Recruitment into a Clinical Trial of People Living with Uncontrolled HIV Infection Who Inject Drugs: a Site Case Report from the CTN 67 CHOICES Study

CHOICES was an open-label, randomized, comparative effectiveness trial of office-based extended-release naltrexone versus treatment as usual in people with untreated opioid use disorder and HIV. This study explored facilitators to recruitment in Miami, a successful recruiting site in the national trial. The mixed-methods study included quantitative surveys of randomized participants, medical record abstraction, and qualitative interviews with study staff. Miami recruited 47 (40.5%) of 116 randomized participants in the six-site national trial. In-depth interviews of study staff (n?=?6) revealed that Miami had a recruitment approach consisting of street level outreach and a close relationship with the local syringe services program (SSP). Partnership with a local SSP provided access to people living with HIV who inject drugs in Miami. SSPs’ fundamental trust within the community of people who inject drugs can be leveraged in studies aiming to improve health outcomes in this underserved and high-priority population.

     

Use of health care services by women who use crack cocaine

Chronic drug users demonstrate a need for access to health care due to both acute health problems related directly to substance use and to other existing medical problems. This study attempts to examine how women differ from men in their utilization of health services. Also, it analyzes how crack use affects men and women differentially. The study population is a community-based sample of 624, comprised equally of men and women, as well as crack users and non-users of crack. Results indicate that women utilized health care more than men; however, crack use among women appears to be an inhibitory factor in the utilization of health services by women.     

Dental Examinations as an Untapped Opportunity to Provide HIV Testing for High-Risk Individuals

We used data from the 2005 National Health Interview Survey to examine the potential role of dental care in reaching untested individuals at self-reported risk for HIV. An estimated 3.6 million Americans report that they are at significant HIV risk yet have never been HIV tested. Three quarters of these people have seen a dentist within the past 2 years. Dental care offers opportunities to serve at-risk individuals who are otherwise unlikely to be tested or to receive preventive care services.Among the estimated 1 million Americans living with HIV and AIDS, roughly one fifth are unaware of their infected status.^1,2 Early diagnosis, combined with other prevention services, could decrease HIV incidence and reduce morbidity and mortality.^3–6 Recent Centers for Disease Control and Prevention guidelines make it a priority to bring HIV screening into many medical and social service settings.⁷ Key professional associations have set similar priorities.⁸Rapid oral HIV testing offers a promising innovation for early HIV diagnosis. These rapid oral-testing technologies permit a highly sensitive and specific, fast, simple, minimally invasive, cost-effective way to screen for HIV serostatus.For several reasons, dental offices provide a promising venue for such testing.^9–14 First, the oral health provider is already conducting an examination. A rapid oral fluid test could be administered at the start of a routine visit, with results available within 20 minutes. Second, oral health providers are becoming involved in other primary-care screening efforts (e.g., hypertension, oral cancer, glycosylated hemoglobin).^15–17 Rapid HIV testing could be a logical extension of such activities. Third, some oral health providers practice in community health care settings that are especially well-equipped to link newly diagnosed patients to HIV primary care. Finally, persons may be more likely to regularly visit dentists than to frequent other settings where HIV testing is offered.Data from the 2005 National Health Interview Survey (NHIS) were used to investigate whether persons at self-identified risk for HIV visit dental settings. In particular, we examined (1) the frequency with which persons at risk for HIV visit dental offices, and (2) whether dental settings reach at-risk persons who have not been tested in other clinical settings.     

Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States

Women in the general population experience more food insecurity than men. Few studies have examined food insecurity’s impact on HIV treatment outcomes among women. We examined the association between food insecurity and HIV outcomes in a multi-site sample of HIV-infected women in the United States (n = 1154). Two-fifths (40%) of participants reported food insecurity. In an adjusted multivariable Tobit regression model, food insecurity was associated with 2.08 times higher viral load (95% confidence interval (CI): 1.04, 4.15) and lower CD4+ counts (? 42.10, CI: ? 81.16, ? 3.03). Integration of food insecurity alleviation into HIV programs may improve HIV outcomes in women.     

Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

There is insufficient research on the impact of perceived discrimination in healthcare settings on adherence to antiretroviral therapy (ART), particularly among women living with HIV, and even less is known about psychosocial mechanisms that may mediate this association. Cross-sectional analyses were conducted in a sample of 1356 diverse women living with HIV enrolled in the Women’s Interagency HIV Study (WIHS), a multi-center cohort study. Indirect effects analysis with bootstrapping was used to examine the potential mediating roles of internalized stigma and depressive symptoms in the association between perceived discrimination in healthcare settings and ART adherence. Perceived discrimination in healthcare settings was negatively associated with optimal (95% or better) ART adherence (adjusted odds ratio (AOR)?=?0.81, p = 0.02, 95% confidence interval (CI) [0.68, 0.97]). Furthermore, internalization of stigma and depressive symptoms mediated the perceived discrimination-adherence association: Serial mediation analyses revealed a significant indirect effect of perceived discrimination in healthcare settings on ART adherence, first through internalized HIV stigma, and then through depressive symptoms (B = ? 0.08, SE = 0.02, 95% CI [? 0.12, ? 0.04]). Perceiving discrimination in healthcare settings may contribute to internalization of HIV-related stigma, which in turn may lead to depressive symptoms, with downstream adverse effects on ART adherence among women. These findings can guide the design of interventions to reduce discrimination in healthcare settings, as well as interventions targeting psychosocial mechanisms that may impact the ability of women living with HIV to adhere to ART regimens.     

American Hospital Association: Prospective Reimbursement Debated; Delegates Request Revised Proposal

Hospital governing board members serve voluntarily, however they are integral to their hospitals' operations. This article investigates if there is a discrepancy between board members' knowledge of healthcare issues and how importanf they perceive these issues to be in their hospitals' operations and direction. In addition, it offers preliminary steps on how to ensure that board members are kept well-informed and up-to-date on issues for strategy planning in the healthcare marketplace.     

A Low-Effort, Clinic-Wide Intervention Improves Attendance for HIV Primary Care

Background.?Retention in care for human immunodeficiency virus (HIV)-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project. Methods.?Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10?018 patients in 2008-2009 (preintervention period) and 11?039 patients in 2009-2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation methods. Results.?Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0% for keeping 2 consecutive visits and 3.0% for the mean proportion of all visits kept (P?相似文献   

Prevention myths and HIV risk reduction by active drug users.

Drug injectors and crack users (526) in South Florida responded to a survey questionnaire that was designed to examine belief in the effectiveness of various strategies, other than condom use, employed to reduce personal risk of contracting HIV during sexual acts. Each strategy was believed to be effective by at least one quarter of the study participants. Factor analysis was used to group these strategies. Subsequent multivariate analysis indicated that the participants who believed in the effectiveness of HIV prevention strategies other than condom use were also less likely to report using condoms. These findings highlight the need for prevention interventions to elicit prevention myths and the full range of risk reduction strategies practiced.