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Sombrea DP, Santarin SLM, Verde TGM, Tidalgo AD, Tolosa CS. The Unheard Stories: Experiences of Young People Living with Human Immunodeficiency Virus in Dealing with Discrimination in the Philippines. HIV AIDS (Auckl) 2024; 16:33-43. [PMID: 38375060 PMCID: PMC10875183 DOI: 10.2147/hiv.s438280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/18/2023] [Indexed: 02/21/2024] Open
Abstract
Purpose The aim of this study is to gain an in-depth understanding of the experiences of young people living with the human immunodeficiency virus (YPLHIV) in dealing with discrimination and contribute to a more efficient response. Patients and Methods We utilised qualitative descriptive research-narrative inquiry. Twenty YPLHIV aged 19 to 24 under treatment from HIV hubs in Metro Manila, Philippines were purposely selected for an in-depth individual interview. Data were transcribed verbatim and manually coded and analysed using narrative thematic analysis. Results We found that HIV knowledge and beliefs of YPLHIV plays a huge role in their experience. Second, dealing with HIV stereotypes contributed to how they assume judgments from others (perceived stigma) and may have internalised the stigma which alters their belief toward self and the disease. Third, thoughts of suicide, experiencing emotional dissonance, and having difficulty embracing one's identity indicate declined mental health. Fourth, they continuously seek and may have received support from significant others and the community. Some may have directly received or perceived discrimination, but the YPLHIV reported that support received from others plays positively vital role in their journey. Finally, the disease helped change their behaviour and, in turn, brought them to lifestyle change as they are eager to be undetectable and untransmissible (U=U) and perpetually reflect on the ordeal challenge of adhering to treatment. Conclusion Our study concluded that the stigma and discrimination that YPLHIVs endured were caused by misinformation about the disease and stems from both within themselves and from others around them. Support received from friends, family members, and the community helped them deal with their circumstances. We recommend that efforts be made by both the government and non-government to develop programs distinctly for YPLHIV. Future research may explore the mental health aspect as this has been found concerning in the narratives among young population patients.
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Affiliation(s)
- Donna P Sombrea
- Psychology Department, Adamson University, Manila, Philippines
| | | | | | | | - Coleen S Tolosa
- Psychology Department, Adamson University, Manila, Philippines
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Pierce LJ, Regan S, Idigbe I, Adeola J, Musa Z, Ezechi O, Oladeji B, Gureje O, Freedberg KA, Okonkwo P, Ahonkhai AA. Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria-a Call for Integrated Mental Health Services. Int J Behav Med 2023; 30:38-48. [PMID: 35226343 DOI: 10.1007/s12529-022-10068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have longitudinally assessed psychological distress among people with HIV (PWH) initiating ART in resource-limited settings. METHOD Baseline, 6-month, and 12-month psychological distress were measured in a Nigerian cohort newly initiating therapy; the relationship between baseline factors and psychological distress at 12 months was assessed; and the association between psychological distress at 12 months and care retention or immunologic failure was determined. RESULTS Among 563 patients, median age was 38 years (IQR: 33-46 years), 62% were female, and 51% were married. Psychological distress increased from 3% at baseline to 34% at 12 months. Age (aOR 1.28, 95% CI 1.06-1.56), female sex (aOR 2.89, 95% CI 1.93-4.33), lack of disclosure (aOR 4.32, 95% CI 2.48-7.51), and time on ART (6 months [aOR 6.91, 95% CI 3.14-15.18] and 12 months [aOR 32.63, 95% CI 16.54-64.36]) were associated with psychological distress while being married (OR 0.42, 95% CI 0.30-0.61) was associated with reduced odds. Tweve-month psychological distress was associated with increased risk of immunologic failure (aOR 2.22, 95% CI 1.31-3.82). CONCLUSION The risk of psychological distress increased 30-fold in the first year on therapy in PWH in Nigeria.
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White JJ, Zaller ND, Fernandez MI, Spikes P, Flores S, Latkin CA, Yang C. Recent Incarceration and Other Correlates of Psychological Distress Among African American and Latino Men Who Have Sex with Men. Community Ment Health J 2022; 58:624-632. [PMID: 34216334 PMCID: PMC8720901 DOI: 10.1007/s10597-021-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
There is a dearth of research on the intersection of incarceration and psychological distress among men who have sex with men including African American (AAMSM) and Latino MSM (LMSM), populations which bear a large burden of HIV in the U.S. Recent incarceration is an important context to examine psychological distress given the critical implications it has on health outcomes. Using baseline data from the Latino and African American Men's Project (LAAMP), a multi-site randomized HIV behavioral intervention trial, this paper examined the association between previous incarceration within the past three months (i.e., recent incarceration) and psychological distress in the past four weeks, assessed by the Kessler Psychological Distress Scale (K10). Among 1482 AAMSM and LMSM (AAMSM: 911, LMSM: 571), we found 768 (52%) were previously incarcerated, but not in past three months and 138 (9.3%) had been recently incarcerated. After adjusting for race, education, access to resources, current living arrangement, HIV status, and substance use, participants who had been recently incarcerated were more likely to have mild psychological distress i.e., K10 score 20-24 (aRRR:1.43, 95% CI 1.20, 1.71) or severe psychological distress, i.e., K10 score > 30 (aRRR: 1.89, 95% CI 1.22, 2.93) in the past four weeks than those never incarcerated and those previously incarcerated, but not in past three months. Our findings have implications for mental health and HIV prevention services for AAMSM and LMSM with previous incarceration within the past three months.
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Affiliation(s)
- Jordan J White
- School of Social Work, Morgan State University, 1700 E. Cold Spring Lane, Jenkins Building, Room 334, Baltimore, MD, USA. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nickolas D Zaller
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Pilgrim Spikes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Flores
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ajuna N, Tumusiime B, Amanya J, Awori S, Rukundo GZ, Asiimwe JB. Social Networks and Barriers to ART Adherence Among Young Adults (18-24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study. HIV AIDS (Auckl) 2021; 13:939-958. [PMID: 34675686 PMCID: PMC8504700 DOI: 10.2147/hiv.s328643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
Background Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18–24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals’ directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.
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Affiliation(s)
- Noble Ajuna
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Brian Tumusiime
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Joseph Amanya
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Sharon Awori
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara City, Southwestern Uganda
| | - John Baptist Asiimwe
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
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Taiwo BO, Kuti KM, Kuhns LM, Omigbodun O, Awolude O, Adetunji A, Berzins B, Janulis P, Johnson AK, Okonkwor O, Oladeji BD, Muldoon A, Adewumi OM, Amoo P, Atunde H, Kapogiannis B, Garofalo R. Effect of Text Messaging Plus Peer Navigation on Viral Suppression Among Youth With HIV in the iCARE Nigeria Pilot Study. J Acquir Immune Defic Syndr 2021; 87:1086-1092. [PMID: 34153015 PMCID: PMC8496997 DOI: 10.1097/qai.0000000000002694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral nonsuppression. Hence, novel interventions are needed. SETTING Infectious Diseases Institute, College of Medicine, University of Ibadan, Nigeria. METHODS In a single-arm trial, participants aged 15-24 years received 48 weeks of a combination intervention, comprising daily 2-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression less than 200 copies/mL. The secondary outcome measures included self-reported adherence on a visual analog scale and medication possession ratio, each dichotomized as ≥90% (good) or <90% (poor) adherence. The outcomes were analyzed using McNemar test. Retention in care, intervention feasibility and acceptability, and participants' satisfaction were also assessed. RESULTS Forty YWH (50% male participants) were enrolled: mean age 19.9 years (SD = 2.5), 55% perinatally infected, and 35% virologically suppressed at baseline. Compared with baseline, the odds of virologic suppression was higher at 24 weeks (odds ratio = 14.00, P < 0.001) and 48 weeks (odds ratio = 6.00, P = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, P = 0.008) and 48 weeks (68%, P = 0.031). Medication possession ratio ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks alone (P = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. CONCLUSION Daily 2-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
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Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Kehinde M. Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Olayinka Omigbodun
- Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olutosin Awolude
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
- Department of Obstetrics and Gynecology, and Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Bibilola D. Oladeji
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Abigail Muldoon
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | | | - Paul Amoo
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Hannah Atunde
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
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Hill SV, Johnson J, Rahman F, Dauria EF, Mugavero M, Matthews LT, Simpson T, Elopre L. Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South. PLoS One 2021; 16:e0248858. [PMID: 33740005 PMCID: PMC7978356 DOI: 10.1371/journal.pone.0248858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults' (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. METHODS We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. RESULTS 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. CONCLUSIONS Primary support persons are willing to support AYAs using PrEP.
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Affiliation(s)
- Samantha V Hill
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Jarvis Johnson
- Division of Infectious Diseases, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Fazlur Rahman
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Emily F Dauria
- Division of Infant, Child and Adolescent Psychiatry, The University of California San Francisco, San Francisco, California, United States of America
| | - Michael Mugavero
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lynn T Matthews
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Tina Simpson
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Latesha Elopre
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Dunn Navarra AM, Whittemore R, Bakken S, Rosenberg MJ, Gormley M, Bethea J, Gwadz M, Cleland C, Liang E, D'Eramo Melkus G. Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res 2020; 69:197-209. [PMID: 31972851 DOI: 10.1097/NNR.0000000000000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. OBJECTIVES As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. METHODS The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. RESULTS Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. DISCUSSION Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.
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Fair CD, Albright JN, Varney O. US Provider Perceptions of Differences in the Sexual and Reproductive Health Needs of Adolescents with Perinatally Acquired and Behaviorally Acquired HIV: A Mixed Methods Study. AIDS Patient Care STDS 2019; 33:440-448. [PMID: 31524504 DOI: 10.1089/apc.2019.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study explores health care providers' perceptions of similarities and differences in the sexual and reproductive needs of adolescents with perinatally acquired HIV (PHIV) and behaviorally acquired HIV (BHIV). Interviews (n = 13) and online surveys (n = 46) were completed by medical and social service providers (n = 30, n = 29, respectively) who care for adolescents with HIV. Eligible providers were recruited using snowball sampling. Responses to open-ended questions were coded for emergent themes. Sixty-eight percent of participants perceived differences in the sexual and reproductive health needs of adolescents with PHIV and BHIV. Differences included factors related to psychosocial, sexual, and medical needs. Providers believed adolescents with PHIV had integrated their diagnosis into their identity, were more adept at communicating with providers, and were more sexually cautious than youth with BHIV. Providers perceived adolescents with BHIV as more comfortable discussing sex-related issues, and suggested youth with PHIV were more comfortable accessing health care. Adolescents with PHIV were thought to have complex medical histories/treatment and greater knowledge of illness/medications. Existing research on adolescent-reported sexual and reproductive health knowledge and experiences in care suggests that provider and adolescent perspectives do not always align. Mode of transmission may provide some information about psychosocial functioning and sexual behavior. However, assumptions about sexual and reproductive health needs based solely on mode of transmission may contribute to gaps in sexual and reproductive health care. Future research is needed to examine whether these differing perspectives indeed lead to discrepancies in the care provided to adolescents with HIV.
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Affiliation(s)
- Cynthia D. Fair
- Department of Public Health Studies, Elon University, Elon, North Carolina
| | - Jamie N. Albright
- Clinical Psychology, University of Virginia, Charlottesville, Virginia
| | - Olivia Varney
- School-Based Outpatient Therapy, T.W. Ponessa and Associates, Mountville, Pennsylvania
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Harper GW, Wagner RL, Popoff E, Reisner SL, Jadwin-Cakmak L. Psychological resilience among transfeminine adolescents and emerging adults living with HIV. AIDS 2019; 33 Suppl 1:S53-62. [PMID: 31397723 DOI: 10.1097/QAD.0000000000002174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The current study sought to examine factors that promote psychological resilience related to engagement in the HIV continuum of care (CoC) among transfeminine adolescents and emerging adults (TF AEA) living with HIV in the U.S. using a qualitative approach. DESIGN The parent study from which these data came utilized a concurrent transformative mixed-methods research design grounded in Gender Affirmation and Gender Minority Stress Theory that focused on advancing our understanding of transgender youth's experiences with healthcare generally and their experiences across the HIV CoC. METHODS Semi-structured in-depth qualitative interviews with 66 TF AEA living with HIV were analysed using a two-stage interpretive phenomenological analytic approach that allowed for both inductive and deductive explorations of the data. RESULTS When discussing health-promoting psychological resilience factors, participants described both interpersonal resources (i.e. support or assistance via interactions with others) and intrapersonal assets (i.e. positive internal cognitive processes) that encouraged their engagement in the HIV CoC. The interpersonal resources described by participants included three main types of support: emotional support, gender support and instrumental-informational support. Three thematic categories describe the intrapersonal assets that participants discussed: health awareness and HIV acceptance; health motivation and health responsibility; and psychological well being and inner strength. CONCLUSION Despite experiences of HIV-related stigma and transphobia, TF AEA living with HIV demonstrate psychological resilience, as they navigate engagement in the HIV CoC. Results highlight possibilities for implementing public health interventions at individual, community and systems levels to bolster resilience among TF AEA living with HIV.
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Casale M, Carlqvist A, Cluver L. Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review. AIDS Patient Care STDS 2019; 33:237-252. [PMID: 31166783 PMCID: PMC6588099 DOI: 10.1089/apc.2018.0320] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adolescents represent a growing proportion of people living with HIV worldwide and the highest risk population group for treatment attrition and AIDS-related mortality. There is an urgent need to design, implement, and test interventions that keep young people in HIV treatment and care. However, previous systematic reviews show scarce and inconclusive evidence of effective interventions for this age group. Recent years have seen an increase in focus on adolescent health and a rapidly changing programmatic environment. This systematic review article provides an evidence update by synthesizing empirical evaluations of interventions designed to improve antiretroviral therapy adherence and retention among adolescents (10-19) and youth (15-24) living with HIV, published between January 2016 and June 2018. A search of 11 health and humanities databases generated 2425 citations and 10 relevant studies, the large majority conducted in sub-Saharan Africa. These include six clinic-level interventions, one individual-level m-Health trial, and three community- or household-level interventions. Implications of their findings for future programming and research with young adults are discussed, in relation to previous reviews and the broader empirical evidence in this area. Findings highlight the need to further develop and test multi-faceted interventions that go beyond health facilities, to address broader social barriers to adherence and retention. In particular, further intervention studies with adolescents (10-19) should be a priority, if we are to retain these young people in treatment and care and aspire to achieve the United Nation's Sustainable Development Goals and 90-90-90 targets.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Rusley JC, Monroe A, Matson P, Gebo KA, Nonyane BAS, Minkovitz CS, Agwu A, Emerson M, Moore R, Rutstein R, Aberg J, Nijhawan A, Boswell S, Sanders R, Edelstein H, Baranoski A, Allen S, Beil R, Felsen U, Urbina A, Korthuis PT, Akbar M, Gaur A, Somboonwit C, Valenti W, Mathews WC, Hellinger F, Fleishman J, Fraser I, Mills R, Malitz F, Keruly J, Gebo K, Voss C, Collins C, Diaz-Reyes R. Discontinuity in Medicaid Coverage Among Young Adults with HIV. AIDS Patient Care STDS 2019; 33:89-92. [PMID: 30844306 DOI: 10.1089/apc.2018.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jack C. Rusley
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Monroe
- Division of General Internal Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Matson
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly A. Gebo
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Cynthia S. Minkovitz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark Emerson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Moore
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judith Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ank Nijhawan
- Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Stephen Boswell
- Fenway Health and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Renata Sanders
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mimiaga MJ, Bogart LM, Thurston IB, Santostefano CM, Closson EF, Skeer MR, Biello KB, Safren SA. Positive Strategies to Enhance Problem-Solving Skills (STEPS): A Pilot Randomized, Controlled Trial of a Multicomponent, Technology-Enhanced, Customizable Antiretroviral Adherence Intervention for HIV-Infected Adolescents and Young Adults. AIDS Patient Care STDS 2019; 33:21-24. [PMID: 30601059 DOI: 10.1089/apc.2018.0138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention-"Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)"-combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as "acceptable" or "very acceptable") and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.
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Affiliation(s)
- Matthew J Mimiaga
- 1 Center for Health Equity Research, Brown University, Providence, Rhode Island
- 2 Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- 3 Department of Psychiatry and Human Behavior, Alpert Medical School Brown University, Providence, Rhode Island
- 4 The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Laura M Bogart
- 5 Health Unit, RAND Corporation, Santa Monica, California
- 6 Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- 7 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Idia B Thurston
- 8 Department of Psychology, The University of Memphis, Memphis, Tennessee
| | | | | | - Margie R Skeer
- 9 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Katie B Biello
- 1 Center for Health Equity Research, Brown University, Providence, Rhode Island
- 2 Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- 4 The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Steven A Safren
- 10 Department of Psychology, The University of Miami, Coral Gables, Florida
- 11 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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