID: PMC10883528 DOI: 10.1371/journal.pone.0298630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The human immunodeficiency virus (HIV) emerged as an endemic health crisis in the United States during the early 1980s. Initially labelled a "gay disease" due to its prevalence among gay men, the spread of HIV led to widespread fear and moral panic, as there was limited medical knowledge on preventing its transmission. While HIV is often associated with Sub-Saharan Africa, this article focuses on Sweden, a pioneering nation that became the first to achieve the remarkable Joint UNAIDS/WHO 90-90-90 continuum in addressing the epidemic. However, despite this significant milestone, the punitive legislation and attitudes prevalent in Sweden have had a counterproductive effect on curbing the virus's spread. Drawing upon a comprehensive triangulation of various data and sources on the evolution of public policy in Sweden, this article argues for the urgent need to reduce stigma surrounding HIV and AIDS. By undertaking further measures to combat stigmatisation, we not only have the potential to prevent the spread of HIV but also significantly enhance the quality of life for individuals living with the virus. An essential step in this journey is to eliminate the legally-enforced mandatory disclosure of one's HIV status, which would mark a tremendous victory for all those affected. With limited evidence to support the effectiveness of criminalisation and penal laws, no longer being viewed as criminals for non-disclosure would be a monumental achievement, positively transforming the lives of people living with HIV and fostering a more inclusive and supportive society.
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Affiliation(s)
- Fredrik Nyman
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Jämtland, Sweden
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Jhunjhunwala R, Jayaram A, Mita C, Davies J, Chu K. Community support for injured patients: A scoping review and narrative synthesis. PLoS One 2024; 19:e0289861. [PMID: 38300931 PMCID: PMC10833531 DOI: 10.1371/journal.pone.0289861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Community-based peer support (CBPS) groups have been effective in facilitating access to and retention in the healthcare system for patients with HIV/AIDS, cancer, diabetes, and other communicable and non-communicable diseases. Given the high incidence of morbidity that results from traumatic injuries, and the barriers to reaching and accessing care for injured patients, community-based support groups may prove to be similarly effective in this population. OBJECTIVES The objective of this review is to identify the extent and impact of CBPS for injured patients. ELIGIBILITY We included primary research on studies that evaluated peer-support groups that were solely based in the community. Hospital-based or healthcare-professional led groups were excluded. EVIDENCE Sources were identified from a systematic search of Medline / PubMed, CINAHL, and Web of Science Core Collection. CHARTING METHODS We utilized a narrative synthesis approach to data analysis. RESULTS 4,989 references were retrieved; 25 were included in final data extraction. There was a variety of methodologies represented and the groups included patients with spinal cord injury (N = 2), traumatic brain or head injury (N = 7), burns (N = 4), intimate partner violence (IPV) (N = 5), mixed injuries (N = 5), torture (N = 1), and brachial plexus injury (N = 1). Multiple benefits were reported by support group participants; categorized as social, emotional, logistical, or educational benefits. CONCLUSIONS Community-based peer support groups can provide education, community, and may have implications for retention in care for injured patients.
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Affiliation(s)
- Rashi Jhunjhunwala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Anusha Jayaram
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Mabuto T, Woznica DM, Ndini P, Moyo D, Abraham M, Hanrahan C, Charalambous S, Zack B, Baral S, Owczarzak J, Hoffmann CJ. Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial. Lancet HIV 2024; 11:e11-e19. [PMID: 38071994 PMCID: PMC10894448 DOI: 10.1016/s2352-3018(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND People released from correctional facilities face multifactorial barriers to continuing HIV treatment. We hypothesised that barriers faced in the first 6 months of community re-entry would be decreased by a multilevel group-based and peer-led intervention, the Transitional Community Adherence Club (TCAC). METHODS We did a pragmatic, open-label, individually randomised controlled trial in five correctional facilities in Gauteng, South Africa. Participants aged 18 years and older and receiving antiretroviral therapy (ART) in correctional facilities were enrolled before release and randomly assigned (1:2) to either passive referral (usual care) or TCACs. TCACs followed a 12-session curriculum over 6 months and were facilitated by trained peer and social workers. Participants were followed up by telephone and in person to assess the primary outcome: post-release enrolment in HIV treatment services at 6 months from the date of release. We did an intention-to-treat analysis to determine the effectiveness of TCACs compared with usual care. The trial was registered with the South African National Clinical Trials Register (DOH-27-0419-605) and ClinicalTrials.gov (NCT03340428). This study is completed and is listed as such on ClinicalTrials.gov. FINDINGS From March 1, to Dec 13, 2019, we screened 222 individuals and enrolled 176 participants who were randomly assigned 1:2 to the usual care group (n=59) or TCACs (n=117). 175 participants were included in the final analysis. In the usual care group, 21 (36%) of 59 participants had enrolled in HIV treatment services at 6 months, compared with 71 (61%) of 116 in the TCAC group (risk ratio 1·7, 95% CI 1·2-2·5; p=0·0010). No adverse events were reported. INTERPRETATION We found strong evidence that a differentiated service delivery model with curriculum and peer support designed specifically to address the needs of people with HIV returning from incarceration improved the primary outcome of enrolment in HIV treatment services. Our approach is a reasonable model to build further HIV treatment continuity interventions for individuals in the criminal justice system in South Africa and elsewhere. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Tonderai Mabuto
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa.
| | | | - Pretty Ndini
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Derrick Moyo
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Munazza Abraham
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Colleen Hanrahan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salome Charalambous
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher J Hoffmann
- The University of the Witwatersrand School of Public Health, Johannesburg, South Africa; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fauk NK, Asa GA, McLean C, Ward PR. "I Was Very Shocked, I Wanted It to Be Over": A Qualitative Exploration of Suicidal Ideation and Attempts among Women Living with HIV in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:9. [PMID: 38276797 PMCID: PMC10815629 DOI: 10.3390/ijerph21010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
HIV diagnosis and poor HIV management have various detrimental impacts on the lives of people living with HIV (PLHIV). As a part of a large qualitative study investigating HIV risk factors and impacts, of which the topic of suicide is not a focus, this paper describes the factors contributing to suicidal ideation and attempts that arose naturally in the stories of women living with HIV (WLHIV; n = 52) in Yogyakarta and Belu districts, Indonesia. The participants were recruited using the snowball sampling technique. Guided by a qualitative data analysis framework, the data were thematically analysed. The findings were grouped into four main themes: (i) the women experienced immense psychological challenges due to the infection, spousal transmission, fear of mother-to-child transmission, and losing a child due to AIDS, which triggered suicidal ideation and attempts; (ii) the lack of awareness of HIV management strategies resulted in them feeling trapped and overwhelmed, and the associated negative thoughts and the anticipation and experience of HIV stigma influenced their thoughts of suicide; (iii) the lack of social support from family and friends during the early stages of HIV diagnosis, compounded with pre-existing financial difficulties, lack of income, unemployment, and feeling overburdened, also triggered the women's thoughts of suicide; and (iv) family breakdown following HIV diagnosis, concern about future relationships, and fear of being rejected or abandoned by their partner were also influencing factors for suicidal ideation and attempts among the women. The findings indicate the need for a nuanced approach to counselling within HIV care interventions for couples to support the acceptance of each other's HIV status whilst maintaining psychological wellbeing. Additionally, the findings indicate the importance of HIV education and awareness among community members for the de-stigmatisation of HIV and to increase the acceptance of PLHIV by their families and communities.
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Affiliation(s)
- Nelsensius Klau Fauk
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St., Adelaide, SA 5000, Australia; (G.A.A.); (C.M.)
- Institute of Resource Governance and Social Change, Kupang 85227, Nusa Tenggara Timur, Indonesia
| | - Gregorius Abanit Asa
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St., Adelaide, SA 5000, Australia; (G.A.A.); (C.M.)
| | - Caitlan McLean
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St., Adelaide, SA 5000, Australia; (G.A.A.); (C.M.)
| | - Paul Russell Ward
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St., Adelaide, SA 5000, Australia; (G.A.A.); (C.M.)
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Fuster-RuizdeApodaca MJ, Pérez-Garín D, Baceiredo V, Laguía A, Carrillo JG, García R, García D. Evaluation of a peer intervention project in the hospital setting to improve the health-related quality of life of recently diagnosed people with HIV infection. Health Qual Life Outcomes 2023; 21:106. [PMID: 37704978 PMCID: PMC10500776 DOI: 10.1186/s12955-023-02185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE This study aims to assess the impact of a peer intervention programme in the hospital setting to improve the health-related quality of life (HRQoL) of people recently diagnosed with HIV infection. METHODS A quasi-experimental single-group study with pre- and post-measurements was conducted. The peer intervention programme consisted of four sessions that took place at the following times: (1) the day of diagnosis, (2) the day when the results of the analyses were collected and ART (antiretroviral therapy) began, (3) one month after the start of ART, and (4) four months after the start of ART. The dependent variables were HRQoL and several of its psychological predictors. Change in the dependent variables was analysed through repeated measures, variance analysis and covariance analysis. Forty-three people with HIV participated in the intervention (40 men, mean age = 39.14). RESULTS A significant positive evolution was found in all the predictors of HRQoL, except avoidant coping (p < .05). A positive evolution was also found in all HRQoL dimensions (p < .05). There was a significant increase in CD4 cells/mm3 lymphocytes (p < .0001) and in the CD4/CD8 ratio (p < .001). The positive differential scores in the psychological health and social relationship dimensions influenced the increase in CD4 cells/mm3 lymphocytes (p = .012, p = .13). The increase in the social relations dimension score and overall health perception influenced the recovery of the CD4/CD8 ratio (p = .044; p = .068). CONCLUSIONS Peer intervention improved the HRQoL of people recently diagnosed with HIV, and enhanced psychological health and social relationships covariate with their immunological recovery. This study represents an essential advance in evaluating peer intervention programmes for positive prevention.
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Affiliation(s)
- M J Fuster-RuizdeApodaca
- Department of Social and Organizational Psychology. Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- Spanish Interdisciplinary AIDS Society, Madrid, Spain
| | - D Pérez-Garín
- Department of Social and Organizational Psychology. Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
| | - V Baceiredo
- Infectious Diseases Unit, University Hospital V. Del Rocío, Seville, Spain
- Adhara Association, Seville, Spain
| | - A Laguía
- Department of Social and Organizational Psychology. Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - J García Carrillo
- Adhara Association, Seville, Spain
- Infectious Diseases Unit, University Hospital V. De Valme, Seville, Spain
| | - R García
- Adhara Association, Seville, Spain
- Infectious Diseases Unit, University Hospital V. Macarena, Seville, Spain
| | - D García
- Adhara Association, Seville, Spain
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Fauk NK, Mwanri L, Gesesew HA, Ward PR. Biographical Reinvention: An Asset-Based Approach to Understanding the World of Men Living with HIV in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6616. [PMID: 37623199 PMCID: PMC10454460 DOI: 10.3390/ijerph20166616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
HIV diagnosis and management have often caused disruption to the everyday life and imagined futures of people living with HIV, both at individual and social levels. This disruption has been conceptualised, in a rather dystopian way, as 'biographical disruption'. This paper explores whether or not biographical disruption of living with HIV encourages men living with HIV (MLHIV; n = 40) in Yogyakarta and Belu, Indonesia, to reinvent their sense of self and future over time using internal and external assets. Our analysis uses the concepts of additive and subtractive resilience strategies, and we show how, rather than having a purely disrupted biography, participants talked about their experiences of 'biographical reinvention'. Study participants were recruited using the snowball sampling technique, beginning with two HIV clinics as the settings. Data were collected using one-on-one in-depth interviews, and a qualitative framework analysis was used to guide step-by-step data analysis. The findings showed that, despite the disruptions in their everyday lives (i.e., mental health condition, work, activities, social relationships, etc.) following the HIV diagnosis and management, MLHIV in our study managed to utilise their internal assets or traits (i.e., hope, optimism, resilience) and mobilised external resources (i.e., support from families, friends and healthcare professionals) to cope with the disruptions. An interweaving of these internal assets and external resources enabled them to take on new activities and roles (additive resilience strategies) and give up health compromising behaviours (subtractive resilience strategies). These were effective for most MLHIV in our study, not only to cope with the HIV repercussions and improve their physical and mental health conditions, but to think or work on a 'reinvented' biography which encompassed resilience, hope and optimism for better health, life and future. The findings indicate the need for HIV interventions and healthcare systems that provide appropriate support for the development and maintenance of internal assets of PLHIV to enable them to cope with the repercussions of HIV and work on a 'reinvented' biography.
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Affiliation(s)
- Nelsensius Klau Fauk
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA 5000, Australia; (L.M.); (H.A.G.); (P.R.W.)
- Institute of Resource Governance and Social Change, Kupang 85227, Indonesia
| | - Lillian Mwanri
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA 5000, Australia; (L.M.); (H.A.G.); (P.R.W.)
| | - Hailay Abrha Gesesew
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA 5000, Australia; (L.M.); (H.A.G.); (P.R.W.)
- College of Health Sciences, Mekelle University, Mekelle P.O. Box 231, Tigray, Ethiopia
| | - Paul Russell Ward
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA 5000, Australia; (L.M.); (H.A.G.); (P.R.W.)
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Gormley M, Loughran C, Conte J, Dunn Navarra AM. Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature. J Assoc Nurses AIDS Care 2023; 34:331-348. [PMID: 37224079 DOI: 10.1097/jnc.0000000000000415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
ABSTRACT Peer health workers (peers) are commonly engaged interventionists in the HIV care spectrum. The objective of this scoping review was to examine the range of evidence on training strategies and approaches for peer-led HIV behavioral interventions in the United States. Four electronic databases (Medline, CINAHL, EMBASE, and PsycINFO) were searched for peer-reviewed published literature (2010-2021) of peer-led HIV behavioral interventions directed to improving antiretroviral therapy adherence and/or retention in care. Eighteen studies met the inclusion criteria. Eleven studies referenced manualized training materials, and nine used role-play as part of their curricula. Peer training content and duration varied across studies, as well as evaluation of intervention fidelity, and peer competency. Findings highlight heterogeneity in peer training strategies and approaches. The expansion and sustainability of peer engagement in the HIV care continuum will require greater consensus among members of the research community on best practices for training.
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Affiliation(s)
- Maurade Gormley
- Maurade Gormley, PhD, CPNP, is an Assistant Professor, School of Nursing, University of Connecticut, Storrs, Connecticut, USA. Claire Loughran, MPH, is a Project Manager, Rory Meyers College of Nursing, New York University, New York, New York, USA. Jill Conte, MA, MSLS, is an Associate Curator, Division of Libraries, New York University, New York, New York, USA. Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
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Meng X, Yin H, Ma W, Gu J, Lu Z, Fitzpatrick T, Zou H. Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score-Matched Analysis of Surveillance Data From 2006 to 2021. JMIR Public Health Surveill 2023; 9:e43635. [PMID: 36961492 PMCID: PMC10131765 DOI: 10.2196/43635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. OBJECTIVE We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. METHODS We performed a propensity score-matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. RESULTS A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. CONCLUSIONS The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Hanlu Yin
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Wenjuan Ma
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Jing Gu
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Martyn E, Eisen S, Longley N, Harris P, Surey J, Norman J, Brown M, Sultan B, Maponga TG, Iwuji C, Flanagan S, Ghosh I, Story A, Matthews PC. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. eLife 2023; 12:e81070. [PMID: 36757862 PMCID: PMC9910830 DOI: 10.7554/elife.81070] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The 'inclusion health' agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.
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Affiliation(s)
- Emily Martyn
- The Francis Crick InstituteLondonUnited Kingdom
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Eisen
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Nicky Longley
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Institute of Global Health, University College LondonLondonUnited Kingdom
- Universidad Autonoma de Madrid, Ciudad Universitaria de CantoblancoMadridSpain
| | - James Norman
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Michael Brown
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Binta Sultan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Tongai G Maponga
- Stellenbosch University, Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Collins Iwuji
- Department of Global Health, Brighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Africa Health Research InstituteDurban, KwaZulu-NatalSouth Africa
| | - Stuart Flanagan
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Collaborative Centre for Inclusion Health, University College LondonLondonUnited Kingdom
| | - Philippa C Matthews
- The Francis Crick InstituteLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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Pollock MD, Brotkin SM, Denio E, Dave S, Fisher EB, Docherty SL, Maslow GR. Clinical Application of a Peer Coaching Intervention to Enhance Self-Management for Adolescents and Young Adults With Inflammatory Bowel Disease. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2022; 10:409-427. [PMID: 37701558 PMCID: PMC10497228 DOI: 10.1037/cpp0000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Objective The purpose of this article is to characterize the current evidence base related to peer support interventions for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) and to describe a peer support program to enhance self-management for AYAs with IBD through a case study. There is strong theory and compelling evidence suggesting that AYAs with IBD could benefit from and are interested in receiving peer support to enhance self-management; however, literature on peer support interventions for AYAs with IBD is lacking. Methods This study (a) presents a topical review describing qualitative factors AYAs with IBD would seek in a peer support program as well as existing peer support programs for this population, (b) presents an innovative one-to-one peer support program targeting self-management through a case study, and (c) discusses clinical implications and directions for future research. Results Peer support offers a promising approach for AYAs with IBD that is feasible and acceptable to patient populations. However, results from the present topical review identified only two studies that examined peer support interventions for AYAs with IBD. The case study demonstrates how a theoretically driven program uses peer support to promote self-management and adaptive behavioral change. Conclusions The paucity of literature in this area reveals a critical opportunity for future research and clinical programming to improve existing practices by leveraging peer support. We present the application of an innovative mobile-based peer coaching intervention that has the potential to support AYAs with IBD in their self-management.
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Affiliation(s)
- McLean D. Pollock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | | | - Erin Denio
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Sneha Dave
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Edwin B. Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Gary R. Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine
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Pressley M, Mahgoub S, Halawani M. Facilitators and Barriers to the Implementation of Interventions in Washington, DC, to Improve Sexually Transmitted Infection Screening, Testing, and Treatment Among People with or at Risk of HIV. AIDS Patient Care STDS 2022; 36:117-126. [PMID: 36178402 DOI: 10.1089/apc.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Bacterial sexually transmitted infection (STI) incidences of gonorrhea, chlamydia, and syphilis are increasing in Washington, DC. Moreover, the availability of HIV pre-exposure prophylaxis for people at risk of HIV and condomless sex has increased, and bacterial STI rates have risen. This indicates the necessity of evidence-based strategies to ensure access to STI care and improve health outcomes for people with HIV in Washington, DC. Three clinics in Washington, DC, implemented three evidence-based interventions, including the use of a standardized audio computer-assisted self-interview to obtain an interval sexual history at each clinic visit, patient self-collection of chlamydia/gonorrhea nucleic acid amplification test specimens, and sexual minority welcoming clinical space indicators to normalize STI screening and testing. Three sites in Washington, DC, used a multi-level socioecological model to identify successes, challenges, and lessons learned from program implementation at the following three levels: (1) individual, (2) interpersonal, and (3) public policy. We conclude with a series of instructional strategies that may be useful for the implementation of similar interventions that may assist district-wide responses to decrease health disparities and increase STI prevention.
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Affiliation(s)
- Megan Pressley
- Infectious Diseases Division, Department of Medicine, Howard University Hospital, Center for Infectious Diseases Management & Research (CIDMAR), Howard University College of Medicine, Washington, District of Columbia, USA
| | - Siham Mahgoub
- Infectious Diseases Division, Department of Medicine, Howard University Hospital, Center for Infectious Diseases Management & Research (CIDMAR), Howard University College of Medicine, Washington, District of Columbia, USA
| | - Mirna Halawani
- School of Nursing, Rutgers University, Newark, New Jersey, USA
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