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Boyd DT, Ramos SR, Maragh-Bass AC, Dyer TV, Zigah EY, Abu-Ba'are GR. Influence of families and other adult support on HIV prevention outcomes among black men who have sex with men. BMC Public Health 2024; 24:822. [PMID: 38491379 PMCID: PMC10941365 DOI: 10.1186/s12889-024-18171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/21/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Prior research has consistently shown that the involvement of families plays a vital role in reducing risk behaviors, such as engaging in condomless sex, and promoting HIV prevention behaviors among young Black men who have sex with men (YBMSM). With the aim of expanding the existing knowledge, this study aimed to examine the specific influence of families and other supportive adults in facilitating casual condom use, partner condom use, HIV testing, and preexposure prophylaxis (PrEP) utilization among young Black MSM. METHODS A sample of YBMSM aged 18-29 years (N = 400) was collected online. We used a path analysis to examine the influence of family factors on PrEP stigma and PrEP use. Respondents were recruited from December 1, 2021, to January 31, 2022. We used a path analysis to examine the direct and indirect effects of family factors on PrEP use through HIV testing and encouraging condom use. RESULTS Among BMSM, other adult support was positive and directly associated with condom use by both casual partners (β = 0.04, p < .05) and partners (β = 0.17, p < .01). Condom use by casual partners was negative and was directly associated with HIV testing (β = - 0.15, p < .01). CONCLUSION The primary aim of this research was to examine the influence of family and adult support on HIV prevention behaviors among young Black MSM, including condom use, HIV testing, and PrEP use. Our findings highlight the significance of implementing interventions that incorporate families and other supportive adults to enhance the engagement of young Black MSM in HIV prevention behaviors.
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Affiliation(s)
- Donte T Boyd
- College of Social Work, The Ohio State University, 1047 College RD, #325K, Columbus, OH, 43215, USA.
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT, USA.
- University of California Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
| | - S Raquel Ramos
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
| | - Allysha C Maragh-Bass
- University of California Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Typhanye V Dyer
- University of California Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- School of Nursing, University of Rochester, Rochester, NY, USA
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Lightfoot M, Campbell C, Maragh-Bass AC, Jackson-Morgan J, Taylor K. What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis. J Med Internet Res 2024; 26:e44861. [PMID: 38416541 PMCID: PMC10938228 DOI: 10.2196/44861] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/06/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. OBJECTIVE This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. METHODS We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. RESULTS We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. CONCLUSIONS Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults.
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Affiliation(s)
- Marguerita Lightfoot
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, United States
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Chadwick Campbell
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | - Kelly Taylor
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
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Budhwani H, Hao J, Maragh-Bass AC, Hill S, Long DM, Simpson T. Viral load and sexually transmitted infection testing among youth with HIV in a southern United States clinic. Int J STD AIDS 2024; 35:11-17. [PMID: 37678958 DOI: 10.1177/09564624231200917] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Background: As compared to their older peers, youth with HIV (YWH) are less likely to attain viral suppression and have higher rates of sexually transmitted infections (STI). In this exploratory study, we examine the relationship between HIV viral suppression, STI testing, and STI diagnosis among YWH receiving care at a clinic in the southern United States.Methods: Data from 933 clinical visits (2017-2020) were aggregated into singular patient records for YWH aged 10-24 years in Alabama (N = 139). Analyses included univariate generalized linear mixed models performed with the PROC GLIMMIX procedure approximating the marginal likelihood by using Laplace's method.Results: Sample median age was 22 years at the index visit. Most YWH were 20-24 years old (69.1%), male (67.6%), and identified as Black (77%); 58.3% were virally unsuppressed at index visit. YWH who identified as White or of other races had 4.79 times higher odds of being virally suppressed as compared to Black YWH (p < .01); STI testing behavior and STI positive diagnosis were associated with lower odds of being virally suppression.Conclusions: Findings suggest that among YWH, receiving STI testing and having an STI diagnosis is associated with a lack of viral suppression, suggesting that extra efforts may be necessary to support YWH who have an STI to attain suppression. Research is needed to examine individual behaviors, structural forces, and clinic features that could impact STI care engagement, specifically among unsuppressed YWH.
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Affiliation(s)
- Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Jiaying Hao
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Samantha Hill
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin M Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tina Simpson
- Tulane University, School of Medicine, New Orleans, LA, USA
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Tuhebwe D, Brittingham S, Kanagaratnam A, Togo E, OlaOlorun FM, Wanyenze RK, Prata N, Maragh-Bass AC. Applying a Power Analysis to Everything We Do: A Qualitative Inquiry to Decolonize the Global Health and Development Project Cycle. Glob Health Sci Pract 2023; 11:e2300187. [PMID: 37903580 PMCID: PMC10615245 DOI: 10.9745/ghsp-d-23-00187] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Global health and development (GHD) systems that centralize power in the Global North were conceived during colonialism. As a result, they often replicate unequal power structures, maintaining dogged inequities. Growing and historic calls to decolonize GHD advocate for the transfer of power to actors in the Global South. This article identifies examples of colonial legacies in today's GHD projects and offers actionable strategies to decolonize. METHODS From August 2021 to March 2022, 20 key informants across 15 organizations participated in interviews about their experiences and perspectives relating to the decolonization of GHD. We used deductive thematic coding to identify examples of challenges and strategies to address them across 3 project life cycle phases: conceptualization and contracting, program planning and implementation, and program evaluation and dissemination. RESULTS Participants described how power is maintained in the Global North, sharing countless examples across the project life cycle, including agenda-setting with minimal local participation or partnership, onerous requirements that limit grantee eligibility, Global North ownership of data collected by and in the Global South, and dissemination in languages and formats that are not easily accessible to Global South audiences. Proposed strategies to decolonize GHD projects include having built-in participatory processes and accountability mechanisms; aligning solicitations with existing local strategies; adapting the process for awarding, contracting, and evaluating investments to increase the representation and competitiveness of Global South entities; creating trusting, respectful relationships with Global South partners; and systematically applying power analyses to each step of the project life cycle. CONCLUSIONS GHD practitioners suggested project life cycle-based strategies for shifting power and redistributing resources, which we argue will ultimately enhance the value, impact, and sustainability of GHD programming.
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Affiliation(s)
- Doreen Tuhebwe
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Amandari Kanagaratnam
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | | - Funmilola M OlaOlorun
- Evidence for Sustainable Human Development Systems in Africa; Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ndola Prata
- Evidence for Sustainable Human Development Systems in Africa; School of Public Health, University of California, Berkeley, CA, USA
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Maragh-Bass AC, Williams T, Agarwal H, Dulin AK, Sales J, Mayer KH, Siegler AJ. Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color. Clin Nurs Res 2023; 32:1046-1056. [PMID: 37401801 DOI: 10.1177/10547738231184295] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Stigmatization on the basis of race, sexuality, gender identity, and/or use of pre-exposure prophylaxis (PrEP) exacerbates HIV disparities for young men who have sex with men of color (YMSM). We explored resilience, healthcare experiences, stigma, and impact of coronavirus disease 2019 (COVID-19) on PrEP care needs among YMSM of color through virtual in-depth interviews. Analyses used adapted grounded theory/constant comparison. Regarding healthcare-based stigma, participants enacted multilevel resilience which was critical to their care retention during COVID-19 (Themes 1 and 2). Some participants noted that remote care could minimize healthcare stigma and promote retention in care and/or on PrEP (Theme 3). Participants were interested in long-acting injectable (LAI) PrEP but expressed concerns about cost, effectiveness, and side effects (Theme 4). Community-based venues like pharmacies were preferred spaces for getting LAI PrEP injections (Theme 4). Although expansion of telehealth that helped mitigate care retention challenges during COVID-19 was temporary, continued telehealth use may reduce stigmatization and promote long-term retention and PrEP persistence.
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Affiliation(s)
- Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Tia Williams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harsh Agarwal
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
| | - Akilah K Dulin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Maragh-Bass AC, Stoner MCD, Castellanos-Usigli A, Agarwal H, Katz AWK, Patani H, Sukhija-Cohen A, Campbell L, Arreola S, Saberi P. New preexposure prophylaxis options need updated counseling approaches: reframing 'risk' in HIV prevention counseling for young sexual and gender minorities of color. AIDS 2023; 37:1361-1366. [PMID: 37070546 DOI: 10.1097/qad.0000000000003563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Center for AIDS Prevention Studies, University of California
| | | | - Antón Castellanos-Usigli
- ACU Innovations & Consulting, New York, New York
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Harsh Agarwal
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360
| | | | | | | | | | | | - Parya Saberi
- Center for AIDS Prevention Studies, University of California
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Poteat TC, Maragh-Bass AC. Interrogating Anti-Blackness in US Healthcare: Contextual Factors and Policy Implications. Healthc Pap 2023; 21:43-48. [PMID: 37887169 DOI: 10.12927/hcpap.2023.27192] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Racial inequities exacerbated by the COVID-19 pandemic highlight how systemic anti-Black racism negatively impacts health. Anti-Black racism pervades the healthcare system, ranging from race-based corrections embedded in clinical algorithms to bias among healthcare providers. Systemic racism takes a physiological toll, causing illness and early mortality among Black people in the US and sending ripple effects across Black communities. The erasure of Black history is a common tool of racism that serves to impede progress toward racial justice. Structural changes, such as policies and laws that centre the lived experiences of Black people and directly address anti-Blackness racism, are essential for achieving health equity.
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Affiliation(s)
- Tonia C Poteat
- Professor, Duke University School of Nursing, Co-Director, Duke Sexual and Gender Minority Health Program, Duke University, Durham, NC
| | - Allysha C Maragh-Bass
- Scientist II, Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Adjunct Professor, Duke Global Health Institute, Duke University, Durham, NC
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Budhwani H, Yiğit İ, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale. AIDS Behav 2023; 27:929-938. [PMID: 36029425 PMCID: PMC9968821 DOI: 10.1007/s10461-022-03829-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/05/2023]
Abstract
To date, there are no established scales to assess PrEP stigma among youth. We validated the Youth PrEP Stigma Scale within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minority youth (16-24 years) who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported. Results yielded a three-factor solution (PrEP Disapproval by Others, Enacted PrEP Stigma, and PrEP User Stereotypes) with strong factor loadings and Cronbach's alphas ranging from 0.83 to 0.90, suggesting excellent internal consistency. Correlations between this Scale, anticipated HIV stigma, perceived HIV risk, and disclosure of sexual identity were significant, indicating potential for robust application. Given the persistence of HIV infections among youth, stigma as a barrier to prevention, and expansion of PrEP modalities, the Youth PrEP Stigma Scale could enhance intervention and mechanistic research among youth at elevated risk for HIV acquisition.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 32306, Tallahassee, FL, USA.
| | - İbrahim Yiğit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Crissi B Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
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Budhwani H, Maragh-Bass AC, Tolley EE, Comello MLG, Stoner MCD, Adams Larsen M, Brambilla D, Muessig KE, Pettifor A, Bond CL, Toval C, Hightow-Weidman LB. Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41240. [PMID: 36689557 PMCID: PMC9930921 DOI: 10.2196/41240] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. OBJECTIVE In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. METHODS Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617). RESULTS Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. CONCLUSIONS If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41240.
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Affiliation(s)
- Henna Budhwani
- Intervention Research and Implementation Science Lab, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI360, Durham, NC, United States
| | - Elizabeth E Tolley
- Behavioral, Epidemiological, Clinical Sciences Division, FHI360, Durham, NC, United States
| | - Maria Leonora G Comello
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | | | - Kathryn E Muessig
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Audrey Pettifor
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, NC, United States
| | - Christyenne L Bond
- Intervention Research and Implementation Science Lab, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Christina Toval
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, NC, United States
| | - Lisa B Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
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Maragh-Bass AC, Hucks-Ortiz C, Beyrer C, Remien RH, Mayer K, Del Rio C, Batey DS, Farley JE, Gamble T, Tolley EE. Multilevel Stigma and Its Associations with Medical Care Ratings Among Men Who Have Sex With Men in HPTN 078. J Prim Care Community Health 2023; 14:21501319231175362. [PMID: 37243342 DOI: 10.1177/21501319231175362] [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] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Our research assessed associations between stigma-related variables and medical care ratings among clients with HIV in HIV Prevention Trials Network (HPTN) 078 who were men who have sex with men (MSM). METHODS Logistic regression explored care ratings, stigma, socio-demographics (N = 637). Qualitative thematic coding and themes explored stigmatizing experiences in different settings (N = 111). RESULTS Whites were twice as likely as African-Americans to report high care ratings (P < .05). Clients who reported familial exclusion due to having sex with men were 40% less likely to report high medical care ratings (P < .05). Clients who agreed healthcare providers think people with HIV "sleep around" were half as likely to report high care ratings (P < .08). Stigmatization included "treating me like they'll catch HIV from my hand," and care avoidance so others didn't "know I was having sex with men". CONCLUSIONS Providers can promote African American MSM client retention with more affirming healthcare provision, namely minimizing assumptions and addressing identities and client needs beyond just HIV care.
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Affiliation(s)
| | - Christopher Hucks-Ortiz
- Black AIDS Institute, Los Angeles, CA, USA
- HIV Prevention Trials Network Black Caucus, Los Angeles, CA, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kenneth Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA
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Stoner MC, Tweedy D, Comello MGL, Toval C, Pettifor AE, Larsen MA, Baez A, Maragh-Bass AC, Tolley EE, Browne EN, Anderson L, Muessig KE, Budhwani H, Hightow-Weidman LB. Using narratives to inform the development of a digital health intervention related to COVID-19 vaccination in Black young adults in Georgia, North Carolina and Alabama. Vaccine 2022; 40:6908-6916. [PMID: 36280559 PMCID: PMC9581799 DOI: 10.1016/j.vaccine.2022.10.027] [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: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Interactive stories are a relatively newer form of storytelling with great potential to correct misinformation while increasing self-efficacy, which is crucial to vaccine acceptance. To address COVID-19 vaccine hesitancy and medical mistrust in young Black adults (BYA), we sought to adapt a pre-existing application ("app"; Tough Talks) designed to address HIV disclosure decision-making through choose-your-own adventure (CYOA) narratives and other activities. The adapted app (Tough Talks - COVID) uses a similar approach to situate COVID-19 vaccination decision-making within social contexts and to encourage greater deliberation about decisions. To inform content for the CYOA narratives, we conducted an online survey that was used to elicit the behavioral, cognitive, and environmental determinants influencing COVID-19 vaccine hesitancy among 150 BYA (ages 18-29) in Georgia, Alabama, and North Carolina. The survey included scenario questions that were developed with input from a youth advisory board to understand responses to peer and family influences. In two scenarios that involved discussions with family and friends about vaccination status, most respondents chose to be honest about their vaccination status. However, vaccinated individuals perceived more social pressure and stigma about not being vaccinated than unvaccinated respondents who were not as motivated by social pressure. Personal choice/agency in the face of perceived vaccine risks was a more common theme for unvaccinated respondents. Results suggest that relying on changing social norms alone may not impact barriers to vaccination in unvaccinated young adults without also addressing other barriers to vaccination such as concerns about autonomy and vaccine safety. Based on these findings, CYOA narratives in the app were adapted to include discussions with family and friends but also to touch on themes of personal choice as well as other topics that influence behaviors besides norms such as safety, side effects, and risk of COVID-19 in an evolving pandemic.
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Affiliation(s)
- Marie C.D. Stoner
- RTI International, Berkeley, CA, USA,Corresponding author at: Women’s Global Health Imperative RTI International, 2150 Shattuck Avenue, Berkeley, CA 94104, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lisa B. Hightow-Weidman
- University of North Carolina, Chapel Hill, NC, USA,Florida State University, Tallahassee, FL, USA
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12
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Budhwani H, Hao J, Maragh-Bass AC, Hill SV, Long DM, Simpson T. Gaps in sexually transmitted infection screening among youth living with HIV in Alabama. BMC Res Notes 2022; 15:347. [PMID: 36348439 PMCID: PMC9644521 DOI: 10.1186/s13104-022-06241-7] [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: 05/12/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Gaps in sexually transmitted infection (STI) testing can lead to poor health outcomes due to untreated illness among youth living with HIV (YLHIV). Thus, the objective of this study is to examine STI testing behavior and outcomes among a sample of YLHIV in the southern United States. Clinical records of 139 YLHIV who received HIV care in Alabama (2017-2020) were evaluated for receipt of STI testing (gonorrhea, chlamydia, syphilis), prevalence of positive test results, and factors associated with testing outcomes (933 clinical visits). RESULTS Nearly 80% of our sample identified as African American, most were 20-24 years, and about 60% reported detectable viral load at first visit during the study period. Just under 60% of cisgender male and transgender female clients reported receipt of at least one STI test, compared to less than 40% of cisgender females. Identifying as a cisgender male and having been diagnosed with HIV related to sex with men were associated with greater likelihood receiving STI testing. Cisgender males reported higher rates of positive syphilis test results than cisgender females; the highest rates of positive STI tests were among transgender females. Results underscore need for providers to promote routine STI testing to YLHIV.
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Affiliation(s)
- Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, FL, USA.
| | - Jiaying Hao
- grid.265892.20000000106344187School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences Division, FHI 360 Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Samantha V. Hill
- grid.265892.20000000106344187School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Dustin M. Long
- grid.265892.20000000106344187School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Tina Simpson
- grid.265892.20000000106344187School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
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13
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Budhwani H, Yigit I, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Validation of HIV Pre-Exposure Prophylaxis (PrEP) Medication Scales with Youth on PrEP: PrEP Confidence Scale and PrEP Difficulties Scale. AIDS Patient Care STDS 2022; 36:443-450. [PMID: 36306520 PMCID: PMC9700336 DOI: 10.1089/apc.2022.0072] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a lifesaving medical intervention that protects against human immunodeficiency virus (HIV), but to date, PrEP uptake has been limited. PrEP utilization and adherence among youth, including stigmatized and highly vulnerable young sexual and gender minorities, have been exceptionally low across all regions, leading to preventable HIV transmission. Considering the scientific value of measuring and understanding predictors or associations of PrEP adherence, our study team validated two scales: a PrEP Difficulties Scale and a PrEP Confidence Scale tested within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minorities who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported herein. Results for the PrEP Difficulties Scale yielded a four-factor solution (Disclosure, Health Effects, Logistics, and Cost), and results for the PrEP Confidence Scale produced a three-factor solution (Scheduling, Distraction, and Planning). Factor loadings and Cronbach's alphas suggested good internal consistency for both scales. PrEP Confidence Scale subscales were correlated with PrEP adherence, and subscales of both scales were associated with dimensions of social support and PrEP-related stigma. Given the persistence of preventable HIV infections among key populations, multi-level barriers and facilitators to medication adherence, and expansion of PrEP modalities, the PrEP Difficulties Scale and PrEP Confidence Scale have the potential to enhance intervention, exploratory, and mechanistic HIV prevention research. ClinicalTrials.gov Identifier: NCT03320512.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida States University (FSU), Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Crissi B. Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kathryn E. Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Lisa B. Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
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14
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Stoner MC, Browne EN, Tweedy D, Pettifor AE, Maragh-Bass AC, Toval C, Tolley EE, Comello MLG, Muessig KE, Budhwani H, Hightow-Weidman LB. Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study. JMIR Form Res 2022; 6:e39144. [PMID: 35969516 PMCID: PMC9446666 DOI: 10.2196/39144] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. OBJECTIVE To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. METHODS We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. RESULTS Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government's involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. CONCLUSIONS Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation.
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Affiliation(s)
| | | | | | | | | | - Christina Toval
- University of North Carolina, Chapel Hill, NC, United States
| | | | | | | | - Henna Budhwani
- Florida State University, Tallahassee, FL, United States
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15
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Stoner MCD, Bhushan NL, Maragh-Bass AC, Mitchell JT, Riggins L, Walker M, LeMasters K, Reese B, Dearing A, Debnam S, Golin C, Lightfoot AF, Pettifor A. Using Participatory Methods to Assess PrEP Interest and Uptake Among Young People Living in the Southeastern US: A Mixed Methods Assessment. AIDS Behav 2022; 26:1672-1683. [PMID: 34724592 PMCID: PMC9007838 DOI: 10.1007/s10461-021-03519-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
Adolescents and young adults (AYA; 13-24 years-old) comprise 22% of new HIV infections in the United States (US), most of whom live in the South. We used the situated-Information, Motivation, Behavioral skills (sIMB) model to identify priorities for intervention on multi-level factors that influence HIV preventive care among Black AYA in Durham, North Carolina. We conducted two participatory workshops (ages 13-17, N = 6; ages 18-24, N = 7) to engage youth about how to discuss HIV. We also assessed sIMB constructs from a separate quantitative sample of youth to contextualize the workshop findings (N = 80). HIV knowledge was low overall, but lower among younger Black AYA, suggesting a need for comprehensive sexual education. Trusted adults provided sexual health information, motivation for health maintenance, and behavioral skills support. HIV prevention interventions should provide comprehensive sexual health education to Black AYA, be age-specific, and include social supporters like parents, teachers, and community members.
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Affiliation(s)
- Marie C D Stoner
- Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Berkeley, CA, USA.
| | | | | | | | | | | | | | | | | | | | - Carol Golin
- University of North Carolina, Chapel Hill, NC, USA
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16
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Dubé K, Kanazawa J, Campbell C, Boone CA, Maragh-Bass AC, Campbell DM, Agosto-Rosario M, Stockman JK, Diallo DD, Poteat T, Johnson M, Saberi P, Sauceda JA. Considerations for Increasing Racial, Ethnic, Gender, and Sexual Diversity in HIV Cure-Related Research with Analytical Treatment Interruptions: A Qualitative Inquiry. AIDS Res Hum Retroviruses 2022; 38:50-63. [PMID: 33947268 PMCID: PMC8785755 DOI: 10.1089/aid.2021.0023] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/03/2023] Open
Abstract
Despite disproportionate incidence and prevalence of HIV among transgender individuals, cisgender women, and racial and ethnic minority groups, all remain underrepresented in HIV cure research. As HIV cure trials are scaled up, there is emerging research on ways to mitigate risks of HIV acquisition for sexual partners of analytical treatment interruption (ATI) trial participants. As such, it is imperative that HIV cure researchers consider the implications of implementing ATIs in populations that are disproportionately affected by HIV, but largely underrepresented in trials to date. In this qualitative study, we sought to derive triangulated perspectives on the social and ethical implications regarding ATIs and partner protection strategies during ATIs among under-represented populations. We conducted 21 in-depth interviews with 5 types of informants: bioethicists, community members [people living with HIV (PLWH) and their advocates], biomedical HIV cure researchers, sociobehavioral scientists, and HIV care providers. We analyzed the data using conventional content analysis and reduced the data to important considerations for implementing ATI trials in diverse communities and settings. Our study revealed the following key themes: (1) attention must be paid to gender and power dynamics in ATI trials; (2) ATI trials should be designed and implemented through the lenses of intersectionality and equity frameworks; (3) ATI trials may have both positive and negative effects on stigma for PLWH and their partners; and (4) partnership dynamics should be considered when designing ATI protocols. Our study generated actionable considerations that could be implemented in ATI trials to promote their acceptability to communities that have been underrepresented in HIV cure research to date. Research teams must invest in robust community and stakeholder engagement to define best practices. Paying attention to representation and equity will also promote better and more equitable implementation of HIV cure strategies once these become ready for rollout.
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Affiliation(s)
- Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Address correspondence to: Karine Dubé, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27516, USA
| | - John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chadwick Campbell
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA.,Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Cheriko A. Boone
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Danielle M. Campbell
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | | | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, California, USA
| | | | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mallory Johnson
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Parya Saberi
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
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17
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Tolley EE, Hamilton EL, Eley N, Maragh-Bass AC, Okumu E, Balán IC, Gamble T, Beyrer C, Remien R. "The role of case management in HIV treatment adherence: HPTN 078". AIDS Behav 2022; 26:3119-3130. [PMID: 35362913 PMCID: PMC9371990 DOI: 10.1007/s10461-022-03644-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Adherence to care and antiretroviral therapy is challenging, especially for people living with HIV (PLWH) with additional co-occurring risk factors. Case management interventions, including motivational interviewing (MI), show promise to improve HIV treatment adherence, but few studies have examined how such interventions are delivered to or experienced by PLWH who have been reengaged in care. We conducted qualitative interviews with six case managers and 110 PLWH exiting from a randomized study (HPTN 078) who received a MI-based case management intervention in addition to standard patient-navigation services, or standard services only. Our study provided greater insight into the main findings from HPTN 078, including an in-depth description of the multiple barriers to adherence faced by this largely "out-of-care" population, as well as a more nuanced understanding of the benefits and challenges of implementing MI. A blend of MI plus more intensive interventions may be needed for PLWH facing multiple structural barriers.
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Affiliation(s)
- Elizabeth E. Tolley
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Erica L. Hamilton
- grid.245835.d0000 0001 0300 5112Science Facilitation, FHI 360, Durham, NC United States
| | - Natalie Eley
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Allysha C. Maragh-Bass
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Eunice Okumu
- grid.410711.20000 0001 1034 1720UNC Center for AIDS Research, University of North Carolina, Chapel Hill, NC United States
| | - Iván C. Balán
- grid.255986.50000 0004 0472 0419Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL United States
| | - Theresa Gamble
- grid.245835.d0000 0001 0300 5112Science Facilitation, FHI 360, Durham, NC United States
| | - Chris Beyrer
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD United States
| | - Robert Remien
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, New York, NY United States
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18
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Maragh-Bass AC, LeMasters K, Sanders T, Harding C, Dearing A, Purcell R, Mitchell JT, Stoner MC, Bhushan N, Walker M, Riggins L, Golin C, Pettifor A, Lightfoot A. Lessons Learned in Centering Youth Voices in HIV Prevention: The Adolescent Health Working Group. Prog Community Health Partnersh 2022; 16:551-561. [PMID: 36533504 PMCID: PMC10982893 DOI: 10.1353/cpr.2022.0076] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There remains critical need for community-based approaches to HIV prevention which center youth voices and needs. OBJECTIVES We established an adolescent health working group (AHWG) to convene youth, parents, providers, and advocates in agenda-setting for interventions to increase pre-exposure prophylaxis uptake in Durham. METHODS Our three study phases included six AHWG meetings from 2019 to 2020, youth-only meetings guided by a participatory engagement framework (Youth Generate and Organize), and interviews (n=13) and surveys with youth in the community (N=87). We also developed materials such as an AHWG mission statement, a list of themes and informational needs, and documented strategies about pivoting the project during the onset of the COVID-19 global pandemic.Lessons Learned/Conclusions: Engaging adults in youth-focused HIV prevention differs greatly to engaging youth themselves. Creating spaces to promote adolescent sexual Health requires trust building, breaking down sensitivities and stigma to, and flexibility to navigate both virtual and in-person spaces to do so.
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Affiliation(s)
- Allysha C. Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences, FHI 360, Durham, NC
- Duke Global Health Institute, Durham, NC
| | - Kate LeMasters
- Dept. of Epidemiology, University of North Carolina (UNC) Gillings School of Public Health, Chapel Hill, NC
| | - Tsharre Sanders
- College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC
| | - Caressa Harding
- North Carolina Department of Health and Human Services, Raleigh, NC
- Health and Housing Committee, Partnership for a Healthy Durham, Durham, NC
| | - Aissa Dearing
- Dept. of Environmental Studies, Howard University, Washington, DC
- NC WARN: Durham Youth Climate Justice Initiative, Durham, NC
| | - Randy Purcell
- Youth Advisory Board, Triangle Empowerment Center, Durham, NC
| | - John T. Mitchell
- Dept. of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Marie C. Stoner
- Women’s Global Health Imperative, RTI International, Berkeley, CA
| | - Nivedita Bhushan
- Institute of Global and Infectious Diseases, UNC, Chapel Hill, NC
| | - Maleka Walker
- Department of Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NC
| | - Linda Riggins
- Department of Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NC
| | - Carol Golin
- Department of Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NC
- Social and Behavioral Sciences Core, Center for AIDS Research, UNC, Chapel Hill, NC
| | - Audrey Pettifor
- Dept. of Epidemiology, University of North Carolina (UNC) Gillings School of Public Health, Chapel Hill, NC
- Institute of Global and Infectious Diseases, UNC, Chapel Hill, NC
| | - Alexandra Lightfoot
- Department of Health Behavior, University of North Carolina Gillings School of Public Health, Chapel Hill, NC
- Community Engagement, Partnerships and Technical Assistance Core, Center for Health Promotion and Disease Prevention, University of North Carolina Gillings School of Public Health, Chapel Hill, NC
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19
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Maragh-Bass AC, Hendricks Sloan D, Aimone EV, Knowlton AR. 'The Woman Gives': Exploring gender and relationship factors in HIV advance care planning among African American caregivers. J Clin Nurs 2021; 30:2331-2347. [PMID: 33829592 DOI: 10.1111/jocn.15772] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race. BACKGROUND Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP. DESIGN The study was mixed methods and observational. METHODS Participants completed self-report surveys (N = 311) and were interviewed (n = 11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor. RESULTS Less than half had discussed ACP (41.2%; N = 267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men, which was qualitatively described as 'being a woman'. CONCLUSIONS The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender-specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships. RELEVANCE TO CLINICAL PRACTICE Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life-sustaining treatments at end-of-life. ACP is crucial now more than ever, as COVID-19 complicates care for older adults with HIV at high risk of complications.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Danetta Hendricks Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth V Aimone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Examining stigma, social support, and gender differences in unsuppressed HIV viral load among participants in HPTN 065. J Behav Med 2021; 44:159-171. [PMID: 33161564 PMCID: PMC11068030 DOI: 10.1007/s10865-020-00186-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/17/2020] [Indexed: 01/13/2023]
Abstract
Successful navigation of the HIV care continuum is necessary to maintain viral suppression. We explored gender-stratified correlates of being virally unsuppressed in the Prevention for Positives (P4P) component of HPTN 065. The outcome of interest was unsuppressed viral load (> 40 copies/mL) among individuals already living with HIV. Correlates included medication adherence factors, social support and stigma. Logistic regression models were stratified by gender (N = 673). Men-specific correlates of being virally unsuppressed included opposite-sex partners, older age and HIV disclosure stigma. Women-specific correlates included time since diagnosis, and personal-level barriers to medication adherence. When more individuals knew about their HIV status, women had over twice the likelihood of being virally unsuppressed; no such association was seen among men. Additionally, higher levels of social support were not associated with viral suppression among women. Interventions should consider gender-specific approaches to engaging social support in de-stigmatization of HIV and promotion of medication adherence and subsequent viral suppression.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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21
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Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 2020; 30:507-519. [PMID: 33052513 DOI: 10.1007/s11136-020-02656-6] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. METHODS Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. RESULTS Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). CONCLUSIONS/PRACTICE IMPLICATIONS Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA. .,FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA.
| | - Danetta Hendricks Sloan
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
| | - Fahid Alghanim
- Internal Medicine Residency Program, Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [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] [Indexed: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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Maragh-Bass AC, Gamble T, Tolley EE. 'Either You Float or You Drown:' The Role of Social Ties and Stigma in Lived Experiences of the HIV Care Continuum in HPTN 065. AIDS Behav 2020; 24:2532-2545. [PMID: 32086602 DOI: 10.1007/s10461-020-02811-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HPTN 065 utilized financial incentives to promote viral suppression among HIV-positive participants. Exit interviews were conducted in a sub-study of participants in Washington, DC and Bronx, NY. The present analyses explored lived experiences of social ties and stigma as individuals navigated the HIV care continuum, including gender differences in lived experiences. Using viral load data and informed by stages-of-change theory, participants were categorized into "Low-Adherers (n = 13)", "Action (n = 29)" and "Maintenance (n = 31)" stages. Secondary analyses of qualitative data were informed by grounded theory, and instances of social ties and stigma discussed by participants were quantified with descriptive statistics. Participants (N = 73) were mostly male (64%), African American (58%), with yearly income under $10,000 (52%). Low-adherers identified fewer, and sometimes more combative social ties than those in other adherence stages. Maintainers identified supportive ties as motivation for medication adherence (68%) but relied less on them for motivation than individuals in other adherence stages. Low-adherers described current experiences of stigma related to being diagnosed with HIV more than other adherence stages (23%). Individuals in Action reported stigma related to disclosing their HIV status to others (52%), while individuals in Maintenance mostly stigmatized others engaging in "risky" behaviors (32%). Findings suggest that women may perceive greater HIV stigma than men, perceive less supportive social ties, and were the majority of Low-adherers. Gender-informed approaches can facilitate community de-stigmatization of HIV, as African American women may be at greater risk of negative HIV health outcomes.
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Affiliation(s)
| | | | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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Maragh-Bass AC. The "Ask" Is the "Answer": Implementing Routine Documentation of Sexual Orientation and Gender Identity in Health Care. Am J Public Health 2019; 109:1071-1073. [PMID: 31268750 DOI: 10.2105/ajph.2019.305192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Allysha C Maragh-Bass
- The author is with the Division of Behavioral, Epidemiological, and Clinical Sciences, FHI 360, Durham, NC; the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and the Department of Prevention and Community Health, George Washington Milken Institute School of Public Health, Washington, DC
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Maragh-Bass AC, Fields JC, Catanzarite Z, Knowlton AR. "We get tunnel vision": Emergency medical service providers' views on the opioid epidemic in Baltimore City. J Opioid Manag 2019; 15:295-306. [PMID: 31637682 DOI: 10.5055/jom.2019.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting. DESIGN Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs. SETTING Baltimore City. PARTICIPANTS Twenty-two Baltimore City Fire Department EMS providers. INTERVENTIONS Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches. MAIN OUTCOME MEASURE Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison. RESULTS Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs. CONCLUSIONS EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie C Fields
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mitchell MM, Isenberg SR, Maragh-Bass AC, Knowlton AR. Chronic Pain Predicting Reciprocity of Support Among Vulnerable, Predominantly African-American Persons Living with HIV/AIDS. AIDS Behav 2018; 22:2002-2007. [PMID: 28451889 DOI: 10.1007/s10461-017-1775-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Among persons living with HIV/AIDS (PLHIV), approximately two-thirds report moderate to severe pain. Chronic pain can negatively affect PLHIVs' health behaviors and outcomes by interfering with their reciprocity (mutual exchange) of support in their caregiving relationships, which has been found to be associated with PLHIVs' antiretroviral adherence and viral suppression. Data were longitudinal (baseline, 6- and 12-month follow-up) from 383 PLHIV who were formerly or currently using drugs. Utilizing a longitudinal lagged fixed effects structural equation model, we found that never having pain in the past 6 months was predictive of increased reciprocity of support. Sub-analyses by care relationship type revealed never having pain was a significant predictor of greater reciprocity for sexual partner caregiving dyads, but not for kin or friend caregiving dyads. Our study emphasizes the importance of pain management in quality caregiving relationships characterized by reciprocity, which has consistently been found to be associated with stronger, more supportive caregiving relationships and better quality of life. Our findings suggest the importance of pain management intervention for improving reciprocity between vulnerable PLHIVs and their primary caregivers, especially between PLHIVs and caregivers who are current or former sexual partners.
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Affiliation(s)
- Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA.
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
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Isenberg SR, Maragh-Bass AC, Ridgeway K, Beach MC, Knowlton AR. A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders. J Opioid Manag 2018; 13:5-16. [PMID: 28345742 PMCID: PMC5560049 DOI: 10.5055/jom.2017.0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. DESIGN Qualitative semistructured interviews and focus groups. SETTING Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. PARTICIPANTS HIV participants with chronic pain and a history of illicit drug use. METHODS Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. RESULTS The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. CONCLUSIONS Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
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Affiliation(s)
- Sarina R Isenberg
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allysha C Maragh-Bass
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen Ridgeway
- Graduate of the MSPH program, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary C Beach
- Professor of Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amy R Knowlton
- Associate Professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Denison JA, Mitchell MM, Maragh-Bass AC, Knowlton AR. Caregivers' Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients. AIDS Behav 2017; 21:3599-3606. [PMID: 28315082 DOI: 10.1007/s10461-017-1746-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Informal care receipt is associated with health outcomes among people living with HIV. Less is known about how caregivers' own social support may affect their care recipient's health. We examined associations between network characteristics of informal caregivers and HIV viral suppression among former or current drug using care recipients. We analyzed data from 258 caregiver-recipient dyads from the Beacon study, of whom 89% of caregivers were African American and 59% were female. In adjusted logistic regression analysis, care recipients had lower odds of being virally suppressed if their caregiver was female, was caring for youth involved in the criminal justice system, and had network members who used illicit drugs. Caregivers' greater numbers of non-kin in their support network was positively associated with viral suppression among care recipients. The findings reveal contextual factors affecting ART outcomes and the need for interventions to support caregivers, especially HIV caregiving women with high-risk youth.
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Maragh-Bass AC, Zhao Y, Isenberg SR, Mitchell MM, Knowlton AR. Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore. J Urban Health 2017; 94:730-745. [PMID: 28560611 PMCID: PMC5610122 DOI: 10.1007/s11524-017-0157-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advance care planning (ACP) is the process of planning for when individuals are unable to make their own healthcare decisions. Research suggests ACP is understudied among HIV-positive African Americans. We explored ACP knowledge, preferences, and practices with HIV-positive African Americans from an urban HIV-specialty clinic (AFFIRM study). Participants completed surveys and interviews. Descriptive analyses and Poisson regression were conducted on survey data. Qualitative interviews were coded using grounded theory/constant comparative method. Participants were mostly male (55.1%). Half rated their current pain as at least six out of ten (50.8%). Two-thirds had discussed ACP with providers or supporters (66.2%). Qualitative themes were: (1) impact of managing pain on quality of life and healthcare, (2) knowledge/preferences for ACP, and (3) sources of HIV supportive care and coping (N = 39). Correlates of having discussed ACP included: moderate pain intensity (p < 0.10), including supporters in health decisions (p < 0.001), religious attendance (p < 0.05), and knowledge of healthcare mandates (p < 0.01; N = 276). Findings highlight the need for patient education to document healthcare preferences and communication skills development to promote inclusion of caregivers in decision-making.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA.
| | - Yiqing Zhao
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Sarina R Isenberg
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Mary M Mitchell
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
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Maragh-Bass AC, Torain M, Adler R, Ranjit A, Schneider E, Shields RY, Kodadek LM, Snyder CF, German D, Peterson S, Schuur J, Lau BD, Haider AH. Is It Okay To Ask: Transgender Patient Perspectives on Sexual Orientation and Gender Identity Collection in Healthcare. Acad Emerg Med 2017; 24:655-667. [PMID: 28235242 DOI: 10.1111/acem.13182] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The National Academy of Medicine and Joint Commission recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare to address lesbian, gay, bisexual, or transgender (LGBT) health disparities. We explored transgender patient-reported views on the importance on SO/GI collection, their willingness to disclose, and their perceived facilitators of SO/GI collection in primary care and emergency department (ED) settings. METHODS We recruited a national sample of self-identified transgender patients. Participants completed demographic questions, survey questions, and free-response comments regarding their views on SO/GI collection. Data were analyzed using descriptive statistics; inductive content analysis was conducted with open-ended responses. RESULTS Patients mostly self-identified as male gender (54.5%), white (58.4%), and SO other than heterosexual or LGB (33.7%; N = 101). Patients felt that it was more important for primary care providers to know their GI than SO (89.1% vs. 57%; p < 0.001); there was no difference among reported importance for ED providers to know the patients' SO versus GI. Females were more likely than males to report medical relevance to chief complaint as a facilitator to SO disclosure (89.1% vs. 80%; p = 0.02) and less likely to identify routine collection from all patients as a facilitator to GI disclosure (67.4% vs. 78.2%; p = 0.09). Qualitatively, many patients reported that medical relevance to chief complaint and an LGBT-friendly environment would increase willingness to disclose their SO/GI. Patients also reported need for educating providers in LGBT health prior to implementing routine SO/GI collection. CONCLUSIONS Patients see the importance of providing GI more than SO to providers; nonetheless they are willing to disclose SO/GI in general.. Findings also suggest that gender differences may exist in facilitators of SO/GI disclosure. Given the underrepresentation of transgender patients in healthcare, it is crucial for providers to address their concerns with SO/GI disclosure, which include LGBT education for medical staff and provision of a safe environment.
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Affiliation(s)
| | - Maya Torain
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
| | - Rachel Adler
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
| | - Anju Ranjit
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
| | - Eric Schneider
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
| | - Ryan Y. Shields
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
| | | | - Claire F. Snyder
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD
- Johns Hopkins University School of Medicine; Baltimore MD
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | - Susan Peterson
- Johns Hopkins University School of Medicine; Baltimore MD
| | | | - Brandyn D. Lau
- Johns Hopkins University School of Medicine; Baltimore MD
| | - Adil H. Haider
- Center for Surgery and Public Health; Harvard Medical School; Harvard T. H. Chan School of Public Health; Boston MA
- Department of Surgery; Brigham & Women's Hospital; Boston MA
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Mitchell MM, Nguyen TQ, Maragh-Bass AC, Isenberg SR, Beach MC, Knowlton AR. Patient-Provider Engagement and Chronic Pain in Drug-Using, Primarily African American Persons Living with HIV/AIDS. AIDS Behav 2017; 21:1768-1774. [PMID: 27787673 DOI: 10.1007/s10461-016-1592-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Among disadvantaged persons living with HIV/AIDS (PLHIV), patient-provider engagement, which has been defined as patient-provider relationships that promote the use of health care services and are characterized by active listening and supportive decision making, has been associated with antiretroviral therapy (ART) maintenance and viral suppression. However, chronic pain, depression, and substance use, all of which are prevalent in this population, can reduce the quality of patient-provider engagement. We hypothesized a model in which chronic pain, depression, and substance use would be associated with poorer patient-provider engagement, which would be positively associated with adherence, with the latter associated positively with viral suppression. We analyzed data from the BEACON study, which included surveys from 383 PLHIV who were primarily African American, on ART, and had histories of drug use. Due to six missing cases on the chronic pain variable, we used data from 377 respondents in a structural equation model. Chronic pain and depressive symptoms were significantly associated with poorer patient-provider engagement, while substance use was associated with better engagement. Patient-provider engagement in turn was associated with better ART adherence, which was associated with higher viral suppression. Results suggest the role of chronic pain in poor patient-physician engagement in this population, which has potential implications for quality of HIV patient care and health outcomes. Findings suggest the need for attention to patient-provider engagement in PLHIV.
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Affiliation(s)
- Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA
| | | | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 745, Baltimore, MD, 21205, USA
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Mitchell MM, Nguyen TQ, Isenberg SR, Maragh-Bass AC, Keruly J, Knowlton AR. Psychosocial and Service Use Correlates of Health-Related Quality of Life Among a Vulnerable Population Living with HIV/AIDS. AIDS Behav 2017; 21:1580-1587. [PMID: 27787675 DOI: 10.1007/s10461-016-1589-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among people living with HIV/AIDS (PLHIV), health-related quality of life (HRQOL) is an important clinical metric of perceived well-being. Baseline data from the BEACON study (N = 383) were used to examine relationships between HRQOL and negative social support, HIV-related stigma, viral suppression, and physical and mental health service use among a vulnerable population of low-income, urban PLHIV who currently or formerly used substances, and were primarily African American. Factor analyses and structural equation modeling indicated that increases in negative social support, stigma, mental health care visits and HIV physician visits were associated with lower HRQOL, while viral suppression was associated with greater HRQOL. The association between negative social support and HRQOL suggests the importance of intervening at the dyad or network levels to shape the type of social support being provided to PLHIV. HIV-related stigma is another negative social factor that is prevalent in this sample and could be addressed by intervention. Results indicate that greater mental and physical health service use can be used to identify individuals with lower HRQOL. Therefore, findings increase an understanding of HRQOL in this understudied population and have implications for designing interventions to improve HRQOL among PLHIV.
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Maragh-Bass AC, Griffin JM, Phelan S, Finney Rutten LJ, Morris MA. Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities. Disabil Health J 2017; 11:155-160. [PMID: 28456614 DOI: 10.1016/j.dhjo.2017.04.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/17/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent healthcare mandates require availability of accessible medical exam equipment, which may reduce barriers to care for patients with disabilities (PWD). However, more research is needed to explore healthcare provider views on implementation and routine use of accessible equipment. OBJECTIVE This study qualitatively explored healthcare provider perceptions of: (1) daily use of accessible medical examination tables with PWD; and (2) recommendations for addressing challenges to using this equipment. METHODS Qualitative interviews and focus groups were conducted with physicians, nurse practitioners and registered nurses at a clinic where accessible examination tables were recently implemented in all clinic rooms. Data were coded and thematically analyzed by two researchers trained in qualitative methods. RESULTS A total of 17 providers participated in focus groups or interviews. Participants were mostly female (82%; N = 14), and registered nurses (47%; N = 8), but also included nurse practitioners (29.4%; N = 5), and physicians (23%; N = 4). Common themes were: (1) Ease of use and functionality of tables; and (2) Challenges with use and available training. Overall, providers reported satisfaction with the tables' ability to accommodate patients who are PWD, although they expressed challenges with functionally using the tables with specific populations, such as pediatric patients. CONCLUSIONS Healthcare organizations seeking to implement height-adjustable tables should account for structural requirements of the height-adjustable tables (e.g. accommodating clearance needed when planning room sizes). Practical recommendations and policies for integrating height-adjustable tables into routine clinical care are needed to ensure equitable care for PWD.
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Affiliation(s)
- Allysha C Maragh-Bass
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Joan M Griffin
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Megan A Morris
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA; Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Maragh-Bass AC, Torain M, Adler R, Schneider E, Ranjit A, Kodadek LM, Shields R, German D, Snyder C, Peterson S, Schuur J, Lau B, Haider AH. Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives. LGBT Health 2017; 4:141-152. [DOI: 10.1089/lgbt.2016.0107] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allysha C. Maragh-Bass
- The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maya Torain
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel Adler
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric Schneider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Ranjit
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa M. Kodadek
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Shields
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle German
- The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claire Snyder
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Peterson
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremiah Schuur
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandyn Lau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H. Haider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Maragh-Bass AC, Torain M, Adler R, Schneider E, Ranjit A, Kodadek LM, Shields R, German D, Snyder C, Peterson S, Schuur J, Lau B, Haider AH. Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives. LGBT Health 2017. [PMID: 28221820 DOI: 10.1089/lgbt.2016.0107:10.1089/lgbt.2016.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Research suggests that LGBT populations experience barriers to healthcare. Organizations such as the Institute of Medicine recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare, to reduce LGBT disparities. We explore patient views regarding the importance of SO/GI collection, and patient and provider views on risks and benefits of routine SO/GI collection in various settings. METHODS We surveyed LGBT/non-LGBT patients and providers on their views on SO/GI collection. Weighted data were analyzed with descriptive statistics; content analysis was conducted with open-ended responses. RESULTS One-half of the 1516 patients and 60% of 429 providers were female; 64% of patients and 71% of providers were White. Eighty percent of providers felt that collecting SO data would offend patients, whereas only 11% of patients reported that they would be offended. Patients rated it as more important for primary care providers to know the SO of all patients compared with emergency department (ED) providers knowing the SO of all patients (41.3% vs. 31.6%; P < 0.001). Patients commonly perceived individualized care as an SO/GI disclosure benefit, whereas providers perceived patient-provider interaction improvement as the main benefit. Patient comments cited bias/discrimination risk most frequently (49.7%; N = 781), whereas provider comments cited patient discomfort/offense most frequently (54.5%; N = 433). CONCLUSION Patients see the importance of SO/GI more in primary care than ED settings. However, many LGBT patients seek ED care due to factors including uninsurance; therefore, the ED may represent an initial point of contact for SO/GI collection. Therefore, patient-centered approaches to collecting SO/GI are needed. Patients and providers differed in perceived risks and benefits to routine SO/GI collection. Provider training in LGBT health may address patients' bias/discrimination concerns, and ultimately reduce LGBT health disparities.
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Affiliation(s)
- Allysha C Maragh-Bass
- 1 The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Maya Torain
- 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Rachel Adler
- 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Eric Schneider
- 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Anju Ranjit
- 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Lisa M Kodadek
- 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ryan Shields
- 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Danielle German
- 1 The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Claire Snyder
- 5 Department of General Internal Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,6 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Susan Peterson
- 7 Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jeremiah Schuur
- 8 Brigham & Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Brandyn Lau
- 4 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Adil H Haider
- 2 Center for Surgery and Public Health , Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
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36
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Maragh-Bass AC, Denison JA, Thorpe RJ, Knowlton AR. The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs. J Ethn Subst Abuse 2017. [PMID: 28632094 DOI: 10.1080/15332640.2016.1264337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/21/2022]
Abstract
Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (p<.05). Interaction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.
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Affiliation(s)
| | - Julie A Denison
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Roland J Thorpe
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Amy R Knowlton
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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Maragh-Bass AC, Appelson JR, Changoor NR, Davis WA, Haider AH, Morris MA. Prioritizing qualitative research in surgery: A synthesis and analysis of publication trends. Surgery 2016; 160:1447-1455. [PMID: 27499145 DOI: 10.1016/j.surg.2016.06.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over the past 2 decades, researchers have recognized the value of qualitative research. Little has been done to characterize its application to surgery. We describe characteristics and overall prevalence of qualitative surgical research. METHODS We searched PubMed and CINAHL using "surgery" and 7 qualitative methodology terms. Four researchers extracted information; a fifth researcher reviewed 10% of abstracts for inter-rater reliability. RESULTS A total of 3,112 articles were reviewed. Removing duplicates, 28% were relevant (N = 878; κ = 0.70). Common qualitative methodologies included phenomenology (34.3%) and grounded theory (30.2%). Interviews were the most common data collection method (81.9%) of patients (64%) within surgical oncology (15.4%). Postdischarge was the most commonly studied topic (30.8%). Overall, 41% of studies were published in nursing journals, while 8% were published in surgical journals. More than half of studies were published since 2011. CONCLUSION Results suggest qualitative surgical research is gaining popularity. Most is published in nonsurgical journals, however, utilizing only 2 methodologies (phenomenology, grounded theory). The surgical journals that have published qualitative research had study topics restricted to a handful of surgical specialties. Additional surgical qualitative research should take advantage of a greater variety of approaches to provide insight into rare phenomena and social context.
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Affiliation(s)
- Allysha C Maragh-Bass
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA.
| | - Jessica R Appelson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Navin R Changoor
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - W Austin Davis
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
| | - Megan A Morris
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Schools of Medicine and Public Health, Boston, MA
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38
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Torain MJ, Maragh-Bass AC, Dankwa-Mullen I, Hisam B, Kodadek LM, Lilley EJ, Najjar P, Changoor NR, Rose JA, Zogg CK, Maddox YT, Britt L, Haider AH. Surgical Disparities: A Comprehensive Review and New Conceptual Framework. J Am Coll Surg 2016; 223:408-18. [DOI: 10.1016/j.jamcollsurg.2016.04.047] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/08/2016] [Accepted: 04/25/2016] [Indexed: 01/11/2023]
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Maragh-Bass AC, Powell C, Park J, Flynn C, German D. Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study. J Ethn Subst Abuse 2016; 16:344-362. [PMID: 27404977 DOI: 10.1080/15332640.2016.1196629] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Persons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2 = 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.
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Affiliation(s)
| | | | - Ju Park
- b Johns Hopkins University , Baltimore , Maryland
| | - Colin Flynn
- c Maryland Department of Health and Mental Hygiene , Baltimore , Maryland
| | - Danielle German
- d Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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40
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Haider AH, Dankwa-Mullan I, Maragh-Bass AC, Torain M, Zogg CK, Lilley EJ, Kodadek LM, Changoor NR, Najjar P, Rose JA, Ford HR, Salim A, Stain SC, Shafi S, Sutton B, Hoyt D, Maddox YT, Britt LD. Setting a National Agenda for Surgical Disparities Research: Recommendations From the National Institutes of Health and American College of Surgeons Summit. JAMA Surg 2016; 151:554-63. [PMID: 26982380 DOI: 10.1001/jamasurg.2016.0014] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Health care disparities (differential access, care, and outcomes owing to factors such as race/ethnicity) are widely established. Compared with other groups, African American individuals have an increased mortality risk across multiple surgical procedures. Gender, sexual orientation, age, and geographic disparities are also well documented. Further research is needed to mitigate these inequities. To do so, the American College of Surgeons and the National Institutes of Health-National Institute of Minority Health and Disparities convened a research summit to develop a national surgical disparities research agenda and funding priorities. Sixty leading researchers and clinicians gathered in May 2015 for a 2-day summit. First, literature on surgical disparities was presented within 5 themes: (1) clinician, (2) patient, (3) systemic/access, (4) clinical quality, and (5) postoperative care and rehabilitation-related factors. These themes were identified via an exhaustive preconference literature review and guided the summit and its interactive consensus-building exercises. After individual thematic presentations, attendees contributed research priorities for each theme. Suggestions were collated, refined, and prioritized during the latter half of the summit. Breakout sessions yielded 3 to 5 top research priorities by theme. Overall priorities, regardless of theme, included improving patient-clinician communication, fostering engagement and community outreach by using technology, improving care at facilities with a higher proportion of minority patients, evaluating the longer-term effect of acute intervention and rehabilitation support, and improving patient centeredness by identifying expectations for recovery. The National Institutes of Health and American College of Surgeons Summit on Surgical Disparities Research succeeded in identifying a comprehensive research agenda. Future research and funding priorities should prioritize patients' care perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities.
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Affiliation(s)
- Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Irene Dankwa-Mullan
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Allysha C Maragh-Bass
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maya Torain
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth J Lilley
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa M Kodadek
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Navin R Changoor
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter Najjar
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - John A Rose
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Henri R Ford
- Department of General Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles
| | - Ali Salim
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven C Stain
- Department of Surgery, Albany Medical College, Albany, New York
| | - Shahid Shafi
- Office of Chief Quality Officer, Baylor Scott and White Health System, Dallas, Texas
| | - Beth Sutton
- Division of General Surgery, United Regional Hospital, Kell West Regional Hospital, Wichita Falls, Texas
| | - David Hoyt
- American College of Surgeons, Chicago, Illinois
| | | | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk
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Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care 2016; 28:1280-6. [PMID: 27050708 DOI: 10.1080/09540121.2016.1168916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/02/2023]
Abstract
Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Maragh-Bass
- b Department of Surgery, Harvard School of Medicine, Harvard School of Public Health, Center for Surgery and Public Health , Brigham and Women's Hospital , Boston , MA , USA
| | - Trang Q Nguyen
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sarina Isenberg
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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