Outcomes from a Group Intervention for Coping with HIV/AIDS and Childhood Sexual Abuse: Reductions in Traumatic Stress

Childhood sexual abuse is common among HIV-infected persons, though few empirically supported treatments addressing sexual abuse are available for men and women with HIV/AIDS. This study reports the outcome from a randomized controlled trial of a group intervention for coping with HIV and sexual abuse. A diverse sample of 202 HIV-positive men and women who were sexually abused as children was randomly assigned to one of three conditions: a 15-session HIV and trauma coping group intervention, a 15-session support group comparison condition, or a waitlist control (later randomly assigned to an intervention condition). Traumatic stress symptoms were assessed at baseline and post-intervention, with analysis conducted for the three-condition comparison followed by analysis of the two-condition comparison between the coping and support group interventions. Participants in the coping group intervention exhibited reductions in intrusive traumatic stress symptoms compared to the waitlist condition and in avoidant traumatic stress symptoms compared to the support group condition. No differences were found between the support group intervention and waitlist conditions. Tests of clinical significance documented the meaningfulness of change in symptoms.     

Effects of behavioral intervention on substance use among people living with HIV: the Healthy Living Project randomized controlled study

AIM: Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). DESIGN, SETTING AND PARTICIPANTS: A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. INTERVENTION: A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. MEASUREMENTS: An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. FINDINGS: Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. CONCLUSIONS: A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.     

Alcohol use and non‐adherence to antiretroviral therapy in HIV‐infected patients in West Africa

Aim To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)‐infected patients in subSaharan Africa. Design and setting Cross‐sectional survey conducted in eight adult HIV treatment centres from Benin, Côte d'Ivoire and Mali. Participants and measurements During a 4‐week period, health workers administered the Alcohol Use Disorders Identification Test to HAART‐treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow‐up questionnaire. Findings A total of 2920 patients were enrolled with a median age of 38 years [interquartile range (IQR) 32–45 years] and a median duration on HAART of 3 years (IQR 1–4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non‐adherence was associated with current drinking [odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1–2.0], hazardous drinking (OR 4.7; 95% CI 2.6–8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5–0.9). Conclusions Alcohol consumption and hazardous drinking is associated with non‐adherence to HAART among HIV‐infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking.     

Effects of comorbid substance use disorders on outcomes in a Housing First intervention for homeless people with mental illness

Background and Aims

Evidence supports the effectiveness of Housing First (HF) programmes for people who are experiencing homelessness and mental illness; however, questions remain about its use in people with comorbid substance use disorders (SUD). The aim of this project was to test whether SUD modifies the effectiveness of an HF intervention.

Design

Secondary analysis of data from a randomized controlled trial of HF versus treatment‐as‐usual (TAU) with 24‐month follow‐up, comparing those with and without SUD at trial entry.

Setting

Vancouver, Toronto, Winnipeg, Moncton and Montreal, Canada.

Participants

A total of 2154 participants recruited from 2009 to 2013 and randomized to HF versus TAU (67% male, mean age 40.8 ± 11.2, 25% ethno‐cultural minority). All were homeless and had a mental disorder at baseline; 35% reported symptoms consistent with SUD.

Intervention

Housing paired with Intensive Case Management or Assertive Community Treatment.

Measurements

Primary outcomes were days housed and community functioning. Secondary outcomes were general and health‐related quality of life and mental health symptoms. Predictors were SUD status crossed with intervention group (HF versus TAU).

Findings

People with SUD in both the HF and TAU groups spent less time in stable housing, but the effect of HF did not vary by SUD status [odds ratio (OR) = 1.17, 95% confidence interval (CI) = ?0.77, 1.76]. Similarly, there was no difference between those with and without SUD in the effect of HF (over TAU) on community functioning (b = 0.75, 95% CI = ?0.36, 1.87), quality of life (b = ?1.27, 95% CI = ?4.17, 1.63), health‐related quality of life (b = ?0.01, 95% CI = ?0.03, 0.02) or mental health symptoms (b = 0.43, 95% CI = ?0.99, 1.86).

Conclusions

Housing First programs in Canada are equally effective in people with and without comorbid substance use disorder (SUD). Overall, the intervention appears to be able to engage people with SUD and is reasonably successful at housing them, without housing being contingent upon abstinence or treatment.     

Evaluation of an evidence-based intervention implemented with African-American women to prevent substance abuse,strengthen relationship skills and reduce risk for HIV/AIDS

African-American females in the U.S. are disproportionately affected by HIV/AIDS, and a large majority of new infections in this population are attributed to heterosexual contact. Risk factors include substance abuse, lack of knowledge about male partners’ possible HIV infection risk, incarceration, disruptions of social networks, and intimate partner violence. This study assessed the effects of a comprehensive, evidence-based prevention intervention, Creating Lasting Family Connections (CLFC) that was implemented with sensitivity to African-American females, using a quasi-experimental design. The CLFC program was implemented with 175 women and their results were compared to a convenience sample of 44 women who were similar on background characteristics. Results showed significant (p?相似文献   

Unreported alcohol use was common but did not impact hepatitis C cure in HIV‐infected persons who use drugs

We investigated the prevalence and impact of heavy alcohol use on the hepatitis C virus (HCV) care continuum amongst HIV/HCV co‐infected persons who use drugs. In the CHAMPS study, 144 HIV/HCV co‐infected persons were randomized to contingent cash incentives, peer mentors and usual care to evaluate the impact on HCV care. Alcohol use was ascertained using the 10‐item AUDIT (hazardous: male ≥8, female ≥4) and phosphatidylethanol (PEth) (heavy: ≥50 ng/mL), an alcohol biomarker. Log binomial regression was used to evaluate the association between heavy alcohol use and failure to initiate treatment and to achieve sustained virologic response (SVR). Of the 135 participants with PEth data, median age was 55 years, 59% were male, 92% were Black, 91% reported a history of drug use, and 97% were on antiretroviral therapy. Hazardous drinking was reported on AUDIT by 28% of participants, and 35% had heavy alcohol use by PEth. Of the 47 individuals with a PEth ≥50 ng/mL, 23 (49%) reported no or minimal alcohol use by AUDIT. HCV treatment was initiated in 103 of 135 participants, and SVR was achieved in 92%. PEth ≥50 ng/mL (Relative Risk [RR] 0.72, 95% CI 0.35‐1.48) was not significantly associated with failure to initiate HCV treatment or failure to achieve SVR (RR 0.85, 95% CI 0.46‐1.57).In conclusion, alcohol use was common and frequently not detected by self‐report. However, heavy alcohol use, even when measured objectively, was not associated with failure to initiate HCV treatment or to achieve cure.     

Impact of injecting drug use on mortality in Danish HIV‐infected patients: a nation‐wide population‐based cohort study

Objectives To estimate the impact of injecting drug use (IDU) on mortality in HIV‐infected patients in the highly active antiretroviral therapy (HAART) era. Design Population‐based, nation‐wide prospective cohort study in Denmark (the Danish HIV Cohort Study). Methods A total of 4578 HIV‐infected patients were followed from 1 January 1997 or date of HIV diagnosis. We calculated mortality rates stratified on IDU. One‐, 5‐ and 10‐year survival probabilities were estimated by Kaplan–Meier methods, and Cox regression analyses were used to estimate mortality rate ratios (MRR). Results Of the patients, 484 (10.6%) were categorized as IDUs and 4094 (89.4%) as non‐IDUs. IDUs were more likely to be women, Caucasian, hepatitis C virus (HCV) co‐infected and younger at baseline; 753 patients died during observation (206 IDUs and 547 non‐IDUs). The estimated 10‐year survival probabilities were 53.2% [95% confidence interval (CI): 48.1–58.3] in the IDU group and 82.1% (95% CI: 80.7–83.6) in the non‐IDU group. IDU as route of HIV infection more than tripled the mortality in HIV‐infected patients (MRR: 3.2; 95% CI: 2.7–3.8). Adjusting for potential confounders did not change this estimate substantially. The risk of HIV‐related death was not increased in IDUs compared to non‐IDUs (MRR 1.1; 95% CI 0.7–1.7). Conclusions Although Denmark's health care system is tax paid and antiretroviral therapy is provided free of charge, HIV‐infected IDUs still suffer from substantially increased mortality in the HAART era. The increased risk of death seems to be non‐HIV‐related and is due probably to the well‐known risk factors associated with intravenous drug abuse.     

Predictors and correlates of reduced frequency or cessation of injection drug use during a randomized HIV prevention intervention trial

Aims This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi‐site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users. Design and Setting A six‐session, cognitive–behavioral skills‐building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time‐equivalent attention control. Follow‐up interviews were conducted at 3 and 6 months post‐baseline. Participants Trial participants were HIV and hepatitis C virus (HCV) antibody‐negative injection drug users aged 15–30 years. Participants who had at least one follow‐up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n = 690). Measurements At each interview, data were collected on the number of times participants injected drugs over the previous 3 months. Findings Twenty‐seven per cent of participants reported at least one 3‐month period of injection cessation. In a multivariate, zero‐inflated negative binomial regression adjusting for prior injection frequency, time of follow‐up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject. Conclusions HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.     

Gender moderates the influence of psychosocial factors and drug use on HAART adherence in the context of HIV and childhood sexual abuse

This study aimed to examine gender moderation within a stress and coping model of HIV medication adherence in adults with a history of childhood sexual abuse (CSA). Sequelae of CSA, including negative coping, psychological distress, and drug use, interfere with adherence to highly active antiretroviral treatment (HAART). These obstacles to adherence are likely moderated by gender. Gender may particularly influence the mediational effect of drug use on adherence. Participants included 206 adults living with HIV/AIDS and CSA. Categorical/continuous variable methodology in a structural equation modeling framework was used to test a multigroup model with women and men. Gender significantly moderated several effects in the model. For women, the effect of psychological distress on HAART adherence was mediated by drug use and the effect of drug use on viral load was mediated by HAART adherence. Among men, drug use did not significantly impact adherence. Since gender appears to moderate the effect of drug use on medication adherence, it is particularly important to address drug use within the context of HIV disease management in women with a history of CSA. Further, interventions to increase HAART adherence should take trauma history, gender, and drug abuse into account when assessing efficacy.     

Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment

Aim We examined the association of substance abuse treatment with uptake, adherence and virological response to highly active antiretroviral therapy (HAART) among HIV‐infected people with a history of alcohol problems. Design Prospective cohort study. Methods A standardized questionnaire was administered to 349 HIV‐infected participants with a history of alcohol problems regarding demographics, substance use, use of substance abuse treatment and uptake of and adherence to HAART. These subjects were followed every 6 months for up to seven occasions. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half‐way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; or participation in any methadone maintenance program. Our outcome variables were uptake of antiretroviral therapy, 30‐day self‐reported adherence and HIV viral load suppression. Findings At baseline, 59% (205/349) of subjects were receiving HAART. Engagement in substance abuse treatment was independently associated with receiving antiretroviral therapy (adjusted OR; 95% CI: 1.70; 1.03–2.83). Substance abuse treatment was not associated with 30‐day adherence or HIV viral load suppression. More depressive symptoms (0.48; 0.32–0.78) and use of drugs or alcohol in the previous 30 days (0.17; 0.11–0.28) were associated with worse 30‐day adherence. HIV viral load suppression was positively associated with higher doses of antiretroviral medication (1.29; 1.15–1.45) and older age (1.04; 1.00–1.07) and negatively associated with use of drugs or alcohol in the previous 30 days (0.51; 0.33–0.78). Conclusion Substance abuse treatment was associated with receipt of HAART; however, it was not associated with adherence or HIV viral load suppression. Substance abuse treatment programs may provide an opportunity for HIV‐infected people with alcohol or drug problems to openly address issues of HIV care including enhancing adherence to HAART.