Lessons Learned from “Integrating” Intensive Family-based Interventions into Medical Care Settings for Mothers Living with HIV/AIDS and their Adolescent Children

Centers for Disease Control and Prevention (CDC) has recommended integrating behavioral interventions into medical care settings for persons living with HIV. Delivering an intensive, family-based intervention for mothers living with HIV (MLH) (n = 173) and their adolescent children (n = 116) integrated into medical care was problematic. Despite the fact that nearly half of MLH were recruited at HIV/AIDS clinics, community centers and children’s hospitals were the most popular and most successful sites for the delivery of the intervention. We provide recommendations for how to integrate intensive interventions into medical care, given the needs of MLH, their adolescents, and the organizations serving them.     

Prevalence and Characteristics of Clients with Co‐Occurring Disorders in Outpatient Substance Abuse Treatment

This article reports on the prevalence of probable mental health disorders among clients entering outpatient substance abuse treatment, their clinical characteristics, and past access to substance abuse and mental health care. Four hundred fifteen individuals (74% of those eligible) entering three publicly funded outpatient substance abuse treatment facilities in Los Angeles County were screened for a probable mental health disorder. Of the 210 with a positive screener (just over 50% of those screened), 195 (93%) were interviewed. Depression and anxiety were the most common disorders, and more than a third had two or more probable disorders. Close to 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. Our results indicate high rates of co‐occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access.     

Effectiveness of Long‐Term Residential Substance Abuse Treatment for Women: Findings from Three National Studies

The effectiveness of residential substance abuse treatment for women was examined using data from the Center for Substance Abuse Treatment's Residential Women and Children/Pregnant and Postpartum Women (RWC/PPW) Cross‐Site Study and two other recent national studies. Treatment success was defined as posttreatment abstinence from further drug or alcohol use, measured through in‐person follow‐up interviews conducted 6–12 months after each client's discharge. Despite differences in treatment programs, client profiles, follow‐up intervals, data collection methods, and other factors, all three studies found high treatment success rates—ranging narrowly from 68% to 71% abstinent—among women who spent six months or more in treatment. Success rates were lower, and between‐study differences were larger, for clients with shorter stays in treatment. Controlling for salient client and treatment project characteristics, strong associations between length of stay in treatment and posttreatment abstinence rate were found in all three studies, suggesting that women's length of stay in residential treatment is a major determinant of treatment effectiveness. In further analysis of RWC/PPW data, treatment completion was also found to be an important outcome factor. Among clients who remained in treatment for at least three months, those who achieved their treatment goals in three to five months abstinence outcomes were as good as those for clients who took more than six months to complete their treatment (76%–78% abstinent) and substantially better than those for clients who did not complete treatment (51%–52% abstinent). Notably, however, most of the RWC/PPW clients who successfully completed treatment (71%) required six months or more to do so.     

NIDA’s Clinical Trials Network: An Opportunity for HIV Research in Community Substance Abuse Treatment Programs

Background/Objectives: HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. Results: While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. Conclusion/Significance: While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.     

U.S. Congregations’ Provision of Programs or Activities for People Living with HIV/AIDS

Using data from a nationally representative sample of U.S. congregations, this study estimates the proportion of congregations that provide programs or activities that serve people living with HIV/AIDS (PLWHA) and examines the effects of congregational characteristics on the likelihood of having them. The analysis finds that 5.6% (95% confidence interval [CI], 0.034–0.078) of U.S. congregations (roughly 18,500 (95% CI, 11,300–25,800) congregations) provide programs or activities to PLWHA. Numerous congregational characteristics increase the likelihood that congregations provide them: the presence of openly HIV positive people in the congregation, having a group that assesses their community’s needs, religious tradition, and openness to gays and lesbians. By building on previous research, this study provides further information about the scope of religious congregations’ involvement with PLWHA and also insight into which congregations may be willing to collaborate with other organizations to provide care for PLWHA.     

Once‐Daily Inhaled Budesonide for the Treatment of Asthma: Clinical Evidence and Pharmacokinetic Explanation

Background. Budesonide, a widely used inhaled corticosteroid (ICS) with a favorable therapeutic ratio, is available via a dry powder inhaler (Pulmicort Turbuhaler®) and as a suspension for nebulization (Pulmicort Respules®). Methods. MEDLINE and an AstraZeneca database were searched to identify relevant controlled clinical trials published between 1986 and 2002 using the key words budesonide OR inhaled corticosteroid, AND once daily. Results. Thirty‐four controlled clinical studies involving once‐daily administration of budesonide to asthmatic patients were identified. Excluding long‐term studies, this review presents data from 23 controlled studies for 4466 adults or adolescents and 1532 children with asthma and demonstrates efficacy of budesonide in both corticosteroid‐naïve patients and patients previously treated with ICS. Once‐daily administration of budesonide achieves clinical efficacy comparable with that of twice‐daily regimens in patients with mild‐to‐moderate asthma and is equally effective when given in the morning or evening. Once‐daily administration simplifies treatment regimens and may improve patient compliance. The tolerability profiles of budesonide once‐daily via Turbuhaler® or as budesonide inhalation suspension are good and comparable with those for twice‐daily dosing. Conclusions. Once‐daily budesonide is effective and well tolerated as initial treatment for adults and children with mild asthma and as maintenance therapy in patients with more severe asthma once asthma control has been achieved.     

Older People Living with HIV/AIDS (OPLWHA) in Lomẻ, Togo: Personal Networks and Disclosure of Serostatus

Purpose

Abstract Increase in the number of people living with HIV/AIDS (PLWHA) who are on antiretroviral treatments in low-income countries has led to a rise in the population of older people living with HIV/AIDS (OPLWHA). This study uses a mixed methods approach to examine the personal network of OPLWHA and disclosure of their positive serostatus in Lomé, Togo.

Design and Methods

Data were collected on 49 OPLWHA through an egocentric model and in-depth interviews. Five name generators were used to gather information on personal networks of the OPLWHA and disclosure.

Results

Overall, the networks of OPLWHA in Lom? are small. The size of the network of people from whom OPLWHA could borrow an important sum of money was extremely low (0.55). Also, there was a variation in disclosure rates by network types. Furthermore, three major themes related to reasons for non-disclosure of positive serostatus emerged from the data: fear of consequences of disclosure, protection of loved ones, and not knowing how to disclose.

Implications

The OPLWHA in our study have less support to tap into, especially economic support. Policy makers should bear in mind the precarious situation of OPLWHA in order to develop programs that will aid OPLWHA. Furthermore, service providers should be aware of the fact that some female OPLWHA do not know how to disclose their seorstatus to potential intimate partners and thus teach women who wish to be sexually active ways to disclose their HIV positive status, because sexuality is beneficial for the physical and emotional well-being of older people.     

Self-reported Health and Personal Social Networks of Older People Living with HIV/AIDS in Lomé, Togo

Personal social networks and their association with the health of older people have been explored, but there are few studies that examined the relationship between the general health of older people living with HIV/AIDS (OPLWHA) and their personal social networks. This exploratory study investigates the characteristics of personal networks among OPLWHA and the relationship between the self-rated health and personal social networks of OPLWHA in Lomé, Togo. Forty-nine OPLWHA were interviewed via an egocentric survey. We examined the composition and size of the networks of OPLWHA. Also, the correlation between networks and self-reported health was examined. Findings show that the OPLWHA had personal social networks that included three types of people: immediate kin, extended kin, and non-kin. Additionally, these networks varied by size. While the mean number of people in the smaller network (people from whom the OPLWHA can borrow an important sum of money) was less than one person (0.55), the mean number of people in the larger network was three (people with whom the OPLWHA enjoy socializing). Furthermore, only the network of people with whom OPLWHA enjoy socializing had a significant positive correlation on the self-rated health of OPLWHA. Consistent with prior research, we found that the mere existence of a network does not imply that the network has a positive correlation with the subject or that the network provides the social support needed to positively influence health. A study of the correlation between social network characteristics and health in the population of older people with HIV/AIDS is important as the number of OPLWHA continues to grow.     

Stigmatization of AIDS Patients: Disentangling Thai Nursing Students’ Attitudes Towards HIV/AIDS, Drug Use, and Commercial Sex

This paper analyzes the interrelationships between the stigma of HIV/AIDS stigma and the co-stigmas of commercial sex (CS) and injecting drug use (IDU). Students of a Bangkok nursing college (N = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, CS, blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes towards the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed. The scales used in this study can be made available to the reader upon request.     

Patient–provider interaction,patient satisfaction,and health outcomes: testing explanatory models for people living with HIV/AIDS

In the era of highly active antiretroviral therapy era, medication adherence and health-related quality of life (HRQOL) have become critical issues for people living with HIV/AIDS (PLWH). The purpose of this study was to test explanatory models of how patient–provider interaction and patient satisfaction are related to medication adherence and HRQOL for PLWH. A total of 344 PLWH receiving health-care services from a federally funded clinic in the southwest USA completed a survey questionnaire about their perception of interactions with providers, their satisfaction with services, their medication adherence, and their HRQOL. Comparing four latent variable structural equation models of direct and mediated effects of patient–provider interaction and patient satisfaction, the findings illustrate that the best model is one in which patient–provider interaction has a direct and positive effect on patient satisfaction, medication adherence, and HRQOL. These findings suggest that quality patient–provider interaction is a critical element of health-care services for PLWH, while patient satisfaction is an outcome measure and not a mediating factor for medication adherence and HRQOL.     

Sexual and reproductive health services for people living with HIV/AIDS in Germany: are we up to the challenge?

Purpose

Germany is witnessing an increase in the number of new infections with human immunodeficiency virus (HIV). Enabling persons living with HIV (PLHIV) to adopt safer sex practices might contribute towards reducing the incidence of HIV infections. The aim of this study was to identify gaps in the sexual and reproductive health (SRH) services provided to PLHIV in Germany.

Methods

Within the framework of the European public health project Eurosupport 5, self-reported questionnaires were distributed to PLHIV and a survey of SRH-service providers was carried out. The completed questionnaires and survey results were analysed.

Results

Of the questionnaires distributed, 218 PLHIV (90 % men, 10 % women) returned a completed questionnaire. Of these, 74 % self-identified as men having sex with men (MSM) and 13 % as heterosexual men. MSM reported a median number of ten casual partners in the previous 6 months and unprotected sex in one-third of anal intercourses with casual partners, demonstrating that this group adopted more risky sexual behaviours than heterosexual PLHIV. Even though all PLHIV stated they would appreciate more support and service providers indicated that they provided a wide range of SRH services, SRH-relevant topics were rarely discussed between PLHIV and service providers. According to the patients’ perception, shortage of time, lack of initiative by service providers and their own difficulty to address SRH-related topics were the most relevant obstacles to receiving satisfactory support.

Conclusion

Many PLHIV consult their HIV-physician regularly for medical follow-up and also indicate that HIV-physicians should be the source of information concerning SRH counselling. HIV-physicians should take advantage of their key role in HIV care and strengthen their efforts to integrate SRH services in routine HIV care.     

Efficacy of a new model for delivering integrated TB and HIV services for people living with HIV/AIDS in Delhi – case for a paradigm shift in national HIV/TB cross-referral strategy

Under National TB/HIV framework, all TB patients are referred by Revised National Tuberculosis Programme (RNTCP) service providers to Integrated Counseling and Testing Centers (ICTCs) for voluntary counseling and testing (C&T) and ICTC “TB-suspects” are referred to RNTCP facilities for TB diagnosis and treatment. HIV–TB coinfected patients are then referred to Anti Retroviral Treatment (ART) center for initiation of ART between two weeks and two months of initiating TB treatment. During the third phase of National AIDS Control Programme (NACP-III, April 2007–April 2012), 30749/130503 (23.6%) TB/HIV cross-referrals were lost to follow up (LTFU) and there was missed opportunity for 940/1884 (49.9%) HIV–TB coinfected patients for initiation of ART during TB treatment. This motivated Delhi State AIDS Control Society (DSACS) and State TB Cell (STC) to revise existing cross-referral strategy. The new strategy was launched in May 2012, wherein HIV–TB coinfected and HIV-positive “TB-suspects” were referred to nearest ART center for HIV care and investigations of TB at Chest Clinic/Designated Microscopy Centre (DMC) located within the same hospital instead of referral to area RNTCP facility. Outcome of the strategy was evaluated in March 2013. The new HIV–TB cross-referral strategy in Delhi has shown advantage over national strategy: first, improved retention of coinfected clients in HIV care; second, ensured timely initiation of TB-treatment and ART; and third, significantly improved survival of HIV–TB coinfected patients.     

Sexual behaviour of women living with HIV/AIDS naïve for antiretroviral therapy: the ICONA-BEHEPI Study

This study describes the sexual behaviours of women living with HIV, and assesses differences by history of drug use. Its general aim is to contribute in the design of programmes to help people with HIV/AIDS (PWH/A) adopt and maintain safe sexual behaviours. A self-administered questionnaire on sexual and drug use behaviours was distributed to study participants. Between 1997 and 1999, 573 women with HIV infection naive to antiretroviral therapies completed the questionnaire (of whom 234 reported a history of injection drug use (IDU) and were enrolled in the study. Non-IDU women reported fewer sexual partners, both in their lifetime and in the preceding month, than IDU women: 19% of IDU and 4% of non-IDU women reported more than 25 lifetime sexual partners (p < 0.001). Interestingly, 83% of non-IDU women were infected by their regular partners: these women reported the lowest number of sexual partners. No difference emerged between IDU and non-IDU women in terms of number of sexual intercourse in the two weeks preceding the interview or in terms of condom use in the last intercourse (reported, overall, by 54% of these 573 women). Among women who had sex partners at the time of interview, more non-IDU (65%) than IDU (43%) women reported HIV-positive partners (p < 0.001). Overall, these findings stress a marked heterogeneity in the levels of past and recent sexual promiscuity according to history of drug use. It suggests the need to differentiate and individualize messages about self-protection and behaviours that may prevent further spread of HIV infection.     

Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: prevention of and care for people with HIV/AIDS

In September 2002, an armed conflict erupted in C?te d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the 'Forces Armées des Forces Nouvelles' (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west C?te d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment.     

‘When I get better I will do the test’: Facilitators and barriers to HIV testing in Northwest Region of Cameroon with implications for TB and HIV/AIDS control programmes

The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counselling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one's status inspired by the anticipated support from loved ones, faith in a supreme being, influence and trust in the medical authority, encouraged HIV testing. Men also demonstrated their masculinity by testing, thus portraying themselves as positive role models for other men. Meanwhile, the overwhelming burden of facing both TB and HIV simultaneously, influenced by the fear of disclosure of results, harmful gender norms and practices, fear of stigma and discrimination, and misconceptions surrounding HIV/AIDS deterred HIV testing. However, as a result of conflicting emotional experiences regarding to test or not to test, the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients.     

Knowledge of Maternal HIV/AIDS and Child Adjustment: The Moderating Role of Children’s Relationships with their Mothers

The current study examined whether child-reported maternal warmth and support moderated the association between knowledge of maternal illness and child psychosocial adjustment among 86 low-income, African American mothers with HIV/AIDS and their non-infected children. Mother–child relationship quality moderated the association between children’s knowledge of maternal HIV/AIDS and children’s externalizing, but not internalizing, difficulties. Consistent with the stress-buffering hypothesis, a warm and supportive mother–child relationship afforded a more robust buffer against externalizing difficulties for children who knew of their mother’s illness than for children who did not. Clinical implications and future directions are discussed.