Showing papers by "Carol E. Golin published in 2008"
TL;DR: The relationship between minority status and adherence was not fully explained by patient-level factors and future studies should consider conceptualizing minority status as a contextual factor rather than predictor.
Abstract: Objective: Although discriminatory health care experiences and health care provider distrust have been shown to be associated with health care disparities, little is known about their contribution to racial/ethnic disparities in antiretroviral therapy adherence. We therefore sought to assess the extent to which discriminatory health care experiences and health care provider distrust influence treatmentrelated attitudes, beliefs, and self-reported adherence in a national sample of HIV-infected patients. Study Design: This secondary analysis used data from the HIV Cost and Services Utilization Study. We used structural equation modeling to identify pathways from minority status to adherence through discrimination, distrust, and treatment-related attitudes and beliefs. Participants: The sample was the 1886 participants who completed the baseline and 2 follow-up interviews and were prescribed antiretroviral therapy at the second follow-up interview (54% white, 28% black, 14% Hispanic, and 3% others). Results: Minorities were less likely to report perfect adherence than whites (40% vs. 50%, P # 0.001). Over one third (40%) of all participants reporting ever having discriminatory health care experiences since having HIV, and 24% did not completely or almost completely trust their health care providers. The effect of minority status on adherence persisted in the full model. More discrimination predicted greater distrust, weaker treatment benefit beliefs, and, in turn, poorer adherence. Distrust affected adherence by increasing treatment-related psychological distress and weakening treatment benefit beliefs. Conclusions: The relationship between minority status and adherence was not fully explained by patient-level factors. Future studies should consider conceptualizing minority status as a contextual factor rather than predictor.
105 citations
TL;DR: The project demonstrated that with only brief training, HIV medical providers successfully conducted an HIV prevention intervention with their clinic patients, and indicated that clinics that serve HIV patients can incorporate such programs as standard of care.
Abstract: We conducted a demonstration project to design, implement, and evaluate a risk-reduction intervention delivered by medical providers to patients with HIV during routine care in 2005 and 2006. Medical providers at seven HIV clinics in the United States received training to deliver an intervention in which they screened patients for behavioral risks, gave targeted counseling, and delivered prevention messages. A longitudinal cohort (n = 767) of patients completed a baseline questionnaire and two follow-up questionnaires (6-month intervals) after the intervention was initiated. Logistic regression and generalized estimating equations (GEE) methods were used in analyses. The cohort had a median age of 41, was 58% black, 28% white, and 10% Hispanic; 32% were women and 42% self-identified as men who have sex with men. The 3-month prevalence of unprotected anal or vaginal intercourse (UAVI) with any partners declined significantly (p < 0.001) from baseline (42%) to follow-up (26% at first follow-up, 23%...
52 citations
TL;DR: Providers’ concern about HIV transmission among their patients was high but did not “translate into action” in the form of counseling, and they anticipated poor outcomes from counseling, including harm to patient–provider relationships, and failure of patients to change their behavior.
Abstract: Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counseling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counseling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers’ beliefs about their patients’ HIV transmission behaviors, expected outcomes of conducting HIV prevention counseling, and perceived barriers and facilitators to counseling. Providers’ concern about HIV transmission among their patients was high but did not “translate into action” in the form of counseling. They anticipated poor outcomes from counseling, including harm to patient–provider relationships, and failure of patients to change their behavior. They also listed barriers and facilitators to counseling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based “Prevention with Positives” programs are discussed.
27 citations
TL;DR: When prospective SES-related confounding factors are matched across comparison communities, PSA IDM interventions can be shown to promote IDM.
26 citations
TL;DR: Residents appropriately used life expectancy and health state to make colon cancer screening recommendations for older adults, and residents reported substantial uncertainty with regard to the potential benefit of screening.
Abstract: Background. Colon cancer screening recommendations for patients aged 75 years and older should account for variation in older adults' health states, life expectancies, and potential to benefit from...
23 citations
29 Feb 2008
1 citations
TL;DR: Understanding exactly how alcohol consumption may be related to medication nonadherence among patients could inform the development of effective interventions to improve adherence and ultimately health outcomes.
Abstract: In this issue, Bryson and colleagues report a direct, dose-related association between alcohol misuse and medication nonadherence for antihypertensives and statins but not oral hypoglycemics. This ...
1 citations
31 Aug 2008
1 citations