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Dadi TL, Tegene Y, Vollebregt N, Medhin G, Spigt M. The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers. AIDS Res Ther 2024; 21:28. [PMID: 38704594 PMCID: PMC11070098 DOI: 10.1186/s12981-024-00612-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH. METHODS A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software. RESULT PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management. CONCLUSION AND RECOMMENDATION HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.
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Affiliation(s)
- Tegene Legese Dadi
- School of Public Health, College of Medicine & Health Science,, Hawassa University, Hawassa, Ethiopia.
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Yadessa Tegene
- School of Public Health, College of Medicine & Health Science,, Hawassa University, Hawassa, Ethiopia
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nienke Vollebregt
- Department of Epidemiology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
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Babicz MA, Matchanova A, Woods SP. Apathy Among Persons Living With HIV Is Associated With Lower Self-efficacy for Health Care Provider Interactions. J Assoc Nurses AIDS Care 2023; 34:389-397. [PMID: 37141172 DOI: 10.1097/jnc.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Apathy is common in persons with HIV (PWH) and has been associated with a variety of health outcomes. We examined the association between apathy and self-efficacy for health care provider interactions in 142 PWH. A composite score comprised of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States was used to measure apathy. Self-efficacy for health care provider interactions was measured using the Beliefs Related to Medication Adherence - Dealing with Health Professional subscale. Higher levels of apathy were associated with lower self-efficacy for health care provider interactions at a medium effect size, independent of mood disorders, health literacy, and neurocognition. Findings suggest that apathy plays a unique role in self-efficacy for health care provider interactions and support the importance of assessment and management of apathy to maximize health outcomes among PWH.
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Affiliation(s)
- Michelle A Babicz
- Michelle A. Babicz, PhD, is a Neuropsychology Resident, Mental Health and Behavioral Services, James A. Haley Veteran's Hospital, Tampa, Florida, USA, and is a formerly Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Anastasia Matchanova, MA, is a Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Steven Paul Woods, PsyD, is a Professor, Department of Psychology, University of Houston, Houston, Texas, USA
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Lukyamuzi Z, Ssuna B, Mirembe RN, Mawanda D, Kinkumu P, Nalugo C, Adikin E, Namisango F, Nakalega R, Atuhaire P, Musoke P, Butler LM. Experiences and challenges of using community health worker-led mechanism in supporting HIV disclosure among adults living with HIV in heterosexual relationships in the rural Uganda. AIDS Res Ther 2023; 20:14. [PMID: 36906557 PMCID: PMC10008611 DOI: 10.1186/s12981-023-00508-0] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND HIV status disclosure among sexual partners is vital in HIV management. Community health workers (CHW) support HIV disclosure among adults living with HIV (ALHIV) in sexual relationships with disclosure difficulties. However, experiences and challenges of using CHW-led disclosure support mechanism were not documented. This study explored experiences and challenges involved in using CHW-led disclosure support mechanism among ALHIV in heterosexual relationships in the rural Uganda. METHODS This was a phenomenological qualitative study involving in-depth interviews among CHWs and ALHIV with HIV disclosure difficulties to sexual partners in greater Luwero region, Uganda. We conducted 27 interviews among purposively selected CHWs and participants who had participated in the CHW-led disclosure support mechanism. Interviews were conducted until saturation was reached; and analysis was done using inductive and deductive content analysis in Atlas. RESULTS All respondents viewed HIV disclosure as an important strategy in HIV management. Provision of adequate counseling and support to those intending to disclose was instrumental for successful disclosure. However, fear of the negative disclosure outcomes was viewed as a barrier to disclosure. The CHWs were viewed as having an added advantage in supporting disclosure as opposed to the routine disclosure counseling. However, HIV disclosure using CHW-led support mechanism would be limited by possible bleach of client's confidentiality. Therefore, respondents thought that appropriate selection of CHWs would improve their trust in the community. Additionally, providing CHWs with adequate training and facilitation during the disclosure support mechanism was viewed to improve their work. CONCLUSION Community health workers were viewed as being more supportive in HIV disclosure among ALHIV with disclosure difficulties to sexual partners compared to routine facility based disclosure counseling. Therefore, near location CHW-led disclosure mechanism was acceptable and useful in supporting HIV disclosure among HIV-affected sexual partners in rural settings.
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Affiliation(s)
- Zubair Lukyamuzi
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - Ruth Nabisere Mirembe
- Infectious Diseases Institute (IDI), College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Mawanda
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Paul Kinkumu
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Christine Nalugo
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Esther Adikin
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | | | - Rita Nakalega
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Patience Atuhaire
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Philippa Musoke
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 06269, USA
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Liao LL, Wang CC, Wu CL, Chu YS, Chou YC, Hsu CH. Poor Quality of Life in HIV-Infected Men Who Have Sex with Men is Associated with Excess-Type Constitution of Traditional Chinese Medicine. Evid Based Complement Alternat Med 2023; 2023:9445111. [PMID: 36700040 DOI: 10.1155/2023/9445111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 01/18/2023]
Abstract
Introduction This study explored the pathological constitution as it relates to low quality of life in HIV-infected MSM patients, as a reference for clinical treatment. Methods It had a cross-sectional research design using structured questionnaires to collect data, including patient's basic data, CD4+, CD4+/CD8+ ratio, Wang Qi constitution, and WHOQOL-BREF-Taiwan version questionnaires. We considered the association between constitutions and quality of life of HIV-infected MSM patients. Results and Discussion. The project accepted 203 HIV-infected MSM participants. The three most common pathological constitutions were Yang deficiency 15.5%, yin deficiency 13.1%, and qi deficiency 11.2%. The study determined scores for various quality of life domains: psychological (13.44 ± 2.27), social relationship (13.81 ± 2.80), physiological (14.43 ± 2.41), and environmental (14.78 ± 2.21). The TCM constitution is strongly correlated with the quality of life. Excess constitution had the worst quality of life. Comparing the infected time over one year with the time of <0-2 weeks, the adjusted odds ratios (AOR) were determined for abnormal CD4+ and CD4+/CD8+ ratio (OR: odds ratio: 0.03, 0.07, respectively, p < 0.001). Compared with the Gentleness constitution, there is a significant difference between the Deficiency and Excess constitution in sleep status and negative mood by multiple regression analysis (p < 0.001). Conclusion The Excess constitutions was correlated with worse quality of life. Even if the immune system was restored, the psychosocial domain, sleep status, and negative mood were not improved.
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Uwamariya J, Nshunguyabahizi M, Nshimyumuremyi JN, Mukesharurema G, Ndayishimiye E, Kamali I, Ndahimana JD, Hedt-Gauthier B, Cubaka VK, Barnhart DA. Rediscovering life after being diagnosed with HIV: A qualitative analysis of lived experiences of youth living with HIV in rural Rwanda. Front Reprod Health 2022; 4:993916. [DOI: 10.3389/frph.2022.993916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
IntroductionIn sub-Saharan Africa, youth living with HIV, especially those who have lost one or both parents, face economic, socially and psychological challenges that hinder adherence to ART, ultimately leading to poor health outcomes. Partners In Health/Inshuti Mu Buzima implemented an Adolescent Support Group (ASG) to support HIV-positive youth aged 15–25 years. During the evaluation of the ASG program, we sought to better understand youths' lived experiences to improve our delivery of HIV care.MethodsWe conducted qualitative in-depth, semi-structured individual interviews with youth enrolled in the ASG program. All interviews were conducted in-person or by telephone. Thematic analysis applying the framework approach with parallel inductive coding in Kinyarwanda and English was used.ResultsWe interviewed 35 youth who ranged in age from 16 to 29 years. The main themes related to the lived experiences of youth were (a) Experiences living with HIV, including disclosure, stigma, interactions with the health care system, and medication adherence; (b) external challenges, defined as challenges that were not related to the implementation of the ASG program; and (c) personal vision. Almost all youth reported acquiring HIV from their mothers and disclosure of HIV status occurred around the age of 10. Disclosure was often unintentional and followed by internalized and enacted stigma. Many reported poor past medication adherence which improved following enhanced counselling. External challenges were overwhelmingly economic in nature, and orphanhood was a root cause of other challenges such as difficulty accessing education, lack of transport to health facility, and lack of insurance fees. Despite these challenges, youth have an optimistic view of the future with dreams of health, economic attainment, marriage, and children.ConclusionHealthcare providers should empower caregivers to support HIV disclosure. Supporting youth as they face many economic challenges could help address socio-economic barriers to good health and promote holistic well-being.
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Chen WT, Shiu C, Zhang L, Zhao H. Care engagement with healthcare providers and symptom management self-efficacy in women living with HIV in China: secondary analysis of an intervention study. BMC Public Health 2022; 22:1195. [PMID: 35705934 PMCID: PMC9199138 DOI: 10.1186/s12889-022-13573-3] [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: 09/05/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Symptom management self-efficacy is a prerequisite for individuals to fully manage their symptoms. The literature reports associations between engagement with healthcare providers (HCPs), internalized stigma, and types of self-efficacy other than symptom management. However, the factors of symptom management self-efficacy are not well understood. This study aimed to investigate the relationship among engagement with HCPs, internalized stigma, and HIV symptom management self-efficacy in Chinese women living with HIV (WLWH). Methods This current analysis was part of the original randomized control trial, we used data collected from 41 women living with HIV (WLWH) assigned to an intervention arm or a control arm from Shanghai and Beijing, China, at baseline, Week 4 and Week 12. The CONSORT checklist was used. The study was registered in the Clinical Trial Registry (#NCT03049332) on 10/02/2017. Results The results demonstrate that HCPs should increase engagement with WLWH when providing care, thereby improving their symptom management self-efficacy. The results suggested that participants’ engagement with HCPs was significantly positively correlated with their HIV symptom management self-efficacy in the latter two time points. Internalized stigma was significantly negatively correlated with HIV symptom management self-efficacy only at the 4-week follow-up. Conclusions This study demonstrated the positive effect of engagement with HCPs on WLWHs’ symptom management self-efficacy as well as the negative effect of internalized stigma on symptom management self-efficacy. Future research can further test the relationship between the three key concepts, as well as explore interventions to decrease internalized stigma.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, 700 Tiverton Ave, Los Angeles, CA, 90095, USA.
| | - Chengshi Shiu
- School of Nursing, University of California Los Angeles, 700 Tiverton Ave, Los Angeles, CA, 90095, USA.,National Taiwan University, Taipei, Taiwan
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
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Okonji EF, Wyk BV, Mukumbang FC. Applying the biopsychosocial model to unpack a psychosocial support intervention designed to improve antiretroviral treatment outcomes for adolescents in South Africa. Pan Afr Med J 2022; 41:166. [PMID: 35655671 PMCID: PMC9120740 DOI: 10.11604/pamj.2022.41.166.31985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/10/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Adolescents (10 to 19 years) living with HIV (ALHIV) experience disproportionately poor adherence to antiretroviral treatment (ART) compared to other age groups. Several barriers, including psychosocial challenges, contribute to this observation. Psychosocial support (PSS) interventions show promising results as a strategy to deal with the biological and psychosocial challenges faced by ALHIV. However, there is dearth of information on how psychosocial support interventions designed to improve treatment adherence and retention in care among ALHIV are effective. In this commentary, we used the biopsychosocial model to formulate hypotheses on how the components of a PSS intervention could improve adherence and retention in ART care. Psychological wellbeing, coping strategies, social support, self-efficacy, and disclosure are key components in the intervention designed to improve ART adherence and retention in care. The management of ALHIV for improved ART adherence and retention requires recognising and addressing the complex biological, psychological and social issues peculiar to them.
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Affiliation(s)
- Emeka Francis Okonji
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa
| | - Brian Van Wyk
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa
| | - Ferdinand Che Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa.,Department of Global Health, University of Washington, Seattle, WA, United State of America
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Leyva-Moral JM, Palmieri PA, Loayza-Enriquez BK, Vander Linden KL, Elias-Bravo UE, Guevara-Vasquez GM, Davila-Olano LY, Aguayo-Gonzalez MP. 'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru. BMJ Glob Health 2021; 6:e006772. [PMID: 34711579 PMCID: PMC8557298 DOI: 10.1136/bmjgh-2021-006772] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. METHODS A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. RESULTS The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. CONCLUSION Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
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Affiliation(s)
- Juan Manuel Leyva-Moral
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick Albert Palmieri
- South American Center for Qualitative Research, Universidad Privada Norbert Wiener, Lima, Peru
- College of Graduate Health Studies, A.T. Still University, Kirksville, Missouri, USA
| | - Blanca Katiuzca Loayza-Enriquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Facultad de Medicina Humana, Universidad San Martin de Porres, Chiclayo, Peru
| | - Kara Lynette Vander Linden
- Department of Research, Saybrook University, Pasadena, California, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, California, USA
| | - Ursula Elisa Elias-Bravo
- Escuela de Enfermería, Universidad Cientifica del Sur, Miraflores, Peru
- Estrategia Sanitaria de Prevención y Control de VIH-SIDA, Hospital Regional Lambayeque, Chiclayo, Peru
| | - Genesis Masiel Guevara-Vasquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Departamento del Desarrollo de Investigación Básica Clínica, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - Mariela Patricia Aguayo-Gonzalez
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
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Saberi P, Lisha NE, Erguera XA, Hudes ES, Johnson MO, Ruel T, Neilands TB. A Mobile Health App (WYZ) for Engagement in Care and Antiretroviral Therapy Adherence Among Youth and Young Adults Living With HIV: Single-Arm Pilot Intervention Study. JMIR Form Res 2021; 5:e26861. [PMID: 34463622 PMCID: PMC8441610 DOI: 10.2196/26861] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) interventions have the potential to interact with youth where they are, using a device they already access. OBJECTIVE Using predefined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth app, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV. WYZ was designed and developed with input from youth and young adults living with HIV using a human-centered design approach and was based on the information, motivation, and behavioral skills framework to address common barriers to care and ART adherence among youth and young adults living with HIV. METHODS We recruited youth and young adults living with HIV (18-29 years old) from the San Francisco Bay Area to take part in a 6-month pilot trial. Their participation included completing baseline and exit surveys, and participating in seven phone check-ins about their use of WYZ. RESULTS Youth and young adults living with HIV (N=79) reported high levels of feasibility and acceptability with WYZ use. We met predefined benchmarks for recruitment (79/84, 94%), mean logins per week (5.3), tracking ART adherence (5442/9393, 57.9%), posting chat topics per week (4.8), and app crashes reported per week (0.24). The ease of app download, install, and setup, and comfort with security, privacy, and anonymity were highly rated (all over 91%). Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the predefined benchmark. CONCLUSIONS We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable youth and young adults living with HIV and their providers to make informed decisions when using, recommending, and prescribing the app for improved engagement in HIV care and ART adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT03587857; https://clinicaltrials.gov/ct2/show/NCT03587857.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Nadra E Lisha
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Estie Sid Hudes
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Gitahi-Kamau N, Wahome S, Memiah P, Bukusi EA. The Role of Self-Efficacy in HIV treatment Adherence and its interaction with psychosocial factors among HIV Positive Adolescents in Transition to Adult Care in Kenya. Vulnerable Child Youth Stud 2021; 17:308-319. [PMID: 36439942 PMCID: PMC9698266 DOI: 10.1080/17450128.2021.1954736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
Adolescents and young adults (15-24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16-19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p<0.001 and p=0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99-24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.
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Affiliation(s)
- Nyawira Gitahi-Kamau
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Wahome
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore Maryland
| | - Elizabeth A Bukusi
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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12
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Huang F, Chen WT, Shiu CS, Sun W, Toma L, Luu BV, Ah-Yune J. Acculturation, HIV-Related Stigma, Stress, and Patient-Healthcare Provider Relationships Among HIV-Infected Asian Americans: A Path Analysis. J Immigr Minor Health 2021; 22:1217-1224. [PMID: 32789735 PMCID: PMC7424136 DOI: 10.1007/s10903-020-01068-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 01/29/2023]
Abstract
Acculturation may limit HIV-positive Asian Americans’ active interactions with patient-healthcare providers (HCP) and utilization of HIV healthcare services; however, the specific mediation effect of acculturation still unknown. A bias-corrected factor score path analysis was performed to examine the proposed model of relations among acculturation, stigma, stress, and patient-HCP relationships. A convenience sample of 69 HIV-positive Asian Americans in San Francisco, Los Angeles, and New York City were recruited and collect data were collected on demographics, HIV-related stigma, stress, and patient-HCP relationships. HIV stigma and stress had a direct, negative effect on patient-HCP relationships. Acculturation had a positive total effect on patient-HCP relationships, and was mediated by HIV stigma and stress. A acculturation also had a direct impact on stigma and stress. Acculturation, HIV-related stigma, and stress are key elements to achieving good patient-HCP relationships, and provide insights on the design of culturally sensitive interventions to improve patient-HCP relationships.
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Affiliation(s)
- Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China.,School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Cheng-Shi Shiu
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Wenxiu Sun
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Binh Vinh Luu
- Chinese-American Planning Council, Inc, New York, NY, USA
| | - Judy Ah-Yune
- Chinese-American Planning Council, Inc, New York, NY, USA
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13
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Ruiz-Robledillo N, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Clement-Carbonell V, Portilla J. Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men. J Clin Med 2021; 10:1662. [PMID: 33924530 DOI: 10.3390/jcm10081662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.
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14
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Saberi P, McCuistian C, Agnew E, Wootton AR, Legnitto Packard DA, Dawson-Rose C, Johnson MO, Gruber VA, Neilands TB. Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV. Telemed Rep 2021; 2:14-25. [PMID: 33575683 PMCID: PMC7869821 DOI: 10.1089/tmr.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 05/04/2023]
Abstract
Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Parya Saberi, PharmD, MAS, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143, USA
| | - Caravella McCuistian
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Emily Agnew
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Angie R. Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Dominique A. Legnitto Packard
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Valerie A. Gruber
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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15
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Abstract
Little is known about how engagement with healthcare providers mediates the relationship between psychosocial factors (anxiety, depression, stigma) and medication adherence among persons living with HIV (PLWH). Moreover, little research has investigated potential biological sex differences in this relationship. We conducted a secondary analysis of data collected from four projects (N = 281) focused on improving health outcomes in PLWH. Males displayed (a) negative association between depression and engagement with healthcare providers (β = - 0.02, z = - 3.20, p = 0.001) and (b) positive association between engagement with healthcare providers and medication adherence (β = 0.55, OR = 1.73, z = 2.62, p = 0.009). Females showed no association between any of these factors. Anxiety and stigma were not significantly associated with medication adherence. Path analysis modeling for males had a very good fit (CFI = 1, TLI = 1, RMSEA = 0); none of the regression coefficients was significant for females. The significant relationship between depression and medication adherence among males was fully mediated by engagement with healthcare providers. Findings suggest that adherence interventions for PLWH should be tailored by biological sex.
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Affiliation(s)
- Dawon Baik
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 E 19th Ave, C288, Aurora, CO, 80045, USA.
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, 10032, USA
| | - Hwayoung Cho
- College of Nursing, University of Florida, Gainesville, FL, 32610, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, 10032, USA
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16
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Stonbraker S, Porras T, Schnall R. Patient preferences for visualization of longitudinal patient-reported outcomes data. J Am Med Inform Assoc 2020; 27:212-224. [PMID: 31670816 PMCID: PMC7025335 DOI: 10.1093/jamia/ocz189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 03/25/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The study sought to design symptom reports of longitudinal patient-reported outcomes data that are understandable and meaningful to end users. MATERIALS AND METHODS We completed a 2-phase iterative design and evaluation process. In phase I, we developed symptom reports and refined them according to expert input. End users then completed a survey containing demographics, a measure of health literacy, and items to assess visualization preferences and comprehension of reports. We then collected participants' perspectives on reports through semistructured interviews and modified them accordingly. In phase II, refined reports were evaluated in a survey that included demographics, validated measures of health and graph literacy, and items to assess preferences and comprehension of reports. Surveys were administered using a think-aloud protocol. RESULTS Fifty-five English- and Spanish-speaking end users, 89.1% of whom had limited health literacy, participated. In phase I, experts recommended improvements and 20 end users evaluated reports. From the feedback received, we added emojis, changed date and font formats, and simplified the y-axis scale of reports. In phase II, 35 end users evaluated refined designs, of whom 94.3% preferred reports with emojis, the favorite being a bar graph combined with emojis, which also promoted comprehension. In both phases, participants literally interpreted reports and provided suggestions for future visualizations. CONCLUSIONS A bar graph combined with emojis was participants' preferred format and the one that promoted comprehension. Target end users must be included in visualization design to identify literal interpretations of images and ensure final products are meaningful.
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Affiliation(s)
| | - Tiffany Porras
- Columbia University School of Nursing, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA
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17
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Du X, He Q, Yang T, Wang Y, Xu H, Hao C, Zhou K, Gu J, Hao Y. Intention to start ART after the launch of expanded treatment strategy among people living with HIV in China: a behavioral theory-based cross-sectional study. AIDS Care 2019; 32:1182-1190. [PMID: 31690087 DOI: 10.1080/09540121.2019.1686601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2022]
Abstract
This study investigated the prevalence of intention to start antiretroviral therapy (ART) immediately among people living with HIV (PLWH) in China and associated perceptions toward ART based on behavioral theories. The study was initiated after the launch of an expanded ART strategy. A cross-sectional study was conducted among 450 PLWH who were ART naive in the city of Guangzhou, China, from June 2016 to February 2017. Among the participants, 311 (69.1%) showed intention to start ART immediately. The summary logistic regression analysis indicated that intention to start ART immediately was significantly associated with perceived severity [multivariate odds ratios (ORm) = 1.62, 95%CI = 1.15-2.28, p < 0.01], perceived barriers (ORm =0.56, 95%CI = 0.38-0.84, p < 0.01), self-efficacy (ORm =2.90, 95%CI = 2.05-4.09, p < 0.001), and subjective norms (ORm =1.95, 95%CI = 1.17-3.25, p < 0.05). The intention to start ART immediately among PLWH in Guangzhou was below the 90-90-90 target. Further promotion research should focus on these perceptional factors.
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Affiliation(s)
- Xuan Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Training and Evaluation Center of Guangdong Power Grid Company Limited, Guangzhou, People's Republic of China
| | - Qiangsheng He
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tinglong Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huifang Xu
- Department of HIV/AIDS Prevention and Control, Guangzhou Center for Disease Prevention and Control, Guangzhou, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kai Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
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18
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Chirambo L, Valeta M, Banda Kamanga TM, Nyondo-Mipando AL. Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi. BMC Public Health 2019; 19:1382. [PMID: 31660947 PMCID: PMC6816213 DOI: 10.1186/s12889-019-7768-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi. METHODS We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach. RESULTS Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships. CONCLUSION The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.
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Affiliation(s)
- Lusungu Chirambo
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Martha Valeta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Tifiness Mary Banda Kamanga
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
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19
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Jiang T, Zhou X, Wang H, Luo M, Pan X, Ma Q, Chen L. Psychosocial Factors Associated with Quality of Life in Young Men Who Have Sex with Men Living with HIV/AIDS in Zhejiang, China. Int J Environ Res Public Health 2019; 16:E2667. [PMID: 31349674 PMCID: PMC6696375 DOI: 10.3390/ijerph16152667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To explore the quality of life (QOL) status and related factors in young human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) aged 16 to 24 years in Zhejiang province. METHODS A cross-sectional study was conducted in 22 counties of Zhejiang province, and 395 subjects took part in our research. A t-test, one-way Analysis of variance (ANOVA), and multivariate stepwise linear regression analysis were used to investigate the factors associated with QOL in young HIV-infected MSM. RESULTS The total score on the QOL was 86.86 ± 14.01. The multivariate stepwise linear regression analysis revealed that self-efficacy and discrimination were associated with all domains on the QOL assessment, monthly income was associated with QOL for all domains except spirituality and consistent condom use during oral sex with men in the past three months was associated with QOL for all domains except the relationship domain. Those individuals within the group of young HIV-infected MSM who have higher self-efficacy, a higher monthly income, greater social support, safer sexual behaviors, a higher level of education, and a higher cluster of differentiation 4 (CD4) count have a better QOL. CONCLUSIONS These findings suggest that to improve the QOL of this population, greater emphasis should be placed on improving social support, self-efficacy, and antiviral therapy adherence and on reducing discrimination, disease progression, and high-risk behaviors.
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Affiliation(s)
- Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Mingyu Luo
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
| | - Lin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
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20
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Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, Hogan JW, Carey MP, Howe CJ. Resilience and HIV: a review of the definition and study of resilience. AIDS Care 2019; 30:S6-S17. [PMID: 30632778 DOI: 10.1080/09540121.2018.1515470] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 10/27/2022]
Abstract
We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.
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Affiliation(s)
- Akilah J Dulin
- a Center for Health Equity Research, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Sannisha K Dale
- b Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Valerie A Earnshaw
- c Department of Human Development and Family Sciences , University of Delaware , Newark , DE , USA
| | - Joseph L Fava
- d Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Michael J Mugavero
- e Division of Infectious Diseases, Department of Medicine, Center for AIDS Research , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sonia Napravnik
- f Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joseph W Hogan
- g Center for Statistical Sciences, Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Michael P Carey
- h Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior , The Miriam Hospital, Alpert Medical School of Brown University , Providence , RI , USA
| | - Chanelle J Howe
- i Centers for Epidemiology and Environmental Health, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
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21
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Li L, Wu Z, Liang LJ, Lin C, Luo S, Cao X, Hsieh J, Rou K. An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China. Drug Alcohol Depend 2019; 194:143-150. [PMID: 30445272 PMCID: PMC6413495 DOI: 10.1016/j.drugalcdep.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/07/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention. METHODS This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period. RESULTS Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90). CONCLUSIONS The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Julie Hsieh
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
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Chen WT, Shiu C, Yang JP, Wang K, Zhang L, Zhang J, Reynolds NR, Kennedy HP, Khoshnood K, Chen LC, Bao M, Zhao H, Lu H. Quality of life in HIV-infected Chinese women and their family caregivers: an intervention study. AIDS Care 2018; 30:1572-1579. [PMID: 30111163 DOI: 10.1080/09540121.2018.1510095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/28/2022]
Abstract
China is experiencing a rapid increase in the number of HIV-infected women. In this study, we describe the development and preliminary evaluation of an intervention tailored for Chinese HIV-infected women and caregivers to improve their self- and family management, with goals of enhancing their physical quality of life (QOL) and decreasing their depressive symptomatology. Forty-one HIV-infected women and their caregivers were recruited from two premier Chinese hospitals from July 2014 through March 2016. Participants were randomized to either the control or intervention arm for the Self- and Family Management Intervention (SAFMI). Each study dyad in the intervention arm received three counseling sessions with a nurse interventionist. At baseline, immediate post-intervention (month 1) and follow-up (month 3), the participants were assessed by a self-reported survey. Generalized Hierarchical Linear Modeling was used to evaluate the efficacy of the intervention. Chinese HIV-infected women in the intervention arm had significantly higher probability of higher physical QOL at month 1 and lower probability of clinically meaningful depressive symptomatology at month 3 compared with women in the control arm. In contrast, the effects of the intervention were less salient for caregivers. This study represents one of the first in China to include family caregivers in HIV management. Feasibility and acceptability were high, in that family members were willing to join the study, learn about HIV, and practice new skills to support the HIV-infected women in their lives. A larger trial is needed to fully evaluate this intervention which shows promising preliminary effects in promoting physical QOL and decreasing depressive symptomatology among Chinese HIV-infected women.
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Affiliation(s)
- Wei-Ti Chen
- a School of Nursing , University of California Los Angeles , Los Angeles , CA , USA
| | - Chengshi Shiu
- a School of Nursing , University of California Los Angeles , Los Angeles , CA , USA
| | - Joyce P Yang
- b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
| | - Kerong Wang
- c Beijing, Ditan Hospital , Capital Medical University , Beijing , People's Republic of China
| | - Lin Zhang
- d Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Jing Zhang
- d Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Nancy R Reynolds
- e School of Nursing , John Hopkins University , Baltimore , MD , USA
| | | | - Kaveh Khoshnood
- g School of Public Health , Yale University , New Haven , CT , USA
| | - Li-Chen Chen
- d Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Meijuan Bao
- h School of Nursing , National Cheng Kung University , Tainan , Taiwan
| | - Hongxin Zhao
- i AIDS Unit, Beijing, Ditan Hospital , Capital Medical University , Beijing , People's Republic of China
| | - Hongzhou Lu
- d Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
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Chen WT, Shiu C, Yang JP, Li CSR, Wang K, Zhang L, Zhang J, Bao M, Aung MN, Chen LC, Zhao H, Lu H. Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis. J Subst Use 2018; 23:408-414. [PMID: 30906222 DOI: 10.1080/14659891.2018.1436603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context In China, the social stigma of both substance use and HIV remains major barriers. HIV+ individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV+ Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives. Objectives We examine the mediation relationship among substance use, anxiety, and self-management efficacy. Method A cross-sectional study design was used. 137 HIV+ individuals were recruited from two premier Chinese hospitals: Beijing's Ditan Hospital and Shanghai's Public Health Clinic Center (SPHCC). Results HIV+ substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety was mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recent effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy. Conclusion It is useful for healthcare providers to assess substance use behaviors in HIV+ individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Chengshi Shiu
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Joyce P Yang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Chiang-Shan Ray Li
- Psychiatry and of Neuroscience, School of Medicine, Yale University, New Haven, CT
| | - Kerong Wang
- Ditan Hospital, Capital Medical University, Beijing, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jing Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Li-Chen Chen
- National Cheng Kung University, School of Nursing, Tainan, Taiwan
| | - Hongxin Zhao
- Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Liu Y, Vermund SH, Ruan Y, Liu H, Rivet Amico K, Simoni JM, Shepherd BE, Shao Y, Qian H. Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study. J Int AIDS Soc 2018; 21:e25079. [PMID: 29430845 PMCID: PMC5808102 DOI: 10.1002/jia2.25079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/29/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Reducing high-risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer- counselling in reducing high-risk behaviours among newly diagnosed HIV-positive Chinese men who have sex with men (MSM). METHODS We randomized 367 newly diagnosed HIV-positive men to either standard-of-care (SOC; n = 183) or peer-counselling intervention (n = 184), and followed them for 12 months (visit at 0-, 3-, 6-, 9- and 12-month). SOC participants received counselling on high-risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre-post diagnosis high-risk behaviour change; logistic regression was used to assess the likelihood of practicing high-risk behaviours between intervention and SOC participants. Both intent-to-treat and per-protocol (full-dosage) approaches were used for the analyses. RESULTS For pre- and post-diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent-to-treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per-protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98). CONCLUSIONS We observed a 14 to 43% decrease in the prevalence of selected high-risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer-counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM. Clinical Trial Number: NCT01904877.
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Affiliation(s)
- Yu Liu
- Department of Public Health SciencesUniversity of Rochester School of Medicine and DentistryRochesterNYUSA
| | | | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID)Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Hongjie Liu
- Department of Epidemiology and BiostatisticsSchool of Public HealthUniversity of MarylandCollege ParkMDUSA
| | - K Rivet Amico
- Department of Health Behavior and Health EducationUniversity of MichiganAnn ArborMIUSA
| | - Jane M Simoni
- Department of PsychologyUniversity of Washington SeattleSeattleWAUSA
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTNUSA
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID)Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Han‐Zhu Qian
- School of Public HealthYale UniversityNew HavenCTUSA
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25
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Chen WT, Shiu C, Yang JP, Chuang P, Zhang L, Bao M, Lu H. A structural equation model of patient-healthcare provider relationships and HIV-infected patient outcomes in Chinese populations. AIDS Care 2017; 30:383-390. [PMID: 28934872 DOI: 10.1080/09540121.2017.1380778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/18/2022]
Abstract
Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.
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Affiliation(s)
- Wei-Ti Chen
- a School of Nursing , Yale University , Orange , CT , USA
| | - Chengshi Shiu
- b School of Social Work , University of Washington , Seattle , WA , USA
| | - Joyce P Yang
- c Department of Psychology , University of Washington , Seattle , WA , USA
| | - Peing Chuang
- d Kunming Branch , Center of Disease Prevention and Control , Taipei , Taiwan
| | - Lin Zhang
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Meijuan Bao
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Hongzhou Lu
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
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Hurley EA, Harvey SA, Keita M, Kennedy CE, Roter D, Dao S, Doumbia S, Winch PJ. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences. SSM Popul Health 2017; 3:539-48. [PMID: 29270460 DOI: 10.1016/j.ssmph.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 11/23/2022] Open
Abstract
Effective patient-provider communication (PPC) promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART), yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power), and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp). Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2%) compared to a biomedical style (22.5%) (p<0.001). Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2%) compared to a provider-dominated style (35.8%). In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4%) and/or “tough” style (40.6%), but significantly fewer preferred the “sharp” style (14.5%) (p<0.001). Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately, clinical outcomes. Emphasis on developing skills in psychosocial regard and on adapting styles of power balance and behavioral guidance to individual patients is likely to yield positive results and should be considered a high priority for ART providers. Examines patient preferences among culturally-relevant PPC styles. Most patients preferred the “high psychosocial regard” over the “biomedical” style. Patients were split in preference for “shared power” versus “provider-dominant”. Preferences were split between “easy” versus “tough” style of recommending behavior change. Patients with lower education were more likely to indicate “no preference” among PPC styles.
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Pokhrel KN, Sharma VD, Shibanuma A, Pokhrel KG, Mlunde LB, Jimba M. Predicting health-related quality of life in people living with HIV in Nepal: mental health disorders and substance use determinants. AIDS Care 2017; 29:1137-1143. [PMID: 28547996 DOI: 10.1080/09540121.2017.1332331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 10/19/2022]
Abstract
HIV-positive people often experience mental health disorders and engage in substance use. Such conditions tend to impair their health-related quality of life (QOL). Evidence, however, is limited about the influence of mental health disorders and substance use on QOL by gender. Also, little is known about the influences of anxiety and high levels of stress on QOL. We recruited 682 HIV-positive people in Nepal and measured their depression, anxiety, stress levels, substance use, and QOL. Multiple linear regressions assessed the association of mental health disorders and substance use with QOL. Presence of depressive symptoms was negatively associated with all domains of QOL including the physical (men: β = -0.68, p = 0.037; women: β = -1.37, p < 0.001) and the psychological (men: β = -1.08, p < 0.001; women: β = -1.13, p < 0.001). Those who experienced anxiety had lower scores in the physical (β = -0.89, p = 0.027) and psychological (β = -1.75, p = 0.018) QOL domains among men and in the spiritual QOL domain (β = -0.061, p = 0.043) among women. High stress levels were associated with lower scores across all QOL domains including the physical (men: β = -0.16, p < 0.001; women: β = -0.14, p < 0.001) and the psychological (men: β = -0.09, p < 0.001; women: β = -0.10, p < 0.001). Substance-using men were more likely to have lower scores in physical (β = -0.70, p = 0.039) and psychological (β = -0.073, p = 0.002) domains. Among women, meanwhile, substance use was negatively associated with the psychological domain only (β = -0.77, p = 0.005). In conclusion, mental health disorders and substance use had negative associations with QOL. Attention should be given to addressing the mental health care needs of HIV-positive people to improve their QOL.
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Affiliation(s)
- Khem N Pokhrel
- a Department of Community and Global Health , Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo , Japan
| | - Vidya D Sharma
- b Department of Psychiatry and Mental Health , Institute of Medicine, Tribhuwan University , Kathmandu , Nepal
| | - Akira Shibanuma
- a Department of Community and Global Health , Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo , Japan
| | - Kalpana G Pokhrel
- c Department of Public Health , Royal Tropical Institute , Amsterdam , the Netherlands
| | - Linda B Mlunde
- a Department of Community and Global Health , Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo , Japan
| | - Masamine Jimba
- a Department of Community and Global Health , Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo , Japan
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Farmer A, Wang X, Ganesan A, Deiss RG, Agan BK, O’Bryan TA, Akers K, Okulicz JF. Factors associated with HIV viral load "blips" and the relationship between self-reported adherence and efavirenz blood levels on blip occurrence: a case-control study. AIDS Res Ther 2016; 13:16. [PMID: 27006682 PMCID: PMC4802903 DOI: 10.1186/s12981-016-0100-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background The uncertain etiology of HIV viral load (VL) blips may lead to increased use of clinical resources. We evaluated the association of self-reported adherence (SRA) and antiretroviral (ART) drug levels on blip occurrence in US Military HIV Natural History Study (NHS) participants who initiated the single-tablet regimen efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). Methods ART-naïve NHS participants started on EFV/FTC/TDF between 2006 and 2013 who achieved VL suppression (<50 copies/mL) within 12 months and had available SRA and stored plasma samples were included. Participants with viral blips were compared with those who maintained VL suppression without blips. Untimed EFV plasma levels were evaluated on consecutive blip and non-blip dates by high performance liquid chromatography, with a level ≥1 mcg/mL considered therapeutic. SRA was categorized as ≥85 or <85 %. Descriptive statistics were performed for baseline characteristics and univariate and multivariate Cox proportional hazard models were used to assess the relationship between covariates and blip occurrence. Results A total of 772 individuals met inclusion criteria, including 99 (13 %) blip and 673 (87 %) control participants. African-American was the predominant ethnicity and the mean age was 29 years for both groups. SRA ≥ 85 % was associated with therapeutic EFV levels at both blip and non-blip time points (P = 0.0026); however no association was observed between blips and SRA or EFV levels among cases. On univariate analysis of cases versus controls, blips were associated with higher mean pre-treatment VL (HR 1.45, 95 % CI 1.11–1.89) and pre-treatment CD4 count <350 cells/µL (68.1 vs 49.7 %). Multivariate analysis also showed that blips were associated with a higher mean VL (HR 1.42, 95 % CI 1.08–1.88; P = 0.0123) and lower CD4 count at ART initiation, with CD4 ≥500 cells/µL having a protective effect (HR 0.45, 95 % CI 0.22–0.95; P = 0.0365). No association was observed for demographic characteristics or SRA. Conclusion Blips are commonly encountered in the clinical management of HIV-infected patients. Although blip occurrence was not associated with SRA or EFV blood levels in our study, blips were associated with HIV-related factors of pre-ART high VL and low CD4 count. Additional studies are needed to determine the etiology of blips in HIV-infected patients.
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Dong XF, Liu YJ, Wang AX, Lv PH. Psychometric properties of the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in patients with stroke. Patient Prefer Adherence 2016; 10:321-7. [PMID: 27042023 PMCID: PMC4798205 DOI: 10.2147/ppa.s101844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It has been reported that stroke has a higher incidence and mortality rate in the People's Republic of China compared to the global average. These conditions can be managed by proper medication use, but ensuring medication adherence is challenging. OBJECTIVE To translate the Self-Efficacy for Appropriate Medication Use Scale into Chinese and test its validity and reliability in patients with stroke. METHODS Instrument performances were measured from January 15, 2015 to April 28, 2015 on a convenience sample of 400 patients with stroke recruited at four neurology departments of the First Affiliated Hospital of Zhengzhou University. Questionnaires included the Chinese versions of the Self-Efficacy for Appropriate Medication Use Scale (C-SEAMS) and the General Self-Efficacy Scale (C-GSE). Construct validity, convergent validity, internal consistency, and test-retest reliability were measured. RESULTS Item analysis showed that item-to-total correlations were in the range of 0.362-0.672. Exploratory factor analysis revealed two factors (which accounted for 60.862% of total variance), with factor loading ranging from 0.534 to 0.756. Confirmatory factor analysis was performed to support the results, with an acceptable fit (χ (2)=73.716; df=64; P<0.01; goodness-of-fit index =0.902; adjusted goodness-of-fit index =0.897; comparative fit index =0.865; root-mean-square error of approximation =0.058). The convergent validity of the C-SEAMS correlated well with the validated measure of the C-GSE in measuring self-efficacy (r=0.531, P<0.01). Good internal consistency (Cronbach's alpha ranged from 0.826 to 0.915) and test-retest reliability (Pearson's correlation coefficient r=0.642, P<0.01) were found. CONCLUSION The C-SEAMS is a brief and psychometrically sound measure for evaluating self-efficacy for medication adherence in the Chinese population with stroke.
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Affiliation(s)
- Xiao-fang Dong
- Neurology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yan-jin Liu
- Nursing Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- Correspondence: Yan-jin Liu, Nursing Department, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, Henan Province, 450052, People’s Republic of China, Tel +86 135 2354 8732, Fax +86 371 6691 3035, Email
| | - Ai-xia Wang
- Neurology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Pei-hua Lv
- Neurology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
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Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
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Areán PA, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Banerjee S, Kiosses DN, Dwyer E, Alexopoulos GS. Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 2015; 23:1307-1314. [PMID: 26628206 PMCID: PMC6033321 DOI: 10.1016/j.jagp.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability. METHODS Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used. RESULTS Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12. CONCLUSION CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Patrick J Raue
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Joanna K Seirup
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Dimitris N Kiosses
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Eleanor Dwyer
- San Mateo Department of Public Health, San Mateo, CA
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Webel AR, Sattar A, Schreiner N, Phillips JC. Social resources, health promotion behavior, and quality of life in adults living with HIV. Appl Nurs Res 2015; 30:204-9. [PMID: 27091279 DOI: 10.1016/j.apnr.2015.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the associations among three social resource variables (social belonging, social support networks, and social capital) and two health promotion behaviors, HIV medication adherence and physical activity, and quality of life among persons living with HIV (PLHIV). METHOD We conducted a cross-sectional analysis in 102 adult PLHIV. Social resource variables and quality of life were assessed using validated and widely-used instruments. Physical activity was assessed using a daily physical activity diary and medication adherence was abstracted from the participant's medical record. Spearman correlations and descriptive statistics were used to analyze associations among variables. RESULTS Fifty-four participants (54%) were male and most were African American (84%), single (69%), and living in poverty (82%). Participants had been living with HIV for an average of 13.6 years (+/-7) and most were living with at least one non-AIDS comorbidity (80%). Social belonging was significantly associated with HIV medication adherence (ρ=0.25, p=0.02), overall functioning (ρ=0.48, p<0.01) and life satisfaction quality of life (ρ=0.50, p<0.01). Social capital was also associated with HIV medication adherence (ρ=0.17, p=0.10) and life satisfaction quality of life (ρ=0.29, p<0.01). CONCLUSIONS We found that there are distinctions among various, widely-used social resource constructs. By describing these unique associations and distinctions, our study helps identify which social resources should be targeted in the development of interventions to improve health promotion and the quality of life of members of this marginalized population.
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University.
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, Case Western Reserve University
| | - Nate Schreiner
- Frances Payne Bolton School of Nursing, Case Western Reserve University
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Abstract
HIV is both a biomedical disease and a social phenomenon that is constructed in particular cultural contexts. A successful and humane HIV cure requires not only the science of eradicating pathogens, but also the art of healing to restore harmony between mind and body. Healing in the context of HIV cure will be both personal and interpersonal, biological and social, and will involve rebuilding connections between HIV patients and their social environment. Social conceptions of healing have been highlighted in many regions with rich non-biomedical healing traditions, including China. Based on an adapted theoretical model on social relationships and health, we address the essential role of social relations for HIV healing in Chinese cultural context, and propose several recommendations for reforming practices and policies regarding HIV healing. In general, family is still a core social unit in HIV patients' medical journey from diagnosis to treatment. A positive patient-physician relationship based on mutual respect and trust also has critical impact on patients' physical and mental health. Physicians may become a key or the main source of social support in circumstances when families are not actively engaged in healing. Reconnecting HIV patients with their communities should be a necessary component of HIV cure, as this will help patients engage more fully in the HIV healing process. We call for a family-centered approach in HIV healing intervention to strengthen patient-family ties; a series of policies to build up and sustain positive patient-physician ties; and multi-level strategies to empower patients and rebuild their bonds to community and larger society. We also call for more empirical research on how non-biomedical healing approaches in various cultural settings could (directly or indirectly) inform HIV cure research.
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Affiliation(s)
- Shan Qiao
- Pediatric Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Jing-Bao Nie
- Bioethics Centre, University of Otago, Dunedin 9054, New Zealand
| | - Joseph Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Xiao-Ming Li
- Pediatric Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI 48201, USA
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