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Grimes KEL, Ebasone PV, Dzudie A, Nash D, Wainberg ML, Pence BW, Barrington C, Pefura E, Yotebieng M, Anastos K, Nsame D, Ajeh R, Nyenti A, Parcesepe AM. Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives. BMC Health Serv Res 2024; 24:519. [PMID: 38658992 PMCID: PMC11044447 DOI: 10.1186/s12913-024-10775-w] [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: 05/31/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
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Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Yotebieng M, Nash D, Anastos K, Parcesepe AM. Underestimation of potentially traumatic events resulting from underreporting of physical and sexual violence among people entering care for HIV in Cameroon. Psychol Trauma 2024; 16:347-352. [PMID: 34941341 PMCID: PMC9218007 DOI: 10.1037/tra0001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Measures ascertaining exposure to potentially traumatic events (PTEs) frequently ask respondents about experienced physical and sexual violence. However, little is known about the performance of physical and sexual violence questions on PTE assessments and its effect on PTE classification overall. We estimated underreporting of physical and sexual violence on a PTE assessment among individuals entering HIV care in Cameroon. METHOD We compared reports of physical and sexual violence captured via a behaviorally specific measure of intimate partner violence (IPV; Demographic and Health Survey [DHS] domestic violence module = referent) to those captured via two single-item questions that assessed exposure to physical and sexual PTEs during one's adult life to determine the degree of underreporting on the single-item PTE assessment questions. We explored correlates of underreporting on the PTE assessment using Pearson's chi-squared tests. RESULTS Overall, 99 (23%) and 113 (27%) of 426 total participants reported instances of sexual and physical violence in their most recent partnership on the behaviorally specific DHS IPV module, respectively. Of those reporting sexual and physical IPV on the DHS module, just 6% (n = 6) and 52% (n = 59) reported sexual and physical violence as an adult on the single-item PTE assessment questions, respectively. Underreporting of physical violence on the PTE assessment was associated with lower educational attainment (p < .05) and reporting being punched (p < .01) or having one's hair pulled or arm twisted (p < .05) by one's most recent partner. CONCLUSIONS PTE assessment tools should assess exposure to behaviorally specific acts of violence to ensure appropriate referral to services among survivors of IPV. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Milton Wainberg
- Department of Psychiatry, Columbia University
- New York State Psychiatric Institute
| | | | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Carolina Population Center, University of North Carolina at Chapel Hill
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Lancaster KE, Stockton M, Remch M, Wester CW, Nash D, Brazier E, Adedimeji A, Finlayson R, Freeman A, Hogan B, Kasozi C, Kwobah EK, Kulzer JL, Merati T, Tine J, Poda A, Succi R, Twizere C, Tlali M, Groote PV, Edelman EJ, Parcesepe AM. Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium. Int J Drug Policy 2024; 124:104309. [PMID: 38228025 PMCID: PMC10939808 DOI: 10.1016/j.drugpo.2023.104309] [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: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS In 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. RESULTS Sites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. CONCLUSIONS Availability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.
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Affiliation(s)
| | - Melissa Stockton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Remch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Denis Nash
- City University of New York (CUNY), New York, NY, USA
| | - Ellen Brazier
- City University of New York (CUNY), New York, NY, USA
| | | | | | - Aimee Freeman
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Breanna Hogan
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Judiacel Tine
- Centre Hospitalier National Universitaire de Fann, Dakar, Senagal
| | - Armel Poda
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Regina Succi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Christelle Twizere
- Centre National de Référence en Matière de VIH/SIDA au Burundi, Bujumbura, Burundi
| | - Mpho Tlali
- University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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Nash D, Srivastava A, Shen Y, Penrose K, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Maroko A, Parcesepe AM, Grov C, Robertson MM. Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults. Sci Rep 2024; 14:644. [PMID: 38182731 PMCID: PMC10770061 DOI: 10.1038/s41598-023-51029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
This study used repeat serologic testing to estimate infection rates and risk factors in two overlapping cohorts of SARS-CoV-2 N protein seronegative U.S. adults. One mostly unvaccinated sub-cohort was tracked from April 2020 to March 2021 (pre-vaccine/wild-type era, n = 3421), and the other, mostly vaccinated cohort, from March 2021 to June 2022 (vaccine/variant era, n = 2735). Vaccine uptake was 0.53% and 91.3% in the pre-vaccine and vaccine/variant cohorts, respectively. Corresponding seroconversion rates were 9.6 and 25.7 per 100 person-years. In both cohorts, sociodemographic and epidemiologic risk factors for infection were similar, though new risk factors emerged in the vaccine/variant era, such as having a child in the household. Despite higher incidence rates in the vaccine/variant cohort, vaccine boosters, masking, and social distancing were associated with substantially reduced infection risk, even through major variant surges.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA.
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA.
- CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 6th Floor, New York, NY, 10027, USA.
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Yanhan Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
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Piltch-Loeb R, Penrose K, Stanton E, Parcesepe AM, Shen Y, Fleary SA, Nash D. Safety, Efficacy, and Ill Intent: Examining COVID-19 Vaccine Perceptions among the New Undervaccinated Moveable Middle in a U.S. Cohort, October 2022. Vaccines (Basel) 2023; 11:1665. [PMID: 38005997 PMCID: PMC10675675 DOI: 10.3390/vaccines11111665] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Individuals who received their primary vaccine series only (with no subsequent booster) may be a new type of "moveable middle" given their receipt of the original COVID-19 vaccination. One population within the moveable middle for whom tailored interventions may be needed is individuals with common mental disorders (CMD). The purpose of this paper is to understand the vaccine perceptions among this new moveable middle-the undervaccinated-and within the undervaccinated to examine the extent to which COVID-19 vaccine perceptions and motivations differ among those with and without symptoms of CMD. Using data from the CHASING COVID Cohort, we examine the relationship between vaccination status, CMD, and vaccine perceptions in the undervaccinated. Among 510 undervaccinated participants who had completed the primary vaccine series but were not boosted, the most common reasons for undervaccination focused on efficacy (not seeing a need for an additional dose, 42.4%; there not being enough evidence that a booster dose is effective, 26.5%; already having had COVID-19, 19.6%). Other concerns were related to safety (long-term side effects, 21.0%; short-term side effects, 17.6%) and logistics (plan to get a booster but haven't had time yet, 18.8%). Overall, the greatest vaccine concerns (over 30%) for the undervaccinated focused on efficacy and safety issues. Symptoms of depression or anxiety were associated with lower levels of vaccine efficacy and greater safety concerns in adjusted models. The implications of our study are that campaigns that are hoping to maximize vaccination uptake should consider focusing on and emphasizing messaging on efficacy and safety issues.
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Affiliation(s)
- Rachael Piltch-Loeb
- Department of Environmental Occupational and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Emergency Preparedness Research Evaluation and Practice Program, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
| | - Eva Stanton
- Emergency Preparedness Research Evaluation and Practice Program, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Yanhan Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
| | - Sasha A. Fleary
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY 10027, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10027, USA
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Nash D, Srivastava A, Shen J, Penrose K, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Maroko A, Parcesepe AM, Grov C, Robertson MM. Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults. medRxiv 2023:2023.09.29.23296142. [PMID: 37873066 PMCID: PMC10593054 DOI: 10.1101/2023.09.29.23296142] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Infectious disease surveillance systems, which largely rely on diagnosed cases, underestimate the true incidence of SARS-CoV-2 infection, due to under-ascertainment and underreporting. We used repeat serologic testing to measure N-protein seroconversion in a well-characterized cohort of U.S. adults with no serologic evidence of SARS-CoV-2 infection to estimate the incidence of SARS-CoV-2 infection and characterize risk factors, with comparisons before and after the start of the SARS-CoV-2 vaccine and variant eras. Methods We assessed the incidence rate of infection and risk factors in two sub-groups (cohorts) that were SARS-CoV-2 N-protein seronegative at the start of each follow-up period: 1) the pre-vaccine/wild-type era cohort (n=3,421), followed from April to November 2020; and 2) the vaccine/variant era cohort (n=2,735), followed from November 2020 to June 2022. Both cohorts underwent repeat serologic testing with an assay for antibodies to the SARS-CoV-2 N protein (Bio-Rad Platelia SARS-CoV-2 total Ab). We estimated crude incidence and sociodemographic/epidemiologic risk factors in both cohorts. We used multivariate Poisson models to compare the risk of SARS-CoV-2 infection in the pre-vaccine/wild-type era cohort (referent group) to that in the vaccine/variant era cohort, within strata of vaccination status and epidemiologic risk factors (essential worker status, child in the household, case in the household, social distancing). Findings In the pre-vaccine/wild-type era cohort, only 18 of the 3,421 participants (0.53%) had ≥1 vaccine dose by the end of follow-up, compared with 2,497/2,735 (91.3%) in the vaccine/variant era cohort. We observed 323 and 815 seroconversions in the pre-vaccine/wild-type era and the vaccine/variant era and cohorts, respectively, with corresponding incidence rates of 9.6 (95% CI: 8.3-11.5) and 25.7 (95% CI: 24.2-27.3) per 100 person-years. Associations of sociodemographic and epidemiologic risk factors with SARS-CoV-2 incidence were largely similar in the pre-vaccine/wild-type and vaccine/variant era cohorts. However, some new epidemiologic risk factors emerged in the vaccine/variant era cohort, including having a child in the household, and never wearing a mask while using public transit. Adjusted incidence rate ratios (aIRR), with the entire pre-vaccine/wild-type era cohort as the referent group, showed markedly higher incidence in the vaccine/variant era cohort, but with more vaccine doses associated with lower incidence: aIRRun/undervaccinated=5.3 (95% CI: 4.2-6.7); aIRRprimary series only=5.1 (95% CI: 4.2-7.3); aIRRboosted once=2.5 (95% CI: 2.1-3.0), and aIRRboosted twice=1.65 (95% CI: 1.3-2.1). These associations were essentially unchanged in risk factor-stratified models. Interpretation In SARS-CoV-2 N protein seronegative individuals, large increases in incidence and newly emerging epidemiologic risk factors in the vaccine/variant era likely resulted from multiple co-occurring factors, including policy changes, behavior changes, surges in transmission, and changes in SARS-CoV-2 variant properties. While SARS-CoV-2 incidence increased markedly in most groups in the vaccine/variant era, being up to date on vaccines and the use of non-pharmaceutical interventions (NPIs), such as masking and social distancing, remained reliable strategies to mitigate the risk of SARS-CoV-2 infection, even through major surges due to immune evasive variants. Repeat serologic testing in cohort studies is a useful and complementary strategy to characterize SARS-CoV-2 incidence and risk factors.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Jenny Shen
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Kate Penrose
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, New York, USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, New York, USA
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Parcesepe AM, Stockton M, Remch M, Wester CW, Bernard C, Ross J, Haas AD, Ajeh R, Althoff KN, Enane L, Pape W, Minga A, Kwobah E, Tlali M, Tanuma J, Nsonde D, Freeman A, Duda SN, Nash D, Lancaster K. Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium, 2016-2017 and 2020. J Int AIDS Soc 2023; 26:e26147. [PMID: 37535703 PMCID: PMC10399924 DOI: 10.1002/jia2.26147] [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: 12/07/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020. METHODS In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys. RESULTS Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048). CONCLUSIONS Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- University of North Carolina at Chapel HillCarolina Population CenterChapel HillNorth CarolinaUSA
| | | | - Molly Remch
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. William Wester
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Charlotte Bernard
- University of BordeauxNational Institute for Health and Medical ResearchResearch Institute for Sustainable DevelopmentBordeaux Population Health Research CentreBordeauxFrance
| | - Jeremy Ross
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
| | - Andreas D. Haas
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland
| | - Rogers Ajeh
- Clinical Research Education and Networking ConsultancyYaoundeCameroon
| | - Keri N. Althoff
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Leslie Enane
- Department of PediatricsThe Ryan White Center for Pediatric Infectious Disease and Global HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | - William Pape
- Groupe Haitien d''Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO)Port au PrinceHaiti
| | - Albert Minga
- Centre Medical de Suivi de Donneurs de Sang/CNTS/PRIMO‐CIAbidjanCote D''Ivoire
| | - Edith Kwobah
- Department of Mental HealthMoi Teaching and Referral HospitalEldoretKenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research (CIDER)School of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Junko Tanuma
- Division of the AIDS Medical Information of AIDS Clinical CareNational Center for Global Health and MedicineTokyoJapan
| | | | - Aimee Freeman
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Stephany N. Duda
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Denis Nash
- City University of New YorkInstitute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - the IeDEA Consortium
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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8
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Lancaster KE, Remch M, Edmonds A, Ajeh R, Dzudie A, Adedimeji A, Nash D, Anastos K, Yotebieng M, Yone-Pefura EW, Nsame D, Parcesepe AM. Age-varying Associations of Depressive Symptoms and Heavy Episodic Drinking Throughout Adulthood Among People with HIV and Receiving care in Cameroon Within a National "treat all" Policy. AIDS Behav 2023; 27:2070-2078. [PMID: 36472684 PMCID: PMC10557023 DOI: 10.1007/s10461-022-03939-4] [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: 11/18/2022] [Indexed: 12/12/2022]
Abstract
Comorbid depression and heavy episodic drinking (HED) may threaten the success of "treat all" policies in sub-Saharan Africa as the population of people with HIV (PWH) ages. We investigated associations between depressive symptoms and heavy episodic drinking (HED) and the extent the relationship differed across ages among PWH receiving HIV care in Cameroon. We conducted a retrospective analysis of 18-60-year-old PWH on antiretroviral therapy in Cameroon from January 2016 to March 2020. Age-varying effect modelling was conducted to assess associations between depressive symptoms and HED across ages and by gender. Prevalence of depression and HED was highest at ages 20 and 25, respectively. After age 25, the magnitude of the association between depressive symptoms and HED was significant and increased until age 30 (aOR: 1.88, 95% CI: 1.48, 2.39), with associations remaining significant until age 55 (aOR: 1.64, 95% CI: 1.17, 2.29). Women had more variability and higher magnitudes of associations between depressive symptoms and HED than men. The interrelationship between depressive symptoms and HED was significant throughout most of adulthood for PWH receiving HIV care in Cameroon. Understanding age and gender trends in these associations can guide integration efforts in HIV care settings.
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Affiliation(s)
| | - Molly Remch
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Andrew Edmonds
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- City University of New York, New York, NY, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marcel Yotebieng
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M Parcesepe
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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9
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Behav 2023; 27:2360-2369. [PMID: 36609704 PMCID: PMC10224854 DOI: 10.1007/s10461-022-03963-4] [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: 11/25/2022] [Indexed: 01/09/2023]
Abstract
Little is known about the coping strategies used among people with HIV (PWH), especially in sub-Saharan Africa, and the extent to which adaptive or maladaptive coping strategies are associated with symptoms of mental health disorders. We interviewed 426 PWH initiating HIV care in Cameroon and reported the prevalence of adaptive and maladaptive coping strategies, overall and by presence of symptoms of depression, anxiety, and PTSD. Log binominal regression was used to estimate the association between each type of coping strategy (adaptive or maladaptive) and symptoms of each mental health disorder, separately. Adaptive and maladaptive coping strategies were commonly reported among PWH enrolling in HIV care in Cameroon. Across all mental health disorders assessed, greater maladaptive coping was associated with higher prevalence of depression, anxiety, and PTSD. Adaptive coping was not associated with symptoms of any of the mental health disorders assessed in bivariate or multivariable models. Our study found that PWH endorsed a range of concurrent adaptive and maladaptive coping strategies. Future efforts should explore the extent to which coping strategies change throughout the HIV care continuum. Interventions to reduce maladaptive coping have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Gomez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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10
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Ng Y, Chang M, Robertson M, Grov C, Maroko A, Zimba R, Westmoreland D, Rane M, Mirzayi C, Parcesepe AM, Kulkarni S, Salgado-You W, Cohen N, Nash D. Food Insecurity During the First Year of COVID-19: Employment and Sociodemographic Factors Among Participants in the CHASING COVID Cohort Study. Public Health Rep 2023; 138:671-680. [PMID: 37209059 PMCID: PMC10200805 DOI: 10.1177/00333549231170203] [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: 05/22/2023] Open
Abstract
OBJECTIVE While much has been reported about the impact of the COVID-19 pandemic on food insecurity, longitudinal data and the variability experienced by people working in various industries are limited. This study aims to further characterize people experiencing food insecurity during the pandemic in terms of employment, sociodemographic characteristics, and degree of food insecurity. METHODS The study sample consisted of people enrolled in the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study from visit 1 (April-July 2020) through visit 7 (May-June 2021). We created weights to account for participants with incomplete or missing data. We used descriptive statistics and logistic regression models to determine employment and sociodemographic correlates of food insecurity. We also examined patterns of food insecurity and use of food support programs. RESULTS Of 6740 participants, 39.6% (n = 2670) were food insecure. Non-Hispanic Black and Hispanic (vs non-Hispanic White) participants, participants in households with children (vs no children), and participants with lower (vs higher) income and education levels had higher odds of food insecurity. By industry, people employed in construction, leisure and hospitality, and trade, transportation, and utilities industries had the highest prevalence of both food insecurity and income loss. Among participants reporting food insecurity, 42.0% (1122 of 2670) were persistently food insecure (≥4 consecutive visits) and 43.9% (1172 of 2670) did not use any food support programs. CONCLUSIONS The pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in industries vulnerable to economic disruption and ensure those experiencing food insecurity can access food support programs for which they are eligible.
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Affiliation(s)
- Yvette Ng
- Graduate School of Public Health and Health Policy, Urban Food Policy Institute, City University of New York, New York, NY, USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Drew Westmoreland
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Madhura Rane
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - William Salgado-You
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Nevin Cohen
- Graduate School of Public Health and Health Policy, Urban Food Policy Institute, City University of New York, New York, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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11
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon. BMC Psychiatry 2023; 23:150. [PMID: 36894918 PMCID: PMC9996899 DOI: 10.1186/s12888-023-04630-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon. METHODS We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score > 9), PTSD (PTSD Checklist for DSM-5 score > 30), anxiety (Generalized Anxiety Disorder-7 scale score > 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score > 7 for men; > 6 for women). RESULTS A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment. CONCLUSIONS PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Departments of Medicine and Epidemiology & Population Health, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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12
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. HIV-Related Stigma, Social Support, and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Patient Care STDS 2023; 37:146-154. [PMID: 36802206 PMCID: PMC10024262 DOI: 10.1089/apc.2022.0187] [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: 02/23/2023] Open
Abstract
HIV-related stigma has been associated with poor mental health among people with HIV (PWH). Social support is a potentially modifiable factor that may buffer negative mental health sequelae of HIV-related stigma. Little is known about the extent to which the modifying effect of social support differs across mental health disorders. Interviews were conducted with 426 PWH in Cameroon. Log binomial regression analyses were used to estimate the association between high anticipated HIV-related stigma and low social support from family or friends and symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and harmful alcohol use, separately. Anticipated HIV-related stigma was commonly endorsed with ∼80% endorsing at least 1 of 12 stigma-related concerns. In multivariable analyses, high anticipated HIV-related stigma was associated with greater prevalence of symptoms of depression {adjusted prevalence ratio (aPR) 1.6 [95% confidence interval (CI) 1.1-2.2]} and anxiety [aPR 2.0 (95% CI 1.4-2.9)]. Low social support was associated with greater prevalence of symptoms of depression [aPR 1.5 (95% CI 1.1-2.2)], anxiety [aPR 1.7 (95% CI 1.2-2.5)], and PTSD [aPR 1.6 (95% CI 1.0-2.4)]. However, social support did not meaningfully modify the relationship between HIV-related stigma and symptoms of any mental health disorders explored. Anticipated HIV-related stigma was commonly reported among this group of PWH initiating HIV care in Cameroon. Social concerns related to gossip or losing friends were of the greatest concern. Interventions focused on reducing stigma and strengthening support systems may be particularly beneficial and have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gomez
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
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13
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Parcesepe AM, Kulkarni SG, Grov C, Zimba R, You W, Westmoreland DA, Berry A, Kochhar S, Rane MS, Mirzayi C, Maroko AR, Nash D. Psychosocial Stressors and Maternal Mental Health in the U.S. During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Analysis. Matern Child Health J 2023; 27:335-345. [PMID: 36625954 PMCID: PMC9838406 DOI: 10.1007/s10995-022-03578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The COVID pandemic has had widespread impacts on maternal mental health. This research aims to examine the relationship between psychosocial stressors and symptoms of depression and anxiety and the extent to which emotional support or resilient coping moderates the relationship between psychosocial stressors and maternal mental health during the first wave of the COVID pandemic. METHODS This analysis includes data collected in October and November 2020 from a geographically and sociodemographically diverse sample of 776 mothers in the U.S. with children ≤ 18 years of age. Log binomial models were used to estimate the association between moderate or severe symptoms of anxiety and depression and psychosocial stressors. RESULTS Symptoms of moderate or severe anxiety and depression were reported by 37.5% and 37.6% of participants, respectively. Moderate (aRR 2.76 [95% CI 1.87, 4.07]) and high (aRR 4.95 [95% CI 3.40, 7.20]) levels of perceived stress were associated with greater risk of moderate or severe anxiety symptoms. Moderate and high levels of parental burnout were also associated with greater prevalence of moderate or severe anxiety symptoms in multivariable models. Results were similar when examining the relationship among stress, parental burnout, and depressive symptoms. Neither resilient coping nor social support modified the relationship between psychosocial stressors and mental health. CONCLUSIONS FOR PRACTICE Evidence-based strategies to reduce stress and parental burnout and improve the mental health of mothers are urgently needed. Strategies focused on bolstering coping and social support may be insufficient to improve maternal mental health during acute public health emergencies.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sarah G Kulkarni
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Christian Grov
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Rebecca Zimba
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - William You
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Drew A Westmoreland
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Amanda Berry
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Shivani Kochhar
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Madhura S Rane
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
| | - Chloe Mirzayi
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Andrew R Maroko
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health (ISPH), City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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14
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Lang R, Hogan B, Zhu J, McArthur K, Lee J, Zandi P, Nestadt P, Silverberg MJ, Parcesepe AM, Cook JA, Gill MJ, Grelotti D, Closson K, Lima VD, Goulet J, Horberg MA, Gebo KA, Camoens RM, Rebeiro PF, Nijhawan AE, McGinnis K, Eron J, Althoff KN. The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum. AIDS 2023; 37:259-269. [PMID: 36541638 PMCID: PMC9782734 DOI: 10.1097/qad.0000000000003420] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHDs). DESIGN Observational study of participants in the North American AIDS Cohort Collaboration on Research and Design. METHODS PWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008 to 2018 based on International Classification of Diseases code mapping. Mental health (MH) multimorbidity was defined as having two or more MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥1 visit/year) and viral suppression (HIV RNA ≤200 copies/ml) by presence vs. absence of each MHD between 2016 and 2018. RESULTS Among 122 896 PWH, 67 643 (55.1%) were diagnosed with one or more MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008 and 2018, whereas bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016 to 2018 (N = 64 684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR = 0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR = 0.99 [0.99-1.00]) compared with PWH without MHD. CONCLUSION The prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.
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Affiliation(s)
- Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiafeng Zhu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Kristen McArthur
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Jennifer Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - David Grelotti
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Viviane D Lima
- University of British Columbia & BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Goulet
- Yale School of Medicine & VA Connecticut Healthcare System, West Haven, Connecticut
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Peter F Rebeiro
- Departments of Medicine & Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ank E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Joseph Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Qasmieh SA, Robertson MM, Rane MS, Shen Y, Zimba R, Picchio CA, Parcesepe AM, Chang M, Kulkarni SG, Grov C, Nash D. The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022. JMIR Public Health Surveill 2022; 8:e38196. [PMID: 36240020 PMCID: PMC9822564 DOI: 10.2196/38196] [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: 03/23/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Passive, case-based surveillance underestimates the true extent of active infections in the population due to undiagnosed and untested cases, the exclusion of probable cases diagnosed point-of-care rapid antigen tests, and the exclusive use of at-home rapid tests which are not reported as part of case-based surveillance. The extent in which COVID-19 surveillance may be underestimating the burden of infection is likely due to time-varying factors such as decreased test-seeking behaviors and increased access to and availability of at-home testing. OBJECTIVE The objective of this study is to estimate the prevalence of SARS-CoV-2 based on different definitions of a case to ascertain the extent to which cases of SARS-CoV-2 may be underestimated by case-based surveillance. METHODS A survey on COVID-19 exposure, infection, and testing was administered to calculate point prevalence of SARS-CoV-2 among a diverse sample of cohort adults from February 8, 2022, to February 22, 2022. Three-point prevalence estimates were calculated among the cohort, as follows: (1) proportion positives based on polymerase chain reaction (PCR) and rapid antigen tests; (2) proportion positives based on testing exclusively with rapid at-home tests; and (3) proportion of probable undiagnosed cases. Test positivity and prevalence differences across booster status were also examined. RESULTS Among a cohort of 4328, there were a total of 644 (14.9%) cases. The point prevalence estimate based on PCR or rapid antigen tests was 5.5% (95% CI 4.8%-6.2%), 3.7% (95% CI 3.1%-4.2%) based on at-home rapid tests, and 5.7% (95% CI 5.0%-6.4%) based on the case definition of a probable case. The total point prevalence across all definitions was 14.9% (95% CI 13.8%-16.0%). The percent positivity among PCR or rapid tests was 50.2%. No statistically significant differences were observed in prevalence between participants with a COVID-19 booster compared to fully vaccinated and nonboosted participants except among exclusive at-home rapid testers. CONCLUSIONS Our findings suggest a substantial number of cases were missed by case-based surveillance systems during the Omicron B.1.1.529 surge, when at-home testing was common. Point prevalence surveys may be a rapid tool to be used to understand SARS-CoV-2 prevalence and would be especially important during case surges to measure the scope and spread of active infections in the population.
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Affiliation(s)
- Saba A Qasmieh
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Madhura S Rane
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Yanhan Shen
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mindy Chang
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Christian Grov
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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16
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Robertson MM, Shamsunder MG, Brazier E, Mantravadi M, Zimba R, Rane MS, Westmoreland DA, Parcesepe AM, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/Ethnic Disparities in Exposure, Disease Susceptibility, and Clinical Outcomes during COVID-19 Pandemic in National Cohort of Adults, United States. Emerg Infect Dis 2022; 28:2171-2180. [PMID: 36191624 PMCID: PMC9622253 DOI: 10.3201/eid2811.220072] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined racial/ethnic disparities for COVID-19 seroconversion and hospitalization within a prospective cohort (n = 6,740) in the United States enrolled in March 2020 and followed-up through October 2021. Potential SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity. Hispanic and Black non-Hispanic participants had more exposure risk and difficulty with healthcare access than white participants. Participants with more exposure had greater odds of seroconversion. Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization. Race/ethnicity positively modified the association between susceptibility and hospitalization. Findings might help to explain the disproportionate burden of SARS-CoV-2 infections and complications among Hispanic/Latino/a and Black non-Hispanic persons. Primary and secondary prevention efforts should address disparities in exposure, vaccination, and treatment for COVID-19.
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17
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. J Affect Disord 2022; 308:421-431. [PMID: 35452755 PMCID: PMC9520993 DOI: 10.1016/j.jad.2022.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes. METHODS We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models. RESULTS Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8). LIMITATIONS Given the design of our study, findings are subject to recall and social desirability bias. CONCLUSIONS Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.
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Affiliation(s)
- Lindsey M. Filiatreau
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, United States of America,Washington University in St. Louis, Brown School, International Center for Child Health and Development, St. Louis, MO, United States of America,University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America,Corresponding author at: Washington University in St. Louis, Department of Psychiatry, United States of America. (L.M. Filiatreau)
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Columbia University, Department of Psychiatry, New York, NY, United States of America
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, New York, NY, United States of America
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America,Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America,University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, United States of America
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18
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS One 2022; 17:e0270042. [PMID: 35771857 PMCID: PMC9246197 DOI: 10.1371/journal.pone.0270042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. Methods We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. Results Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. Conclusion Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
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19
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Nash D, Rane MS, Robertson MM, Chang M, Gorrell SK, Zimba R, You W, Berry A, Mirzayi C, Kochhar S, Maroko A, Westmoreland DA, Parcesepe AM, Waldron L, Grov C. Severe Acute Respiratory Syndrome Coronavirus 2 Incidence and Risk Factors in a National, Community-Based Prospective Cohort of US Adults. Clin Infect Dis 2022; 76:e375-e384. [PMID: 35639911 PMCID: PMC9213857 DOI: 10.1093/cid/ciac423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prospective cohort studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence complement case-based surveillance and cross-sectional seroprevalence surveys. METHODS We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6738 US adults, enrolled in March-August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using least absolute shrinkage selection operator (LASSO) regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups of ≥10, and no masking in gyms or salons. RESULTS Among 4510 individuals with ≥1 serologic test, 323 (7.3% [95% confidence interval (CI), 6.5%-8.1%]) seroconverted by January 2021. Among 3422 participants seronegative in May-September 2020 and retested from November 2020 to January 2021, 161 seroconverted over 1646 person-years of follow-up (9.8 per 100 person-years [95% CI, 8.3-11.5]). The seroincidence rate was lower among women compared with men (incidence rate ratio [IRR], 0.69 [95% CI, .50-.94]) and higher among Hispanic (2.09 [1.41-3.05]) than white non-Hispanic participants. In adjusted models, participants who reported social distancing with people they did not know (IRR for always vs never social distancing, 0.42 [95% CI, .20-1.0]) and with people they knew (IRR for always vs never, 0.64 [.39-1.06]; IRR for sometimes vs never, 0.60 [.38-.96]) had lower seroconversion risk. Seroconversion risk increased with epidemiologic risk score (IRR for medium vs low score, 1.68 [95% CI, 1.03-2.81]; IRR for high vs low score, 3.49 [2.26-5.58]). Only 29% of those who seroconverted reported isolating, and only 19% were asked about contacts. CONCLUSIONS Modifiable risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the United States.
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Affiliation(s)
- Denis Nash
- CORRESPONDING AUTHOR: Denis Nash, Ph.D., MPH CUNY Graduate School of Public Health and Health Policy 55 W. 125th St., 6th Floor New York, NY USA 10027
| | - Madhura S. Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah Kulkarni Gorrell
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Drew A. Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA,Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
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20
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Rane MS, Kochhar S, Poehlein E, You W, Robertson MKM, Zimba R, Westmoreland DA, Romo ML, Kulkarni SG, Chang M, Berry A, Parcesepe AM, Maroko AR, Grov C, Nash D, CHASING COVID Cohort Study Team FT. Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study. Am J Epidemiol 2022; 191:570-583. [PMID: 34999751 PMCID: PMC8755394 DOI: 10.1093/aje/kwab293] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022] Open
Abstract
We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.
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Affiliation(s)
- Madhura S Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Correspondence to Dr. Madhura S. Rane, The CUNY Institute for Implementation Science In Population Health, 55 W 125th Street, New York, NY 10027 ()
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Emily Poehlein
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mc Kaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Matthew L Romo
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew R Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY) New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
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21
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Parcesepe AM, Remch M, Dzudie A, Ajeh R, Nash D, Anastos K, Yotebieng M, Adedimeji A, Pefura-Yone E, Lancaster K. Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon. AIDS Behav 2022; 26:651-661. [PMID: 34403021 PMCID: PMC8915538 DOI: 10.1007/s10461-021-03425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/05/2021] [Indexed: 10/20/2022]
Abstract
Depression is associated with suboptimal HIV care outcomes. Little is known about the extent to which the prevalence of depressive symptoms varies across the HIV care continuum. Also, the relationship among gender, HIV disclosure, HIV care stage, and depressive symptoms in PLWH remains poorly understood. We analyzed cross-sectional data from 12,507 PLWH at enrollment in International epidemiology Databases to Evaluate AIDS (IeDEA) Cameroon between 2016 and 2020. Recent depressive symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2). A score of three or greater on the PHQ-2 was considered indicative of likely major depressive disorder. We estimated the prevalence of depressive symptoms across three stages of HIV care: those not yet on antiretroviral therapy (ART), recent ART initiators (ART initiation ≤ 30 days prior), and ART users (ART initiation > 30 days prior). Adjusted prevalence differences (aPD) of depressive symptoms were estimated comparing recent ART initiators and ART users. Disclosure and gender were examined as effect measure modifiers of the relationship between HIV care stage and depressive symptoms. The prevalence of depressive symptoms was 11.9%, 22.0%, and 8.7% among PLWH not yet on ART, recent ART initiators, and ART users, respectively. ART users had significantly lower prevalence of depressive symptoms compared to recent ART initiators (aPD - 0.09 [95% CI - 0.11, - 0.08]). Neither gender nor HIV disclosure modified the effect measure of the relationship between HIV care stage and depressive symptoms. Depressive symptoms were commonly reported among this group of PLWH and were associated with recent ART initiation. Integration of screening and treatment of depression into HIV care should be prioritized and may be particularly relevant for PLWH initiating ART.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Molly Remch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Kathryn Lancaster
- Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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22
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Zotova N, Familiar I, Kawende B, Kasindi FL, Ravelomanana N, Parcesepe AM, Adedimeji A, Lancaster KE, Kaba D, Babakazo P, Yotebieng M. HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo. J Int AIDS Soc 2022; 25:e25865. [PMID: 35129301 PMCID: PMC8819634 DOI: 10.1002/jia2.25865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
- Natalia Zotova
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Itziar Familiar
- Department of PsychiatryMichigan State UniversityEast LansingMichiganUSA
| | - Bienvenu Kawende
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | | | - Noro Ravelomanana
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public HealthOhio State UniversityColumbusOhioUSA
| | - Didine Kaba
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Pélagie Babakazo
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
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23
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Robertson MM, Shamsunder M, Brazier E, Mantravadi M, Rane MS, Westmoreland DA, Parcesepe AM, Zimba R, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort. medRxiv 2022:2022.01.11.22269101. [PMID: 35043126 PMCID: PMC8764735 DOI: 10.1101/2022.01.11.22269101] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Meghana Shamsunder
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Mekhala Mantravadi
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Madhura S Rane
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Angela M Parcesepe
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Gillings School of Public Health, University of North Carolina, 427 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH); 55 W 125th St, 6th Floor, New York, NY 10027, USA
- Graduate School of Public Health and Health Policy; 55 W 125th St, New York, NY 10027, USA
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24
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Zimba R, Romo ML, Kulkarni SG, Berry A, You W, Mirzayi C, Westmoreland DA, Parcesepe AM, Waldron L, Rane MS, Kochhar S, Robertson MM, Maroko AR, Grov C, Nash D. Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment. JMIR Public Health Surveill 2021; 7:e32846. [PMID: 34793320 PMCID: PMC8722498 DOI: 10.2196/32846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. OBJECTIVE This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. METHODS We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. RESULTS Of the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider's office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. CONCLUSIONS We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.
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Affiliation(s)
- Rebecca Zimba
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Matthew L Romo
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Amanda Berry
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - William You
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Levi Waldron
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Madhura S Rane
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Christian Grov
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
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25
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, Pence B, Pefura-Yone E, Yotebieng M, Nsame D, Anastos K, Nash D. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy. AIDS Behav 2021; 25:4018-4028. [PMID: 34091803 DOI: 10.1007/s10461-021-03328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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26
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Ajeh R, Nash D. Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national "treat all" policy: a cross-sectional analysis. J Int AIDS Soc 2021; 24:e25842. [PMID: 34811945 PMCID: PMC8609224 DOI: 10.1002/jia2.25842] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Rapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care. Methods We conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire‐9; cut‐point 10), anxiety (Generalized Anxiety Disorder‐7; cut‐point 10), post‐traumatic stress disorder (PTSD) (PTSD Checklist for DSM‐5; cut‐point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut‐point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log‐binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care. Results and discussion Overall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models. Conclusions Symptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a “treat all” policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Lindsey M Filiatreau
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA
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27
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Nash D, Rane MS, Chang M, Kulkarni SG, Zimba R, You W, Berry A, Mirzayi C, Kochhar S, Maroko A, Robertson MM, Westmoreland DA, Parcesepe AM, Waldron L, Grov C. SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults. medRxiv 2021:2021.02.12.21251659. [PMID: 33619505 PMCID: PMC7899475 DOI: 10.1101/2021.02.12.21251659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Epidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys. METHODS We estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion. FINDINGS Among the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and tested during November 2020-January 2021, we observed 161 seroconversions over 1,646 person-years of follow-up (incidence rate of 9.8 per 100 person-years [95%CI 8.3-11.5]). In adjusted models, participants who reported always or sometimes social distancing with people they knew (IRRalways vs. never 0.43, 95%CI 0.21-1.0; IRRsometimes vs. never 0.47, 95%CI 0.22-1.2) and people they did not know (IRRalways vs. never 0.64, 95%CI 0.39-1.1; IRRsometimes vs. never 0.60, 95%CI 0.38-0.97) had lower rates of seroconversion. The rate of seroconversion increased across tertiles of the composite score of epidemiologic risk (IRRmedium vs. low 1.5, 95%CI 0.92-2.4; IRRhigh vs. low 3.0, 95%CI 2.0-4.6). Among the 161 observed seroconversions, 28% reported no symptoms of COVID-like illness (i.e., were asymptomatic), and 27% reported a positive SARS-CoV-2 diagnostic test. Ultimately, only 29% reported isolating and 19% were asked about contacts. INTERPRETATION Modifiable epidemiologic risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the U.S during May 2020-January 2021. FUNDING U.S. National Institutes of Allergy and Infectious Diseases (NIAID).
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Madhura S. Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Mindy Chang
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Andrew Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Drew A. Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
| | - Angela M. Parcesepe
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York City, New York USA
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence B, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 2021; 21:293. [PMID: 34090367 PMCID: PMC8180128 DOI: 10.1186/s12888-021-03306-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon. METHODS We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression. RESULTS Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80). CONCLUSIONS Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
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Affiliation(s)
- Lindsey M. Filiatreau
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian Pence
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Milton Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Denis Nash
- grid.212340.60000000122985718Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Marcel Yotebieng
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn Anastos
- grid.251993.50000000121791997Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Parcesepe AM, Lahuerta M, Lamb MR, Ahoua L, Abacassamo F, Elul B. Prevalence and psychosocial factors associated with self-injurious thoughts among people living with HIV presenting for HIV testing in Mozambique. AIDS Care 2021; 34:771-775. [PMID: 33749451 DOI: 10.1080/09540121.2021.1902930] [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: 10/21/2022]
Abstract
Self-injurious thoughts have been associated with psychiatric morbidity and suicide. Little is known about psychosocial factors associated with self-injurious thoughts among people newly diagnosed with HIV in sub-Saharan Africa. This study examined whether food insufficiency, mental health symptoms, or social support were associated with recent self-injurious thoughts among people newly diagnosed with HIV in Mozambique. The sample included 2001 PLWH aged ≥ 18 newly diagnosed with HIV at 10 health clinics in Mozambique between April 2013 and June 2015. Data were collected at time of HIV diagnosis. Multivariable logistic regression modeled the association of social support, affective mental health symptom severity, somatic mental health symptom severity, and food insufficiency on recent self-injurious thoughts. Ten percent of respondents reported recent self-injurious thoughts, which was higher among women than men (11% vs 7%). In multivariable analyses, food insufficiency [adjusted odds ratio (aOR) 1.7 (95% CI 1.3, 2.2)], and low [aORvs no = 4.8, 95% CI 1.7, 13.4) and moderate/high affective symptom severity [aORvs no = 8.7, 95% CI 2.8, 27.6) were associated with greater odds of self-injurious thoughts. Interventions to address self-injurious thoughts should consider accompanying psychosocial stressors. Longitudinal research to examine mechanisms through which psychosocial stressors are associated with self-injurious thoughts is warranted.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew R Lamb
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Laurence Ahoua
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Parcesepe AM, Cordoba E, Gallis JA, Headley J, Tchatchou B, Hembling J, Soffo C, Baumgartner JN. Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis. BMC Pregnancy Childbirth 2021; 21:178. [PMID: 33663428 PMCID: PMC7934543 DOI: 10.1186/s12884-021-03673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. METHODS This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. RESULTS Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. CONCLUSIONS Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC 27599 USA
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC USA
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC USA
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Cordoba E, Parcesepe AM, Gallis JA, Headley J, Soffo C, Tchatchou B, Hembling J, Baumgartner JN. The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon. PLoS One 2021; 16:e0246467. [PMID: 33606692 PMCID: PMC7894814 DOI: 10.1371/journal.pone.0246467] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background This research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger. Methods The sample included 220 pregnant WLWH in Cameroon. Multivariable modified Poisson regression was conducted to assess the relationship between IPV, hunger, and CMD on ART adherence. Results Almost half (44%) of participants recently missed/mistimed an ART dose. Probable CMD was associated with greater risk of missed/mistimed ART dose (aRR 1.5 [95% CI 1.1, 1.9]). Hunger was associated with greater risk of missed/mistimed ART dose among those who reported IPV (aRR 1.9 [95% CI 1.2, 2.8]), but not among those who did not (aRR 0.8 [95% CI 0.2, 2.3]). Conclusion Suboptimal ART adherence, CMD, and IPV were common among pregnant WLWH in Cameroon. Pregnant WLWH experiencing IPV and hunger may be especially vulnerable to suboptimal ART adherence.
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Affiliation(s)
- Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- School of Nursing, Columbia University, New York, New York, United States of America
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | - John Hembling
- Catholic Relief Services, Baltimore, Maryland, United States of America
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Romo ML, Zimba R, Kulkarni S, Berry A, You W, Mirzayi C, Westmoreland D, Parcesepe AM, Waldron L, Rane M, Kochhar S, Robertson M, Maroko AR, Grov C, Nash D. Patterns of SARS-CoV-2 testing preferences in a national cohort in the United States. medRxiv 2020:2020.12.22.20248747. [PMID: 33398293 PMCID: PMC7781336 DOI: 10.1101/2020.12.22.20248747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
In order to understand preferences about SARS-CoV-2 testing, we conducted a discrete choice experiment among 4793 participants in the Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. We used latent class analysis to identify distinct patterns of preferences related to testing and conducted a simulation to predict testing uptake if additional testing scenarios were offered. Five distinct patterns of SARS-CoV-2 testing emerged. "Comprehensive testers" (18.9%) ranked specimen type as most important and favored less invasive specimen types, with saliva most preferred, and also ranked venue and result turnaround time as highly important, with preferences for home testing and fast result turnaround time. "Fast track testers" (26.0%) ranked result turnaround time as most important and favored immediate and same day turnaround time. "Dual testers" (18.5%) ranked test type as most important and preferred both antibody and viral tests. "Non-invasive dual testers" (33.0%) ranked specimen type and test type as similarly most important, preferring cheek swab specimen type and both antibody and viral tests. "Home testers" (3.6%) ranked venue as most important and favored home-based testing. By offering less invasive (saliva specimen type), dual testing (both viral and antibody tests), and at home testing scenarios in addition to standard testing scenarios, simulation models predicted that testing uptake would increase from 81.7% to 98.1%. We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options, which consider this heterogeneity, would likely increase testing uptake. SIGNIFICANCE During the COVID-19 pandemic, diagnostic testing has allowed for early detection of cases and implementation of measures to reduce community transmission of SARS-CoV-2 infection. Understanding individuals' preferences about testing and the service models that deliver tests are relevant in efforts to increase and sustain uptake of SARS-CoV-2 testing, which, despite vaccine availability, will be required for the foreseeable future. We identified substantial differences in preferences for SARS-CoV-2 testing in a discrete choice experiment among a large national cohort of adults in the US. Offering additional testing options that account for or anticipate this heterogeneity in preferences (e.g., both viral and antibody tests, at home testing), would likely increase testing uptake. CLASSIFICATION Biological Sciences (major); Psychological and Cognitive Sciences (minor).
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Affiliation(s)
- Matthew L. Romo
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY, 10027 USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - William You
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Drew Westmoreland
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, 27599 USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516 USA
| | - Levi Waldron
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY, 10027 USA
| | - Madhura Rane
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
| | - Andrew R. Maroko
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY, 10027 USA
| | - Christian Grov
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY, 10027 USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York, NY, 10027 USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY, 10027 USA
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Parcesepe AM, Robertson M, Berry A, Maroko A, Zimba R, Grov C, Westmoreland D, Kulkarni S, Rane M, Salgado-You W, Mirzayi C, Waldron L, Nash D. The relationship between anxiety, health, and potential stressors among adults in the United States during the COVID-19 pandemic. medRxiv 2020. [PMID: 33173880 DOI: 10.1101/2020.10.30.20221440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To estimate the prevalence of anxiety symptoms and the association between moderate or severe anxiety symptoms and health and potential stressors among adults in the U.S. during the COVID-19 pandemic. Methods This analysis includes data from 5,250 adults in the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study surveyed in April 2020. Poisson models were used to estimate the association between moderate or severe anxiety symptoms and health and potential stressors among U.S. adults during the COVID-19 pandemic. Results Greater than one-third (35%) of participants reported moderate or severe anxiety symptoms. Having lost income due to COVID-19 (adjusted prevalence ratio [aPR] 1.27 (95% CI 1.16, 1.30), having recent COVID-like symptoms (aPR 1.17 (95% CI 1.05, 1,31), and having been previously diagnosed with depression (aPR 1.49, (95% CI 1.35, 1.64) were positively associated with anxiety symptoms. Conclusions Anxiety symptoms were common among adults in the U.S. during the COVID-19 pandemic. Strategies to screen and treat individuals at increased risk of anxiety, such as individuals experiencing financial hardship and individuals with prior diagnoses of depression, should be developed and implemented.
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Parcesepe AM, Lancaster K, Edelman EJ, DeBoni R, Ross J, Atwoli L, Tlali M, Althoff K, Tine J, Duda SN, Wester CW, Nash D. Substance use service availability in HIV treatment programs: Data from the global IeDEA consortium, 2014-2015 and 2017. PLoS One 2020; 15:e0237772. [PMID: 32853246 PMCID: PMC7451518 DOI: 10.1371/journal.pone.0237772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn Lancaster
- Department of Epidemiology, The Ohio State University, Columbus, Ohio, United States of America
| | - E Jennifer Edelman
- Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Raquel DeBoni
- National Institute of Infectology, Evandro Chagas, Fiocruz, Brazil
| | - Jeremy Ross
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Judicaël Tine
- Maladies Infectieuses du Centre Hospitalier, National Universitaire de FANN, Dakar, Senegal
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - C William Wester
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, City University of New York, New York, New York, United States of America
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Parcesepe AM, Lahuerta M, Lamb MR, Ahoua L, Abacassamo F, Elul B. Household Decision-Making and HIV Care Continuum Outcomes Among Women Living with HIV in Mozambique. AIDS Patient Care STDS 2020; 34:173-183. [PMID: 32324485 DOI: 10.1089/apc.2019.0268] [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] [Indexed: 11/12/2022] Open
Abstract
Gender inequality has been associated with HIV infection among women. Less is known about the relationship between gender inequality and HIV care continuum outcomes. This study assessed whether household decision-making power (DMP), one component of gender inequality, was associated with linkage to HIV care, antiretroviral therapy (ART) initiation, or retention in care among women living with HIV in Mozambique. The sample included 600 women ≥18 years of age newly diagnosed with HIV in Mozambique. Data were collected between April 2013 and June 2016. DMP was assessed with three questions about participation in decisions regarding: major household decisions, routine household decisions, and visits to family. Women who did not contribute to decision making in any domain were categorized as having low DMP. HIV care information was obtained from electronic medical records. Multivariable log-Poisson regression analyses were conducted to assess the relationship between DMP and HIV care continuum outcomes. Almost half (49%) of participants reported medium DMP, followed by high (39%) and low DMP (12%). In multivariable regression analyses, when compared with respondents with medium DMP, those with low DMP had a lower likelihood of retention in care 12 months after diagnosis [adjusted risk ratio (aRR) 0.69 (95% CI 0.49-0.98)]. There was no significant relationship between low DMP and linkage to HIV care or ART initiation. High DMP was not significantly associated with HIV outcomes assessed. Women who report low DMP may face barriers to long-term engagement in HIV care. Interventions to improve retention in care among women should consider the role of household decision making and gender inequality.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Matthew R. Lamb
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Laurence Ahoua
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Parcesepe AM, Nash D, Tymejczyk O, Reidy W, Kulkarni SG, Elul B. Gender, HIV-Related Stigma, and Health-Related Quality of Life Among Adults Enrolling in HIV Care in Tanzania. AIDS Behav 2020; 24:142-150. [PMID: 30927114 PMCID: PMC6768763 DOI: 10.1007/s10461-019-02480-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HIV-related stigma has been associated with worse health-related quality of life (HRQoL) among people living with HIV (PLWH). Little is known about how different types of HIV-related stigma (i.e., anticipatory, internalized, or enacted HIV-related stigma) influence HRQoL and whether these relationships differ by gender. The sample included 912 PLWH aged 18 years or older enrolling in HIV care at four health facilities in Tanzania. HRQoL was assessed with the life satisfaction and overall function subscales of the HIV/AIDS-Targeted Quality of Life (HAT-QoL) instrument. Sex-stratified multivariable logistic regression modeled the association of anticipatory, internalized, and enacted HIV-related stigma on poor HRQoL. Across all participants, the mean life satisfaction score was 63.4 (IQR: 43.8, 81.3) and the mean overall function score was 72.0 (IQR: 58.3, 91.7). Mean HRQoL scores were significantly higher for women compared to men for overall function (5.1 points higher) and life satisfaction (4.3 points higher). Fourteen percent of respondents reported recent enacted HIV-related stigma and 13% reported recent medium or high levels of internalized stigma. In multivariable models, high internalized and high anticipatory stigma were significantly associated with higher odds of poor life satisfaction and poor overall function in both men and women. Psychosocial interventions to prevent or reduce the impact of internalized and anticipatory stigma may improve HRQoL among persons in HIV care. Future research should longitudinally examine mechanisms between HIV-related stigma, poor HRQoL, and HIV care outcomes.
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Parcesepe AM, Mugglin C, Nalugoda F, Bernard C, Yunihastuti E, Althoff K, Jaquet A, Haas AD, Duda SN, Wester CW, Nash D. Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle-income countries within the global IeDEA consortium. J Int AIDS Soc 2019; 21:e25101. [PMID: 29603887 PMCID: PMC5878412 DOI: 10.1002/jia2.25101] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low‐ and middle‐income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Methods We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia‐Pacific and sub‐Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post‐traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders. Results Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on‐site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On‐site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children. Conclusions Significant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed.
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Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Charlotte Bernard
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, Bordeaux, France.,INSERM, ISPED, Bordeaux Population Health Research Center, Bordeaux, France
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Keri Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Antoine Jaquet
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, Bordeaux, France
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C William Wester
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Yotebieng M, Brazier E, Addison D, Kimmel AD, Cornell M, Keiser O, Parcesepe AM, Onovo A, Lancaster KE, Castelnuovo B, Murnane PM, Cohen CR, Vreeman RC, Davies M, Duda SN, Yiannoutsos CT, Bono RS, Agler R, Bernard C, Syvertsen JL, Sinayobye JD, Wikramanayake R, Sohn AH, von Groote PM, Wandeler G, Leroy V, Williams CF, Wools‐Kaloustian K, Nash D. Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA). J Int AIDS Soc 2019; 22:e25218. [PMID: 30657644 PMCID: PMC6338103 DOI: 10.1002/jia2.25218] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION "Treat All" - the treatment of all people with HIV, irrespective of disease stage or CD4 cell count - represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub-Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. METHODS The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision-makers, and HIV community representatives in East, Central, Southern and West Africa. RESULTS AND DISCUSSION The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders - groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub-national estimates of the size of key populations and describe those who remain underserved along the HIV-care continuum; (2) characterize the timeliness of HIV care and short- and long-term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV-drug resistance and regimen switching; and (4) identify cost-effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV-care continuum, particularly among underserved populations. CONCLUSIONS Reflecting consensus among a broad group of experts, researchers, policy- and decision-makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.
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Affiliation(s)
| | - Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Diane Addison
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - April D Kimmel
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology& ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | - Amobi Onovo
- University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Pamela M Murnane
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive SciencesBixby Center for Global Reproductive HealthUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rachel C Vreeman
- Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Mary‐Ann Davies
- School of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Rose S Bono
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | | | - Charlotte Bernard
- InsermCentre INSERM U1219‐Epidémiologie‐BiostatistiqueSchool of Public Health (ISPED)University of BordeauxBordeauxFrance
| | | | | | - Radhika Wikramanayake
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Annette H Sohn
- TREAT AsiaamfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Per M von Groote
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Valeriane Leroy
- Inserm (French Institute of Health and Medical Research)UMR 1027 Université Toulouse 3ToulouseFrance
| | - Carolyn F Williams
- Epidemiology BranchDivision of AIDS at National Institute of Allergy and Infectious Diseases (NIAID)National Institute of Health (NIH)RockvilleMDUSA
| | | | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
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Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, Kwobah E, Adedimeji A, Goulet J, Althoff KN. Mental health and HIV: research priorities related to the implementation and scale up of 'treat all' in sub-Saharan Africa. J Virus Erad 2018; 4:16-25. [PMID: 30515310 PMCID: PMC6248852] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
World Health Organization (WHO) guidelines call for antiretroviral therapy (ART) for all people living with HIV (PLWH) regardless of CD4 cell count, a policy often referred to as 'treat all'. This article seeks to: (1) provide an overview of mental health research among PLWH in sub-Saharan Africa (SSA) and interventions or strategies to address comorbid mental illness among those living with HIV; and (2) describe key mental health-related recommendations to inform the successful implementation and scale up of 'treat all' policies in SSA. An initial set of mental health-related research recommendations was developed by a working group comprising investigators affiliated with the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Recommendations were shared with those who attended the All-Africa IeDEA Meeting in Kigali, Rwanda in November 2017 and refined following the meeting. Recommendations reflect a need for epidemiological research to examine the prevalence, incidence, and impact of mental health multimorbidities on HIV treatment outcomes, intervention research to examine the extent to which improving the mental health of people living with HIV enhances HIV treatment outcomes, and implementation science research to evaluate promising models of integrated mental health and HIV care. Key research recommendations can advance understanding and treatment of mental illness among those living with HIV in sub-Saharan Africa and beyond.
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Affiliation(s)
- Angela M Parcesepe
- Corresponding author: Angela M. Parcesepe;
University of North Carolina at Chapel Hill,
Gillings School of Global Public Health,
Department of Maternal and Child Health,
CB#7445Chapel Hill,
NC,
27599-7445,
USA
| | | | - Robert Agler
- Department of Psychology, Ohio State University,
Columbus, OH,
USA
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research,
Bangkok,
Thailand
| | - Marcel Yotebieng
- College of Public Health, Division of Epidemiology, Ohio State University,
Columbus, OH,
USA
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,
USA
| | - Edith Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital and Moi University,
Eldoret,
Kenya
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine,
Bronx, NY,
USA
| | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,
USA
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Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, Kwobah E, Adedimeji A, Goulet J, Althoff KN. Mental health and HIV: research priorities related to the implementation and scale up of ‘treat all’ in sub-Saharan Africa. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30341-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Parcesepe AM, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia, Ethiopia. AIDS Care 2018; 30:211-218. [PMID: 28774191 PMCID: PMC5748326 DOI: 10.1080/09540121.2017.1360998] [Citation(s) in RCA: 3] [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] [Indexed: 12/20/2022]
Abstract
Low decision-making power (DMP) has been associated with HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, greater attention to the mental health and well-being of HIV-positive women is needed. This study examined whether low DMP was associated with psychological distress, social support or health-related quality of life (HRQoL) among women initiating ART. The sample included 722 women aged 18 or older initiating ART during 2012-2013 at six HIV clinics in Oromia, Ethiopia. DMP was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). HRQoL was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural). Most respondents (63%) reported high DMP, followed by medium (27%) and low (10%) DMP. More than half (57%) reported psychological distress. Compared to medium DMP, low DMP among married or cohabitating women was associated with greater odds of low social support (aOR: 1.9 [1.3, 2.9]; high DMP among women not in a relationship was associated with greater odds of low social support (aOR: 4.4 [2.4, 8.1]) and psychological distress (aOR: 1.7 [1.1, 2.6]). Interventions to reduce psychological distress among women initiating ART should consider the familial context, as high DMP among women not in a relationship was associated with psychological distress. High DMP may indicate weak social ties and fewer material resources, particularly among women not in a relationship.
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Affiliation(s)
- Angela M Parcesepe
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | - Olga Tymejczyk
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
- c Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | - Robert Remien
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | | | - Sarah Gorrell Kulkarni
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | | | - Batya Elul
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | - Denis Nash
- b Institute for Implementation Science in Population Health, City University of New York , New York , NY , USA
- c Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
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Parcesepe AM, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. Psychological distress, health and treatment-related factors among individuals initiating ART in Oromia, Ethiopia. AIDS Care 2017; 30:338-342. [PMID: 28820273 DOI: 10.1080/09540121.2017.1363367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HIV diagnosis may be a source of psychological distress. Late initiation of antiretroviral therapy (ART) and treatment-related beliefs may intensify psychological distress among those recently diagnosed. This analysis describes the prevalence of psychological distress among people living with HIV (PLWH) and examines the association of recent HIV diagnosis, late ART initiation and treatment-related beliefs with psychological distress. The sample includes 1175 PLWH aged 18 or older initiating ART at six HIV clinics in Ethiopia. Psychological distress was assessed with Kessler Psychological Distress Scale. Scores ≥ 29 were categorized as severe psychological distress. Individuals who received their first HIV diagnosis in the past 90 days were categorized as recently diagnosed. Multivariable logistic regression modeled the association of recent diagnosis, late ART initiation and treatment-related beliefs on severe psychological distress, controlling for age, sex, education, area of residence, relationship status, and health facility. Among respondents, 29.5% reported severe psychological distress, 46.6% were recently diagnosed and 31.0% initiated ART late. In multivariable models, relative to those who did not initiate ART late and had longer time since diagnosis, odds of severe psychological distress was significantly greater among those with recent diagnosis and late ART initiation (adjusted OR [aOR]: 1.9 [95% CI 1.4, 2.8]). Treatment-related beliefs were not associated with severe psychological distress in multivariable models. Severe psychological distress was highly prevalent, particularly among those who were recently diagnosed and initiated ART late. Greater understanding of the relationship between psychological distress, recent diagnosis, and late ART initiation can inform interventions to reduce psychological distress among this population. Mental health screening and interventions should be incorporated into routine HIV clinical care from diagnosis through treatment.
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Affiliation(s)
- Angela M Parcesepe
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | - Olga Tymejczyk
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
| | - Robert Remien
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | | | - Sarah Gorrell Kulkarni
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA.,e Department of Epidemiology , Columbia University , New York , NY , USA
| | | | - Batya Elul
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | - Denis Nash
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
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Abstract
Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1501 Riverside Drive, New York, NY, USA.
| | - Kelly L L'Engle
- Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sherri Green
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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L'Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review. Pediatrics 2016; 138:peds.2016-0884. [PMID: 27553221 DOI: 10.1542/peds.2016-0884] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Interventions for adolescent sexual and reproductive health (ASRH) are increasingly using mobile phones but may not effectively report evidence. OBJECTIVE To assess strategies, findings, and quality of evidence on using mobile phones to improve ASRH by using the mHealth Evidence Reporting and Assessment (mERA) checklist recently published by the World Health Organization mHealth Technical Evidence Review Group. DATA SOURCES Systematic searches of 8 databases for peer-reviewed studies published January 2000 through August 2014. STUDY SELECTION Eligible studies targeted adolescents ages 10 to 24 and provided results from mobile phone interventions designed to improve ASRH. DATA EXTRACTION Studies were evaluated according to the mERA checklist, covering essential mHealth criteria and methodological reporting criteria. RESULTS Thirty-five articles met inclusion criteria. Studies reported on 28 programs operating at multiple levels of the health care system in 7 countries. Most programs (82%) used text messages. An average of 41% of essential mHealth criteria were met (range 14%-79%). An average of 82% of methodological reporting criteria were met (range 52%-100%). Evidence suggests that inclusion of text messaging in health promotion campaigns, sexually transmitted infection screening and follow-up, and medication adherence may lead to improved ASRH. LIMITATIONS Only 3 articles reported evidence from lower- or middle-income countries, so it is difficult to draw conclusions for these settings. CONCLUSIONS Evidence on mobile phone interventions for ASRH published in peer-reviewed journals reflects a high degree of quality in methods and reporting. In contrast, current reporting on essential mHealth criteria is insufficient for understanding, replicating, and scaling up mHealth interventions.
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Affiliation(s)
- Kelly L L'Engle
- School of Nursing and Health Professions, University of San Francisco, California;
| | - Emily R Mangone
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Angela M Parcesepe
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Smisha Agarwal
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
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Parcesepe AM, L'Engle KL, Martin SL, Green S, Suchindran C, Mwarogo P. Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis. Sex Transm Infect 2016; 92:593-598. [PMID: 27217378 DOI: 10.1136/sextrans-2016-052549] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/28/2016] [Accepted: 04/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya. METHODS In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status. RESULTS FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early. CONCLUSIONS Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Kelly L L'Engle
- FHI 360, Durham, North Carolina, USA.,Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sherri Green
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Chirayath Suchindran
- Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Parcesepe AM, L Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial. Drug Alcohol Depend 2016; 161:21-8. [PMID: 26872880 PMCID: PMC4936780 DOI: 10.1016/j.drugalcdep.2015.12.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. DESIGN Randomized controlled trial. SETTING HIV prevention drop-in centers in Mombasa, Kenya. PARTICIPANTS 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). INTERVENTION 6 session alcohol harm reduction intervention. COMPARATOR 6 session non-alcohol related nutrition intervention. MEASUREMENTS In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. FINDINGS The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. CONCLUSIONS The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.
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Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States.
| | - Kelly L L Engle
- FHI 360, 359 Blackwell St., Durham, NC 27701, United States; Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, United States
| | - Sandra L Martin
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Sherri Green
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), PO Box 21761 Ngong Road, 00505 Nairobi, Kenya
| | - Chirayath Suchindran
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Rosenau Hall, Chapel Hill, NC, United States
| | - Ilene S Speizer
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Peter Mwarogo
- FHI 360, The Chancery 2nd and 3rd Floor Valley Road, PO Box 38835-00623, Nairobi, Kenya
| | - Nzioki Kingola
- International Center for Reproductive Health, PO Box 91109, Mombasa, Kenya
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Parcesepe AM, Toivgoo A, Chang M, Riedel M, Carlson C, DiBennardo R, Witte SS. Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia. Glob Public Health 2014; 10:88-102. [PMID: 25383593 DOI: 10.1080/17441692.2014.976240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 10/24/2022]
Abstract
Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs.
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Affiliation(s)
- Angela M Parcesepe
- a Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Abstract
Public stigma is a pervasive barrier that prevents many individuals in the U.S. from engaging in mental health care. This systematic literature review aims to: (1) evaluate methods used to study the public's stigma toward mental disorders, (2) summarize stigma findings focused on the public's stigmatizing beliefs and actions and attitudes toward mental health treatment for children and adults with mental illness, and (3) draw recommendations for reducing stigma towards individuals with mental disorders and advance research in this area. Public stigma of mental illness in the U.S. was widespread. Findings can inform interventions to reduce the public's stigma of mental illness.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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