1
|
McKinnon K, Lentz C, Boccher-Lattimore D, Cournos F, Pather A, Sukumaran S, Remien RH, Mellins CA. Interventions for Integrating Behavioral Health into HIV Settings for US Adults: A Narrative Review of Systematic Reviews and Meta-analyses, 2010-2020. AIDS Behav 2024:10.1007/s10461-024-04324-z. [PMID: 38578597 DOI: 10.1007/s10461-024-04324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
Mental health and substance use disorders can negatively affect physical health, illness management, care access, and quality of life. These behavioral health conditions are prevalent and undertreated among people with HIV and may worsen outcomes along the entire HIV Care Continuum. This narrative review of tested interventions for integrating care for HIV and behavioral health disorders summarizes and contextualizes findings from systematic reviews and meta-analyses conducted in the past decade. We sought to identify gaps in research that hinder implementing evidence-based integrated care approaches. Using terms from the Substance Abuse and Mental Health Services Administration-Health Resources & Services Administration standard framework for integrated health care, we searched PubMed and PsycInfo to identify peer-reviewed systematic reviews or meta-analyses of intervention studies to integrate behavioral health and HIV published between 2010 and 2020. Among 23 studies identified, only reviews and meta-analyses that described interventions from the United States designed to integrate BH services into HIV settings for adults were retained, leaving six studies for narrative review by the study team. Demonstrated benefits from the relatively small literature on integrated care interventions include improved patient- and service-level outcomes, particularly for in-person case management and outreach interventions. Needed are systems-level integration interventions with assessments of long-term outcomes on behavioral health symptoms, HIV viral suppression, HIV transmission rates, and mortality. HIV, primary care, and other providers must include behavioral health as a part of overall healthcare and must play a central role in behavioral health care delivery. Research is needed to guide their way.
Collapse
Affiliation(s)
- Karen McKinnon
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA.
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Daria Boccher-Lattimore
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA
| | - Francine Cournos
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St, New York, 10032, USA
| | - Ariana Pather
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Stephen Sukumaran
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| |
Collapse
|
2
|
Rael CT, Kutner BA, Lentz C, Lopez-Ríos J, Dolezal C, Arumugam S, Sia SK, Balán IC. Transgender Women's Experiences Using SMARTtest, a Smartphone Application to Facilitate Self- and Partner-HIV/Syphilis Testing Using the INSTI Multiplex. Arch Sex Behav 2023; 52:1961-1968. [PMID: 37188893 PMCID: PMC10726688 DOI: 10.1007/s10508-023-02602-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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
We present experiences of transgender women (TW) who have sex with men with SMARTtest, a smartphone app to accompany the INSTI Multiplex®, a one-minute, dual blood-based HIV/syphilis rapid test. TW participants (N = 11) received 10 INSTI Multiplex® tests to take home for self- and/or partner-testing and installed the SMARTtest app on their phones. The SMARTtest app aimed to support INSTI Multiplex users in correctly performing the test, interpreting the results, and connecting with care following a positive HIV or syphilis screening. After 3 months, users completed in-depth interviews on their experiences. A total of 9 TW used SMARTtest with partners. App feedback was positive, but refining is necessary. Specifically, TW reported that SMARTtest is easy to use and convenient; instructions on how to use the INSTI Multiplex presented on the app were helpful to complete procedures correctly; the most frequently used feature on SMARTtest was the information on clinics that offered confirmatory testing; and participants and their partners were not concerned about app privacy but reported that this could change if INSTI Multiplex detected an HIV-positive result. Further, participants provided recommendations on how to improve SMARTtest, and changes were mostly related to features, content, functionality, navigation, and overall "look" of the app. SMARTtest is promising to facilitate INSTI Multiplex® use in TW. User feedback should be integrated in future versions.
Collapse
Affiliation(s)
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Javier Lopez-Ríos
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Samuel K Sia
- Columbia University School of Engineering, New York, NY, USA
| | - Iván C Balán
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| |
Collapse
|
3
|
López Rios J, Lentz C, Balán IC, Grosskopf N, D'Angelo A, Stief M, Grov C. Engagement in Care Among Newly Diagnosed HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From the Together 5,000 Study. AIDS Educ Prev 2022; 34:349-364. [PMID: 36181497 PMCID: PMC9619412 DOI: 10.1521/aeap.2022.34.5.349] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
One-quarter of gay, bisexual, and other men who have sex with men (GBMSM) with diagnosed HIV are not engaged in HIV care. Between 2018 and 2019, 50 GBMSM completed qualitative interviews 3 months after receiving an HIV-positive result. Interviews explored barriers to and facilitators of engagement and retention in HIV testing and care. Thematic analysis revealed five major themes: (1) reason for HIV testing (e.g., self-testing), (2) linkage to care (e.g., appointment/logistic issues and social support as encouragement), (3) barriers to engagement in care (e.g., financial burden, competing priorities, and fear/stigma), (4) facilitators of engagement (e.g., financial assistance, patient-provider relationships, auxiliary support services, and health agency), and (5) PrEP as a missed prevention opportunity. Addressing individual-, social-, and policy-level barriers could improve GBMSM's engagement in HIV care. Further, capitalizing on GBMSM's health agency through partnerships with local agencies and fostering better patient-provider relationships could optimize HIV care continuity.
Collapse
Affiliation(s)
- Javier López Rios
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | - Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida
| | - Nicholas Grosskopf
- Department of Health and Human Performance, York College of the City University of New York, Queens, New York
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Alexa D'Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Matthew Stief
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| |
Collapse
|
4
|
Lentz C, Lopez-Rios J, Dolezal C, Kutner BA, Rael CT, Balán IC. Negotiating Use of a Blood-Based, Dual HIV and Syphilis Test with Potential Sexual Partners Among a Sample of Cisgender Men and Transgender Women Who Have Sex with Men in New York City. Arch Sex Behav 2022; 51:2015-2025. [PMID: 35449365 PMCID: PMC9197957 DOI: 10.1007/s10508-021-02275-3] [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] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 05/03/2023]
Abstract
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been "fairly" or "very easy" to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples' dynamics that may impact test usage.
Collapse
Affiliation(s)
- Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Javier Lopez-Rios
- Department of Community Health and Prevention, Dornsife School of Public Health at Drexel University, Philadelphia, PA, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- College of Nursing, Anschutz Medical Campus at Colorado University, Aurora, CO, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, 32310, USA.
| |
Collapse
|
5
|
Kutner BA, Zucker J, López-Rios J, Lentz C, Dolezal C, Balán IC. Infrequent STI Testing in New York City Among High Risk Sexual and Gender Minority Individuals Interested In Self- and Partner-Testing. AIDS Behav 2022; 26:1153-1162. [PMID: 34554292 DOI: 10.1007/s10461-021-03468-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
Testing for sexually transmitted infections (STIs) remains low among sexual and gender minority populations. We assessed STI testing history using a retrospective survey among 129 HIV-negative cisgender men who have sex with men (cMSM) and transgender women who have sex with men (tWSM) who were at high risk for STI acquisition. All participants were enrolled in a parent study on self- and partner-testing for HIV and syphilis, and reported condomless anal intercourse with multiple partners during the prior 3 months. We additionally used bivariate tests to evaluate participants' STI testing by their history of using pre-exposure prophylaxis (PrEP). One-in-seven respondents (n = 18) reported having never tested for an STI, one-quarter (n = 33) had not tested in the past year, and two-thirds (n = 83) had never used PrEP. PrEP-naïve respondents were less likely to report recent STI testing (47% vs. 85%). "Routine doctor's visit" was the most prevalent reason for testing, but was less common among PrEP-naïve respondents (83% vs. 100%). Testing was remarkably low given the sample's high risk of HIV and STI infection. Findings suggest that STI testing is more frequent among those who have ever used PrEP, but the risk of selection bias warrants evaluation in a larger probability sample.
Collapse
Affiliation(s)
- Bryan A Kutner
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jason Zucker
- Columbia University Irving Medical Center, New York, NY, USA
| | - Javier López-Rios
- Department of Community Health & Prevention, Dornsife School of Public Health Drexel University, 3215 Market street, Nesbitt Hall, 4th Fl., Philadelphia, PA, USA
| | - Cody Lentz
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Curtis Dolezal
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Iván C Balán
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 2010 Levy Ave Building B, Suite B0266, Tallahassee, FL, 32310, USA.
| |
Collapse
|
6
|
Balán IC, Lentz C, Giguere R, Dolezal C, Kajura-Manyindo C, Kutner BA, Zalwango A, Makoni R, Madlala B, Makala Y, Khanyile N, Kadyamusuma M, Kachenjera L, Ndhlovu-Forde Z, Tuswa-Haynes N. Inconsistent Counselor Fidelity in Delivering an Evidence-Based Adherence Intervention During a PrEP Trial. AIDS Behav 2022; 26:698-708. [PMID: 34390433 PMCID: PMC8840968 DOI: 10.1007/s10461-021-03429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Evidence-based adherence counseling interventions must be delivered with fidelity to ensure that their effectiveness is retained, but little is known regarding how counselors in biomedical HIV trials deliver these interventions. Forty-two counselors from the MTN-025/HOPE Study, which was conducted in 14 sites in sub-Saharan Africa, participated. They completed a quantitative assessment and consented for their HOPE counseling session ratings to be analyzed. Twenty-two (52%) self-identified as research nurses and 20 (48%) as counselors. Of 928 session ratings, 609 (66%) were classified as Good, 188 (20%) as Fair, and 131 (14%) as Poor, based on pre-established criteria. Overall mean ratings for session tasks and global components (each rated from 1 to 5) were 4.12 (SD = 0.45; range 2.46-4.73) and 4.02 (SD = 0.64; range 1.75-4.79), respectively. Twenty-six (62%) counselors attained Good or Fair ratings on at least 85% of their sessions, but 33% of counselors had more than 25% of their sessions rated as Poor; three counselors (7%) never met criteria for a Good session. Even after extensive training, counselors' fidelity to the intervention varied. Our findings highlight the value of fidelity monitoring using session audio-recordings, the importance of ongoing coaching and support, and the need to plan for counselors with consistently poor fidelity.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
- Florida State University College of Medicine, Tallahassee, FL, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Aisha Zalwango
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Rujeko Makoni
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Bernadette Madlala
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - McLoddy Kadyamusuma
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Lonely Kachenjera
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Zanele Ndhlovu-Forde
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - NoCamagu Tuswa-Haynes
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| |
Collapse
|
7
|
Kutner BA, Pho AT, López-Rios J, Lentz C, Dolezal C, Balán IC. Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing. AIDS Educ Prev 2021; 33:234-248. [PMID: 34014111 PMCID: PMC8209687 DOI: 10.1521/aeap.2021.33.3.234] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.
Collapse
Affiliation(s)
- Bryan A. Kutner
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Anthony T. Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, MC5376, Palo Alto, CA 94304, USA
| | - Javier López-Rios
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cody Lentz
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Curtis Dolezal
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Iván C. Balán
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| |
Collapse
|
8
|
Kutner BA, Giguere R, Lentz C, Kajura-Manyindo C, Dolezal C, Butheliezi S, Gwande M, Nampiira S, Ndlovu T, Mvinjelwa P, Mwenda W, Balán IC. Sharing Objective Measures of Adherence to a Vaginal Microbicide Promotes Candor About Actual Use and Bolsters Motivation to Prevent HIV. AIDS Behav 2021; 25:721-731. [PMID: 32920652 PMCID: PMC7887002 DOI: 10.1007/s10461-020-03026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
Discrepancies between self-reported and actual adherence to biomedical HIV interventions is common and in clinical trials can compromise the integrity of findings. One solution is to monitor adherence biomarkers, but it is not well understood how to navigate biomarker feedback with participants. We surveyed 42 counselors and interviewed a subset of 22 to characterize their perspectives about communicating with participants about residual drug levels, an objective marker of adherence, within MTN-025/HOPE, a Phase 3b clinical trial of a vaginal ring to prevent HIV. When biomarkers indicated low drug levels that mismatched high adherence by self-report, counselors encountered barriers to acceptance and comprehension among participants. However, discrepancies between low self-report and higher drug levels generally stimulated candor. Women recollected times they had not used the product and disclosed problems that counselors thought might otherwise have remained forgotten or concealed. Navigating conversations toward HIV prevention was easier at mid-range drug levels and when women indicated motivation to prevent HIV. Ratings of residual drug level offered a somewhat objective measure of adherence and protection that counselors perceived as meaningful to participants and as a valuable catalyst for broaching conversation about HIV prevention. However, communication about drug levels required that counselors navigate emotional barriers, respond skillfully to questions about accuracy, and pivot conversations non-judgmentally away from numerical results and toward the priority of HIV prevention. Findings suggest a role for biomarker feedback in future clinical trials as well as other clinical contexts where biomarkers may be monitored, to motivate disclosure of actual adherence and movement toward HIV prevention.Clinical Trial Number NCT02858037.
Collapse
Affiliation(s)
- Bryan Andrew Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | | | - Miriam Gwande
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Susan Nampiira
- Makerere University - Johns Hopkins University Research Collaboration Clinical Research Site, Kampala, Uganda
| | - Thakasile Ndlovu
- South African Medical Research Council Clinical Trials Unit, Durban, South Africa
| | | | - Wezi Mwenda
- College of Medicine Clinical Research Site, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| |
Collapse
|
9
|
Balán IC, Giguere R, Lentz C, Kutner BA, Kajura-Manyindo C, Byogero R, Asiimwe FB, Makala Y, Jambaya J, Khanyile N, Chetty D, Soto-Torres L, Mayo A, Mgodi NM, Palanee-Phillips T, Baeten JM. Client-Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN-025 (The HOPE Study). AIDS Behav 2021; 25:447-458. [PMID: 32833192 DOI: 10.1007/s10461-020-03011-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fostering adherence and open communication about adherence challenges is key to harnessing the potential of biomedical HIV prevention products. We describe the counseling intervention and objective adherence measure feedback process implemented to support adherence to the dapivirine vaginal ring among participants in four sub-Saharan countries and present findings on the counselors' likeability and acceptability of the intervention. Most counselors (N = 42; 86%) liked Options counseling "very much" and during in-depth interviews (N = 22), reported that the intervention reshaped their adherence counselling approach by emphasizing understanding participants' experiences using the ring, which facilitated open discussion of adherence challenges. Counselors found that reframing residual drug level (RDL) discussions from the "adherence" to "protection" perspective encouraged adherence among consistent users and facilitated decisions to switch to a different HIV prevention approach among infrequent users. Among counselors, 24% said participants "liked it very much" while 26% said that participants "liked it a little" possibly due to two main complaints: perceived repetitiousness of sessions and variability in the RDL assay, which at times resulted in unexpected low RDLs.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Counseling, Montclair State University, Montclair, NJ, USA
- Department of Social Sciences, Essex County College, Newark, NJ, USA
| | - Rose Byogero
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Florence Biira Asiimwe
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Jane Jambaya
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - Diane Chetty
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | | | - Nyaradzo M Mgodi
- University of Zimbabwe - University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Lentz C, Giguere R, Kutner BA, Dolezal C, Kajura-Manyindo C, Yambira M, Asiimwe F, Mugocha C, Mwenda W, Ndlovu T, Naidu N, Madlala B, Balán IC. Culturally-Based Challenges to and Recommendations for Delivering Adherence Counseling in a Multicultural Biomedical HIV Prevention Trial in Four African Countries. AIDS Educ Prev 2020; 32:512-527. [PMID: 33779210 PMCID: PMC8059360 DOI: 10.1521/aeap.2020.32.6.512] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Research is needed to identify how to effectively tailor evidence-based interventions across cultures with limited resources, particularly for behavioral components in large HIV prevention trials. Through surveys and interviews with counselors of sub-Saharan African women during an open-label microbicide trial (MTN-025), we examined language, education, and cultural barriers in delivering a motivational interviewing-based adherence counseling intervention (i.e., Options Counseling). Counselors encountered an array of barriers, most prominently that participants struggled to comprehend culturally incongruent pictorial guides, such as traffic light images, and to uphold product use when primary partners disapproved. Overwhelmingly, counselors cited the intervention's inherent flexibility as an asset; it encouraged them to tailor language and examples to be more culturally relevant to participants. Future resource-conscious researchers may preemptively offset similar barriers by consulting with communities during intervention development. Similarly, affording counselors flexibility while delivering the chosen intervention may enable them to troubleshoot barriers that arise on the ground.
Collapse
Affiliation(s)
- Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Bryan A. Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Makanaka Yambira
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Florence Asiimwe
- Makerere University – Johns Hopkins University Research Collaboration Clinical Research Site, Kampala, Uganda
| | - Caroline Mugocha
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Wezi Mwenda
- Queen Elizabeth Central Hospital, College of Medicine Clinical Research Site, Blantyre, Malawi
| | - Thakasile Ndlovu
- South African Medical Research Council Clinical Trials Unit, Durban, South Africa
| | - Nalini Naidu
- South African Medical Research Council Clinical Trials Unit, Durban, South Africa
| | | | - Iván C. Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| |
Collapse
|
11
|
Giguere R, Lentz C, Kajura-Manyindo C, Kutner BA, Dolezal C, Buthelezi M, Lukas I, Nampiira S, Rushwaya C, Sitima E, Katz A, van der Straten A, Balán IC. Counselors' acceptability of adherence counseling session recording, fidelity monitoring, and feedback in a multi-site HIV prevention study in four African countries. AIDS Care 2020; 32:19-28. [PMID: 33021118 DOI: 10.1080/09540121.2020.1823312] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biomedical HIV prevention trials increasingly include evidence-based adherence counseling to encourage product use. To retain effectiveness, interventions must contain key components. Monitoring counseling fidelity ensures inclusion of components but is challenging in multinational contexts with different languages and scarce local supervision. The MTN-025/HOPE Study, a Phase 3b open-label trial to assess continued safety of and adherence to the dapivirine vaginal ring for HIV prevention, was the largest such trial to integrate fidelity monitoring using audio recordings of counseling sessions. We describe the monitoring process, along with counselor and participants' perceptions of it, which were collected via quantitative online survey (counselors only N = 42) and in-depth interviews with a subset of counselors (N = 22) and participants (N = 10). Sessions were conducted in five languages across 14 study sites in four countries. In total, 1238 sessions (23% of submitted sessions) were randomly selected and rated. Assessment of interrater reliability was essential to address drift in ratings. Counselors were apprehensive about being monitored, but appreciated clear guidance and found ratings very helpful (mean = 6.64 out of 7). Some participants perceived sessions as time-consuming; others found monitoring improved counseling quality. Fidelity monitoring of counseling sessions in mult-isite biomedical HIV studies is feasible and supportive for counselors.
Collapse
Affiliation(s)
- Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Mbongeleni Buthelezi
- South African Medical Research Council, Chatsworth Clinical Trials Unit, Durban, South Africa
| | - Irene Lukas
- Wits Reproductive Health and HIV Institute Clinical Research Site, Johannesburg, South Africa
| | - Susan Nampiira
- Makerere University - Johns Hopkins University Research Collaboration Clinical Research Site, Kampala, Uganda
| | - Chenai Rushwaya
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Edith Sitima
- Johns Hopkins University - Blantyre Clinical Trials Unit, Blantyre, Malawi
| | - Ariana Katz
- RTI International, Women's Global Health Imperative, San Francisco, CA, USA
| | - Ariane van der Straten
- RTI International, Women's Global Health Imperative, San Francisco, CA, USA.,University of California San Francisco (UCSF), Center for AIDS Prevention Studies, San Francisco, CA, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| |
Collapse
|
12
|
Dolezal C, Rael CT, Balán IC, Giguere R, Lentz C, Lopez-Rios J, Sheinfil AZ, Febo I, Carballo-Diéguez A. Substance Use and Testing Sexual Partners Using HIV Self-tests. AIDS Behav 2020; 24:2856-2862. [PMID: 32200448 DOI: 10.1007/s10461-020-02834-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV self-tests (HIVST) provide the possibility of testing partners prior to sexual activity. This study examines the role of substance use among men who have sex with men (n = 123) and transgender women (n = 13) who were provided HIVST to use with potential sex partners. Several reported avoiding/delaying alcohol (44%) or drug use (27%) because they intended to use HIVST. Those who used HIVST with alcohol (37%) or drugs (24%) did not differ from those who did not on number of partners asked, proportion who agreed, or intentions to use HIVST. A minority reported problems caused by substances. Ten did not ask someone to test because they were too drunk/high. Fourteen said it was fairly or very hard to use HIVST when under the influence. Eleven reported substances caused problems when discussing or administering HIVST, but only two of those felt the problems were major.
Collapse
Affiliation(s)
- Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Alan Z Sheinfil
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| |
Collapse
|
13
|
Sheinfil AZ, Giguere R, Dolezal C, Lopez-Rios J, Iribarren S, Brown W, Rael C, Lentz C, Balán I, Frasca T, Torres CC, Crespo R, Febo I, Carballo-Diéguez A. Information and Motivation Predict HIV-Serostatus Among a Population of High-Risk Men and Transgender Women Who Have Sex with Men. AIDS Behav 2020; 24:2863-2871. [PMID: 32200447 PMCID: PMC7978500 DOI: 10.1007/s10461-020-02835-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two constructs from the information-motivation-behavioral skills model were used to predict HIV-serostatus among a sample of men and transgender women who have sex with men. Hypotheses were that lower levels of HIV knowledge and lower levels of motivation to remain HIV-negative would be associated with an increased likelihood of receiving a positive HIV test result at a study eligibility-screening session. Results of a backwards stepwise logistic regression analysis demonstrated that lower levels of HIV knowledge, lower levels of motivation to remain HIV-negative, lower levels of education, and identifying as Hispanic/Latinx were associated with greater odds of receiving a positive HIV test result. These findings are consistent with the broader HIV-prevention literature that demonstrates that information and motivation are fundamental determinants of HIV preventive behavior. This work has implications for informing the development and improvement of HIV-prevention interventions.
Collapse
Affiliation(s)
- Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA.
| | - Rebecca Giguere
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Javier Lopez-Rios
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Sarah Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, USA
| | - William Brown
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations At Zuckerberg San Francisco General Hospital and Trauma Center, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
| | - Christine Rael
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Cody Lentz
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Ivan Balán
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Timothy Frasca
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Alex Carballo-Diéguez
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, USA
| |
Collapse
|
14
|
Balán IC, Lopez-Rios J, Dolezal C, Rael CT, Lentz C. Low sexually transmissible infection knowledge, risk perception and concern about infection among men who have sex with men and transgender women at high risk of infection. Sex Health 2020; 16:580-586. [PMID: 31699208 DOI: 10.1071/sh18238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/06/2019] [Indexed: 11/23/2022]
Abstract
Background Amidst an increase in STI rates among men who have sex with men (MSM) and transgender women (TGW), there is little research on STI knowledge, risk perception and concern about infection in these populations. METHODS This mixed-methods study explored these constructs among 60 racially and ethnically diverse MSM and TGW who regularly engage in condomless anal intercourse with multiple partners. RESULTS Participants had a mean age of 40.63 years. Most (95%) identified as a man and as gay or homosexual (73%); 55% were college graduates. Almost half the respondents reported a prior STI. Participants correctly answered a mean of 55.36% and 76.90% STI and HIV knowledge items respectively. STI knowledge was positively correlated with education and prior HIV tests, and was higher among those with a prior STI. During in-depth interviews, some participants expressed concerns about limited knowledge of STIs and syphilis. Half reported low concern about syphilis infection, due to prior treatment that was perceived as relatively simple, lack of STI infection in the past, erroneous information about transmission routes or simply not thinking about it. CONCLUSIONS Among this high-risk sample who perceived themselves to be at low risk of infection, knowledge was primarily gained through being diagnosed and treated for an STI rather than from acquiring knowledge to prevent STI infection. Participants expressed interest in increasing their STI knowledge and recognised the importance of regular STI testing. Dissemination of targeted information about STI prevention, routinising of STI testing and STI self-testing might contribute to decreasing STI infection rates among this population.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA; and Corresponding author.
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| |
Collapse
|
15
|
Rael CT, Giguere R, Lopez-Rios J, Lentz C, Balán IC, Sheinfil A, Dolezal C, Brown W, Frasca T, Torres CC, Crespo R, Iribarren S, Leu CS, Febo I, Carballo-Diéguez A. Transgender Women's Experiences Using a Home HIV-Testing Kit for Partner-Testing. AIDS Behav 2020; 24:2732-2741. [PMID: 32193729 DOI: 10.1007/s10461-020-02829-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/28/2022]
Abstract
HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. We report on in-depth interviews (IDIs) with N = 10 transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial (iSUM; "I'll Show You Mine") that took place in New York City and San Juan, Puerto Rico. Participants were assigned to intervention (supplied with 10 self-test kits immediately) or control groups (received 6 test kits after 3 months). We conducted IDIs with the first N = 10 transgender women to enroll in the intervention group after three months in the study (after participants used kits with partners) to understand their experiences. Themes discussed in IDIs included: partners' reaction to HIV testing, participants' reactions to partners' test results or refusal to test, partners' own reaction to their test results, and decision-making around test use. Data were independently analyzed by two coders. Overwhelmingly, participants' experiences with PT was positive. Participants reported kits were convenient and acceptable to most partners. Transgender women felt that PT could pose additional risk for them; one woman experienced violence related to kit use. Furthermore, the availability of kits appeared to encourage participants and their partners to think about their HIV status and, in some cases, modify sexual behavior. Work suggests that HIV PT could be a viable risk-reduction strategy for transgender women.
Collapse
Affiliation(s)
- Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA.
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - William Brown
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
- Baker Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Raynier Crespo
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Iribarren
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| |
Collapse
|
16
|
Balán IC, Lopez-Rios J, Giguere R, Lentz C, Dolezal C, Cruz Torres C, Brown W, Crespo R, Sheinfil A, Tagliaferri Rael C, Febo I, Carballo-Diéguez A. Then We Looked at His Results: Men Who Have Sex With Men from New York City and Puerto Rico Report Their Sexual Partner's Reactions to Receiving Reactive HIV Self-Test Results. AIDS Behav 2020; 24:2597-2605. [PMID: 32078078 DOI: 10.1007/s10461-020-02816-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Secondary distribution of HIV self-tests to sexual partners is acceptable but concerns remain about reactions if a partner tests HIV-positive. We report on 14 participants whose sexual partners tested HIV-positive during the "I'll Show You Mine" Study, a randomized controlled trial (N = 272) of HIV self- and partner-testing among men who have sex with men (MSM) and transgender women (TGW). All 14 were MSM and racial/ethnic minorities, mean age was 36.6 years; 86% were gay-identified. Twenty-four partners tested positive; about half were new partners. Six participants had multiple partners test positive. During in-depth interviews with 10 of these participants, they reported their partners' reactions ranged from tearful and worried among those whose result was unexpected, to resignation among those who suspected a positive result, to nonchalance among partners who participants concluded knew of their HIV infection. After testing, some HIV-positive partners disclosed prior knowledge of their status. No partner reacted violently. Participants typically comforted their partners and encouraged confirmatory testing. Four participants had anal intercourse with partners who tested positive. Participants and partners were able to effectively handle situations in which the partner tested HIV-positive.
Collapse
|
17
|
Rael CT, Lentz C, Carballo-Diéguez A, Giguere R, Dolezal C, Feller D, D'Aquila RT, Hope TJ. Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study. J Med Internet Res 2020; 22:e16904. [PMID: 32348277 PMCID: PMC7418007 DOI: 10.2196/16904] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/27/2020] [Accepted: 03/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. Objective Our mixed methods study aimed to understand (1) users’ experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. Methods Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users’ experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. Results In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7%), white (125/238, 52.5%), cisgender men (231/238, 97.1%), and 42.0% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). Conclusions PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration.
Collapse
Affiliation(s)
- Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Daniel Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Richard T D'Aquila
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Thomas J Hope
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,McCormick School of Engineering and Applied Sciences, Northwestern University, Chicago, IL, United States
| |
Collapse
|
18
|
Carballo-Diéguez A, Giguere R, Balán IC, Dolezal C, Brown W, Lopez-Rios J, Sheinfil A, Frasca T, Rael C, Lentz C, Crespo R, Cruz Torres C, Leu CS, Febo I. Few Aggressive or Violent Incidents are Associated with the Use of HIV Self-tests to Screen Sexual Partners Among Key Populations. AIDS Behav 2020; 24:2220-2226. [PMID: 32030526 DOI: 10.1007/s10461-020-02809-1] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enroll due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.
Collapse
Affiliation(s)
- Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - William Brown
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, USA
- Center for Vulnerable Populations At Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Christine Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| |
Collapse
|
19
|
Carballo-Diéguez A, Giguere R, Balán IC, Brown W, Dolezal C, Leu CS, Lopez Rios J, Sheinfil AZ, Frasca T, Rael CT, Lentz C, Crespo R, Iribarren S, Cruz Torres C, Febo I. Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study. AIDS Behav 2020; 24:1929-1941. [PMID: 31853772 PMCID: PMC7771229 DOI: 10.1007/s10461-019-02763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance (p = .08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.
Collapse
Affiliation(s)
- Alex Carballo-Diéguez
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Rebecca Giguere
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Iván C Balán
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - William Brown
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York, NY, USA
| | - Javier Lopez Rios
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Timothy Frasca
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Christine Tagliaferri Rael
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Sarah Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| |
Collapse
|
20
|
Giguere R, Lopez-Rios J, Frasca T, Lentz C, Balán IC, Dolezal C, Rael CT, Brown W, Sheinfil AZ, Cruz Torres C, Crespo R, Febo I, Carballo-Diéguez A. Use of HIV Self-Testing Kits to Screen Clients Among Transgender Female Sex Workers in New York and Puerto Rico. AIDS Behav 2020; 24:506-515. [PMID: 31865516 DOI: 10.1007/s10461-019-02730-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transgender female sex workers (TFSW) are highly affected by HIV, with a global prevalence of 27%. HIV self-testing (HIVST) to screen sexual partners has helped men who have sex with men and female sex workers make informed sexual decisions and avoid HIV exposure. This is the first report on TFSW's experiences screening clients using HIVST. Ten TFSW were each given ten HIVST kits and returned after 3 months to complete an online questionnaire and undergo an interview. Eight of them reported using HIVST with potential partners. Among fifty potential partners who were asked in person to test, 42 (84%) were clients. Thirty-four out of fifty (68%) accepted and 16 (32%) refused. Very few violent incidents occurred, and participants felt empowered by offering HIVST to others. Nevertheless, HIVST market cost was prohibitive for future use. HIVST use with clients could be feasible for TFSW if the cost were lowered or subsidized.
Collapse
|
21
|
Balán IC, Lentz C, Giguere R, Mayo AJ, Rael CT, Soto-Torres L, Palanee-Phillips T, Mgodi NM, Hillier S, Baeten JM. Implementation of a fidelity monitoring process to assess delivery of an evidence-based adherence counseling intervention in a multi-site biomedical HIV prevention study. AIDS Care 2020; 32:1082-1091. [PMID: 31899954 DOI: 10.1080/09540121.2019.1709614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) trials often implement counseling to support product adherence. Counseling fidelity can vary significantly across providers and time. Fidelity monitoring can ensure that counseling is delivered as designed. We describe the process, feasibility, and outcomes of monitoring Options counseling fidelity in an open-label study of the dapivirine vaginal ring MTN-025/HOPE. After initial training, 63 counselors from 14 sites in Sub-Sahara Africa audio-recorded counseling sessions with study participants. Sessions were rated by a New York-based team that included bilingual emigres from the study countries. Completed session rating forms were sent to counselors to provide feedback and counseling difficulties were discussed during monthly calls. Of 1456 study participants, 85.7% consented to at least one session, and 20% to all sessions, being audio-recorded. Among 9926 study visits in which Options was expected to occur, 5366 (54.1%) Options sessions were audio-recorded, of which 1238 (23.1%) were reviewed; 1039 (83.9%) were rated as "good" or "fair." Eleven counselors who failed to consistently deliver the intervention were reassigned to back-up status. This study demonstrates the feasibility and benefits of monitoring counseling fidelity using audio-recordings in a multi-site, multi-language, multi-country PrEP trial. Given the investment necessary to conduct such trials, providing counseling oversight is highly warranted.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Division of AIDS, Rockville, MD, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyaradzo M Mgodi
- University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Sharon Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and Magee-Women's Hospital of UPMC, Pittsburgh, PA, USA
| | - Jared M Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | -
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| |
Collapse
|
22
|
Nayak S, Guo T, Lopez-Rios J, Lentz C, Arumugam S, Hughes J, Dolezal C, Linder V, Carballo-Diéguez A, Balán IC, Sia SK. Integrating user behavior with engineering design of point-of-care diagnostic devices: theoretical framework and empirical findings. Lab Chip 2019; 19:2241-2255. [PMID: 31168548 PMCID: PMC6592761 DOI: 10.1039/c9lc00188c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
With point-of-care (POC) diagnostic devices becoming increasingly available to untrained users, it will be critical to understand how real-world user behavior can best inform and guide the engineering design process. Social sciences present frameworks for analyzing user behavior, but they have not yet been applied to POC diagnostics in a methodical manner. Here, we develop a framework that synthesizes two models that can collectively account for user behavior and experience with POC diagnostic devices: a social psychological information-motivation-behavior (IMB) model (first described by Fisher and Fisher) for identifying determinants for health-related behavior, and user experience (UX) elements for studying interactions between users and products. Based on studies of 40 naïve users of our smartphone-enabled microfluidics device that can be used for HIV home-testing, we found that untrained participants could perform 90% of steps correctly, with engineering design elements that provided feedback that was either direct (e.g., a light or click) or binary (e.g., a switch) enhancing usability. Interestingly, of the steps performed incorrectly, over 70% were due not to errors in the device or user operation, but user-to-user variability (e.g. time in collecting fingerstick and force applied to initiate vacuum), which could be addressed by further modifications to the device. Overall, this study suggests that microfluidic POC HIV home-testing is likely to benefit from smartphone integration, and that engineering design of POC diagnostic devices can benefit from a structured evaluation of user behavior and experience, as guided by a social-psychological framework, which emphasizes user credibility, accessibility, acceptability, usability, and value.
Collapse
Affiliation(s)
- Samiksha Nayak
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Tiffany Guo
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Siddarth Arumugam
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Joshua Hughes
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Vincent Linder
- OPKO Diagnostics, LLC, 4 Constitution Way, Suite E, Woburn, MA, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Iván C. Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| |
Collapse
|
23
|
Carballo-Dieguez A, Giguere R, Lentz C, Dolezal C, Fuchs EJ, Hendrix CW. Rectal Douching Practices Associated with Anal Intercourse: Implications for the Development of a Behaviorally Congruent HIV-Prevention Rectal Microbicide Douche. AIDS Behav 2019; 23:1484-1493. [PMID: 30415431 DOI: 10.1007/s10461-018-2336-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tenofovir administration via rectal douching results in higher rectal-mucosa drug concentration than oral administration. Many who engage in receptive anal intercourse (RAI) use cleansing rectal douches. To inform development of a behaviorally-congruent tenofovir douche, 4751 individuals ≥ 18 years-old, born male, from all US states/territories, who engaged in anal intercourse responded to an online survey. Of those who reported RAI in the prior 3 months, 80% douched beforehand, 82% within 1 h, mean 2.9 consecutive applications; 27% douched afterwards, 83% within 1 h, mean 1.7 consecutive applications. Among multidose users, 78% applied doses within 2 min, and 76% retained liquid < 1 min. Most used tap water (89%) in an enema bottle (50%) or rubber bulb (43%), and douched for cleanliness (97%), to avoid smelling bad (65%), and to enhance pleasure (24%). 98% reported high likelihood of using an HIV-prevention douche. An ideal product will protect within a user's typical number of applications, within 1 h, and be dissolvable in tap water.
Collapse
Affiliation(s)
- Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
24
|
Brown W, Sheinfil A, Lopez-Rios J, Giguere R, Dolezal C, Frasca T, Lentz C, Balán IC, Rael C, Cruz Torres C, Crespo R, Febo I, Carballo-Diéguez A. Methods, system errors, and demographic differences in participant errors using daily text message-based short message service computer-assisted self-interview (SMS-CASI) to measure sexual risk behavior in a RCT of HIV self-test use. Mhealth 2019; 5:17. [PMID: 31380409 PMCID: PMC6624350 DOI: 10.21037/mhealth.2019.06.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Assessment of sexual risk behavior is crucial to HIV prevention trials. Currently, there are no biomarkers or objective measures to detect and characterize sexual risk behavior; therefore, we must rely on self-reports. Self-report accuracy may be improved by collecting data in real-time. Our objective was to demonstrate how a text message-based short message service computer-assisted self-interview (SMS-CASI) system can collect daily sexual risk behavior data. METHODS During the course of a 2-arm randomized controlled trial, confidential daily SMS-CASI was used to assess sexual risk behavior over three months for participants using only condoms in the control condition and using condoms and HIV self-tests to test themselves and their non-monogamous sexual partner over six months for participants in the intervention condition (total N=272). Active monitoring of participants responses and data cleaning took place concurrently with trial execution. Descriptive statistics were used to examine frequencies related to system functionality, participant reporting, system errors, communication patterns, and overall feasibility of using the SMS-CASI system for reporting sexual risk behavior. RESULTS The SMS-CASI system processed 272,565 messages. In addition, 87 classifications of metadata were collected, for a total of 22,895,460 different data points. Types of messages included these sent (N=171,749; 63.01%) to participants, received (N=100,646; 36.93%) from participants, and failed (N=168; 0.06%) to be sent. Most errors (N=1,858) were due to system malfunctions (N=535; 28.79%) or participants' mistakes (N=1,289; 69.38%). Participant errors included: wrong password, incomplete surveys, and invalid response. The highest error rates by demographic characteristics were by age among older participants [ages 30-39; 383 errors (29.71%), and 40-69; 545 errors (42.28%)] and by race among Hispanic/Latino participants [487 errors (37.78%)]. CONCLUSIONS The SMS-CASI system was effective at confidentially collecting sexual risk behavior data on a daily basis, potentially contributing to reduced recall and social desirability bias. This study provides methodological examples and data demonstrating how SMS-CASI can be used for sexual health data collection.
Collapse
Affiliation(s)
- William Brown
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Iván C. Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| |
Collapse
|
25
|
Abstract
To inform the development of HIV-prevention rectal douches, we reviewed the scientific literature and online instructional videos on rectal douching associated with receptive anal intercourse (RAI). Up to 88% of men who practice RAI ever have douched, while 43-64% have douched recently. Of them, 87-97% douche before RAI and 13-48% afterwards. Water, occasionally mixed with soap or salt, is used most often, although up to 31% of men use commercial products. Douching is more common among individuals reporting substance use, sexually transmitted infections, or being HIV-infected. Scant literature is available on women's rectal douching practices, but it is apparently less frequent than among men (32 vs. 70%). Videos advise using 2-3 doses of liquid and retaining it for 10-30 s before expelling. These findings can inform the development of a safe and acceptable rectal douche for HIV prevention.
Collapse
Affiliation(s)
- Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
26
|
Devanand D, Lentz C, Chunga RE, Ciarleglio A, Scodes JM, Andrews H, Schofield PW, Stern Y, Huey ED, Bell K, Pelton GH. Change in Odor Identification Impairment is Associated with Improvement with Cholinesterase Inhibitor Treatment in Mild Cognitive Impairment. J Alzheimers Dis 2017; 60:1525-1531. [DOI: 10.3233/jad-170497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D.P. Devanand
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
| | - Cody Lentz
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
| | - Richard E. Chunga
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
| | - Adam Ciarleglio
- Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Jennifer M. Scodes
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Howard Andrews
- Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health of Columbia University, New York, NY, USA
| | | | - Yaakov Stern
- Columbia University Medical Center, New York, NY, USA
| | | | - Karen Bell
- Columbia University Medical Center, New York, NY, USA
| | - Gregory H. Pelton
- Memory Disorders Center and the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
27
|
Kerner NA, Roose SP, Pelton GH, Ciarleglio A, Scodes J, Lentz C, Sneed JR, Devanand DP. Association of Obstructive Sleep Apnea with Episodic Memory and Cerebral Microvascular Pathology: A Preliminary Study. Am J Geriatr Psychiatry 2017; 25:316-325. [PMID: 28040430 PMCID: PMC5316492 DOI: 10.1016/j.jagp.2016.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/30/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of obstructive sleep apnea (OSA) on neurocognitive function and brain morphology in older adults with depression and cognitive impairment. METHODS We prospectively screened OSA with the STOP-Bang questionnaire in the last 25 patients enrolled into the Donepezil Treatment of Cognitive Impairment and Depression (DOTCODE) trial. High and low probability of OSA were defined as a STOP-Bang score of ≥5 (h-OSA) and of <5 (l-OSA), respectively. Baseline magnetic resonance imaging (MRI) was used to evaluate brain morphology. The initial 16 weeks of antidepressant treatment were part of the DOTCODE trial. RESULTS After 16 weeks of antidepressant treatment, the h-OSA group performed significantly worse on the Selective Reminding Test delayed recall task than the l-OSA group, controlling for baseline performance (F = 19.1, df = 1,22, p < 0.001). In 19 of 25 participants who underwent brain MRI, the h-OSA group had significantly greater volumes of MRI hyperintensities in deep white matter, periventricular white matter, and subcortical gray matter compared with the l-OSA group. There was no significant association between OSA and hippocampal or entorhinal cortex volumes in our sample, even after controlling for intracranial volume. CONCLUSIONS OSA is associated with impaired verbal episodic memory and microvascular damage in older adults with depression and cognitive impairment. One possibility is that by contributing to cerebral microvascular damage, OSA may exacerbate progressive memory decline.
Collapse
Affiliation(s)
- Nancy A. Kerner
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Steven P. Roose
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Gregory H. Pelton
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
| | - Adam Ciarleglio
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Jennifer Scodes
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Cody Lentz
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Joel R. Sneed
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Queens College, City University of New York, New York
| | - D. P. Devanand
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
| |
Collapse
|
28
|
|
29
|
Kuntz-Hehner S, Goenechea J, Pohl C, Schlosser T, Veltmann C, Lentz C, Lohmaier S, Ehlgen A, Omran H, Becher H, Tiemann K. Continuous-infusion contrast-enhanced US: in vitro studies of infusion techniques with different contrast agents. Radiology 2001; 220:647-54. [PMID: 11526262 DOI: 10.1148/radiol.2203001628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the infusion properties of three ultrasonographic (US) contrast agents and to compare different infusion techniques for achieving constant signals during harmonic power Doppler US. MATERIALS AND METHODS In vitro studies were performed in a flow phantom. SH U 508A, NC100100, or FS069 was continuously infused at clinically usable doses and infusion rates. To assess agent-specific physical properties, these agents were administered by using a vertically fixed infusion pump and varying infusion start times. The contrast agents were administered by also using a horizontally oriented infusion pump that was either fixed or continuously rotated to homogenize the agent in the syringe. RESULTS With SH U 508A and NC100100, constant signals were achieved, regardless of the infusion modality used. Compared with conventional infusion, the continuous homogenization of SH U 508A, although not necessary for signal constancy, increased the agent's usefulness (P <.05). With FS069, only continuous homogenization yielded constant signals (P <.001). CONCLUSION Continuous infusion of SH U 508A or NC100100 provided constant harmonic power Doppler US signals, regardless of the infusion modality used. Because of the special physical properties of FS069, only homogenization produced constant harmonic power Doppler US signals during continuous infusion of this agent.
Collapse
Affiliation(s)
- S Kuntz-Hehner
- Department of Cardiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Köster J, Schlosser T, Pohl C, Lentz C, Lohmaier S, Veltmann C, Kuntz-Hehner S, Omran H, Lüderitz B, Becher H, Tiemann K. Blood flow assessment by ultrasound-induced destruction of echocontrast agents using harmonic power Doppler imaging: which parameters determine contrast replenishment curves? Echocardiography 2001; 18:1-8. [PMID: 11182774 DOI: 10.1046/j.1540-8175.2001.00001.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of flow determinations by contrast replenishment using harmonic power Doppler imaging (H-PDI). BACKGROUND The application of indicator dilution principles on contrast echocardiography is limited by numerous methodical problems. Recently, a new method was introduced that relies on ultrasound-mediated microbubble destruction and evaluation of the contrast replenishment. METHODS Definity, a perfluorocarbon-derived contrast agent under development, was continuously infused into a steady flow phantom and H-PDI registrations were performed within a silicone tube (d = 8 mm). Replenishment interval between destruction and imaging frame was varied from 0.04-2 seconds. Nonlinear curve fitting was performed using an exponential mathematical model. RESULTS Strong linear correlation between contrast dose and maximum signal intensity as well as between flow and the slope variable beta of the replenishment curve was found for all settings (r > 0.96). Maximum signal intensity and contrast replenishment rate were found to be a function of emission power and were significantly influenced by depth and focus position. CONCLUSION The feasibility of flow assessment using replenishment curves obtained by H-PDI was demonstrated. However, in experimental conditions, flow analysis was severely influenced by ultrasound system settings and imaging conditions such as emission power, sound field geometry, and investigation depth. For a clinical use of this promising approach, algorithms that take specific system settings and imaging conditions into account have to be found. Imaging modalities that enable a most homogeneous scan field are best suited for the assessment of contrast replenishment.
Collapse
Affiliation(s)
- J Köster
- Department of Cardiology, University of Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Lentz C, Sturm HJ. Of trees and earth shrines: an interdisciplinary approach to settlement histories in the West African savanna. Hist Afr 2001; 28:139-68. [PMID: 17657912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
|
32
|
Kilgore K, Snyder J, Lentz C. The contribution of parental discipline, parental monitoring, and school risk to early-onset conduct problems in African American boys and girls. Dev Psychol 2000; 36:835-45. [PMID: 11081706 DOI: 10.1037/0012-1649.36.6.835] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [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: 11/08/2022]
Abstract
The association of parental discipline and monitoring with the early conduct problems of 123 boys and girls was assessed in a highly disadvantaged, African American sample. Prospective analyses indicated that, after earlier conduct problems were controlled for, coercive parent discipline and poor parental monitoring at age 4 1/2 were independent, reliable predictors of age 6 conduct problems for both boys and girls. The association of parental monitoring with later child conduct problems was mediated, in part, by parents' choice of higher risk schools for their children's kindergarten education. The association of family income with child conduct problems was mediated by parental discipline and monitoring. These models are consistent with previous research on older, European American, more advantaged, male samples, which supports the generality of the association of family processes with child conduct problems across child gender, age, and ethnicity.
Collapse
Affiliation(s)
- K Kilgore
- Department of Psychology, Wichita State University, Kansas 67260-0034, USA
| | | | | |
Collapse
|
33
|
Abstract
The Veterans Health Administration clinical guideline for major depressive disorder was used in screening 574 male veterans treated in primary care settings in the Department of Veterans Affairs health care system. Thirteen percent (N=73) screened positive for depression, and 33 percent of those patients showed evidence of a major depressive episode. Pre- and posttreatment assessment of a sample of 16 patients treated for depression in a primary care setting revealed statistically significant improvement with treatment.
Collapse
Affiliation(s)
- M A Foster
- Clinical Psychology, Bedford-Somerset Mental Health and Mental Retardation Program, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
34
|
Hunt J, Baker C, Lentz C. Thoracic Aorta Injuries. J Trauma Nurs 1996. [DOI: 10.1097/00043860-199604000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Rudner EJ, Lentz C, Brown J. Bronchial carcinoid tumor with skin metastases. Arch Dermatol 1965; 92:73-5. [PMID: 11850960] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The occurrence of multiple dermal and subcutaneous nodules and tumors as a significant sign in a case of a metastatic bronchial carcinoid is reported. The clinical manifestations of bronchial carcinoid often differ from those associated with the more common malignant carcinoids of the intestinal tract. It is possible that these differences might be due to an enzymatic defect in the bronchial carcinoid tumors.
Collapse
Affiliation(s)
- E J Rudner
- Departments of Dermatology and Medicine, Wayne State University College of Medicine, Detroit Receiving Hospital, USA
| | | | | |
Collapse
|