Network support,technology use,depression, and ART adherence among HIV-positive MSM of color

Depression is associated with poor antiretroviral therapy (ART) adherence among people living with HIV/AIDS. This relationship may be moderated by an individual’s social network characteristics. Our study sought to examine social network correlates of treatment adherence among HIV-positive men recruited from social service agencies throughout Los Angeles County (N?=?150) to inform technology-driven social support interventions for this population. We administered egocentric social network and computer-assisted survey interviews focused on demographic characteristics, health history, depressive symptoms, and ART adherence, where adherence was assessed by the number of reasons participants missed taking their medication, if ever. Significant univariate correlates of adherence were included in a multivariable regression analysis, where the moderating effect of having a network member who reminds participants to take their HIV medication on the relationship between depression and adherence was tested. Over 60% of participants reported clinically significant depressive symptoms; this was significantly associated with lower adherence among those without someone in their social network to remind them about taking their HIV medication, even after adjusting for covariates in an ordinary least squares regression (adjusted mean difference b?=??1.61, SE?=?0.42, p?=?0.0003). Having a network member who reminds participants to take their ART medication significantly ameliorated the negative association between depression and treatment adherence, especially for those reporting greater depressive symptoms (p?=?0.0394). Additionally, participants demonstrated high rates of technology use to communicate with social network members. In order to achieve the aims of the National HIV/AIDS Strategy, innovative interventions addressing mental health to improve ART adherence are needed. Network strategies that leverage technology may be helpful for improving ART adherence among HIV-positive men with comorbid depressive symptoms.     

艾滋病致孤儿童的心理健康问题研究及相关对策建议

目的了解艾滋病致孤儿童的心理健康问题,提出相关对策和建议。方法采用访谈、追踪调查和心理干预相结合的方法,对受艾滋病影响儿童的心理发展进行了5年的系列研究。结果共追踪调查1 625名儿童,其中孤儿755名,非孤儿童466名,对照儿童404名。发现艾滋孤儿存在着严重的心理问题,艾滋孤儿具有仇恨的心理,封闭、自卑和孤独心理严重,未来发展压力大,悲伤情绪异常严重,双孤和单孤的心理健康状况都很差。在心理干预和3年追踪研究的基础上,提出了相关对策和建议。结论时间解决不了艾滋孤儿的心理健康问题,要重视对艾滋孤儿的心理救助。     

Exploring the dynamics of ART adherence in the context of a mindfulness instruction intervention among youth living with HIV in Baltimore,Maryland

Youth living with HIV have sub-optimal rates of adherence to antiretroviral therapy (ART). Mindfulness instruction interventions have shown promise for improving medication adherence, but the effects and mechanisms of these interventions are still being explored among people living with HIV, including youth. In the context of a randomized controlled trial of the efficacy of a Mindfulness-Based Stress Reduction (MBSR) program on ART adherence and viral suppression among youth living with HIV, we conducted 44 iterative, semi-structured, in-depth interviews with 20 study participants (13–24 years) recruited from clinics at two academic centers in Baltimore, Maryland. Interviews explored the social context and psychosocial dynamics of ART adherence in the context of the MBSR intervention, compared with those in a control arm. We employed thematic content analysis to systematically code and synthesize textual interview data. Participants’ challenges with ART adherence were often situated within an ongoing process of working to manage HIV as a stigmatized, chronic condition in addition to other intersecting social stigmas, inequalities, and stressors. Participation in the MBSR program and related group support allowed participants to non-judgmentally observe and accept difficult thoughts, feelings, and experiences associated with living with HIV and taking ART, which facilitated greater reported adherence. Mindfulness training may stimulate new perspectives and understanding, including greater self- and illness-acceptance among youth living with HIV, leading to improved HIV outcomes.     

What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review

The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.     

Associations of medically documented psychiatric diagnoses and risky health behaviors in highly active antiretroviral therapy-experienced perinatally HIV-infected youth

The Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) study is a prospective, multisite, longitudinal cohort of U.S. HIV-infected youth. This analysis was limited to perinatally HIV-infected youth (n=197), 13 years and older, with selected variables completely abstracted from HIV diagnosis through 2006. We evaluated relationships between ever having one or more nonsubstance related medically documented psychiatric diagnoses and three risky health behaviors (substance abuse, preadult sexual activity, and treatment adherence problems) recorded between 2001 and 2006. Logistic regression was used for all binary outcomes and participant age was included as a covariate when possible. All 197 participants included in the analysis were prescribed antiretroviral therapy during the study period; 110 (56%) were female, 100 (51%) were black non-Hispanic, and 86 (44%) were Hispanic; mean age at the last visit was 16.8 years, ranging from 13 to 24 years. One hundred forty-six (74%) participants had a history of at least one risky health behavior. There were 108 (55%) participants with at least one medically documented psychiatric diagnosis, 17 (9%) with at least one record of substance abuse, 12 (6%) with documented preadult sexual activity, and 142 (72%) participants with reported adherence problems. In the final model, a history of at least one psychiatric diagnosis was associated with having at least one of the three risky behaviors (odds ratio [OR]=2.33, p=0.015). There is a need for a continued close partnership between HIV specialty care providers and mental health services treating perinatally HIV-infected youth with an added focus on improving treatment adherence.     

Mental Health Treatment to Reduce HIV Transmission Risk Behavior: A Positive Prevention Model

Secondary HIV prevention, or “positive prevention,” is concerned with reducing HIV transmission risk behavior and optimizing the health and quality of life of people living with HIV/AIDS (PLWHA). The association between mental health and HIV transmission risk (i.e., sexual risk and poor medication adherence) is well established, although most of this evidence is observational. Further, a number of efficacious mental health treatments are available for PLWHA yet few positive prevention interventions integrate mental health treatment. We propose that mental health treatment, including behavioral and pharmacologic interventions, can lead to reductions in HIV transmission risk behavior and should be a core component of secondary HIV prevention. We present a conceptual model and recommendations to guide future research on the effect of mental health treatment on HIV transmission risk behavior among PLWHA.     

Mindfulness instruction for HIV-infected youth: a randomized controlled trial

HIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14–22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P?=?.03), problem-solving coping (P?=?.03), and life satisfaction (P?=?.047), and lower aggression (P?=?.002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P?=?.02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P?=?.04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth.     

Expanding community through ARV provision in Thailand

Anti-retrovirals (ARVs) have altered the complexion of HIV/AIDS management in Thailand. In 2005, ARVs were included within a subsidised health scheme making provision widespread. Increased access has been brought about through the legal and political advocacy of the Thai Network for People Living with HIV/AIDS (TNP+) who now play a central role in expanded ARV provision. HIV-infected volunteers help the state deliver comprehensive services and assist with follow-up and adherence programs. Alongside improvements in drug provision, a focus on pharmaceutical treatment has left other issues, such as community support of orphans and the social responses to living with HIV, less central within community responses. As they take on new responsibilities, people living with HIV/AIDS (PLHA) groups move from activities focused on reversing local stigma to constitute a new social movement that is increasingly prominent in Thai civil society. Networks of PLHA confront new social and political challenges as they also seek to broaden access to marginalised groups who remain excluded from these services. Many ethnic minority groups without full Thai citizenship have been denied access to subsidised health services including ARVs. As part of a broadening advocacy profile, the PLHA movement is now engaging in a politics of difference defined not simply by presence or absence of HIV but also by wider issues of national identity and belonging.     

中国艾滋病致孤儿童生长发育与营养水平及心理健康研究

目的调研中国艾滋病致孤儿童生长发育、营养水平与心理健康状况,为政策制定提供依据。方法按性别、年龄1：1匹配,调查96对艾滋病致孤儿童与非孤儿的身心健康水平,并进行差异比较。结果孤儿组BMIz评分与肩胛下皮褶厚度显著低于非孤儿（P〈0．01）,消瘦明显。孤儿组自尊量表（SES）总分更低,而抑郁问卷（BDI）总分更高（P〈0．05）。男性孤儿身心健康弱势明显,女性组间未见显著性差异。结论中国艾滋病致孤儿童的身心健康脆弱性显著,需探索可持续性更强的孤儿抚养策略,并进行以心理支持为核心的综合健康干预,而且对男性孤儿应给予更多关注。     

Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care center in Kenya

Consistent individual effort in engagement in HIV medical services has been associated with positive health outcomes in people living with HIV (PLHIV). However, whether these benefits are facilitated by improved medication adherence has not been widely studied. This study aimed to investigate the marginal effect of engagement in HIV care on medication adherence at a public health facility in Kenya. Between February and April 2013, 392 patients on HIV care at Nyeri Provincial General Hospital participated in this study. Data were collected using a self-administered health survey questionnaire assessing health and sociodemographic statuses. A manual stepwise general linear model was specified to measure the effect of engagement in HIV and other associated predictors on medication adherence. Engagement in HIV care was significantly associated with log-transformed medication adherence in the sample (100·β = 9.2%, 95% CI 3.2–15.1) irrespective of gender and other selected predictors. Longer duration on antiretroviral therapy was also a significant predictor of better medication adherence (100·β = 3.2%, 95% CI 2.3–4.1). Despite inter-gender differences in adherence and engagement determinants, gender's independent effect on medication adherence and engagement in care were not statistically significant. Poor medication adherence was associated with lower patient engagement in HIV care services, suggesting that interventions which remove obstacles to regular observance of scheduled clinic appointments and eventual retention may have a beneficial impact on medication adherence and, accordingly, health outcomes in PLHIV.     

The influence of neurocognitive impairment on HIV treatment outcomes among drug-involved people living with HIV/AIDS

Findings to date indicate that it is feasible to deliver a brief behavioral risk reduction/medication adherence group intervention to HIV-infected injection drug users in a community-based setting. HIV infection and substance abuse can result in neurocognitive impairment and this is directly relevant to intervention development, because a significant number of people living with HIV/AIDS have a positive history of substance abuse and being able to successfully participate in behavioral interventions often requires a relatively high level of cognitive performance. The aim of the current study was to evaluate if changes in information, motivation, and behavior skills with respect to medication adherence, sex- and drug-risk behavior outcomes from baseline to post-intervention are predicted by cognitive impairment following the brief four-session Holistic Health for HIV intervention for HIV-infected Drug Users (3H+). Significant associations were found between change in motivation and certain neurocognitive performance domains. Findings suggest that it may be helpful to specifically tailor such behavioral interventions to accommodate cognitive impairment.     

Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension

As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p?=?0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.     

The Relationship Between Type and Quality of Social Support and HIV Medication Adherence

Abstract

In the last 10 years HIV has become a disease that can be effectively managed using antiretroviral medications. However, many factors affect adherence, including demographics, income, housing, mental health issues, and access to health care, as well as types and quality of social support. This paper summarizes results regarding specific sources of social support that are part of a larger, randomized study of medication adherence among people with HIV/AIDS. Results summarize findings from 98 program participants and include information regarding support from partners, family and health care providers, as well as the impact of support from these sources on medication adherence. Among participants in this study, those with higher levels of social support from partners demonstrated higher rates of medication adherence. Those who received more social support from their families, however, reported significantly lower adherence rates. These results suggest that efforts to improve medication adherence need to address the diverse types of social support networks of people diagnosed with HIV/AIDS.     

Prevalence and change in psychiatric disorders among perinatally HIV-infected and HIV-exposed youth

As the pediatric HIV epidemic in resource-rich countries evolves into an adolescent epidemic, there is a substantive need for studies elucidating mental health needs of perinatally HIV-infected (PHIV +) youth as they transition through adolescence. This article examines the role of perinatal HIV infection in influencing mental health by comparing the changes in psychiatric disorders and substance use disorders (SUD) in PHIV + and perinatally HIV-exposed, but uninfected (PHIV -) youth over time. Participants were recruited from four medical centers in New York City. Individual interviews were administered at baseline and 18-month follow-up to 166 PHIV + and 114 PHIV- youth (49% male, age 9-16 years at baseline). Youth psychiatric disorder was assessed using the caregiver and youth versions of the Diagnostic Interview Schedule for Children (DISC-IV). Over two-thirds of participants met criteria for at least one psychiatric disorder at either baseline or follow-up, with few group differences. Among PHIV + youth, there was a significant decrease in the prevalence of any psychiatric disorder, as well as anxiety disorders specifically over time, whereas the prevalence of any psychiatric disorder among PHIV- youth remained the same and mood disorders increased. Rates of SUD were low in both groups, increasing slightly by follow-up. PHIV + youth reported more use of mental health services at follow-up. CD4 count and HIV RNA viral load were not associated with the presence or absence of disorder at either time point. In conclusion, among PHIV + and PHIV- youth, the rates of psychiatric disorder were high, even compared to other vulnerable populations, suggesting that factors other than perinatal HIV infection may be important determinants of mental health. PHIV + youth were more likely to improve over the observation period. The data underscore the critical need for mental health interventions for both PHIV + and PHIV- youth.     

Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's Behavioral Model

Andersen's Behavioral Model (ABM) provides a framework for understanding how patient and environmental factors impact health behaviors and outcomes. We compared patient-identified barriers/facilitators to retention in care and antiretroviral therapy (ART) adherence and evaluated how they mapped to ABM. Qualitative semi-structured interviews with 51 HIV-infected adults at HIV clinics in Philadelphia, PA, in 2013 were used to explore patients' experiences with HIV care and treatment. Interview data were analyzed for themes using a grounded theory approach. Among those interviewed, 53% were male and 88% were nonwhite; 49% were retained in care, 96% were on ART, and 57% were virally suppressed. Patients discussed 18 barriers/facilitators to retention in care and ART adherence: 11 common to both behaviors (stigma, mental illness, substance abuse, social support, reminder strategies, housing, insurance, symptoms, competing life activities, colocation of services, provider factors), 3 distinct to retention (transportation, clinic experiences, appointment scheduling), and 4 distinct to adherence (medication characteristics, pharmacy services, health literacy, health beliefs). Identified barriers/facilitators mapped to all ABM domains. These data support the use of ABM as a framework for classifying factors influencing HIV-specific health behaviors and have the potential to inform the design of interventions to improve retention in care and ART adherence.     

HIV medication adherence amid multiple inequities: Detailing the lived challenges of the most at risk people with HIV

Abstract

This study aimed to identify patterns of barriers to help inform adherence interventions for the most at-risk people living with HIV. Ethnographic data from two peer-led HIV medication adherence intervention studies (N?=?35) were analyzed. Trained Peer Interventionists met with intervention participants for six weeks and wrote semi-structured field notes about participants’ adherence experiences. The most common challenges were physical illness (HIV and non-HIV related), mental health, isolation, poverty, homelessness, substance abuse, and hunger or poor diet. Successful interventions necessitate connections to various multileveled services that address trauma and multiple challenges and are preferably available in one location.     

Predictors of antiretroviral adherence

This study was conducted in order to help determine the key factors that predict adherence to antiretroviral medications. A total of 115 HIV/AIDS patients who were having trouble adhering to their antiretroviral regimens completed face-to-face interviews in which adherence levels, medication side effects, mental health, social support, patient-provider relationship characteristics, substance use and health anxiety were assessed. Three measures of adherence were used: adherence over the past three days, adherence over the past week, and adherence over the past month. Logistic regression analyses indicated strongest prediction of three-day adherence, with mental health, social support, patient-provider relationship characteristics and side effects contributing to prediction. Past week adherence was associated with age and social support measures, and showed a marginal association with side effects. Past month adherence was less strongly predicted, with social support and alcohol use contributing to prediction. Thus, a variety of factors were found to determine adherence, and implications of the findings for adherence models and interventions are discussed.     

The initial feasibility of a computer-based motivational intervention for adherence for youth newly recommended to start antiretroviral treatment

Young people represent the largest number of new HIV infections, thus youth living with HIV (YLH) are likely to be the largest group to initiate antiretroviral treatment (ART). Adherence patterns for behaviorally infected YLH are not adequate to effectively manage the disease; therefore, novel interventions are needed to improve medication adherence. The purpose of the current study, which will precede a randomized controlled trial, was to assess the initial feasibility of an individually tailored computer-based two-session interactive motivational interviewing (MI) intervention for YLH newly recommended to start ART. Intervention development occurred in collaboration with three youth advisory groups. Ten youth (ages 18–24) were recruited to participate in this study. Participants completed the intervention online. Intervention components focused on medication adherence (rating perceived importance and confidence, and goal setting). Retention was 100% for both intervention sessions. All participants (n=10) felt medication adherence was important, but 80% felt confident they could manage their adherence to HIV medications. Ninety percent of participants set the goal of taking their HIV medications exactly as prescribed and reported success achieving this goal at follow-up. Additionally, participants were satisfied with the quality of the sessions and the amount of assistance they received for managing their adherence to HIV medications (90% participants for Session 1; 89% for Session 2). Per exit interview responses, participants felt that the intervention made them think more about their health and was a motivator for them to take better care of their health. In conclusion, the intervention was feasible for YLH enrolled in the study.     

"+CLICK": pilot of a web-based training program to enhance ART adherence among HIV-positive youth

Youth account for almost half of all new HIV infections in the United States. Adherence to antiretroviral treatment (ART) is critical for successful management, yet reported adherence rates for youth are often low. This study pilot-tested "+CLICK," an innovative, web-based, adherence intervention for HIV-positive youth as an adjunct to traditional clinic-based, self-management education. The theory-based application, developed for HIV-infected youth, 13-24 years of age, provides tailored activities addressing attitudes, knowledge, skills, and self-efficacy related to ART adherence. HIV-positive youth (N=10) pilot-tested "+CLICK" to assess usability (ease of use, credibility, understandability, acceptability, motivation) and short-term psychosocial outcomes (importance and self-efficacy related to ART adherence) using a single-group, pre-/post-test study design in a hospital-based pediatric clinic (n=8) and home (n=2) location. Youth were mostly female (80%) and Black (80%). Mean age was 17.8 years (SD=2.65, range 14-22). All were infected perinatally and had been living with HIV all their lives. Most learned their HIV status by age 10 years. Sixty percent reported an undetectable viral load, whilst 10% reported a viral load of over 50,000. Half (50%) reported a normal CD4 count, whilst 20% reported having low CD4 (<200). Usability ratings indicated "+CLICK" was very easy to use (70%), trustworthy, and understandable (both>90%). Most (70%) indicated they would use "+CLICK" again. Short-term psychosocial outcomes indicate significant increase in medication adherence self-efficacy (p<0.05), perceived importance of taking antiretroviral medicine close to the right time every day (p<0.05), and knowledge about HIV and adherence (p<0.01). Other psychosocial variables and behavioral intentions were not significantly impacted. Results suggest that "+CLICK" has the potential to affect psychological antecedents to ART adherence. Further research on long-term and behavioral effects is indicated prior to broader dissemination into clinical practice.     

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.