Showing papers in "Aids Patient Care and Stds in 2008"

Common Mental Disorders among HIV-Infected Individuals in South Africa: Prevalence, Predictors, and Validation of Brief Psychiatric Rating Scales

Abstract: Despite the high prevalence of both mental disorders and HIV infection in much of sub-Saharan Africa, little is known about the occurrence of mental health disorders among HIV-infected individuals. We conducted a cross-sectional study among individuals enrolled into HIV care and treatment services near Cape Town, South Africa. Psychiatric diagnoses were measured using the Mini-International Neuropsychiatric Interview (MINI) administered by trained research nurses. In addition, all participants were administered brief rating scales for depression (the Center for Epidemiological Studies Depression Scale [CES-D]), posttraumatic stress disorder (PTSD), the Harvard Trauma Questionnaire (HTQ), and alcohol dependence/abuse (the Alcohol Use Disorders Identification Test [AUDIT]). The median age among the 465 participants was 33 years and 75% were female; 48% were receiving antiretroviral therapy. Overall, the prevalence of depression, PTSD and alcohol dependence/abuse was 14% (n = 62), 5% (n = 24), and 7...

HIV stigma and social support among African Americans.

Abstract: HIV-related stigma and discrimination negatively impact African Americans living with HIV. Social support theory hypothesizes that social support can serve to protect individuals against the negative effects of stressors, such as discrimination, by leading them to interpret stressful occasions less negatively. This study sought to examine the relationship between perceived social support and perceived HIV stigma among HIV-positive African Americans. A cross-sectional convenience sample of 283 HIV-positive African Americans was recruited from three social service agencies. Bivariate and multivariate regressions were used to determine the variables predicting perceived HIV stigma. The study participants were found to have a wide variety of opinions concerning perceived HIV stigma. Of the three different sources of perceived social support examined (from family, friends and a “special person”), only perceived social support from friends was found to be related to perceived HIV stigma when controlling for the presence of other relevant factors. High perceived social support from friends was associated with less perceived HIV stigma. Other factors associated with low perceived HIV stigma included a lack of current symptoms of major depression, a longer time since HIV diagnosis and higher education. Information about the beneficial effects of perceived social support from friends and other factors can help to provide guidance to those working to decrease the negative impact of HIV stigma among HIV-positive African Americans.

The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals.

Abstract: Information regarding the prevalence of mental illness and substance use among HIV-infected patients and the effect of these problems on HIV treatment is needed. We conducted an observational study of patients in the University of Washington (UW) HIV Cohort to determine prevalence rates for mental illness and substance use. Cox regression analyses were used to examine the relationship between mental illness and substance use, pharmacologic treatment for depression/anxiety, and initiation of highly active antiretroviral therapy (HAART) within 9 months of becoming eligible for HAART. Among 1774 patients in the UW HIV cohort during 2004, 63% had a mental illness (including mood, anxiety, psychotic, or personality disorders), 45% had a substance use disorder, and 38% had both. There were 278 patients who met criteria for HAART eligibility. After controlling for other factors, patients with depression and/or anxiety were significantly less likely to initiate HAART compared with patients without a ment...

Tenofovir-Associated Fanconi Syndrome: Review of the FDA Adverse Event Reporting System

Abstract: Tenofovir disoproxil fumarate (TDF) is a commonly used HIV antiretroviral. A relatively uncommon adverse effect of this drug is Fanconi syndrome. What is known about this toxicity, especially in regards to concomitant medication use and outcomes, is limited to isolated case reports and small case series. Therefore, a retrospective review of the FDA Adverse Event Reporting System from 2001 through 2006 was conducted to examine demographics, concomitant medication use, outcomes, and temporal trends in reporting of Fanconi syndrome associated with TDF use. In this large case series of 164 subjects who met the case definition for Fanconi syndrome, the majority (83%) of the subjects received protease inhibitors (PI) with TDF; specifically, 74% of the total received a ritonavir-boosted PI. Didanosine was the most commonly (43%) prescribed nucleoside reverse transcriptase inhibitor (NRTI). The combination of didanosine with boosted PI was frequently observed (34%), and in particular, didanosine plus lopinavir/ritonavir was documented for 22%. Nearly half (46%) of the total were hospitalized. Fracture (2%) and requirement for dialysis (2%) were infrequent while Fanconi syndrome contributed to death in 2% of these subjects. Patients receiving ritonavir-boosted protease inhibitors or didanosine with tenofovir should be closely monitored for development of nephrotoxicity. Although reporting biases and the exclusion of reports with serious confounding conditions likely affected the estimation of outcomes in this case series, severe complications of tenofovir-associated Fanconi syndrome were uncommon.

Obesity among patients with HIV: the latest epidemic.

Abstract: Since the advent of highly active antiretroviral therapy (HAART), studies have been conflicting regarding weight information among patients with HIV. We performed a retrospective study among male patients with HIV between June 2004 and June 2005 at two large U.S. Navy HIV clinics to describe the prevalence and factors associated with being overweight/obese. Rates of obesity/overweight among HIV-positive patients were also compared to data from HIV-negative military personnel. Of the 661 HIV-infected patients, 419 (63%) were overweight/obese and only 5 (1%) were underweight. Patients with HIV had a mean age of 41.0 years (range, 20-73 years) and were racially diverse. The prevalence rates of being overweight/obese at the last visit were similar among both HIV-positive and -negative military members. Being overweight/obese at the last clinic visit was associated with gaining weight during the course of HIV infection (10.4 versus 4.0 pounds, p < 0.001), hypertension (36% versus 23%, p = 0.001), low high-density lipoprotein (HDL; 40% versus 31%, p < 0.001), and a higher CD4 cell count at last visit (592 versus 499 cells/mm(3), p < 0.001). These data demonstrate that patients with HIV in the HAART era are commonly overweight and/or obese with rates similar to the general population. Being overweight/obese is associated with hypertension and dyslipidemia. Weight assessment and management programs should be a part of routine HIV clinical care.

Factors affecting disclosure in South African HIV-positive pregnant women.

Abstract: To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20–4.47), prior discussion about testing (AOR 4.19; CI 2.34–7.49), having a partner with tertiary education (AOR 2.76; CI 1.29–5.88) and less experience of violence (AOR 0.48; CI 0.24–0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (...

The Relationship of Post-traumatic Stress Disorder and Depression to Antiretroviral Medication Adherence in Persons with HIV

Abstract: In HIV/AIDS, symptoms of depression or post-traumatic stress may interfere with important self-care behaviors such as the ability to adhere to one's medical treatment regimen. However, these problems may frequently go undetected in HIV care settings. The present study used brief self-report screening measures of depression and post-traumatic stress disorder (PTSD) in the HIV/AIDS care settings to examine (1) frequency of positive screens for these diagnoses; (2) the degree to which those with a positive screen were prescribed antidepressant treatment; and (3) the association of continuous PTSD and depression symptom scores, and categorical (screening positive or negative) PTSD and depression screening status, to each other and to ART adherence as assessed by the Medication Event Monitoring System, regardless of antidepressant treatment. Participants were 164 HIV-infected individuals who took part in a multisite adherence intervention study in HIV treatment settings in Massachusetts. Available dat...

Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize.

Abstract: This study, conducted from August to September 2007, utilized a population-based survey to investigate stigmatizing attitudes and acts of discrimination against HIV/AIDS patients among doctors and nurses working in public hospitals in Belize. A total of 230 subjects (81.0%) completed the survey. The mean age was 36.8 years; 75% were women; 61% were nurses; 74% were Belizean. Stigmatization was greatest for "attitudes of blame/judgment"; disclosing a patient's HIV/AIDS status to colleagues was the most frequent act of discrimination (29%). Formal HIV/AIDS training was significantly associated with less stigmatization for "attitudes towards imposed measures" (p < .01); "attitudes of blame/judgment" (p < 0.05); and testing without consent (p < 0.05). Doctors showed more stigmatization in "attitudes towards imposed measures," conducted HIV tests without consent and disclosed patient status to colleagues more frequently than nurses (p < 0.05) while nurses gave differential care to patients based on HIV status more frequently (p < 0.01) than doctors. Female and religious health care workers (HCWs) were more stigmatizing in their "attitudes of blame/judgment" than male and nonreligious HCWs (p < 0.05). Cuban HCWs were more stigmatizing in their "attitudes toward imposed measures" and were less comfortable dealing with HIV/AIDS patients than their Belizean counterparts (p < 0.01). Older age was associated with less frequent disclosure of patients' HIV status (p < 0.05). HIV/AIDS training that incorporates stigma reduction strategies tailored to the target groups identified is needed. Additionally, we recommend that the effectiveness of national HIV/AIDS policies be investigated.

Stressful Life Events and Adherence in HIV

Abstract: Because medication adherence is critical to improving the virologic and immunologic response to therapy and reducing the risk of drug resistance, it is important that we understand the predictors of nonadherence. The goal of the current study is to examine demographic, health behavior and psychosocial correlates (e.g., stressful life events, depressive symptoms) of nonadherence among a sample of HIV infected men and women from one south Florida metropolitan area. We collected questionnaire data from on 105 HIV infected men and women who were taking antiretroviral medication during the years 2004 to 2007. In this sample, 44.8% had missed a medication dose in the past 2 weeks, and 22.1% had missed their medication during the previous weekend. Those with three or more stressful life events in the previous 6 months were 2.5 to more than 3 times as likely to be nonadherent (in the past 2 weeks and previous weekend, respectively) compared to those without such events. Fully 86.7% of those with six or m...

Review: Thromboses among HIV-Infected Patients during the Highly Active Antiretroviral Therapy Era

Abstract: Venous thrombotic events (VTEs) may occur at higher rates among patients with HIV; some studies suggest that highly active antiretroviral therapy (HAART) may increase the risk for these potentially life-threatening events. We performed a retrospective study among patients with HIV to evaluate the incidence and risk factors for VTEs during the HAART era. A literature review was performed examining VTEs in the pre- and post-HAART eras. Seventeen (3.7%) of 465 patients with HIV experienced a VTE. The overall incidence rate of deep VTEs among HIV-positive persons was 377 cases per 100,000 person-years, a fourfold higher rate compared to age-matched males in the general population. The median age at VTE was 36 years (range, 27-68). Patients with a thrombosis compared to those without had significantly lower current CD4 (153 versus 520 cells/mm(3), p < 0.001) and nadir (76 versus 276 cells/mm(3), p < 0.001) CD4 counts, higher viral loads (3.6 versus 1.7 log(10) copies per milliliter, p = 0.003), and more likely to have a diagnosis of AIDS (76% versus 32%, p < 0.001); there were no differences in demographics, hyperlipidemia, current use of HAART, the duration of HAART or protease inhibitor (PI) exposure. A review of the literature noted 129 VTE cases; mean age was 40 years, mean CD4 count was 181 cells/mm(3), the majority of patients were not receiving HAART, and the most common risk factor was an ongoing infection. Thrombotic events are occurring among patients with HIV despite their relatively young ages. Advanced HIV disease is a risk factor for development of thromboses, possibly due to an increased inflammatory state or the presence of concurrent comorbidities such as infections. HAART or PI therapy does not appear to play a significant role in the occurrence of VTEs.

Health-Related Quality of Life in HIV-Infected Patients: The Role of Substance Use

Abstract: HIV infection and substance use disorders are chronic diseases with complex contributions to health-related quality of life (HRQOL). We conducted a cross-sectional survey of 951 HIV-infected adults receiving care at 14 HIV Research Network sites in 2003 to estimate associations between HRQOL and specific substance use among HIV-infected patients. HRQOL was assessed by multi-item measures of physical and role functioning, general health, pain, energy, positive affect, anxiety, and depression. Mental and physical summary scales were developed by factor analysis. We used linear regression to estimate adjusted associations between HRQOL and current illicit use of marijuana, analgesics, heroin, amphetamines, cocaine, sedatives, inhalants, hazardous/binge alcohol, and drug use severity. Current illicit drug use was reported by 37% of subjects. Mental HRQOL was reduced for current users [adjusted β coefficient −9.66, 95% confidence interval [(CI]) −13.4, −5.94] but not former users compared with never u...

A Brief HIV Stigma Reduction Intervention for Service Providers in China

Abstract: This study assessed the effect of a brief intervention aimed at reducing HIV-related stigma among service providers in China. From December 2005 to June 2006, 138 service providers from four county hospitals in the Yunnan province of China were randomly assigned into either an intervention or a control condition. HIV stigma reduction concepts were conveyed through participatory small group activities, including role-plays, games, group discussions, and testimony by an HIV advocate. Participants were assessed at baseline before the intervention, and at 3- and 6-month follow-ups. Data were analyzed using a logistic regression mixed-effects model. Service providers in the brief intervention condition were significantly more likely to report better protection of patients' confidentiality and right to HIV testing, lower levels of negative feelings toward people living with HIV/AIDS, and more accurate understanding and practice of universal precautions. This brief intervention pilot showed potential in reducing HIV stigma and discrimination among service providers in China. Further intervention trials are needed to test the efficacy and long-term outcomes of this intervention.

Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast.

Abstract: Alcohol and drug use are common among HIV-infected patients and are important determinants of secondary transmission risk and medication adherence. As part of the Coping with HIV/AIDS in the Southeast (CHASE) Study, 611 HIV-infected patients were consecutively recruited from eight clinical care sites in five southeastern U.S. states in 2001–2002. We examined the distribution and predictors of alcohol and drug use in this sample with an emphasis on psychosocial predictors of use. In the prior 9 months, 27% of participants drank alcohol and 7% drank to intoxication at least weekly. The most common drugs used at least weekly were marijuana (12%) and crack (5%); 11% used a non-marijuana drug. 7% reported polysubstance use (use of multiple substances at one time) at least weekly. Injection drug use was rare (2% injected at least once in the past 9 months). There were few differences in alcohol and drug use across sociodemographic characteristics. Stronger adaptive coping strategies were the most consi...

Adherence to Antiretroviral Therapy among Older Children and Adolescents with HIV: A Qualitative Study of Psychosocial Contexts

Abstract: Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10–16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest chil...

Diagnostic value of different adherence measures using electronic monitoring and virologic failure as reference standards.

Abstract: Nonadherence to antiretroviral therapy is a substantial problem in HIV and jeopardizes the success of treatment. Accurate measurement of nonadherence is therefore imperative for good clinical management but no gold standard has been agreed on yet. In a single-center prospective study nonadherence was assessed by electronic monitoring: percentage of doses missed and drug holidays and by three self reports: (1) a visual analogue scale (VAS): percentage of overall doses taken; (2) the Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ): percentage of overall doses missed and drug holidays and (3) the European HIV Treatment Questionnaire (EHTQ): percentage of doses missed and drug holidays for each antiretroviral drug separately. Virologic failure prospectively assessed during 1 year, and electronic monitoring were used as reference standards. Using virologic failure as reference standard, the best results were for (1) the SHCS-AQ after electronic monitoring (sensitivity, 87.5%; specificity, 78.6%); (2) electronic monitoring (sensitivity, 75%; specificity, 85.6%), and (3) the VAS combined with the SHCS-AQ before electronic monitoring (sensitivity, 87.5%; specificity, 58.6%). The sensitivity of the complex EHTQ was less than 50%. Asking simple questions about doses taken or missed is more sensitive than complex questioning about each drug separately. Combining the VAS with the SHCS-AQ seems a feasible nonadherence measure for daily clinical practice. Self-reports perform better after electronic monitoring: their diagnostic value could be lower when given independently.

Asymptomatic Sexually Transmitted Infections in HIV-Infected Men Who Have Sex with Men: Prevalence, Incidence, Predictors, and Screening Strategies

Abstract: Sexually transmitted infections (STIs) have increased among men who have sex with men (MSM) and are associated with unsafe sex practices, intrinsic morbidity, and enhanced genital shedding and transmission of HIV. Screening for asymptomatic STIs is recommended as part of the HIV prevention efforts, however, optimal screening strategies among HIV-infected MSM have not been well defined. In this study, conducted from April 2004 to September 2006, 212 HIV-infected MSM from two urban HIV clinics were screened for asymptomatic STIs. Testing for Neisseria gonorrhea and Chlamydia trachomatis from pharynx, rectum, and urine, as well as serologic testing for syphilis were performed initially, and then after 6 and 12 months. A self-administered questionnaire was used to assess possible predictors of incident asymptomatic STIs. A cost analysis was performed to assess different screening strategies for detecting incident STIs. The baseline prevalence of STIs was 14% (n = 29; 95% confidence interval [CI] 9%–1...

Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort.

Abstract: Roll-out of antiretroviral treatment (ART) raises concerns about the potential for unprotected sex if sexual activity increases with well-being, resulting in continued HIV spread. Beliefs about reduced risk for HIV transmission with ART may also influence behavior. From September 2003 to November 2004, 234 adults enrolled in a trial assessing the efficacy of modified directly observed therapy in improving adherence to ART. Unsafe sexual behavior (unprotected sex with an HIV-negative or unknown status partner) before starting ART and 12 months thereafter was compared. Participants were a mean 37.2 years (standard deviation [SD] = 7.9 years) and 64% (149/234) were female. Nearly half (107/225) were sexually active in the 12 months prior to ART, the majority (96/107) reporting one sexual partner. Unsafe sex was reported by half of those sexually active in the 12 months before ART (54/107), while after 12 months ART, this reduced to 28% (30/107). Unsafe sex was associated with nondisclosure of HIV status to partner; recent HIV diagnosis; not being married or cohabiting; stigma; depression and body mass index <18.5 kg/m(2). ART beliefs, adherence, and viral suppression were not associated with unsafe sex. After adjusting for gender and stigma, unsafe sex was 0.59 times less likely after 12 months ART than before initiation (95% confidence interval [CI] = 0.37-0.94; p = 0.026). In conclusion, although risky sexual behaviors had decreased, a considerable portion do not practice safe sex. Beliefs about ART's effect on transmission, viral load, and adherence appear not to influence sexual behavior but require long-term surveillance. Positive prevention interventions for those receiving ART must reinforce safer sex practices and partner disclosure.

Use of Electronic Reminder Devices to Improve Adherence to Antiretroviral Therapy: A Systematic Review

Abstract: Adherence to prescribed antiretroviral therapy (ART) is one of the strongest predictors of progression to AIDS and death among people living with HIV/AIDS Incorrect or inconsistent adherence to ART compromises the effectiveness of medications in achieving viral suppression The objective of this review is to systematically and critically appraise existing evidence on the use of electronic reminder devices (ERDs) to improve adherence to ART among people living with HIV/AIDS Twelve electronic databases not limited by language or nationality were systematically searched using a combination of relevant search criteria through early August 2007 Primary outcomes of interest were level of adherence and virologic or immunologic response Ten intervention studies, 5 qualitative studies, and 6 unpublished studies presented in conference abstracts were included Methodological limitations across the 15 published studies precluded meta-analysis Evidence that patient adherence to ART was significantly imp

Self-Reported adherence to antiretroviral treatment among HIV-infected people in Central China.

Abstract: Although the number of patients receiving antiretroviral (ARV) therapy in Central China is expanding, little is known about their medication adherence. The purpose of this study was to: (1) describ...

Letter to the Editor: Responding to the Human Resource Crisis: Peer Health Workers, Mobile Phones, and HIV Care in Rakai, Uganda.

Abstract: Dear Editor: Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations1 We read with interest the modeling study by Barnighausen et al which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA)2 The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda In May 2006, the RHSP ART program recruited and trained nineteen PHWs These PHWs are persons living with HIV themselves and receiving care through the program Each PHW was assigned approximately 15–20 patients with whom they would typically conduct biweekly home visits At visits, PHWs documented a review of symptoms (headache, fever, etc), a missed pills by self-report, and a pill count, along with providing adherence counseling, health education, and social support Documentation was returned to higher-trained providers for review and triage PHWs were supplied bikes, identifying t-shirts, and compensation for part-time employment Over a 6-month pilot period, PHWs completed documentation on 3,642 home visits (approximately 75 visits per PHW per week) Nine PHWs were additionally trained to use mobile phones to send real-time text messages containing clinical and adherence data to higher-trained providers for review and triage These texts were numeric codes produced by converting home visit data, eg, yes=1, no=0 PHWs could also place calls to a central toll-free clinic phone with any concerns Due to limited electrical power, a lead-acid battery system was used to charge phones All technology used was available in-country These nine PHWs successfully sent 1,177 text messages (approximately 5 per PHW per week) over the pilot period PHWs also made 101 calls to the central clinic over the study period, mostly for guidance on illnesses, urgent care needs, and concerns about drug side effects A Likert scale (1–5, 1=strongly agree, 5=strongly disagree) survey administered to 39 PEPFAR clinical staff (response rate = 100%) found 44% (17/39) strongly agreed and 56% (22/39) agreed that the PHW and mobile phone intervention had improved the overall health of patients; 20% (8/39) strongly agreed and 49% (19/39) agreed it had improved patient adherence Direct per PHW program startup costs were approximately $115 USD with monthly maintenance costs approximately $15 USD The mobile phone intervention per PHW startup costs were an additional $100 USD with monthly maintenance costs of approximately $10 USD We found that a simple and inexpensive clinical and adherence monitoring intervention leveraging PHWs empowered with mobile phones could be successfully implemented in a rural RLS PHWs are currently an underutilized resource which may provide one solution to increasing HRHA3 As the numbers of potential PHWs are inherently related to the prevalence of HIV, these individuals represent a flexible and sustainable work force that is unlikely to emigrate and able to remain proportional in size to the epidemic This PHW work force can concentrate its efforts on monitoring and supporting patients on ART, while the limited number of more highly trained health workers (eg, nurses and clinical and medical officers) can focus their time on more clinically demanding tasks Further operations research is needed to better understand PHW effects on HIV care outcomes, which responsibilities are appropriate to task-shift to PHWs, determine acceptable training and evaluation standards, assess cost-effectiveness, and evaluate the sustainability of PHW-based programs A unique aspect to our PHW program was the use of a mobile phone intervention as a simple support strategy The mobile phones allowed us to use local technology to improve communications between PHWs and higher-level providers in a rural setting with poor transport infrastructure Mobile phone coverage has rapidly expanded in Africa and other RLSs over the past several years, providing opportunities such as this one to creatively use this tool to improve health care by optimizing the way care is organized and delivered4–6 Addressing the HRHA limitations will require a multifaceted and sustained approach A valuable and vital component to this approach involves people living with HIV themselves Interventions utilizing PHWs and mobile phone technology may offer one practical strategy for expanding and improving HIV care in environments with limited health workers and infrastructure

Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men.

Abstract: The relationships between coping strategies, goal adjustment, and symptoms of depression and anxiety were studied in 104 HIV-positive men who have sex with men, in December 2006. The mean age of the respondents was 50 years, and almost were of Dutch nationality. On average people had known about their HIV-positive status for 10 years and the majority was on HIV-medication. The Cognitive Emotion Regulation Questionnaire, COPE, the Goal Obstruction Questionnaire, and the Hospital Anxiety and Depression Scale were filled out at home. Pearson correlations and Hierarchical Regression Analyses were performed. The findings suggested that cognitive coping strategies had a stronger influence on well-being than the behavioral coping strategies: positive refocusing, positive reappraisal, putting into perspective, catastrophizing, and other-blame were all significantly related to symptoms of depression and anxiety. In addition, withdrawing effort and commitment from unattainable goals, and reengaging in alternative meaningful goals, in case that preexisting goals can no longer be reached, seemed to be a fruitful way to cope with being HIV positive. These findings suggest that intervention programs for people with HIV should pay attention to both cognitive coping strategies and goal adjustment.

Growth in HIV-infected children receiving antiretroviral therapy at a pediatric infectious diseases clinic in Uganda.

Abstract: Antiretroviral therapy (ART) improves growth and survival of HIV-infected individuals. We designed a retrospective cohort study to assess clinical factors associated with growth in HIV-infected children on ART in Uganda between July 2003 and March 2006. Height and weight measurements taken pre- and post-ART initiation for at least 6 months were age- and gender-standardized to CDC 2000 reference. We analyzed medical records of 749 children receiving ART. Descriptive and logistic regression analyses were conducted to identify covariates associated with risk of either stunting or being underweight. Longitudinal regression analysis with a mixed model using autoregressive covariance structure was used to compare change in height and weight before and after initiation of ART. The mean age of the study population at first visit was 7.5 years. Mean height-for-age, weight-for-age, and weight-for-height percentiles at first visit were 8.6, 7.7, and 7.9, respectively. At last visit mean height-for-age, weig...

Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing Department of Public Health mobile van services: implications for intervention development.

Abstract: Polysubstance use has been posited to be a significant contributor to excess burden of HIV disease among men who have sex with men (MSM) The current study investigated polysubstance use and sexual risk among men who utilize Massachusetts Department of Public Health (MDPH) van services (such as HIV, chlamydia, gonorrhea, or syphilis testing; Hepatitis A and B vaccinations) at venues targeting MSM Participants (n = 214) completed a one-time, cross-sectional survey via an audio computer-assisted self-interview (ACASI) in English or Spanish between June 2007 and September 2007 Fifteen percent of the overall sample did not know their HIV status; 11% reported polysubstance use (concurrent use of three or more: poppers, ecstasy, GHB, cocaine, crystal methamphetamine, Viagra) during sex in the 12 months prior to study enrollment Polysubstance users were more likely to be HIV infected (odds ratio [OR] = 462; p = 003) and to have a history of one or more sexually transmitted diseases (STDs; OR = 474; p = 003) relative to participants who did not report polysubstance use during sex After controlling for covariates of age, race/ethnicity, education level, insurance status, sexual orientation, STD history, HIV status, and depression, multivariable logistic regression analyses revealed that polysubstance users were 9 times more likely to have reported unprotected anal (insertive or receptive) sex in the 12 months prior to study enrollment (adjusted OR = 953; p = 0007) compared to nonpolysubstance-using MSM Polysubstance users lacked access to care (21% were uninsured) and the overwhelming majority (96%) were first time users of mobile health van services Accessible outreach services for MSM such as mobile van services need to include drug screening and interventions that triage men into treatment programs; year-round availability of van services is warranted

Family experiences with pediatric antiretroviral therapy: responsibilities, barriers, and strategies for remembering medications.

Abstract: This study examines the relationship between adherence to pediatric HIV regimens and three family experience factors: (1) regimen responsibility; (2) barriers to adherence; and (3) strategies for remembering to give medications Caregivers of 127 children ages 2–15 years in the PACTS-HOPE multisite study were interviewed Seventy-six percent of caregivers reported that their children were adherent (taking ≥ 90% of prescribed doses within the prior 6 months) Most caregivers reported taking primary responsibility for medication-related activities (72%–95% across activities); caregivers with primary responsibility for calling to obtain refills (95%) were more likely to have adherent children More than half of caregivers reported experiencing one or more adherence barriers (59%) Caregivers who reported more barriers were also more likely to report having non-adherent children Individual barriers associated with nonadherence included forgetting, changes in routine, being too busy, and child refusa

Networks of Older New Yorkers with HIV: Fragility, Resilience, and Transformation

Abstract: To better understand how HIV-infected older persons receive and perceive social support, the perceptions and experiences of 34 older HIV-positive persons in New York City were explored in July and August 2005 through five focus groups. The participants' network members tended to be HIV positive and the presence of so many people with HIV in their networks tended to be serendipitous. The advantages of having a HIV-positive network include being members of a caring community that provides safety, support, mentors, and inspiration, while the disadvantage is shrinkage of the network due to illness and death. These participants demonstrated that living with HIV changes one's network because people die of HIV; new friends are made when one seeks services; and HIV-positive networks replace those lost through stigma and rejection. Social service providers and policy makers in the HIV and aging networks should expand their view of "family" and not make assumptions about the networks for older persons living with HIV. Networks expand and shrink at different times and are resilient and fragile at the same time.

Spectrum of adverse events after generic HAART in southern Indian HIV-infected patients.

Abstract: To determine the incidence of clinically significant adverse events after long-term, fixed-dose, generic highly active antiretroviral therapy (HAART) use among HIV-infected individuals in ...

High-density lipoprotein cholesterol in HIV-infected patients: evidence for an association with HIV-1 viral load, antiretroviral therapy status, and regimen composition.

Abstract: Low high-density lipoprotein-cholesterol (HDL-C) levels have been associated with cardiovascular risk in non-HIV populations. Limited information exists on the prevalence of low HDL-C in HIV- infected patients and related factors remain largely unknown. The aims of this study were to estimate the prevalence and characteristics of low HDL-C levels in HIV-infected patients. A cross-sectional study was performed in consecutive HIV-infected patients cared for in an outpatient HIV clinic on the Mediterranean coast of Spain during a 2-month period (September 15, 2003 to November 15, 2003). HDL-C levels below 40 mg/dL were considered low. We analyzed data from 219 patients, 167 of whom were on antiretroviral therapy. The majority (45.20 %) were on non-nucleoside reverse transcriptase inhibitors (NNRTI); 22.83 % were on treatment with protease inhibitors. The prevalence of low HDL-C levels was 44.74 % (98 of 219 patients). In multivariate analysis, hypertriglyceridemia (triglycerides >150 mg/dL; odds rat...

Patients' attitudes about rapid oral HIV screening in an urban, free dental clinic.

Abstract: The 2006 Centers for Disease Control recommendations for routine HIV screening in all health care settings could include dental clinics an important testing venue. However, little is known about patients' attitudes regarding the routine use of rapid oral HIV screening at an urban free dental clinic. This pilot study seeks to evaluate the patient perspective on rapid HIV screening in this setting. In June 2007, patients at a free dental clinic in Kansas City, Missouri, were provided an attitude assessment survey prior to their dental visit. This dental clinic serves a diverse patient population consisting of approximately 37% white, 47% black, 6% Hispanic, 4% Asian, and 1% Native American uninsured patients. Results were analyzed for acceptance of testing and potential barriers. Of the 150 respondents, 73% reported they would be willing to take a free rapid HIV screening test during their dental visit. Overall, 91% of Hispanics, 79% of Caucasians, and 73% of African American patients reported they would be willing to be screened. Patients with a history of multiple prior screening tests for HIV were more likely to agree to oral rapid HIV screening in the dental clinic. The majority (62%) reported that it did not matter who provided them with the screening result, although some (37%) preferred their dentist above any other provider. Low self-perception of risk (37%) and having already received screening elsewhere (24%) were the main reasons for not accepting a free, rapid HIV screening. Overall, dental clinic patients widely accepted the offer of rapid oral HIV screening. Rapid HIV screening in the dental clinic setting is a viable option to increase the number of individuals who know their HIV status.

Analysis of HIV Medication Adherence in Relation to Person and Treatment Characteristics Using Hierarchical Linear Modeling

Abstract: The purpose of this investigation was to consider person characteristics, treatment level variables, and illicit drug use to help explain the HIV antiviral adherence patterns of a community-based, non-drug-treatment-seeking sample of men who have sex with men (MSM). Adherence data were gathered for 300 MSM eight times over the course of 1 year using electronic monitoring. Treatment and person level characteristics were assessed at baseline assessment using computer-administered surveys, and drug usage was established via a diagnostic inventory. These longitudinal data were analyzed via Hierarchical Linear Modeling. The sample was diverse in terms of age and race/ethnicity. Across the span of the year in which the participants were assessed, adherence rates were relatively stable and high (means: 82% to 90%) at each time point and remained relatively stable across the yearlong investigation. Lower adherence rates were evident among those who were drug users, black identified (in terms of race), older, and by pill burden. Individuals on HIV antiretroviral therapy demonstrated consistent although not optimal adherence rates when assessed during the course of a year. The significance of numerous person level factors such as age, race, and drug use suggest that adherence to treatment may in part be impacted by the circumstances that the individual brings to the treatment behavior, and suggests interventions that delve beyond the behavioral to consider and address life social and intrapersonal circumstances that may interfere with adherence behaviors.

Implementation and Evaluation of a Clinic-Based Behavioral Intervention: Positive Steps for Patients with HIV

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%...