Showing papers by "Jane M. Simoni published in 2009"

Alcohol use and antiretroviral adherence: review and meta-analysis.

Abstract: Background:Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by a

Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial.

Abstract: Objective: To determine the relative efficacy of peer support and pager messaging strategies versus usual care to improve medication adherence and clinical outcomes among HIV-positive outpatients initiating or switching to a new highly active antiretroviral therapy regimen. Design: A 2 × 2 factorial randomized controlled trial of a 3-month intervention with computer-assisted self-interviews and blood draws administered at baseline, 3, 6, and 9 months. Methods: HIV-positive patients at a public HIV specialty clinic in Seattle, WA (N = 224) were randomly assigned to peer support, pager messaging, both strategies, or usual care. The main outcomes were adherence according to self-report and electronic drug monitoring, CD4 count, and HIV-1 RNA viral load. Results: Intent-to-treat analyses suggested the peer intervention was associated with greater self-reported adherence at immediate postintervention. However, these effects were not maintained at follow-up assessment; nor were there significant differences in biological outcomes. The pager intervention, on the other hand, was not associated with greater adherence but was associated with improved biological outcomes at postintervention that were sustained at follow-up. Conclusions: Analyses indicate the potential efficacy of peer support and pager messaging to promote antiretroviral adherence and biological outcomes, respectively. More potent strategies still are needed.

Ecological models of sexual satisfaction among lesbian/bisexual and heterosexual women.

Abstract: Sexual satisfaction is an integral component of sexual health and well-being, yet we know little about which factors contribute to it among lesbian/bisexual women. To examine a proposed ecological model of sexual satisfaction, we conducted an internet survey of married heterosexual women and lesbian/bisexual women in committed same-sex relationships. Structural equation modeling included five final latent variables for heterosexual women and seven final latent variables for lesbian/bisexual women. Overall, results indicated that, for both groups of women, a similar constellation of factors (depressive symptoms, relationship satisfaction, sexual functioning, and social support) was related to sexual satisfaction. In lesbian/bisexual women, internalized homophobia was an additional factor. Contrary to expectations, the presence of children in the home and a history of childhood sexual abuse did not contribute significantly to the model for either group. Findings support the idea that gender socialization may influence sexual satisfaction more than socialization around sexual orientation. Additionally, given that for both groups of women relationship satisfaction explained a substantial amount of variance in sexual satisfaction, sexual concerns may be better addressed at the relationship than the individual level.

Decolonizing strategies for mentoring American Indians and Alaska Natives in HIV and mental health research.

Abstract: American Indian and Alaska Native (AIAN) scholars in the fields of mental health and HIV face formidable barriers to scientific success. These include justifiable mistrust of historically oppressive educational systems, educational disparities, role burdens within academe, the devaluation and marginalization of their research interests, and outright discrimination. Research partners can work to dismantle these barriers by embracing indigenous worldviews, engaging in collaborative research partnerships, building research capacity within universities and tribal communities, changing reward systems, and developing mentoring programs. At the individual level, aspiring AIAN scholars must build coalitions, reject internalized colonial messages, and utilize indigenous ethical frames. The creation of a cadre of AIAN researchers is crucial to improving the health of AIAN peoples.

Discussion and revision of the mathematical modeling tool described in the previously published article "Modeling HIV Transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy".

Abstract: Mathematical models are increasingly used in social and behavioral studies of HIV transmission; however, model structures must be chosen carefully to best answer the question at hand and conclusions must be interpreted cautiously. In Pearson et al. (2007), we presented a simple analytically tractable deterministic model to estimate the number of secondary HIV infections stemming from a population of HIV-positive Mozambicans and to evaluate how the estimate would change under different treatment and behavioral scenarios. In a subsequent application of the model with a different data set, we observed that the model produced an unduly conservative estimate of the number of new HIV-1 infections. In this brief report, our first aim is to describe a revision of the model to correct for this underestimation. Specifically, we recommend adjusting the population-level sexually transmitted infection (STI) parameters to be applicable to the individual-level model specification by accounting for the proportion of individuals uninfected with an STI. In applying the revised model to the original data, we noted an estimated 40 infections/1000 HIV-positive persons per year (versus the original 23 infections/1000 HIV-positive persons per year). In addition, the revised model estimated that highly active antiretroviral therapy (HAART) along with syphilis and herpes simplex virus type 2 (HSV-2) treatments combined could reduce HIV-1 transmission by 72% (versus 86% according to the original model). The second aim of this report is to discuss the advantages and disadvantages of mathematical models in the field and the implications of model interpretation. We caution that simple models should be used for heuristic purposes only. Since these models do not account for heterogeneity in the population and significantly simplify HIV transmission dynamics, they should be used to describe general characteristics of the epidemic and demonstrate the importance or sensitivity of parameters in the model.