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Mujwara D, Kelvin EA, Dahman B, George G, Nixon D, Adera T, Mwai E, Kimmel AD. The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya. Health Policy Plan 2024; 39:355-362. [PMID: 38441272 PMCID: PMC11005835 DOI: 10.1093/heapol/czae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.
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Affiliation(s)
- Deo Mujwara
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
- Analysis Group, Inc, 111 Huntington Ave 4th floor, Boston, MA 02199, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics & CUNY Institute for Implementation Science in Population Health, City University of New York, 205 East 42nd Street, New York, NY 10017, USA
| | - Bassam Dahman
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
| | - Daniel Nixon
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23219, USA
| | - Tilahun Adera
- Department of Family Medicine and Population Health, Division of Epidemiology, 1200 E. Broad Street, Richmond, VA 23298, USA
| | - Eva Mwai
- North Star Alliance, 8 Silanga Road, Nairobi, Kenya
| | - April D Kimmel
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23219, USA
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Aziz N, Shih R, Alexopoulos N, Jamieson BD, Mimiaga MJ, Martinez-Maza O, Detels R. Relationship among serum levels of IL-6, sIL-6R, s gp130 and CD126 on T-cell in HIV-1 infected and uninfected men participating in the Los Angeles Multi-Center AIDS Cohort Study. PLoS One 2023; 18:e0290702. [PMID: 37812611 PMCID: PMC10561848 DOI: 10.1371/journal.pone.0290702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Interleukin 6 (IL-6) activates cells through its unique heterodimeric signaling complex of IL-6 receptor (IL6R) subunit and interleukin 6 signal transducer β-subunit glycoprotein 130 (gp130). The objective of this study was to investigate associations among serum levels of IL-6, sIL-6R, sgp130 and relative fluorescence intensity (RFI) of the α-subunit of the IL-6 receptor (CD126) on T-cells of HIV-1 infected and uninfected men. METHODS Blood samples were obtained from 69 HIV-1-infected men on Highly Active Antiretroviral Therapy (HAART) with mean age of 49.1 and 52 HIV-1-uninfected with mean age of 54.3 years -. All men were participating in the Los Angeles Multi-Center AIDS Cohort Study (MACS). Serum levels of IL-6, sIL-6R, sgp130 were measured by enzyme-linked immunoassays and T-cell phenotypic analysis and RFI of CD126 on CD4+ and CD8+ by flow cytometry. RESULTS Mean serum levels of IL-6, sIL6R, sgp130 and of CD126 RFI on CD4+ were 4.34 pg/mL, 39.3 ng/mL, 349 ng/mL and 526 RFI respectively for HIV-1-infected men and 2.74 pg/mL, 41.9 ng/mL, 318 ng/mL and 561 RFI respectively for HIV-1-uninfected men. The mean serum concentrations of IL-6, sIL-6R in HIV-1-infected and uninfected men were not significantly different (p>0.05). There was a positive correlation between plasma HIV-1 RNA and the levels of IL-6 (p<0.001), sIL6R (p = 0.002) but no correlation with sgp130 (p = 0.339). In addition, there was a negative correlation between serum levels of IL-6 with RFI of CD126 on CD4+ (p = 0.037) and a positive correlation between serum levels of sgp130 (p = 0.021) and sIL-6R in HIV-1-infected men. CONCLUSION Knowledge of biological variation, differences in the blood levels of biomarkers among healthy individuals and individuals experiencing illness, are very important for selection of appropriate tests for stage and progression of disease. Our data suggest no correlation among IL-6, and sIL-R6, in the treated phase of HIV-1 infection. The action and blood level of IL-6 and its receptors may be different at each stage of a disease progression.
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Affiliation(s)
- Najib Aziz
- Department of Epidemiology, Fielding School of Public Health, University California Los Angeles, Los Angeles, California, United States of America
| | - Roger Shih
- Department of Epidemiology, Fielding School of Public Health, University California Los Angeles, Los Angeles, California, United States of America
| | - Nicole Alexopoulos
- Department of Epidemiology, Fielding School of Public Health, University California Los Angeles, Los Angeles, California, United States of America
| | - Beth D. Jamieson
- Department of Medicine, David Geffen School of Medicine, University California Los Angeles, Los Angeles, California, United States of America
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University California Los Angeles, Los Angeles, California, United States of America
| | - Otoniel Martinez-Maza
- Departments of Obstetrics & Gynecology and Microbiology Immunology and Molecular Genetics, UCLA, David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University California Los Angeles, Los Angeles, California, United States of America
- Department of Medicine, David Geffen School of Medicine, University California Los Angeles, Los Angeles, California, United States of America
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Hetelekides E, Joseph VW, Pearson MR, Bravo AJ, Prince MA, Conner BT. Early Birds and Night Owls: Distinguishing Profiles of Cannabis Use Habits by Use Times with Latent Class Analysis. Cannabis 2023; 6:79-98. [PMID: 37287731 PMCID: PMC10212251 DOI: 10.26828/cannabis/2023.01.007] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Understanding, predicting, and reducing the harms associated with cannabis use is an important field of study. Timing (i.e., hour of day and day of week) of substance use is an established risk factor of severity of dependence. However, there has been little attention paid to morning use of cannabis and its associations with negative consequences. Objectives The goal of the present study was to examine whether distinct classifications of cannabis use habits exist based on timing, and whether these classifications differ on cannabis use indicators, motives for using cannabis, use of protective behavioral strategies, and cannabis-related negative outcomes. Methods Latent class analyses were conducted on four independent samples of college student cannabis users (Project MOST 1, N=2,056; Project MOST 2, N=1846; Project PSST, N=1,971; Project CABS, N=1,122). Results Results determined that a 5-class solution best fit the data within each independent sample consisting of the classes: (1) "Daily-morning use",(2) "Daily-non-morning use", (3) "Weekend-morning use", (4) "Weekend-night use", and (5) "Weekend-evening use." Classes endorsing daily and/or morning use reported greater use, negative consequences and motives, while those endorsing weekend and/or non-morning use reported the most adaptive outcomes (i.e., reduced frequency/quantity of use, fewer consequences experienced, and fewer cannabis use disorder symptoms endorsed). Conclusions Recreational daily use as well as morning use may be associated with greater negative consequences, and there is evidence that most college students who use cannabis do avoid these types of use. The results of the present study offer evidence that timing of cannabis use may be a pertinent factor in determining harms associated with use.
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Affiliation(s)
| | - Verlin W. Joseph
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | - Matthew R. Pearson
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | - Adrian J. Bravo
- Department of Psychological Sciences, College of William & Mary
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Pascoe S, Fox M, Kane J, Mngadi S, Manganye P, Long LC, Metz K, Allen T, Sardana S, Greener R, Zheng A, Thea DM, Murray LK. Study protocol: A randomised trial of the effectiveness of the Common Elements Treatment Approach (CETA) for improving HIV treatment outcomes among women experiencing intimate partner violence in South Africa. BMJ Open 2022; 12:e065848. [PMID: 36549749 PMCID: PMC9772682 DOI: 10.1136/bmjopen-2022-065848] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is a barrier to consistent HIV treatment in South Africa. Previous trials have established that the Common Elements Treatment Approach (CETA), a cognitive-behavioural-based intervention, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. This paper describes the protocol for a randomised trial that is testing the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa. METHODS AND ANALYSIS We are conducting a randomised trial among HIV-infected women on antiretroviral therapy, who have experienced sexual and/or physical IPV, to test the effect of CETA on increasing retention and viral suppression and reducing IPV. Women living with HIV who have an unsuppressed viral load or are at high risk for poor adherence and report experiencing recent IPV, defined as at least once within in the last 12 months, will be recruited from HIV clinics and randomised 1:1 to receive CETA or an active attention control (text message reminders). All participants will be followed for 24 months. Follow-up HIV data will be collected passively using routinely collected medical records. HIV outcomes will be assessed at 12 and 24 months post-baseline. Questionnaires on violence, substance use and mental health will be administered at baseline, post-CETA completion and at 12 months post-baseline. Our primary outcome is retention and viral suppression (<50 copies/mL) by 12 months post-baseline. We will include 400 women which will give us 80% power to detect an absolute 21% difference between arms. Our primary analysis will be an intention-to-treat comparison of intervention and control by risk differences with 95% CIs. ETHICS AND DISSEMINATION Ethics approval provided by University of the Witwatersrand Human Research Ethics Committee (Medical), Boston University Institutional Review Board and Johns Hopkins School Institutional Review Board. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04242992.
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Affiliation(s)
- Sophie Pascoe
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sithabile Mngadi
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Pertunia Manganye
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence C Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | - Kristina Metz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Taylor Allen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Srishti Sardana
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ross Greener
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Zheng
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Price J, Ma Y, Adimora A, Fischl M, French AL, Golub ET, Konkle-Parker D, Kuniholm MH, Ofotokun I, Plankey M, Sharma A, Tien PC. Multisite prospective Liver Disease and Reproductive Ageing (LIVRA) study in US women living with and without HIV. BMJ Open 2022; 12:e055706. [PMID: 35393310 PMCID: PMC8991036 DOI: 10.1136/bmjopen-2021-055706] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The Liver Disease and Reproductive Ageing (LIVRA) study leverages the infrastructure of the decades-long multicentre prospective Women's Interagency HIV Study (WIHS) to examine the contributions of HIV, hepatitis C virus (HCV) and ageing to liver disease progression in women. PARTICIPANTS From 2013 to 2018, LIVRA enrolled 1576 participants (77 HCV-seropositive only, 248 HIV/HCV-seropositive, 868 HIV-seropositive only and 383 HIV/HCV-seronegative) who underwent vibration controlled transient elastography (VCTE). A VCTE quality assurance programme was established to ensure consistency and accuracy for longitudinal assessment of steatosis (fatty liver) via the controlled attenuation parameter (CAP) and fibrosis via liver stiffness (LS). Demographic, lifestyle factors, anthropometry, clinical and medication history, host genetics, immune markers and hormone levels were collected as part of the WIHS. FINDINGS TO DATE At baseline, 737 of 1543 women with CAP measurements had steatosis (CAP ≥248 dB/m) and 375 of 1576 women with LS measurements had significant fibrosis (LS ≥7.1 kPa), yielding a prevalence of 48% and 24%, respectively. On multivariable analysis, waist circumference (WC) and insulin resistance were independently associated with higher CAP (17.8 dB/m per 10 cm (95% CI:16.2 to 19.5) and 1.2 dB/m per doubling (95% CI:0.8 to 1.6), respectively). By contrast, HIV/HCV seropositivity and HCV seropositivity alone were associated with less steatosis compared with HIV/HCV-seronegative women, although the latter did not reach statistical significance (-9.2 dB/m (95% CI:-18.2 to -0.3) and -10.4 dB/m (95% CI: -23.8 to 3.1), respectively). Factors independently associated with higher LS were age (4.4% per 10 years (95% CI: 0.4% to 8.4%)), WC (5.0% per 10 cm (95% CI: 3.3% to 6.6%)), CAP steatosis (0.6% per 10 dB/m (95% CI: 0.1% to 1.0%)), HIV/HCV seropositivity (33% (95% CI: 24% to 44%)) and HCV seropositivity alone (43% (95% CI: 28% to 60%)). Excluding scans that were invalid based on traditional criteria for unreliability did not affect the results. FUTURE PLANS Enrolled women undergo VCTE at 3-year intervals unless LS is ≥9.5 kPa, indicating advanced fibrosis, in which case VCTE is performed annually. Participants also undergo VCTE every 6 months until 18 months after HCV treatment initiation. Analysis of the data collected will provide insights into the impact of ageing/ovarian function, host genetics, immune function and contemporary HIV and HCV treatments on liver disease progression.
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Affiliation(s)
- Jennifer Price
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Yifei Ma
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Adaora Adimora
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University of Albany, State University of New York, Rensselaer, New York, USA
| | | | - Michael Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Phyllis C Tien
- Department of Veterans Affairs, University of California San Francisco, San Francisco, California, USA
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Haas AD, Kunzekwenyika C, Hossmann S, Manzero J, van Dijk J, Manhibi R, Verhey R, Limacher A, von Groote PM, Manda E, Hobbins MA, Chibanda D, Egger M. Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study. BMJ Open 2021; 11:e049824. [PMID: 34233999 PMCID: PMC8264908 DOI: 10.1136/bmjopen-2021-049824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). SETTING Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. DESIGN Cross-sectional study. PARTICIPANTS HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months. OUTCOME MEASURES The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence. RESULTS Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50-59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70). CONCLUSIONS A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe. TRIAL REGISTRATION NUMBER NCT03704805.
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Affiliation(s)
- Andreas D Haas
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Stefanie Hossmann
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | | | | | | | - Per M von Groote
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | - Dixon Chibanda
- Friendship Bench Zimbabwe, Harare, Zimbabwe
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthias Egger
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Brem MJ, Shorey RC, Anderson S, Stuart GL. Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behaviour among women in substance use treatment? Clin Psychol Psychother 2018; 25:692-700. [PMID: 29873145 PMCID: PMC6177301 DOI: 10.1002/cpp.2300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/21/2018] [Accepted: 05/02/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Untreated compulsive sexual behaviour (CSB) poses a risk to efficacious substance use disorder (SUD) treatment. Yet the ways in which CSB manifests in women with SUDs remains poorly understood. Shame and trauma exposure are well-documented correlates for women's CSB. Prior theory suggested women with shame and trauma-related symptoms may engage in CSB in an effort to escape aversive internal experiences. Thus, the present study examined experiential avoidance as a mediator of the relationship between defectiveness/shame beliefs, post-traumatic stress disorder symptoms, and CSB in a sample of women with SUDs. METHOD Cross-sectional, self-report data were collected from 446 women (M age = 37.40) in residential treatment for SUDs. RESULTS Experiential avoidance partially mediated the relationship between both post-traumatic stress disorder symptoms and defectiveness/shame beliefs and CSB. CONCLUSIONS These results extend theoretical conceptualizations of women's CSB to a treatment population. CSB intervention efforts may benefit from targeting women's avoidance of painful experiences.
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Affiliation(s)
- Meagan J Brem
- Psychology, University of Tennessee - Knoxville, Knoxville, TN, USA
| | | | - Scott Anderson
- Clinical Director, Cornerstone of Recovery, Louisville, TN, USA
| | - Gregory L Stuart
- Psychology, University of Tennessee - Knoxville, Knoxville, TN, USA
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