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Koester KA, Fuller SM, Steward WT, Arnold EA. Impacts of COVID-19 on HIV/AIDS-Related Services in California. J Int Assoc Provid AIDS Care 2022; 21:23259582221128500. [PMID: 36214179 PMCID: PMC9551343 DOI: 10.1177/23259582221128500] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The degree to which COVID-19 has disrupted the advances in reducing new HIV
infections and preventing AIDS-related deaths is unknown. We present findings
related to the effect COVID-19 had on HIV, sexual health and harm reduction
service delivery in the state of California. We conducted a qualitative rapid
assessment with health care providers, as well as representatives from
non-medical support service agencies serving clients living with HIV in a range
of counties in California. Some organizations adapted fairly easily while others
struggled or were unable to adapt at all. Clinics were better positioned than
community-based organizations to accommodate COVID restrictions and to quickly
reestablish services. Influential forces that softened or calcified the
hardships created by COVID-19 included influx of funding, flexibility in
managing funds, networking and relationships, and workforce vulnerabilities.
These data clearly suggest that an enhanced level of flexibility within funding
streams and reporting requirements should be continued.
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Affiliation(s)
- Kimberly A. Koester
- Division of Prevention Science, University of California San
Francisco, San Francisco, CA, USA,Kimberly A. Koester, Division of Prevention
Science, University of California San Francisco, 550 16th St., Third Floor, UCSF
Mailcode 0886, San Francisco, CA, 94143, USA.
| | - Shannon M. Fuller
- Division of Prevention Science, University of California San
Francisco, San Francisco, CA, USA
| | - Wayne T. Steward
- Division of Prevention Science, University of California San
Francisco, San Francisco, CA, USA
| | - Emily A. Arnold
- Division of Prevention Science, University of California San
Francisco, San Francisco, CA, USA
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Fuller SM, Kotwal AA, Tha SH, Hill D, Perissinotto C, Myers JJ. Key Elements and Mechanisms of a Peer-Support Intervention to Reduce Loneliness and Isolation among Low-Income Older Adults: A Qualitative Implementation Science Study. J Appl Gerontol 2022; 41:2574-2582. [PMID: 36053132 PMCID: PMC9669726 DOI: 10.1177/07334648221120458] [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: 11/16/2022] Open
Abstract
This paper describes the evaluation of a longitudinal peer-support program developed to address loneliness and isolation among low-income, urban community-dwelling older adults in San Francisco. Our objective was to determine barriers, challenges, and successful strategies in implementation of the program. In-depth qualitative interviews with clients (n = 15) and peers (n = 6) were conducted and analyzed thematically by program component. We identified barriers and challenges to engagement and outlined strategies used to identify clients, match them with peers, and provide support to both peers and clients. We found that peers played a flexible, non-clinical role and were perceived as friends. Connections to community resources helped when clients needed additional support. We also documented creative strategies used to maintain inter-personal connections during the COVID-19 pandemic. This study fills a gap in understanding how a peer-support program can be designed to address loneliness and social isolation, particularly in low-income, urban settings.
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Affiliation(s)
- Shannon M Fuller
- Division of Prevention Science, Department of Medicine, 8785University of California San Francisco, San Francisco, CA, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, 8785University of California, San Francisco, San Francisco, CA, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Soe Han Tha
- Division of Geriatrics, Department of Medicine, 8785University of California, San Francisco, San Francisco, CA, USA
| | | | - Carla Perissinotto
- Division of Geriatrics, Department of Medicine, 8785University of California, San Francisco, San Francisco, CA, USA
| | - Janet J Myers
- Division of Prevention Science, Department of Medicine, 8785University of California San Francisco, San Francisco, CA, USA
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Fuller SM, Koester KA, Botta EW, Zeman L, Lazar D, Guevara E, Steward WT. Patient and Provider Experiences From HIV Clinics in the United States That Integrated Primary Care: A Brief Report. J Assoc Nurses AIDS Care 2022; 33:353-358. [PMID: 32282429 DOI: 10.1097/jnc.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shannon M Fuller
- Shannon M. Fuller, MS, is a Qualitative Analyst, Division of Prevention Science, University of California San Francisco, San Francisco, California, USA. Kimberly A. Koester, PhD, is an Assistant Professor of Medicine, Division of Prevention Science, University of California San Francisco, San Francisco, California, USA. Emma Wilde Botta, MS, was a Policy Analyst, Division of Prevention Science, University of California San Francisco, San Francisco, California, USA. Lindsay Zeman, MPH, is an Evaluation Specialist, Access Community Health Network, Chicago, Illinois, USA. Danielle Lazar, MA, is an Executive Director of Research, Evaluation and Innovation, Access Community Health Network, Chicago, Illinois, USA. Ernesto Guevara, RN, is a Compliance and Performance Improvement Officer, Special Health Resources, Longview, Texas, USA. Wayne T. Steward, PhD, MPH, is a Professor of Medicine, Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
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Kotwal AA, Fuller SM, Myers JJ, Hill D, Tha SH, Smith AK, M Perissinotto C. A peer intervention reduces loneliness and improves social well-being in low-income older adults: A mixed-methods study. J Am Geriatr Soc 2021; 69:3365-3376. [PMID: 34449870 DOI: 10.1111/jgs.17450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/29/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence-based interventions addressing loneliness and social isolation are needed, including among low-income, community-dwelling older adults of diverse racial and ethnic backgrounds. Our objective was to assess the effect of a peer intervention in addressing loneliness, isolation, and behavioral health needs in this population. METHODS We conducted a mixed-method, two-year longitudinal study of a peer-outreach intervention in 74 low-income older adults recruited via an urban senior center in San Francisco. Structured participant surveys were conducted at baseline and every 6 months for up to 2 years. Outcomes included loneliness (3-item UCLA loneliness scale), social interaction (10-item Duke index), self-perceived socializing barriers (range: 0-10), and depression (PHQ-2 screen). Data were analyzed using mixed-effects linear and logistic regression adjusted for age and gender. Qualitative, semi-structured interviews with participants (N = 15) and peers (N = 6) were conducted in English and Spanish and analyzed thematically. RESULTS Participants were on average 71 years old (range: 59-96 years), with 58% male, 15% LGBT, 18% African American, 19% Latinx, 8% Asian, 86% living alone, and 36% with an ADL impairment. On average, 43 contact visits (IQR: 31-97 visits) between participants and peers occurred over the first year. Loneliness scores decreased by, on average, 0.8 points over 24 months (p = 0.015). Participants reported reduced depression (38%-16%, p < 0.001) and fewer barriers to socializing (1.5 fewer, p < 0.001). Because of the longitudinal relationship and matching of characteristics of peers to participants, participants reported strong feelings of kinship, motivations to reach out in other areas of life, and improved mood. CONCLUSION Diverse older adults in an urban setting participating in a longitudinal peer program experienced reduced loneliness, depression, and barriers to socializing. Matching by shared backgrounds facilitated rapport and bonding between participants and peers.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Shannon M Fuller
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Janet J Myers
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Daniel Hill
- Curry Senior Center, San Francisco, California, USA
| | - Soe Han Tha
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
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Koester KA, Saberi P, Fuller SM, Arnold EA, Steward WT. Attitudes about community pharmacy access to HIV prevention medications in California. J Am Pharm Assoc (2003) 2020; 60:e179-e183. [PMID: 32665097 DOI: 10.1016/j.japh.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP. METHODS We conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences. RESULTS We launched the study in October 2018 and interviewed pharmacists (n = 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n = 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n = 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions. CONCLUSION This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.
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Steward WT, Koester KA, Guzé MA, Kirby VB, Fuller SM, Moran ME, Botta EW, Gaffney S, Heath CD, Bromer S, Shade SB. Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study. PLoS Med 2020; 17:e1003079. [PMID: 32214312 PMCID: PMC7098549 DOI: 10.1371/journal.pmed.1003079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS). METHODS AND FINDINGS Data were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation. CONCLUSIONS In this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes.
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Affiliation(s)
- Wayne T. Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
- * E-mail:
| | - Kimberly A. Koester
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mary A. Guzé
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Valerie B. Kirby
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Shannon M. Fuller
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mary E. Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Emma Wilde Botta
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Stuart Gaffney
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Corliss D. Heath
- U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Steven Bromer
- Department of Family and Community Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Starley B. Shade
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco (UCSF), San Francisco, California, United States of America
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Arnold EA, Fuller SM, Martinez O, Lechuga J, Steward WT. Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse. PLoS One 2020; 15:e0229291. [PMID: 32069309 PMCID: PMC7028255 DOI: 10.1371/journal.pone.0229291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/03/2020] [Indexed: 01/20/2023] Open
Abstract
Changes in the United States federal-level political landscape have been felt within immigrant communities, and the public health clinics that serve them. We sought to document how HIV prevention and care clinics are reaching and retaining their immigrant community patients during a period of retrenchment of accessible public resources and immigrant rights. From May 2018 through January 2019, we conducted 20 in-depth interviews with clinicians, case workers, advocates, legal experts, and peer navigators in Northern and Central California. Interviews were recorded and transcribed. Several themes emerged which can be grouped into three primary areas: changes post-election, challenges meeting the needs of patients, and best practices for maintaining access to prevention and care services. Post-election, providers reported some of their patients skipping clinic appointments due to fear of Immigration and Customs Enforcement (ICE) raids and deportation while other patients had moved to locations that they felt were less policed. Challenges emerged around linguistic competency, meeting basic needs such as housing stability and employment, and treating mental health sequelae resulting from trauma experienced in home countries or during migration itself. Best practices included hiring bi-lingual and bi-cultural staff, linking to legal services to assist with immigration status, holding trainings around immigrant rights and responses to ICE raids, and building trust with immigrant patients by assuring them that their status would not be collected or reported. In light of adverse policy changes affecting immigrants, agencies have begun to institute best practices to mitigate the negative impact of those policies on their clients and patients.
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Affiliation(s)
- Emily A. Arnold
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Shannon M. Fuller
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Omar Martinez
- Department of Social Work, Temple University, Philadelphia, PA, United States of America
| | - Julia Lechuga
- Department of Public Health Sciences, University of Texas El Paso, El Paso, TX, United States of America
| | - Wayne T. Steward
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
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Fuller SM, Steward WT, Martinez O, Arnold EA. Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California. J Immigr Minor Health 2020; 22:212-215. [PMID: 31332651 PMCID: PMC10729648 DOI: 10.1007/s10903-019-00919-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical-legal partnerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations.
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Affiliation(s)
- Shannon M Fuller
- Division of Prevention Science, University of California San Francisco, 550 16th St., 3rd Floor, UCSF Mailcode 0886, San Francisco, CA, 94143, USA.
| | - Wayne T Steward
- Division of Prevention Science, University of California San Francisco, 550 16th St., 3rd Floor, UCSF Mailcode 0886, San Francisco, CA, 94143, USA
| | - Omar Martinez
- School of Social Work, Temple University, Ritter Annex, 505, Philadelphia, PA, 19122, USA
| | - Emily A Arnold
- Division of Prevention Science, University of California San Francisco, 550 16th St., 3rd Floor, UCSF Mailcode 0886, San Francisco, CA, 94143, USA
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Hufstedler HC, Dorsman KA, Rivera EJ, Lanata SC, Bogner JA, Corrigan JD, Fuller SM, Borja XR, Wilson F, Gardner RC. Linguistic and Cultural Acceptability of a Spanish Translation of the Ohio State University Traumatic Brain Injury Identification Method Among Community-Dwelling Spanish-Dominant Older Adults. Arch Rehabil Res Clin Transl 2019; 1:100020. [PMID: 33543051 PMCID: PMC7853324 DOI: 10.1016/j.arrct.2019.100020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Our objective was to (1) evaluate the linguistic and cultural acceptability of a Spanish translation of the Ohio State University traumatic brain injury identification method (OSU TBI-ID) and (2) to assess the usability and acceptability of a tablet-based version of this instrument in a cohort of Spanish-dominant older adults. Setting University clinical research center and local community center. Participants Community-dwelling Spanish-dominant adults age 50 years or older without dementia residing in the Bay Area of California (N=22). Design Cross-sectional cohort study. Main Outcome Measures Qualitative assessment of linguistic or cultural acceptability of a Spanish translation of the OSU TBI-ID as well as usability or acceptability of a tablet-based self-administered version of this instrument. Results The Spanish translation had high linguistic and cultural acceptability and was further optimized based on participant feedback. Cognitive interviews to review survey wording revealed high levels of homogeneity in the clinical definitions and synonyms given by participants—for example, results for the clinical term “Quedó Inconsciente/Pérdida (temporal) de la conciencia” (To be unconscious/[Temporary] loss of consciousness) used in the survey included “perder el conocimiento” (loss of consciousness), “knockeado” (knocked out), “No es que esté dormida, porque está inconsciente, pero su corazón está todavía palpitando” (it’s not that they’re sleeping, because they’re unconscious, but their heart is still palpitating). The tablet interface had low observer-based usability, revealing that participants with <13 years of education (n=6) had more difficulty using the tablet which could be improved with minor changes to the coding of the application and minimal in-person technology support. Acceptability of the tool was low among all but 1 participant. Conclusion This linguistically optimized Spanish translation of the OSU TBI-ID is recommended for use as a semistructured interview among Spanish-dominant older adults. Although the tablet-based instrument may be used by interviewers as an efficient electronic case report form among older adults, further research is needed, particularly among older adults with varying levels of education, to validate this instrument as a self-administered survey.
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Affiliation(s)
- Heather C Hufstedler
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Karen A Dorsman
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California.,Global Brain Health Institute, San Francisco, California
| | - Ernesto J Rivera
- Department of Neurosurgery, University of California, San Francisco, California
| | - Serggio C Lanata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California.,Global Brain Health Institute, San Francisco, California
| | - Jennifer A Bogner
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ohio State University, Columbus, Ohio
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ohio State University, Columbus, Ohio
| | - Shannon M Fuller
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Xochilt R Borja
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Raquel C Gardner
- Institute for Global Health Sciences, University of California, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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Fuller SM, Koester KA, Erguera XA, Wilde Botta E, von Beetzen F, Steward WT, Avery A. The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States. SAGE Open Med 2019; 7:2050312119842249. [PMID: 31044076 PMCID: PMC6446432 DOI: 10.1177/2050312119842249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: Collaborative care models may improve outcomes for both HIV and depression. The model includes routine screening and re-assessment of depressive symptoms as well as care coordination services delivered by an ancillary provider focused on mental health. We sought to explore patient experiences and attitudes about the services received through the collaborative care model, including measurement-based care using the Patient Health Questionnaire-9. Methods: We conducted 17 qualitative interviews with patients in a collaborative care model implemented at an HIV primary care clinic in a safety-net hospital in the United States. Interviews were analyzed using Framework Analysis. Results: Our findings illustrate the ways in which the collaborative care model for depression may be meaningful to patients in HIV care settings. Participants appreciated the support offered through the collaborative care model. Most participants perceived measurement-based care as useful to their providers, and an additional subset used the Patient Health Questionnaire-9 for their own self-management and awareness of depression. Over time, the collaborative care model appeared to motivate some patients to address depressive symptoms. Conclusion: The collaborative care model may be particularly helpful to patients in the way that it reinforces how depressive symptoms can be measured and managed. Furthermore, routine screening and re-measurement for depressive symptoms using the Patient Health Questionnaire-9 hold promise as an additional self-management tool to complement other clinical and supportive services.
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Affiliation(s)
- Shannon M Fuller
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly A Koester
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Xavier A Erguera
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Emma Wilde Botta
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Fredrik von Beetzen
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Wayne T Steward
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA.,Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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Fuller SM, Koester KA, Maiorana A, Steward WT, Broaddus MR, Lass K, Zamudio-Haas S, Quinlivan EB, Myers JJ. "I don't have to do this all by myself": Systems Navigation to Ensure Continuity of HIV Care for Persons Leaving Prison. AIDS Behav 2019; 23:14-24. [PMID: 29442194 DOI: 10.1007/s10461-018-2050-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ensuring continuity of and retention in care after release from prison is critical for optimizing health outcomes among people living with HIV. As part of a large federal initiative, we conducted qualitative interviews (n = 24) with individuals living with HIV and recently released from prison in four states to understand their experiences in different navigation interventions to improve access to HIV care post-release. Interventions were delivered only in prison, only in the community, or in both settings. While the interventions varied by design, overall, participants appreciated the breadth of support received from interventionists, including health system navigation, case management and social support. Even when individuals leaving prison were returning to clinics that they were familiar with, systems navigation supported continuity of care. Our findings elucidate why navigational support was instrumental, and underscore the value of a variety of types of navigation programs in facilitating continuity of care and reintegration post-prison.
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Steward WT, Koester KA, Fuller SM. Shaping the Patient-Centered Medical Home to the Needs of HIV Safety Net Patients: The Impact of Stigma and the Need for Trust. J Assoc Nurses AIDS Care 2018; 29:807-821. [PMID: 30017667 DOI: 10.1016/j.jana.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022]
Abstract
The patient-centered medical home (PCMH) is a promising model for increasing the efficiency and quality of HIV care. We evaluated the implementation of PCMH-related demonstration projects in HIV care settings serving safety net populations. We conducted 113 qualitative interviews with key informants and patients to understand which PCMH components were perceived as best meeting patient medical and support service needs. Our results demonstrate the value and limitations of the PCMH, as currently conceived, for HIV care settings. Clinics focused on modifying workflows and improving care coordination. Patients welcomed such changes because they reinforced existing trust in the providers. Clinics dedicated less attention to promoting patient activation, such as building self-management skills, because such changes were seen as duplicative or undermined existing practices to meet patient social support needs. Research should explore how components of the PCMH could be modified to more fully meet the needs of this patient population.
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Koester KA, Fuller SM, Maiorana A, Steward WT, Zamudio-Haas S, Xavier J, Safon C, Collins SP, Morin SF, Myers JJ. Implementing Multi-Level Interventions to Improve HIV Testing, Linkage-to-and Retention-in-Care Interventions. J Health Care Poor Underserved 2018; 27:1234-51. [PMID: 27524765 DOI: 10.1353/hpu.2016.0138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 2011, the Health Resources and Services Administration launched the Systems Linkage and Access to Care for Populations at High Risk of HIV Infection Initiative. Six state Departments of Health were funded to develop and implement HIV testing, linkage-to-care, and retention-in-care interventions over a four-year period. We conducted qualitative interviews with stakeholders (n = 68) involved in intervention development and/or implementation in order to characterize and compare the interventions; assess factors shaping the implementation of different interventions; and identify barriers to and facilitators of linkage and retention interventions. Our findings provide important lessons learned for achieving a more coordinated state-level response to the HIV epidemic.
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Fuller SM, Koester KA, Guinness RR, Steward WT. Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics. J Assoc Nurses AIDS Care 2016; 28:75-84. [PMID: 27712863 DOI: 10.1016/j.jana.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.
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Kim B, Ayran JC, Sagar SG, Adman ET, Fuller SM, Tran NH, Horrigan J. New human immunodeficiency virus, type 1 reverse transcriptase (HIV-1 RT) mutants with increased fidelity of DNA synthesis. Accuracy, template binding, and processivity. J Biol Chem 1999; 274:27666-73. [PMID: 10488107 DOI: 10.1074/jbc.274.39.27666] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infidelity of DNA synthesis by human immunodeficiency virus, type 1 reverse transcriptase (HIV-1 RT) is a presumptive determinant of HIV-1 hypervariability and is incompletely understood at the mechanistic and structural levels. Amino acid substitution at only three residues, including Asp-76 (Kim, B., Hathaway, T. R., and Loeb, L. A. (1996) Biochemistry 37, 5831-5839), is known to increase fidelity. We report here that substitution at Arg-78 can also increase accuracy. Mutant R78A RT showed reduced primer extension in misincorporation assays lacking a complementary dNTP and exhibited a 9-fold decrease in mutation frequency in the M13mp2 lacZ forward mutation assay. Previous structural studies indicate that Arg-78 and Asp-76 lie in a region that interacts with template nucleotides. Interestingly, R78A RT exhibited 6- to 8-fold decreases in binding affinity (K(d)) for RNA and DNA templates relative to wild type RT. In contrast, D76V RT, which also increases fidelity (Kim et al., 1996), showed a 6- to 7-fold increased affinity. The processivity of R78A RT on both RNA and DNA templates was substantially reduced relative to wild type RT, whereas the processivity of D76V RT was increased. We discuss relationships of fidelity, template binding, and processivity in these and other HIV RT mutants.
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Affiliation(s)
- B Kim
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York 14642, USA.
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Abstract
Cocaine dependent patients (n = 27) with and without concurrent alcohol dependence disorder were compared on measures of substance use, addiction severity (ASI), coping, and psychopathology taken before, during, and after outpatient relapse prevention treatment for cocaine dependence. At pre-treatment, the cocaine-alcohol (CA) group reported more frequent alcohol use, and more severe alcohol and family/social problems compared to the cocaine-only (CO) group. By the end of treatment, both groups reported significantly fewer days of alcohol and cocaine use, with sustained reductions observed at 24 weeks following treatment. On most of the addiction severity and psychiatric symptomatology scales, results indicated overall improvement as a function of time, however scores remained relatively 'worse' in the CA group. Implication of these findings and the need for specific programming in the treatment of dual drug use are explored.
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Affiliation(s)
- J M Schmitz
- Substance Abuse Research Center, Department of Psychiatry and Behavioral Sciences, Houston, Texas 77030, USA
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Fuller SM, McDermott RJ, Roetzheim RG, Marty PJ. Breast cancer beliefs of women participating in a television-promoted mammography screening project. Public Health Rep 1992; 107:682-90. [PMID: 1454981 PMCID: PMC1403721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A survey of breast cancer and breast cancer screening beliefs was mailed to a random sample of 1,000 women who contacted a telephone bank in response to a television-promoted, reduced-cost mammography project. Beliefs and demographics of women in the sample who subsequently completed a mammogram were compared with those who did not. No statistically significant differences were found between participants (persons who completed a mammogram) and nonparticipants with respect to age, race, marital status, income, or educational preparation. Groups also did not differ significantly in the series of beliefs examined. Factor analysis revealed respondents' most salient beliefs about breast cancer and early detection of breast cancer. Evidence is presented to suggest a need for enhanced efforts to recruit minority group women to participate in mammography screening.
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Affiliation(s)
- S M Fuller
- Department of Community and Family Health, University of South Florida College of Public Health, Tampa
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Hennessey JF, Harrison KL, Fuller SM, Gutteridge BH, Wordsworth BA. Establishment of a visiting provincial in vitro fertilization (IVF) service. J In Vitro Fert Embryo Transf 1989; 6:117-9. [PMID: 2723505 DOI: 10.1007/bf01130739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J F Hennessey
- Queensland Fertility Group, St. Andrews Hospital, Brisbane, Australia
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Cummins JM, Breen TM, Fuller SM, Harrison KL, Wilson LM, Hennessey JF, Shaw JM, Shaw G. Comparison of two media in a human in vitro fertilization program: lack of significant differences in pregnancy rate. J In Vitro Fert Embryo Transf 1986; 3:326-30. [PMID: 3783015 DOI: 10.1007/bf01133394] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ramirez G, Chen M, Boyce HW, Fuller SM, Ganguly R, Brueggemeyer CD, Butcher DE. Longitudinal follow-up of chronic hemodialysis patients without vitamin supplementation. Kidney Int 1986; 30:99-106. [PMID: 3747349 DOI: 10.1038/ki.1986.157] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vitamin supplementation for dialysis patients is still controversial. In our study, we followed longitudinally over a period of a year, 15 patients on chronic hemodialysis who were deprived of vitamin supplementation. Microbiological assays were used to determine the levels of five vitamins of the B group (folate, niacin, B12, B6, and thiamine). Vitamin C was measured chemically. During the observation period when vitamins were not supplemented, a marked drop of many of these vitamins in blood levels were encountered. For vitamins B12 and C, the plasma levels remained within the normal range in all the subjects studied. For the other vitamins, the blood levels were found to be low in a few patients. Our data suggest that vitamin supplementation is probably not needed in most stable hemodialysis patients as it is recommended now, and that perhaps, if supplementation is indicated, less should be given than is presently prescribed. Further research is needed in this area.
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Ramirez G, Chen M, Boyce HW, Fuller SM, Butcher DE, Brueggemeyer CD, Newton JL. The plasma and red cell vitamin B levels of chronic hemodialysis patients: a longitudinal study. Nephron Clin Pract 1986; 42:41-6. [PMID: 3941749 DOI: 10.1159/000183631] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Plasma B12, folate, B6 and thiamine, and red blood cell folate, thiamine and niacin levels were monitored for a period of 6 months in 15 clinically stable, chronic hemodialysis patients who were not supplemented with the water-soluble vitamins. Microbiological assays were used to determine the blood levels of the water-soluble vitamins. Over the period of 6 months, none of the patients had plasma or red cell vitamin levels below the normal range. No appreciable changes were observed in the plasma and red blood cell vitamin levels before and after dialysis in 5 patients. This study showed that chronic hemodialysis patients are able to maintain normal plasma and red cell levels of some water-soluble vitamins without daily supplementation.
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