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Trepka MJ, Gong Z, Ward MK, Fennie KP, Sheehan DM, Jean-Gilles M, Devieux J, Ibañez GE, Gwanzura T, Nawfal ES, Gray A, Beach MC, Ladner R, Yoo C. Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression. AIDS Behav 2024:10.1007/s10461-024-04310-5. [PMID: 38573473 DOI: 10.1007/s10461-024-04310-5] [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: 03/04/2024] [Indexed: 04/05/2024]
Abstract
We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA.
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA.
| | - Zhenghua Gong
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Jessie Devieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, FL, USA
| | - Changwon Yoo
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Gray A, Ward MK, Fernandez SB, Nawfal ES, Gwanzura T, Li T, Sheehan DM, Jean-Gilles M, Beach MC, Ladner RA, Trepka MJ. Exploring the use of self-management strategies for antiretroviral therapy adherence among women with HIV in the Miami-Dade County Ryan White Program. J Behav Med 2024; 47:282-294. [PMID: 37946027 PMCID: PMC10947905 DOI: 10.1007/s10865-023-00459-x] [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: 04/25/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Women with HIV (WWH) face increased difficulties maintaining adherence to antiretroviral therapy (ART) due to a variety of demographic and psychosocial factors. To navigate the complexities of ART regimens, use of strategies to maintain adherence is recommended. Research in this area, however, has largely focused on adherence interventions, and few studies have examined self-reported preferences for adherence strategies. The purpose and objectives of this study were to explore the use of ART self-management strategies among a diverse sample of WWH, examine demographic and psychosocial differences in strategy use, and assess the association between strategies and ART adherence. The current study presents secondary data of 560 WWH enrolled in the Miami-Dade County Ryan White Program. Participants responded to questionnaire items assessing demographic and psychosocial characteristics, use of adherence strategies, and ART adherence during the past month. Principal component analysis identified four categories among the individual strategies and multivariable binomial logistic regression assessed adherence while controlling for individual-level factors. The majority of WWH reported optimal ART adherence, and nearly all used multiple individual strategies. The number of individual strategies used and preferences for strategy types were associated with various demographic and psychosocial characteristics. Adjusting for demographic and psychosocial characteristics, optimal ART adherence during the past month was associated with the use of four or more individual strategies. When conducting regular assessments of adherence, it may be beneficial to also assess use of adherence strategies and to discuss with WWH how using multiple strategies contributes to better adherence.
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Affiliation(s)
- Aaliyah Gray
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
| | - Melissa K Ward
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Sofia B Fernandez
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- School of Social Work, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Biostatistics, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Room 2-511, Baltimore, MD, 21287, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Boulevard, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
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Ramírez-Ortiz D, Jean-Gilles M, Sheehan DM, Ladner R, Li T, Trepka MJ. Factors Associated With COVID-19 Vaccination Among Racial/Ethnic Minority Groups With HIV in South Florida. J Acquir Immune Defic Syndr 2024; 95:329-341. [PMID: 38133577 PMCID: PMC10922309 DOI: 10.1097/qai.0000000000003369] [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: 08/24/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Racial/ethnic minority groups with HIV in the United States are particularly vulnerable to COVID-19 consequences and can significantly benefit from increased uptake of COVID-19 vaccines. This study identified factors associated with full COVID-19 vaccination among people with HIV. SETTING Ryan White HIV/AIDS Program in Miami-Dade County, FL. METHODS Data were collected from 299 Ryan White HIV/AIDS Program adult clients during January-March 2022 using a cross-sectional phone survey. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were weighted to be representative of the race/ethnicity and sex distribution of clients in the Ryan White HIV/AIDS Program. RESULTS Eighty-four percent of participants were fully vaccinated with a primary vaccine series; stratified by race/ethnicity, the percentages were 88.9% of Hispanic, 72.0% of black/African American, and 67.5% of Haitian participants. Fully vaccinated participants were less likely to be black/African American than Hispanic (aOR = 0.18; 95% CI: 0.05 to 0.67) and more likely to not endorse any misconceptions about COVID-19 vaccines (aOR = 8.26; 95% CI: 1.38 to 49.64), to report encouragement to get vaccinated from sources of information (aOR = 20.82; 95% CI: 5.84 to 74.14), and to perceive that more than 50% of their social network was vaccinated (aOR = 3.35; 95% CI: 1.04 to 10.71). Experiences of health care discrimination, structural barriers to access vaccines, and recommendations from HIV providers were not associated with full vaccination. CONCLUSIONS These findings highlight the importance of delivering accurate and positive messages about vaccines and engaging social networks to promote COVID-19 vaccination among people with HIV. This information can be leveraged to promote uptake of subsequent boosters and other recommended vaccines.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, Florida, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Ward MK, Fernandez SB, Sheehan DM, Li T, Dawit R, Fennie K, Beach MC, Brock P, Ladner R, Trepka MJ. Sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression in the Miami-Dade County Ryan White Program, 2017. AIDS Care 2023; 35:1437-1442. [PMID: 35621306 PMCID: PMC9701240 DOI: 10.1080/09540121.2022.2080800] [Citation(s) in RCA: 2] [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: 02/22/2021] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
This exploratory study examined sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression (SVS). The study population included 6,489 Miami-Dade Ryan White Program (RWP) clients receiving services during 2017; administrative data was analyzed. SVS was defined as having all viral load tests during 2017 below 200 copies/ml. Multilevel logistic regression models accounted for clustering by medical case management site. Models were stratified by sex. Overall, a higher proportion of females did not achieve SVS (23.5%) than males (18.1%). For females (n = 1,503), having acquired HIV perinatally and not having a partner oradult household member were associated with not achieving SVS. For males (n = 4,986), lacking access to food, Black or Haitian race/ethnicity, problematic substance use, and unknown physician were associated with not achieving SVS. For both sexes, younger age, lower household income, ever having an AIDS diagnosis, feeling depressed or anxious, and experiencing homelessness were associated with not achieving SVS. Elements of the transition from adolescent to adult HIV care that may differentially impact female clients and factors associated with disclosure should be explored further. Male clients may require additional support for food security. Improving culturally specific care for Haitian and non-Hispanic Black male clients should also be explored.
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Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, Florida, USA
| | | | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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Ramírez-Ortiz D, Ward MK, Sheehan DM, Fernandez SB, Jean-Gilles M, Ladner R, Trepka MJ. Increased alcohol use during the COVID-19 pandemic among people with HIV from racial/ethnic minority groups in South Florida. J Ethn Subst Abuse 2023:1-12. [PMID: 37729468 PMCID: PMC10950834 DOI: 10.1080/15332640.2023.2259340] [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] [Indexed: 09/22/2023]
Abstract
People with HIV (PWH) from racial/ethnic minority groups may be particularly vulnerable to the effects of the COVID-19 Pandemic. Exacerbated COVID-19-related stressors may lead to maladaptive coping mechanisms such as increased alcohol use. This study examined socioeconomic and psychosocial predictors of increased alcohol use during the first year of the COVID-19 Pandemic among PWH from racial/ethnic minority groups in South Florida. Data were collected from Ryan White Program clients during October 2020-January 2021 using a cross-sectional phone survey, and were analyzed using logistic regression modeling. Among 139 participants, 20% reported increased alcohol use. Findings showed that being unable to buy needed food (adjusted odds ratio [aOR]: 3.37; 95% confidence interval [CI]: 1.01-11.31) and spending more time caring for children (aOR: 5.22, 95% CI: 1.61-16.88) was associated with increased alcohol use during the Pandemic. Providing support to alleviate food insecurity and manage caregiving burden during public health crises like the COVID-19 Pandemic might help prevent increases in alcohol use among PWH.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Florida International University, Department of Epidemiology, Miami, Florida, USA
- Florida International University, Research Center for Minority Institutions, Miami, Florida, USA
| | - Melissa K. Ward
- Florida International University, Department of Epidemiology, Miami, Florida, USA
- Florida International University, Research Center for Minority Institutions, Miami, Florida, USA
| | - Diana M. Sheehan
- Florida International University, Department of Epidemiology, Miami, Florida, USA
- Florida International University, Research Center for Minority Institutions, Miami, Florida, USA
| | - Sofia B. Fernandez
- Florida International University, Research Center for Minority Institutions, Miami, Florida, USA
- Florida International University, School of Social Work, Miami, Florida, USA
| | - Michele Jean-Gilles
- Florida International University, Department of Health Promotion and Disease Prevention, Miami, Florida, USA
| | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, Florida, USA
| | - Mary Jo Trepka
- Florida International University, Department of Epidemiology, Miami, Florida, USA
- Florida International University, Research Center for Minority Institutions, Miami, Florida, USA
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Forney DJ, Sheehan DM, Dale SK, Li T, De La Rosa M, Spencer EC, Sanchez M. The Impact of HIV-Related Stigma on Racial/Ethnic Disparities in Retention in HIV Care Among Adults Living with HIV in Florida. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01715-1. [PMID: 37495905 PMCID: PMC10811278 DOI: 10.1007/s40615-023-01715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Our study examines the effects of distinct HIV stigma subtypes on retention in care and racial-ethnic differences among persons with HIV (PWH). METHODS Using Florida Medical Monitoring Project 2015-2017 data, we analyzed patients' clinical and behavioral characteristics. We analyzed 89,889 PWH in Florida (50.0% non-Hispanic Blacks, 20.8% Hispanics, 29.2% non-Hispanic whites). HIV stigma subtypes, negative self-image, anticipated stigma, personalized stigma, and retention in care were examined with logistic regressions. RESULTS People with high negative self-image and anticipated stigma were less likely to be retained (CI: 0.84-0.92; 0.47-0.53). The association between HIV-related stigma subtypes and retention in care differed between Black, White, and Hispanic participants. Negative self-image was associated with higher retention rates among Hispanics (CI: 5.64-9.26) and Whites (CI: 1.04-1.27), while low retention rates among Blacks (0.617-0.686). The likelihood of staying in care was lower across all racial-ethnic groups when the anticipated stigma was high or moderate. In contrast, personalized stigma increased retention across all racial-ethnic groups. CONCLUSION Results showed that distinct types of HIV stigma differentially impact retention, and these associations differ by race and ethnicity. Future interventions should address the effect HIV stigma subtypes have on racially minoritized PWH retention.
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Affiliation(s)
- Derrick J Forney
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA.
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA.
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA.
| | - Diana M Sheehan
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Miami, USA
| | - Sannisha K Dale
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA
- Department of Psychology, University of Miami, Coral Gables, Miami, USA
| | - Tan Li
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
| | | | - Mariana Sanchez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
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Trepka MJ, Ward MK, Fennie K, Sheehan DM, Fernandez SB, Li T, Jean-Gilles M, Dévieux JG, Ibañez GE, Gwanzura T, Nawfal E, Gray A, Beach MC, Ladner R. Patient-Provider Relationships and Antiretroviral Therapy Adherence and Durable Viral Suppression Among Women with HIV, Miami-Dade County, Florida, 2021-2022. AIDS Patient Care STDS 2023; 37:361-372. [PMID: 37432309 PMCID: PMC10354312 DOI: 10.1089/apc.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Women with HIV in the United States are more negatively affected by adverse social determinants such as low education and poverty than men, and thus, especially need a supportive health care system. This cross-sectional study assessed the role of the patient-provider relationship on antiretroviral therapy (ART) adherence and durable viral suppression among women with HIV (WHIV) in Miami-Dade County, Florida. Patient-provider relationship was measured, in part, using the Health Care Relationship Trust Scale and Consumer Assessment of Health Care Providers and Systems. The survey was administered by telephone to women in the Ryan White Program June 2021-March 2022. Adherence was defined as 90% adherent on the average of three self-reported items. Lack of durable viral suppression was defined by at least one viral load ≥200 copies/mL among all tests conducted in a year. Logistic regression models were generated using backward stepwise modeling. Of 560 cis-gender women, 401 (71.6%) were adherent, and 450 (80.4%) had durable viral suppression. In the regression model, adherence was associated with higher patient-provider trust and provider communication as well as excellent perceived health, lack of significant depressive symptoms, no alcohol use within the last 30 days, and lack of transportation problems. In the regression model using provider as a random effect, durable viral suppression was associated with older age, Hispanic ethnicity, and lack of illegal drug use. While the results show that a strong patient-provider relationship facilitates ART adherence in WHIV, there was no association with durable viral suppression.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia Beatriz Fernandez
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Jessy G. Dévieux
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Ekpereka Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert Ladner
- Behavioral Science Research Corp., Coral Gables, Florida, USA
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Ward MK, Aleite S, Sheehan DM, Li T, Gbadamosi SO, Jean-Gilles M, Ladner RA, Trepka MJ. Self-reported Nonadherence to Antiretroviral Therapy Among Miami-Dade Ryan White Program Clients During the COVID-19 Pandemic: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:198-206. [PMID: 36607312 PMCID: PMC10062022 DOI: 10.1097/jnc.0000000000000382] [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: 06/28/2022] [Indexed: 01/07/2023]
Abstract
This study examined factors associated with self-reported ART nonadherence during the COVID-19 pandemic among Miami-Dade County Ryan White HIV/AIDS Program (RWHAP) clients. A cross-sectional survey was conducted from October 2020-January 2021 in English, Spanish, and Haitian Creole. The survey included questions on self-reported ART adherence, HIV care access (compared to before the pandemic), social and economic pandemic impacts, and demographics. We carried out descriptive bivariate analyses and weighted logistic regression to estimate unadjusted and adjusted odds ratios (aORs) for self-reported nonadherence. 12.7% of participants reported ART nonadherence. Adjusting for age, sex, race/ethnicity, and nativity, factors associated with nonadherence included greater difficulty accessing an HIV doctor compared with before the COVID-19 pandemic (aOR=3.6, 95% CI: 1.4–9.2) and experiencing financial impacts due to the pandemic (aOR=4.2, 95% CI: 1.5–12.2). Ensuring RWHAP clients maintain access to HIV medical care providers and receive support for financial shocks are critical to sustaining ART adherence.
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Affiliation(s)
- Melissa K Ward
- Melissa K. Ward, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA. Stephanie Aleite, BA, is an MSW Student, School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Diana M. Sheehan, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Research Center in Minority Institutions, and Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA. Tan Li, PhD, is an Associate Professor, Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Semiu O. Gbadamosi, PhD, MBBS, MPH, was a PhD Candidate, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Michèle Jean-Gilles, PhD, is a Research Associate Professor, Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Robert A. Ladner, PhD, is President, Behavioral Science Research Corporation, Miami, Florida, USA. Mary Jo Trepka, MD, MSPH, is a Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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Kiplagat S, Ravi K, Sheehan DM, Srinivas V, Khan A, Trepka MJ, Bursac Z, Stephens D, Krupp K, Madhivanan P. Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis. J Biosoc Sci 2023; 55:260-274. [PMID: 35129110 PMCID: PMC9357236 DOI: 10.1017/s0021932022000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.
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Affiliation(s)
- Sandra Kiplagat
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL
| | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), FIU, Miami, FL
- Research Center for Minority Institutions (RCMI), FIU, Miami, FL
| | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL
- Research Center for Minority Institutions (RCMI), FIU, Miami, FL
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Dionne Stephens
- Department of Psychology, College of Arts and Science Education, FIU, Miami, FL
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India
- Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
- Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, AZ
- Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, AZ
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11
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Dawit R, Trepka MJ, Duncan DT, Gbadamosi SO, Li T, Pires SF, Ladner RA, Sheehan DM. Factors Associated with Geographic Patterns of Poor Sustained Viral Suppression in Miami-Dade County Florida, 2017. J Racial Ethn Health Disparities 2023; 10:357-366. [PMID: 35099764 PMCID: PMC9339030 DOI: 10.1007/s40615-021-01227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Identifying geographic locations most affected by the HIV epidemic is essential to addressing disparities that impact people living with HIV. This study sought to identify individual and neighborhood-level factors that are associated with residing in geographic hotspots of poor sustained HIV viral suppression. METHODS Using data from the Miami-Dade County Ryan White HIV/AIDS program, spatial autocorrelation of poor sustained viral suppression (at least 1 laboratory test ≥ 200 copies/ml in 2017) was investigated using Global Moran's I followed by Local Moran's I and Getis Ord Gi* statistics by ZIP code tabulation areas (ZCTAs). Subsequently, multivariable logistic regression analysis was conducted to identify factors associated with residing in geographic hotspots of poor sustained viral suppression. RESULTS Several ZCTAs in the northern part of the county, accounting for 1/3 of the Ryan White program clients, had significantly higher clustering of poor sustained viral suppression. Client-level sociodemographic characteristics such as race/ethnicity, age, and poverty, and neighborhood-level characteristics (socioeconomic disadvantage index, residential instability index, and racial/language homogeneity index) were significantly associated with living in a hotspot of poor sustained viral suppression. CONCLUSION These findings highlight that spatial variation in sustained viral suppression exists within the county. Targeted strategies that address structural factors and the needs of people with HIV living in specified geographic areas may improve their HIV health outcomes and contribute towards local, regional, and national goals of ending the HIV epidemic.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Stephen F Pires
- Department of Criminology & Criminal Justice, Steven J. Green School of International & Public Affairs, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd #240, Coral Gables, FL, 33134, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA.
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
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Gbadamosi SO, Trepka MJ, Dawit R, Bursac Z, Raymond A, Ladner RA, Sheehan DM. Person-time spent with HIV viral load above 1500 copies/mL among Miami-Dade County Ryan White Program clients, 2017-2019: a retrospective analysis. Ann Epidemiol 2023; 78:19-27. [PMID: 36563765 PMCID: PMC9885974 DOI: 10.1016/j.annepidem.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/07/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
HIV transmission risk significantly increases at HIV viral load (VL) >1500 copies/mL. We sought to determine the percentage of person-time spent with VL >1500 copies/mL (pPT >1500) and the associations of demographic, clinical, and psychosocial factors and this outcome among persons with HIV receiving care. A retrospective analysis of data from clients enrolled in the Ryan White Program from 2017 to 2019 was performed. We assessed pPT >1500 in HIV care by utilizing consecutive VL pairs and calculating the length of time between each pair and the corresponding time spent for the observation period. The association between pPT >1500 and selected client characteristics were analyzed using a random-effects zero-inflated negative binomial model. Among the 6390 clients, 42% were aged 50 or older, 52% MSM, and 59% Hispanic. Overall, 7.5% of clients spent, on average, 27.4 days per year at substantial risk of transmitting HIV. Younger age, AIDS diagnosis, and reported drug use in the preceding 12 months were associated with higher pPT >1500. Tailored interventions should be implemented to meet the unique HIV needs of groups with consistent viremia to significantly minimize transmission risk.
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Affiliation(s)
- Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Andrea Raymond
- Department of Immunology and Nanomedicine, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Rober A. Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL 33134, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
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13
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Fernandez SB, Sheehan DM, Dawit R, Brock-Getz P, Ladner RA, Trepka MJ. Relationship between Housing Characteristics and Care Outcomes among Women Living with HIV: Latent Class Analysis. Soc Work Res 2022; 46:267-279. [PMID: 36420427 PMCID: PMC9672486 DOI: 10.1093/swr/svac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 03/25/2021] [Indexed: 06/16/2023]
Abstract
Housing plays a critical role in the care outcomes of individuals living with a HIV, yet few studies have examined the unique housing profiles of women living with HIV (WLH), especially among those belonging to low-income racial/ethnic minority groups. In this study, authors conducted a latent class analysis to generate latent profiles of women (N = 1,501) according to their housing status and household characteristics and assessed associations between classes and sociodemographic and behavioral characteristics and between classes and three HIV care outcomes: retention in care, viral suppression, and sustained viral suppression. A three-class model was selected using five dichotomized housing indicators: housing status, head of household status, living with minors, living with another adult, and disclosure of HIV status to adults with whom they live. While class 1 and class 2 had comparable HIV care outcomes, women in class 3-who were predominately unstably housed, living alone, and did not disclose their HIV status with those with whom they lived-had significantly lower crude odds of successful care outcomes. When accounting for sociodemographic and behavioral factors, significant differences in retention in care persisted. Findings underscore the need for tailored interventions for subgroups of low-income WLH and provide contextual details around the role of housing experiences.
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Affiliation(s)
| | - Diana M Sheehan
- MPH, PhD, is assistant professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Rahel Dawit
- PhD, MS, is a postdoctoral fellow, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Petra Brock-Getz
- MS, is qualitative/quantitative market researcher, Deft Research, Minneapolis, MN, USA
| | - Robert A Ladner
- PhD, is president, Behavioral Science Research Corporation, Coral Gables, FL, USA
| | - Mary Jo Trepka
- MD, MSPH, is professor and chair, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Kiplagat S, Khan A, Sheehan DM, Jaykrishna P, Ravi K, Jo Trepka M, Bursac Z, Stephens D, Krupp K, Madhivanan P. Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India. Sex Reprod Healthc 2022; 34:100787. [PMID: 36302276 PMCID: PMC10848242 DOI: 10.1016/j.srhc.2022.100787] [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: 02/10/2022] [Revised: 09/25/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Indian government established the Accredited Social Health Activists (ASHA) program in 2006 to improve access and healthcare coverage in rural regions. The objective of this study was to examine the moderating role of ASHA home visits and ASHA-accompanied antenatal care visits (ANC) on the relationship between sociodemographic latent classes of pregnant women and preterm birth and low birth weight infants in rural Mysore District, India. METHODS Utilizing a prospective cohort study conducted between 2011 and 2014, secondary data analysis was performed among 1540 pregnant women in rural Mysore, India. Latent class analysis was performed to identify sociodemographic distinct patterns. Multivariable logistic regression was performed to examine the moderating effects of ASHA-accompanied ANC visits and ASHA home visits on preterm birth and low birth weight. RESULTS Among women who never/rarely had ASHA-accompanied ANC visits, women in Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more" had higher odds of preterm birth (adjusted odds ratio [aOR]: 2.62, 95% confidence interval [CI]: 1.12-6.12 compared to Class 4 "high SES/later marriage/primigravida/no children.". Women in Class 3 "high SES/later marriage/multigravida/1 child or more" had higher odds of preterm birth compared to class 4. Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight infant. CONCLUSION The findings demonstrate that ASHA accompanying women to ANC moderates the risk of preterm births among women in high-risk SES groups. Targeted policies and interventions in improving and strengthening the ASHA program are needed to reduce inequalities in adverse birth outcomes in rural India.
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Affiliation(s)
- Sandra Kiplagat
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL, United States.
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL, United States; Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), FIU, Miami, FL, United States; Research Center for Minority Institutions (RCMI), FIU, Miami, FL, United States
| | | | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), Miami, FL, United States; Research Center for Minority Institutions (RCMI), FIU, Miami, FL, United States
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL, United States
| | - Dionne Stephens
- Department of Psychology, College of Arts and Science Education, FIU, Miami, FL, United States
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India; Division of Public Health Practice and Translational Research, United States
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India; Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States; Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, AZ, United States; Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
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15
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Ramírez-Ortiz D, Seitchick J, Polpitiya M, Algarin AB, Sheehan DM, Fennie K, Cyrus E, Trepka MJ. Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review. Ethn Health 2022; 27:1859-1899. [PMID: 34647837 PMCID: PMC9008069 DOI: 10.1080/13557858.2021.1990217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors. DESIGN We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020. RESULTS A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship. CONCLUSION These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
| | - Jessica Seitchick
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Medhani Polpitiya
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Angel B. Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL
| | | | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
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Gbadamosi SO, Trepka MJ, Dawit R, Bursac Z, Raymond A, Ladner RA, Sheehan DM. A Comparative Analysis of Different HIV Viral Load Suppression Definitions Among Clients Receiving Care in the Miami-Dade Ryan White HIV/AIDS Program. AIDS Behav 2022; 26:3576-3588. [PMID: 35536517 PMCID: PMC9561086 DOI: 10.1007/s10461-022-03694-6] [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: 04/11/2022] [Indexed: 11/30/2022]
Abstract
The study's objective was to examine variations in viral load (VL) suppression definitions among clients in the Ryan White Program (RWP). Data from clients enrolled in the RWP during 2017 were examined to calculate the proportion of virally suppressed clients using three definitions: recent viral suppression, defined as having a suppressed VL (< 200 copies/mL) in the last test in 2017; maintained viral suppression, having a suppressed VL for both the first and last tests in 2017; and sustained viral suppression, having all tests in 2017 showing suppression. Relative differences across all three definitions were computed. Recent viral suppression measures were higher than maintained and sustained viral suppression measures by 7.0% and 10.1%, respectively. Significant relative differences in definitions by demographic, socioeconomic and clinical status were observed. It may be beneficial for care planning to report not only estimates of recent viral suppression but maintained and sustained viral suppression as well.
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Affiliation(s)
- Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Andrea Raymond
- Department of Immunology and Nanomedicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA.
- Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
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17
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Mauck DE, Fennie KP, Ibañez GE, Fenkl EA, Sheehan DM, Maddox LM, Spencer EC, Trepka MJ. Gay Neighborhoods: Can They Be Identified in a Systematic Way Using Latent Class Analysis? Arch Sex Behav 2022; 51:3395-3401. [PMID: 35927366 PMCID: PMC9588699 DOI: 10.1007/s10508-022-02369-6] [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: 09/27/2020] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Identifying gay neighborhoods could help in targeting HIV prevention efforts for men who have sex with men. This study's purpose was to identify gay neighborhoods using latent class analysis (LCA). Data at the ZIP code level were drawn from the American Community Survey, website lists of gay bars and neighborhoods, and the Florida Department of Health HIV surveillance system. A two-class model was selected based on fit. About 9% of the ZIP code data was in class two, which was designated as gay neighborhoods. Cohen's kappa coefficient was used to examine agreement between the classification of ZIP codes from LCA and websites. Fair agreement was found (0.2501). Gay neighborhoods could serve as a place to disseminate information about pre-exposure prophylaxis and other methods for HIV prevention. Improved measures, such as the planned question about same-sex spouses for the 2020 US Census, are needed to identify gay neighborhoods in population-level surveys.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Division of Natural Sciences, New College of Florida, Sarasota, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
| | - Eric A Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA
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18
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Mauck DE, Fennie KP, Ibañez GE, Fenkl EA, Sheehan DM, Maddox LM, Spencer EC, Trepka MJ. Correction to: Gay Neighborhoods: Can They Be Identified in a Systematic Way Using Latent Class Analysis? Arch Sex Behav 2022; 51:3403. [PMID: 36048297 PMCID: PMC10754204 DOI: 10.1007/s10508-022-02417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Division of Natural Sciences, New College of Florida, Sarasota, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
| | - Eric A Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Miami, FL, 33199, USA
- Research Center in Minority Institutions, Florida International University, Miami, FL, USA
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19
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Fernandez SB, Lopez C, Ibarra C, Sheehan DM, Ladner RA, Trepka MJ. Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing. Int J Environ Res Public Health 2022; 19:11484. [PMID: 36141757 PMCID: PMC9517674 DOI: 10.3390/ijerph191811484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.
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Affiliation(s)
- Sofia B. Fernandez
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cindy Lopez
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| | - Diana M. Sheehan
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL 33199, USA
| | | | - Mary Jo Trepka
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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20
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Trepka MJ, Dawit R, Fernandez SB, Sheehan DM, Degarege A, PhD TL, Maddox LM, Spencer EC. Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences. J Rural Health 2022; 38:960-969. [PMID: 34861068 PMCID: PMC9163207 DOI: 10.1111/jrh.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St, AHC 5, Miami, Florida, USA
| | - Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tan Li PhD
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Lorene M. Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
| | - Emma C. Spencer
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
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21
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Ward MK, Fernandez SB, Sheehan DM, Li T, Dawit R, Fennie K, Beach MC, Brock P, Ladner R, Trepka MJ. Sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression in the Miami-Dade County Ryan White Program, 2017. AIDS Care 2022. [DOI: https://doi.org.10.1080/09540121.2022.2080800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, Sarasota, Florida, USA
| | | | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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22
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Gbadamosi SO, Trepka MJ, Dawit R, Jebai R, Sheehan DM. A Systematic Review and Meta-analysis to Estimate the Time from HIV Infection to Diagnosis for People with HIV. AIDS Rev 2022; 24:32-40. [PMID: 34077404 PMCID: PMC8636511 DOI: 10.24875/aidsrev.21000007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Timely HIV diagnosis is critical to minimizing transmission events. We sought to estimate the meantime from HIV infection to diagnosis and its temporal trend among people with HIV. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of MEDLINE, Embase, and Google Scholar, supplemented by a hand search of bibliographies of articles, was conducted. Study information and outcome measures of time from HIV infection to diagnosis were synthesized. Random-effects metaanalyses were performed. The search identified 12 articles from 4541 unduplicated citations. Studies were conducted in the UK (k = 3), US (k = 3), France (k = 2), Australia (k = 1), Switzerland (k = 1), Netherlands (k = 1), and China (k = 1). The pooled meantime from HIV infection to diagnosis was 3.00 years (95% confidence interval: 2.16-3.84). From 1996 to 2002, meantime reduced from 4.68 to 2.66 years. Subsequently, it increased to 3.20 years in 2003 and remained relatively stable until 2015. In sub-group meta-analyses, men who have sex with men (MSM) had a meantime of 2.62 years (1.91-3.34), while for heterosexuals and people who inject drugs, it was 5.00 (4.15-5.86) and 4.98 (3.97-5.98) years, respectively. In the high- and upper-middle-income countries included in this study, persons live with undiagnosed HIV for about 3 year before being diagnosed. This period is shorter for MSM relative to people with infections attributable to other risk factors.
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Affiliation(s)
- Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA,Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA,Research Center in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA,Corresponding author: Diana M. Sheehan, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, Florida 33199, Telephone: 1– (305) 348-0118, Fax: 1– (305) 348-4901,
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23
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Trepka MJ, Ward MK, Ladner RA, Sheehan DM, Li T, Ibarra C, Gbadamosi SO, Ibañez GE, Jean-Gilles M. HIV Care Access During the COVID-19 Pandemic as Perceived by Racial/Ethnic Minority Groups Served by the Ryan White Program, Miami-Dade County, Florida. J Int Assoc Provid AIDS Care 2022; 21:23259582221084536. [PMID: 35243926 PMCID: PMC8899832 DOI: 10.1177/23259582221084536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
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24
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Dawit R, Trepka MJ, Duncan DT, Li T, Pires SF, Brock P, Ladner RA, Sheehan DM. Neighborhood Factors Associated with Racial/Ethnic Disparities in Achieving Sustained HIV Viral Suppression Among Miami-Dade County Ryan White Program Clients. AIDS Patient Care STDS 2021; 35:401-410. [PMID: 34623889 PMCID: PMC8665786 DOI: 10.1089/apc.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/24/2022] Open
Abstract
Racial/ethnic minorities are disproportionately affected by poor HIV care outcomes. Studies have also examined the effects of neighborhood-level factor on an individual's health outcomes. Thus, the objective of this study was to assess the effects of neighborhood factors on the association between race/ethnicity and sustained viral suppression (all viral load tests <200 copies/mL per year). Data for 6491 people with HIV in the 2017 Miami-Dade County Ryan White Program and neighborhood-level data by ZIP code tabulated areas from the American Community Survey were utilized. Multi-level logistic regression models were used to assess the role of neighborhood factors on the association between race/ethnicity and sustained viral suppression. Results show that non-Hispanic Blacks had lower odds of sustained viral suppression in low socioeconomic disadvantage [adjusted odds ratio (aOR): 0.39; 95% confidence interval (CI): 0.20-0.74], moderate residential instability (aOR: 0.31; 95% CI: 0.15-0.65), and low and high racial/language homogeneity neighborhoods (aOR: 0.38; 95% CI: 0.16-0.88) and (aOR: 0.38; 95% CI: 0.19-0.75), respectively, when compared to non-Hispanic Whites (NHWs). Haitians also exhibited poor outcomes in neighborhoods characterized by moderate residential instability (aOR: 0.42; 95% CI: 0.18-0.97) and high racial/language homogeneity (aOR: 0.49; 95% CI: 0.26-0.93), when compared to NHWs. In conclusion, disparities in rates of sustained viral suppression were observed for racial/ethnic minorities within various neighborhood-level factors. These findings indicate the importance of addressing neighborhood characteristics to achieve optimal care for minorities.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Dustin T. Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Stephen F. Pires
- Department of Criminology and Criminal Justice, Steven J. Green School of International and Public Affairs, Florida International University, Miami, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA.,Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA.,Address correspondence to: Diana M. Sheehan, PhD, MPH, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Room 479, Miami, FL 33199, USA
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25
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Ramírez-Ortiz D, Forney DJ, Sheehan DM, Cano MÁ, Romano E, Sánchez M. Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida. AIDS Behav 2021; 25:2841-2851. [PMID: 33751312 DOI: 10.1007/s10461-021-03233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Derrick J Forney
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Mariana Sánchez
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA.
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5 411, Miami, FL, 33199, USA.
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26
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Caleb-Adepoju SO, Dawit R, Gbadamosi SO, Sheehan DM, Fennie KP, Ladner RA, Brock P, Trepka MJ. Factors Associated with Viral Suppression Among Racial/Ethnic Minority Women in the Miami-Dade County Ryan White Program, 2017. AIDS Res Hum Retroviruses 2021; 37:631-641. [PMID: 34078113 PMCID: PMC8501466 DOI: 10.1089/aid.2021.0039] [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: 11/13/2022] Open
Abstract
The study's objective was to identify factors associated with differences in the rate of viral suppression among minority women with HIV/AIDS in care in the Miami-Dade County Ryan White Program (RWP). A retrospective cohort study was conducted using social characteristics and laboratory data of minority women enrolled in the Miami-Dade County RWP in 2017. Viral suppression was defined as <200 copies/mL using the last viral load test of 2017. Multilevel logistic regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence intervals (CIs). Of the 1,550 racial/ethnic minority women in the study population, 43.1% were African American, 31.3% were Hispanic, and 25.6% were Haitian. The proportion of women virally suppressed was lower among African Americans (80.8%) than among Hispanics (86.4%) and Haitians (85.1%). Viral suppression rates were significantly lower among women aged 18-34 years (aOR: 0.41, CI: 0.27-0.64) and 35-49 years (0.63, 0.45-0.90) vs. ≥50 years, born in the United States (0.48, 0.30-0.78), having a household income of <100% the federal poverty level (0.54, 0.30-0.95), previously diagnosed with AIDS (0.60, 0.44-0.81), reporting problematic drug use (0.23, 0.08-0.69), and living in a residentially unstable neighborhood (0.77, 0.64-0.93). Race/ethnicity was not associated with viral suppression after adjusting for other factors. Factors associated with lack of viral suppression were similar among minority racial/ethnic groups. Interventions at the individual level focusing on young, U.S. born individuals, and those who report drug use, and at the neighborhood level for those living in residentially unstable neighborhoods are needed to improve viral suppression outcomes.
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Affiliation(s)
- Sikeade O. Caleb-Adepoju
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
| | | | - Robert A. Ladner
- Behavioral Science Research Corporation, Coral Gables, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Coral Gables, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
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Trepka MJ, Sheehan DM, Dawit R, Li T, Fennie KP, Gebrezgi MT, Brock P, Beach MC, Ladner RA. Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program. J Int Assoc Provid AIDS Care 2021; 19:2325958220950087. [PMID: 32815475 PMCID: PMC7444131 DOI: 10.1177/2325958220950087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), 5450Florida International University, Miami, FL, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Division of Natural Sciences, 10648New College of Florida, Sarasota, FL, USA
| | - Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, FL, USA
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Gebrezgi MT, Trepka MJ, Gbadamosi SO, Fennie KP, Ramirez-Ortiz D, Li T, Fernandez SB, Brock P, Ladner RA, Sheehan DM. Development and Validation of Vulnerable and Enabling Indices for HIV Viral Suppression among People with HIV Enrolled in the Ryan White Program. Int J Environ Res Public Health 2021; 18:ijerph18137048. [PMID: 34280985 PMCID: PMC8297082 DOI: 10.3390/ijerph18137048] [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] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). METHODS We used Ryan White Program (RWP) data and principal component analysis to develop general and gender- and racial/ethnic-specific indices. We assessed internal reliability (Cronbach's alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. RESULTS Three general factors accounting for 79.2% of indicators' variability surfaced: mental health, drug use, and socioeconomic status (Cronbach's alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender- or racial/ethnic-specific indices did not improve psychometric performance. DISCUSSION General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender- and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Kristopher P. Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bayshore Rd, Sarasota, FL 34243, USA;
| | - Daisy Ramirez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA;
| | - Sofia B. Fernandez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Petra Brock
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Robert A. Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
- Correspondence:
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Dawit R, Trepka MJ, Gbadamosi SO, Fernandez SB, Caleb-Adepoju SO, Brock P, Ladner RA, Sheehan DM. Latent Class Analysis of Syndemic Factors Associated with Sustained Viral Suppression among Ryan White HIV/AIDS Program Clients in Miami, 2017. AIDS Behav 2021; 25:2252-2258. [PMID: 33471241 DOI: 10.1007/s10461-020-03153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
The study's objective was to identify the association between sustained viral suppression (all viral load tests < 200 copies/ml per year) and patterns of co-occurring risk factors including, mental health, substance use, sexual risk behavior, and adverse social conditions for people with HIV (PWH). Latent class analysis followed by multivariable logistic regression was conducted for 6554 PWH in the Miami-Dade County Ryan White Program during 2017, and a five-class model was selected. Compared to Class 1 (no risk factors), the odds of achieving sustained viral suppression was significantly lower for Class 2 (mental health) (aOR: 0.67; 95% CI 0.54-0.83), Class 3 (substance use and multiple sexual partners) (0.60; 0.47-0.76), Class 4 (substance use, multiple sexual partners, and domestic violence) (0.71; 0.55-0.93), and Class 5 (mental health, substance use, multiple sexual partners, domestic violence, and homelessness) (0.26; 0.19-0.35). Findings indicate the need for targeted interventions that address these syndemic factors.
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Sheehan DM, Cano MÁ, Trepka MJ. Measuring Race Among Latinos to Address Racism, Discrimination, and HIV Health Inequities: Comparing Self-Reported Race and Fitzpatrick Skin Phototype. J Assoc Nurses AIDS Care 2021; 32:522-525. [PMID: 33859078 PMCID: PMC8422302 DOI: 10.1097/jnc.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Limited research suggests there are significant disparities in HIV outcomes between Black and White Latinos. However, race among Latinos is largely absent from the scientific literature, and relevant measures of race for Latino populations have not been widely incorporated into ongoing research. Using a sample (N = 24) of young (18–34 years old) Latino men who have sex with men living with HIV, we compared self-reported Fitzpatrick skin phototype and self-reported race. Self-identified White Latinos reported skin phototypes 1 “light, pale white” through 4 “olive, moderate brown.” Multiracial Latinos reported skin phototypes 2 “white, fair” through 5 “brown, dark brown.” One-third of participants did not identify with commonly used racial categories, White or Black. Results suggest a widespread of skin phototypes among Latinos self-identifying as White and Multiracial, which may impact the identification of HIV racial disparities, as well as racism, discrimination, and health inequities HIV research among Latino sexual and gender minorities.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA, a Faculty Affiliate, Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA, and a Faculty Affiliate, Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA, and a Faculty Affiliate, Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA, and a Faculty Affiliate, Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
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31
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Algarin AB, Hee Shrader C, Hackworth BT, Varas-Diaz N, Fennie KP, Sheehan DM, Ibañez GE. Development and Validation of the Community PrEP-Related Stigma Scale (Community-PSS). AIDS Educ Prev 2021; 33:120-128. [PMID: 33821676 PMCID: PMC8054770 DOI: 10.1521/aeap.2021.33.2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
Despite increasing availability of pre-exposure prophylaxis (PrEP), HIV prevention efforts have stalled. It is important to study potential barriers to HIV prevention methods, such as pre-exposure prophylaxis stigma. This study aims to develop and validate the Community PrEP-related Stigma Scale (Community-PSS) to address gaps in the literature. Participants were 108 sexual and gender minority men recruited through virtual and community-posted advertisements in Florida. The authors assessed reliability using Cronbach's alpha analysis, determined scale components using principal component analysis, and assessed construct validity based on five a priori hypotheses. The scale had high internal consistency (α = 0.86) and four components (stigma of actions outside of sex, stigma of sexual actions, extreme stigma perceptions, and positive community perception). The Community-PSS was valid, supporting four out of five hypotheses and in the expected directions. The Community-PSS was a valid and reliable tool in the sample and correlates with a previously validated PrEP stigma scale, HIV knowledge, PrEP knowledge, and likelihood of condom use with a partner on PrEP.
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Affiliation(s)
- Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
| | - Cho Hee Shrader
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | | | - Nelson Varas-Diaz
- Department of Global & Sociocultural Studies, Florida International University, Miami, Florida
| | | | - Diana M Sheehan
- Department of Epidemiology, Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), and the FIU Research Center in Minority Institutions (FIU-RCMI), Florida International University, Miami, Florida
| | - Gladys E Ibañez
- Department of Epidemiology, Florida International University, Miami, Florida
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32
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Fernandez SB, Clarke RD, Sheehan DM, Trepka MJ, Rose SM. Perceptual Facilitators for and Barriers to Career Progression: A Qualitative Study With Female Early Stage Investigators in Health Sciences. Acad Med 2021; 96:576-584. [PMID: 33369901 PMCID: PMC8012232 DOI: 10.1097/acm.0000000000003902] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE Despite efforts to increase the representation of women in the national scientific workforce, results still lag. While women's representation in health-related sciences has increased substantially, women remain underrepresented in senior leadership roles. This study was conducted to elucidate influences at the individual, interpersonal, organizational, and societal levels that present as barriers to and facilitators for advancement in research careers for women, with the goal of promoting and retaining a more diverse leadership. METHOD The authors conducted individual, 1-hour, in-depth, semistructured interviews with 15 female early stage investigators pursuing careers in health sciences research at a large minority-serving institution in Florida in 2018. Interview guides were designed by using a social ecological framework to understand the influence of multilevel systems. Employing a qualitative approach, drawing from a phenomenological orientation, 2 researchers independently coded transcripts and synthesized codes into broad themes. RESULTS Barriers and facilitators were reported at all ecological levels explored. Illustrative quotations reflect the unequal distribution of familial responsibilities that compete with career advancement, family members' lack of understanding of the demands of a research career, the importance of female mentors, perceived differences in the roles and expectations of female and male faculty at institutions, and normative upheld values that influence early career progression. CONCLUSIONS Achieving pervasive and sustained changes that move toward gender equity in research requires solutions that address multilevel, explicit and implicit influences on women's advancement in science. Suggestions include shifting familial and institutional norms, creating support systems for women with female mentors, and enforcing consistent policies regarding the roles and expectations of faculty. Findings shed light on the influence of gender on career progression by providing context for the experiences of women and underscore the importance of addressing pervasive societal and structural systems that maintain inequities hindering women's progress in the scientific workforce.
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Affiliation(s)
- Sofia B Fernandez
- S.B. Fernandez is a postdoctoral research fellow, Investigator Development Core, Research Center for Minority Institutions, Florida International University, Miami, Florida; ORCID: https://orcid.org/0000-0001-6243-9463
| | - Rachel D Clarke
- R.D. Clarke is a postdoctoral research fellow, Community-Based Research Institute, Florida International University, Miami, Florida; ORCID: https://orcid.org/0000-0001-9606-2510
| | - Diana M Sheehan
- D.M. Sheehan is assistant professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and co-investigator, Investigator Development Core, Research Center for Minority Institutions, Florida International University, Miami, Florida; ORCID: https://orcid.org/0000-0002-1316-3189
| | - Mary Jo Trepka
- M.J. Trepka is professor and chair, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and principal investigator, Investigator Development Core, Research Center for Minority Institutions, Florida International University, Miami, Florida; ORCID: https://orcid.org/0000-0002-6585-1194
| | - Suzanna M Rose
- S.M. Rose is associate provost, Office to Advance Women, Equity, and Diversity in Academic Affairs, and professor of psychology, Florida International University, Miami, Florida; ORCID: https://orcid.org/0000-0002-0946-4173
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Predictors of chlamydia or gonorrhea among people with HIV in Miami-Dade County Ryan White Program in 2017. AIDS Care 2021; 34:615-620. [PMID: 33576239 PMCID: PMC8357847 DOI: 10.1080/09540121.2021.1883510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess the prevalence of chlamydia or gonorrhea and factors associated with the diagnoses among people with HIV (PHIV) in the Ryan White Program Part A (RWP) in Miami-Dade County, Florida. We used 2017 calendar year data to identify factors associated with a chlamydia or gonorrhea diagnoses using logistic regression. About 50% of the 7110 PHIV who were ≥18 years old in active Ryan White care in 2017 reported being screened for chlamydia or gonorrhea. Of those screened, 2.3% reported diagnoses of chlamydia, gonorrhea or both. In the adjusted model, compared to PHIV ≥40 years-old, PHIV aged 18-24 and 25-39 years reported higher odds of diagnoses (adjusted odds ratio [aOR] 4.29; 95% confidence interval [CI]: 1.73-10.63 and aOR 4.58; 95% CI; 2.62-7.99 respectively). Those with multiple sexual partners in the last 12 months reported higher odds of diagnoses (aOR 1.67; (95% CI; 1.04-2.69)). Screening rates for chlamydia or gonorrhea are low, relative to CDC guidelines. Interventions are needed to increase rates of screening and targeted behavioral risk reduction techniques are highly recommended among those 18-39 years of age and those who have multiple sexual partners.
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Affiliation(s)
- Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sandra G Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, FL, USA
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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Sheehan DM, De La Cruz Y, Ramírez-Ortiz D, Swendeman D, Muñoz-Laboy M, Duncan DT, Cano MÁ, Devieux JG, Trepka MJ. A qualitative study of antiretroviral therapy adherence interruptions among young Latino men who have sex with men with HIV: Project D.A.I.L.Y. AIDS Care 2021; 33:962-969. [PMID: 33486977 DOI: 10.1080/09540121.2021.1874277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Consistent antiretroviral therapy (ART) adherence is necessary for HIV viral suppression. However, adherence may fluctuate around daily routines and life events, warranting intervention support. We examined reasons for ART adherence interruptions, using in-depth, semi-structured qualitative interviews, among young (18-34-year-old) Latino men who have sex with men (YLMSM) with HIV. Interviews (n = 24) were guided by the Theory of Planned Behavior, the Information-Motivation-Behavioral Skills Theory, and the Socio-Ecological Model. Two coders independently coded transcripts using NVivo 12 software and synthesized codes into themes using Thematic Content Analysis. Results suggested 4 primary influences on ART adherence interruptions: (1) HIV diagnosis denial, (2) breaks in daily routine, (3) substance use, and (4) HIV status disclosure. Participant quotes highlighted routinization of pill-taking and planning ahead for breaks in routine as critically important. The narrative suggested modification of pill-taking routines during alcohol use, and that periods most vulnerable for long-term interruptions in ART adherence were following an HIV diagnosis and during periods of drug use. Support at the time of HIV diagnosis, including a plan for routinization of pill taking, and adaptive interventions incorporating real-time support during breaks in routines and substance use episodes may be one way to help YLMSM adhere to ARTs.
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Affiliation(s)
- Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Yazmine De La Cruz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Miguel Muñoz-Laboy
- Community Health and Social Medicine Department, The City College of New York, New York, NY, USA
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA
| | - Jessy G Devieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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Algarin AB, Sheehan DM, Varas-Diaz N, Fennie K, Zhou Z, Spencer EC, Cook CL, Cook RL, Ibanez GE. Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida. AIDS Behav 2021; 25:93-103. [PMID: 32564164 DOI: 10.1007/s10461-020-02948-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI] 3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.
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Mauck DE, Gebrezgi MT, Sheehan DM, Fennie KP, Ibañez GE, Fenkl EA, Trepka MJ. Population-based methods for estimating the number of men who have sex with men: a systematic review. Sex Health 2020; 16:527-538. [PMID: 31658435 DOI: 10.1071/sh18172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
The objective of this systematic review was to summarise population-based methods (i.e. methods that used representative data from populations) for estimating the population size of men who have sex with men (MSM), a high-risk group for HIV and other sexually transmissible infections (STIs). Studies using population-based methods to estimate the number or percentage of MSM or gay men were included. Twenty-eight studies met the inclusion criteria. Seven studies used surveillance data, 18 studies used survey data, and six studies used census data. Sixteen studies were conducted in the US, five were conducted in European countries, two were conducted in Canada, three were conducted in Australia, one was conducted in Israel, and one was conducted in Kenya. MSM accounted for 0.03-6.5% of men among all studies, and ranged from 3.8% to 6.4% in the US, from 7000 to 39100 in Canada, from 0.03% to 6.5% in European countries, and from 127947 to 182624 in Australia. Studies using surveillance data obtained the highest estimates of the MSM population size, whereas those using survey data obtained the lowest estimates. Studies also estimated the MSM population size by dimensions of sexual orientation. In studies examining these dimensions, fewer people identified as MSM than reported experience with or attraction to other men. Selection bias, differences in recall periods and sampling, or stigma could affect the estimate. It is important to have an estimate of the number of MSM to calculate disease rates, plan HIV and STI prevention efforts, and to allocate resources for this group.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; and Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Eric A Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; and Corresponding author.
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Cano MÁ, Sánchez M, De La Rosa M, Rojas P, Ramírez-Ortiz D, Bursac Z, Meca A, Schwartz SJ, Lorenzo-Blanco EI, Zamboanga BL, Garcini LM, Roncancio AM, Arbona C, Sheehan DM, de Dios MA. Alcohol use severity among Hispanic emerging adults: Examining the roles of bicultural self-efficacy and acculturation. Addict Behav 2020; 108:106442. [PMID: 32353693 DOI: 10.1016/j.addbeh.2020.106442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 03/13/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to (1) examine respective associations of acculturation orientations (e.g., U.S. orientation and Hispanic orientation) and domains (e.g., social groundedness and role repertoire) of bicultural self-efficacy, the perceived confidence to function effectively within the receiving culture and the heritage culture, with alcohol use severity among Hispanic emerging adults. This study also aimed to (2) examine potential moderating factors of respective associations among acculturation orientations and bicultural self-efficacy with alcohol use severity. METHOD 200 Hispanic emerging adults from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Inclusion criteria were being ages 18-25, self-identify as Hispanic or Latina/o, and currently living in Maricopa County or Miami-Dade County. Data were analyzed using hierarchical multiple regression and moderation analyses. RESULTS Findings indicate that neither of the acculturation orientations nor role repertoire had main effects with alcohol use severity. However, higher social groundedness was associated with lower alcohol use severity. Moderation analyses indicate that the interaction between the U.S. orientation and study site and the interaction between the Hispanic orientation and social groundedness were statistically significant in relation to alcohol use severity. CONCLUSIONS Considering that the U.S. orientation was associated with alcohol use severity only in Arizona highlights the need for multisite studies on acculturation. Our findings demonstrate that other sociocultural processes such as acculturation can impact bicultural self-efficacy; and that the association between bicultural self-efficacy and alcohol merits further investigation. However, more thorough assessments of bicultural self-efficacy are needed to better understand its effects on alcohol.
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Algarin AB, Sheehan DM, Varas-Diaz N, Fennie KP, Zhou Z, Spencer EC, Cook RL, Morano JP, Ibanez GE. Health Care-Specific Enacted HIV-Related Stigma's Association with Antiretroviral Therapy Adherence and Viral Suppression Among People Living with HIV in Florida. AIDS Patient Care STDS 2020; 34:316-326. [PMID: 32639208 DOI: 10.1089/apc.2020.0031] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/20/2022] Open
Abstract
Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample (n = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95), p = 0.198; AOR = 1.17, CI: (0.65-2.11), p = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42), p = 0.702; AOR = 1.16, CI: (0.64-2.13), p = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20), p = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92), p = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.
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Affiliation(s)
- Angel B. Algarin
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), and Florida International University, Miami, Florida, USA
- FIU Research Center in Minority Institutions (FIU-RCMI), Florida International University, Miami, Florida, USA
| | - Nelson Varas-Diaz
- Department of Global & Sociocultural Studies, Florida International University, Miami, Florida, USA
| | | | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Jamie P. Morano
- Division of Infectious Diseases and International Medicine, University of South Florida, Tampa, Florida, USA
| | - Gladys E. Ibanez
- Department of Epidemiology, Florida International University, Miami, Florida, USA
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39
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Dawit R, Sheehan DM, Gbadamosi SO, Fennie KP, Li T, Curatolo D, Maddox LM, Spencer EC, Trepka MJ. Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015-2017. AIDS Care 2020; 33:131-135. [PMID: 32460517 DOI: 10.1080/09540121.2020.1771264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The study objective was to classify women with newly diagnosed HIV into patterns of retention in care (≥2 HIV care visits ≥3 months apart) and viral suppression over time and identify factors associated with class membership. Florida HIV/AIDS surveillance data were used to conduct Latent Class Analysis to classify women into patterns, and multinomial regression was used to compare the prevalence of class membership by demographic and clinical factors. Four classes were selected based on model fit parameters: (Class 1) consistently retained and suppressed (>90% probability of being retained and suppressed), (Class 2) not consistently retained or suppressed (≤10% probability of being retained and suppressed), (Class 3) increasingly retained and suppressed, and (Class 4) decreasingly retained and suppressed. The proportion of women in each class was 48.6%, 24.9%, 14.3%, and 12.2%, respectively. Women aged 25-34 compared to 35-49 years old, injection drug use mode of exposure, US born, and not linked to care three months post-diagnosis had a lower prevalence of belonging to the consistently retained and suppressed class. Findings may be useful in tailoring and targeting interventions to increase the prevalence of women who are consistently retained in care and virally suppressed.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Danielle Curatolo
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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40
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Ramírez-Ortiz D, Sheehan DM, Ibañez GE, Ibrahimou B, De La Rosa M, Cano MÁ. HIV testing intentions and cognitive reappraisal among Latino emerging adults. AIDS Care 2020; 33:548-552. [PMID: 32408760 DOI: 10.1080/09540121.2020.1763905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Negative emotions related to HIV testing may influence an individual's intentions to test for HIV. However, emotion regulation strategies such as cognitive reappraisal which involves reframing the meaning of an event to modify one's emotional response to it may potentially help to regulate these emotions and facilitate decisions to get tested for HIV. In this exploratory study, we examined the association between cognitive reappraisal and HIV testing intentions and whether this association differs by gender. Cross-sectional data were collected from a convenience sample of 157 Latino emerging adults aged 18-25 years living in Arizona and Florida through an online survey. Hierarchical logistic regression models were used to analyze the data. Results indicated that cognitive reappraisal was significantly associated with HIV testing intentions (aOR: 1.44, 95% CI:1.04-1.99) and that this association was specific to females (aOR: 2.48, 95% CI: 1.39-4.43). Our results demonstrate the potential of cognitive reappraisal to facilitate HIV testing intentions among females. HIV prevention interventions should incorporate cognitive reappraisal training to regulate and adapt to the negative emotions associated with HIV testing in efforts to increase HIV testing.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida.,Research Center in Minority Institutions, Florida International University, Miami
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida.,Department of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Development and Validation of a Risk Prediction Tool to Identify People with HIV Infection Likely Not to Achieve Viral Suppression. AIDS Patient Care STDS 2020; 34:157-165. [PMID: 32324484 DOI: 10.1089/apc.2019.0224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Identifying people with HIV infection (PHIV), who are at risk of not achieving viral suppression, is important for designing targeted intervention. The aim of this study was to develop and test a risk prediction tool for PHIV who are at risk of not achieving viral suppression after a year of being in care. We used retrospective data to develop an integer-based scoring method using backward stepwise logistic regression. We also developed risk score categories based on the quartiles of the total risk score. The risk prediction tool was internally validated by bootstrapping. We found that nonviral suppression after a year of being in care among PHIV can be predicted using seven variables, namely, age group, race, federal poverty level, current AIDS status, current homelessness status, problematic alcohol/drug use, and current viral suppression status. Those in the high-risk category had about a 23 increase in the odds of nonviral suppression compared with the low-risk group. The risk prediction tool has good discriminative performance and calibration. Our findings suggest that nonviral suppression after a year of being in care can be predicted using easily available variables. In settings with similar demographics, the risk prediction tool can assist health care providers in identifying high-risk individuals to target for intervention. Follow-up studies are required to externally validate this risk prediction tool.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Sandra G. Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida, USA
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
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42
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Sheehan DM, Dawit R, Gbadamosi SO, Fennie KP, Li T, Gebrezgi M, Brock P, Ladner RA, Trepka MJ. Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors. BMC Public Health 2020; 20:326. [PMID: 32169065 PMCID: PMC7069036 DOI: 10.1186/s12889-020-8442-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men. Methods Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression. Results Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18–24 and 25–34 year-old MSM compared with 35–49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression. Conclusion Despite access to treatment, age and racial disparities in sustained viral suppression exist among MSM living with HIV. Addressing substance use, mental health, and social services’ needs may improve the ability of MSM to sustain viral suppression long-term. Furthermore, physician characteristics may be associated with HIV outcomes and should be explored further.
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Affiliation(s)
- Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA. .,Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA. .,Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA.
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bayshore Rd, Sarasota, FL, 34243, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Merhawi Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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43
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Ramírez-Ortiz D, Sheehan DM, Ibañez GE, Ibrahimou B, De La Rosa M, Cano MÁ. Self-efficacy and HIV testing among Latino emerging adults: examining the moderating effects of distress tolerance and sexual risk behaviors. AIDS Care 2020; 32:1556-1564. [PMID: 32131621 DOI: 10.1080/09540121.2020.1736259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latino emerging adults in the United States are at a high risk of HIV and have a low prevalence of HIV testing. This study examined the association between self-efficacy for HIV testing, distress tolerance and lifetime history of HIV testing, and tested the moderating effect of distress tolerance and sexual risk behaviors on the association between self-efficacy and lifetime history of HIV testing. Data were collected from a cross-sectional sample of 157 Latino emerging adults aged 18-25 using an online survey and were analyzed using hierarchical logistic regression and moderation analyses. We found that 62.8% of those engaging in sexual risk behaviors had ever been tested for HIV. Participants that reported higher levels of self-efficacy (aOR=3.49, 95%CI: 1.78-6.83) were more likely to have ever been tested for HIV in their lifetime. There was a statistically significant three-way interaction among self-efficacy for HIV testing, distress tolerance and sexual risk behaviors (b=2.76, 95%CI: .52, 5.00, p=.016). This interaction suggests that among those that reported any sexual risk behaviors, higher levels of self-efficacy were associated with lifetime history of HIV testing only at higher levels of distress tolerance. Further research is warranted to determine how self-efficacy and distress tolerance work together among high-risk groups to promote HIV testing.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA.,Department of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
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44
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Developing a triage tool for use in identifying people living with HIV who are at risk for non-retention in HIV care. Int J STD AIDS 2020; 31:244-253. [PMID: 32036751 PMCID: PMC7044017 DOI: 10.1177/0956462419893538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Identifying PLHIV in HIV care who are at particular risk of non-retention in care is an important element in improving their HIV care outcomes. The purpose of this study was to develop a risk prediction tool to identify PLHIV at risk of non-retention in care over the course of the next year. Method: We used stepwise logistic regression to assess sociodemographic, clinical and behavioral predictors of non-retention in HIV care. Retention in care was defined as having evidence of at least two encounters with an HIV care provider (or CD4 or viral load lab tests as a proxy measure for the encounter), at least 3 months apart within a year. We validated the risk prediction tool internally using the bootstrap method. Results: The risk prediction tool included a total of six factors: age group, race, poverty level, homelessness, problematic alcohol/drug use and viral suppression status. The total risk score ranged from 0 to 17. Compared to those in the lowest quartile (0 risk score), those who were in the middle two quartiles (score 1–4) and those in the upper quartile (>4 risk score) were more likely not to be retained in care (odds ratio [OR] 1.63 [CI; 1.39–1.92] and OR 4.82 [CI; 4.04–5.78] respectively). The discrimination ability for the prediction model was 0.651. Conclusion: We found that increased risk for non-retention in care can be predicted with routinely available variables. Since the discrimination of the tool was low, future studies may need to include more prognostic factors in the risk prediction tool.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Kristopher P. Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, FL 34243, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Sandra G. Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
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45
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Mauck DE, Fennie KP, Ibañez GE, Fenkl EA, Sheehan DM, Maddox LM, Spencer EC, Trepka MJ. Estimating the size of HIV-negative MSM population that would benefit from pre-exposure prophylaxis in Florida. Ann Epidemiol 2020; 44:52-56. [PMID: 32145998 DOI: 10.1016/j.annepidem.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/12/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to estimate the size of the population of men who have sex with men (MSM) in Florida with high-risk behaviors that would indicate eligibility for pre-exposure prophylaxis (PrEP) use. METHODS Three methods were used to estimate the MSM population. Estimates from the three methods were averaged, and the number of MSM living with HIV in each zone improvement plan (ZIP) code was subtracted. RESULTS The average MSM estimate was 1-2184 men (1.5-22.9%) by ZIP code. The size of the MSM population with indications for PrEP use was highest when using estimates of MSM with more than one sex partner in the past year obtained from the National HIV Behavioral Surveillance system and lowest when the MSM estimate was multiplied by 24.7% (percentage of MSM with PrEP indications from other studies). CONCLUSION Areas with high numbers of MSM with PrEP indications could be targeted with information to reduce HIV acquisition.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Eric A Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami; Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami; Research Center in Minority Institutions, Florida International University, Miami
| | - Lorene M Maddox
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL
| | - Emma C Spencer
- Florida Department of Health, Division of Disease Control and Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami; Research Center in Minority Institutions, Florida International University, Miami
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46
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Gebrezgi MT, Sheehan DM, Mauck DE, Fennie KP, Ibanez GE, Spencer EC, Maddox LM, Trepka MJ. Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13-24) living with HIV in 2015. Int J STD AIDS 2019; 30:1095-1104. [PMID: 31551004 DOI: 10.1177/0956462419857302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).
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Affiliation(s)
- Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA
| | - Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibanez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary J Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Gebrezgi MT, Mauck DE, Sheehan DM, Fennie KP, Cyrus E, Degarege A, Trepka MJ. Acceptance of Opt-Out HIV Screening in Outpatient Settings in the United States: A Systematic Review and Meta-Analysis. Public Health Rep 2019; 134:484-492. [PMID: 31365316 DOI: 10.1177/0033354919860510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States. METHODS We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses. RESULTS We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients' most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested. CONCLUSIONS The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.
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Affiliation(s)
- Merhawi T Gebrezgi
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Daniel E Mauck
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,2 Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,3 Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Elena Cyrus
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Abraham Degarege
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,3 Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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Sheehan DM, Miller RP, Trepka MJ, Smith LR, Latkin C. Role of Social Network Sexual Norms and Behaviors on the HIV Sexual Risk Behaviors of People Who Inject Drugs in HPTN 037. AIDS Behav 2019; 23:1604-1611. [PMID: 30826975 DOI: 10.1007/s10461-019-02409-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the effect of social network descriptive sexual norms and behaviors on the sexual behaviors of people who inject drugs (PWID). Data from HPTN037 of 232 PWID (egos) and 464 network members (alters) were used in multilevel multivariate logistic regression models. Egos whose alters reported multiple sex partners had greater odds of multiple sex partners (aOR 2.20, 1.13-4.29). Egos' norms of condomless sex with primary (aOR 2.67, 1.15-6.17) and casual (aOR 2.38, 1.01-5.59) partners and egos' norms of giving (aOR 5.52, 1.87-16.25) and receiving (aOR 7.38, 1.34-40.66) money/drugs for sex were associated with the egos' respective behaviors. History of sex between an ego and alter was not associated with increased influence of alters' norms and behaviors on egos' sexual behavior. Findings provide support for developing interventions that target descriptive norms and selective network behavioral characteristics to decrease sexual HIV risk behavior among PWID.
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Sheehan DM, Auf R, Cyrus E, Fennie KP, Maddox LM, Spencer EC, Rosa MDL, Trepka MJ. Changing demographic among Latino MSM diagnosed with HIV in Florida, 2007-2016. AIDS Care 2019; 31:1593-1596. [PMID: 31035779 DOI: 10.1080/09540121.2019.1612019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The study's objective was to assess temporal changes in birth country and age among newly diagnosed Latino men who have sex with men (MSM). We used records from Hispanics/Latinos (2007-2016) who were reported to the Florida HIV/AIDS surveillance system. We compared trends in birth country/region and age by year using a two-sided Cochran-Armitage Trend Test. Of 12,427 new diagnoses, 85.9% were among men. Of men, 79.5% were MSM. The proportion attributable to MSM increased from 70.0% in 2007-85.7% in 2016 (p-value < .0001). Compared with the trend in the proportion of MSM cases born in US-mainland, the proportion born in Cuba (20.0-29.9%; p-value < .0001) and South America (13.8% to 23.2%; p-value < .0001) increased significantly over time, and the proportion born in Central America (8.1% to 4.5%; p-value < .0001) decreased significantly over time. Compared with the trend in the proportion of MSM aged 35-49 years, the proportion aged 13-24 (15.4% to 20.6%; p-value < .0001) and 25-34 (25.0% to 35.6%; p-value < .0001) years increased significantly over time. In Florida, HIV prevention and screening strategies should be enhanced for Cuban and South American immigrants and young Latinos to address the increasing trend in new diagnoses among Latino MSM.
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Affiliation(s)
- Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA.,Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA
| | - Rehab Auf
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA.,Department of Health, Human Performance, and leisure (HHPL), College of Arts and Science (COAS), Howard University , Washington , DC , USA
| | - Elena Cyrus
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health , Tallahassee , FL , USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health , Tallahassee , FL , USA
| | - Mario De La Rosa
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA
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Duncan DT, Park SH, Goedel WC, Sheehan DM, Regan SD, Chaix B. Acceptability of smartphone applications for global positioning system (GPS) and ecological momentary assessment (EMA) research among sexual minority men. PLoS One 2019; 14:e0210240. [PMID: 30689651 PMCID: PMC6349317 DOI: 10.1371/journal.pone.0210240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/19/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Emerging research is using global positioning system (GPS) and ecological momentary assessment (EMA) methods among sexual minority men (SMM), a population that experiences multiple health disparities. However, we are not aware of any research that has combined these approaches among SMM, highlighting the need for acceptability and feasibility research. The purpose of this study was to examine the acceptability of implementing GPS and EMA research protocols using smartphone applications among SMM as well as related socio-demographic correlates. METHODS Data come from a sample of SMM on a popular geosocial-networking app in Paris, France (n = 580). We assessed the acceptability of implementing GPS and EMA research protocols on smartphone apps as well as socio-demographic characteristics (i.e., age, sexual orientation, country of origin, employment status, and relationship status). We examined the anticipated acceptability of GPS and EMA data collection methods as well as socio-demographic correlates of acceptability of GPS and EMA methods. RESULTS We found that over half (54.1%) of the sample was willing to download a smartphone app for GPS-based research and we found that almost 60% of the participants were willing to download a smartphone app for EMA-based research. In total, 44.0% reported that they were willing to download both GPS and EMA apps. In addition, we found that older participants were less willing to download a smartphone app for EMA research than younger participants aged 18-24 (40-49 years: aPR = 0.40; 95% CI = 0.20, 0.78) and students were more willing to download smartphone apps for both GPS and EMA research (aPR = 1.41; 95% CI = 1.02, 1.95). CONCLUSION Results from this study suggest that using smartphone apps to implement GPS and EMA methods among some SMM are acceptable. However, care should be taken as segments of SMM are less likely to be willing to engage in this type of research.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Su Hyun Park
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University Robert Stempel College of Public Health and Social Work, Miami, Florida, United States of America
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Basile Chaix
- Inserm, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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