Enlaces Por La Salud: A Personal Health Navigator Intervention Grounded in the Transnational Framework

AbstractDespite the disproportionate burden of HIV among Latinxs, there is a paucity of culturally appropriate interventions that have shown efficacy at increasing their engagement and retention in HIV care. We describe the development and implementation of Enlaces, a six-session, individual-level intervention, guided by the transnational framework, to improve HIV care outcomes for newly diagnosed and out-of-care Mexican men and transgender women (TW). Descriptive statistics summarizing baseline data and implementation outcomes are provided. 91 participants enrolled between October 2014 and August 2017. Intervention engagement and satisfaction was high; 81.3% completed all six sessions and 100% were very satisfied/satisfied with their experience. Successful implementation of the ENLACES intervention was the result of establishing client trust and maintaining a flexible, supportive approach to intervention delivery. Use of the transnational framework provided a contextualized approach to engaging with Mexican men and TW living with HIV that can be adapted to other Latino populations.

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Salud y Orgullo Mexicano: Development of a Culturally Specific Transnational Linkage and Retention in Care Intervention for Mexican Men Who Have Sex with Men Living with HIV in Chicago

Journal of Immigrant and Minority Health ◽

10.1007/s10903-021-01185-9 ◽

2021 ◽

Author(s):

Amy K. Johnson ◽

Román Buenrostro ◽

Gilberto Soberanis ◽

Banita McCarn ◽

Bridget Magner ◽

...

Keyword(s):

Intervention Mapping ◽

Retention In Care ◽

Hiv Care ◽

Individual Level ◽

Expert Advisory ◽

Mapping Process ◽

Sex With Men ◽

Peer Navigation ◽

Living With Hiv ◽

Mexican Men

AbstractThis manuscript documents the development of an innovative individual-level peer navigation intervention “Salud y Orgullo Mexicano” (SOM) designed to increase linkage and retention to HIV care for Mexican men who have sex with men (MSM) in Chicago, Illinois. The intervention was developed via a modified intervention mapping process. Elements of two existing interventions were combined and refined with input from the Mexican MSM community, including informant interviews, an expert advisory board, and a design team. A manualized transnational intervention was developed via intervention mapping. A peer health navigation intervention “SOM” was created using intervention mapping and input from the focus community. Next steps include implementing and evaluating the intervention to determine acceptability and efficacy.

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Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

AIDS and Behavior ◽

10.1007/s10461-020-03041-7 ◽

2020 ◽

Author(s):

Melissa A. Stockton ◽

Bradley N. Gaynes ◽

Mina C. Hosseinipour ◽

Audrey E. Pettifor ◽

Joanna Maselko ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Care ◽

People Living With Hiv ◽

Load Testing ◽

Art Initiation ◽

Retention In Hiv Care ◽

Hiv Care Engagement ◽

Care Outcomes ◽

Sub Saharan ◽

Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

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Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

Implementation Science ◽

10.1186/s13012-020-01064-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Aaron R. Lyon ◽

Michael D. Pullmann ◽

Shannon Dorsey ◽

Carol Levin ◽

Larissa M. Gaias ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Behavior Change ◽

Implementation Strategy ◽

Youth Mental Health ◽

Successful Implementation ◽

Individual Level ◽

Implementation Outcomes ◽

Cluster Randomized

Abstract Background More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services—schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes. Methods Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4–6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness. Discussion This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS—a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation—to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting. Trial registration ClinicalTrials.gov registration number NCT04451161. Registered on June 30, 2020.

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An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana

AIDS and Behavior ◽

10.1007/s10461-020-02778-5 ◽

2020 ◽

Vol 24 (7) ◽

pp. 2119-2129 ◽

Cited By ~ 4

Author(s):

Russell Brewer ◽

Kristina B. Hood ◽

Mary Moore ◽

Andrew Spieldenner ◽

Chris Daunis ◽

...

Keyword(s):

Exploratory Study ◽

Hiv Care ◽

Related Stigma ◽

Care Outcomes ◽

Sex With Men ◽

Living With Hiv

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Perceptions of Strategies and Intervention Approaches for HIV Self-Management among Ugandan Adolescents: A Qualitative Study

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958218823246 ◽

2019 ◽

Vol 18 ◽

pp. 232595821882324 ◽

Cited By ~ 1

Author(s):

Massy Mutumba ◽

Henry Mugerwa ◽

Victor Musiime ◽

Anudeeta Gautam ◽

Hellen Nakyambadde ◽

...

Keyword(s):

Healthcare Providers ◽

Self Care ◽

Hiv Care ◽

Self Management ◽

Care Needs ◽

Behavioral Skills ◽

Social Challenges ◽

Management Intervention ◽

Care Outcomes ◽

Living With Hiv

The heightened vulnerability of adolescents to poor HIV care outcomes underscores the need for interventions that create and promote HIV self-management behavioral skills. Adolescents living with HIV (ALHIV) experience a complex array of physical, emotional, and social challenges that constrain their self-care, but the majority of existing psychosocial programs focus primarily on medication adherence. Understanding adolescents’ self-care needs, challenges, and preferences is necessary for developing effective culturally relevant interventions. The involvement of caregivers and stakeholders is also critical to realizing positive self-care outcomes. This article presents the findings from focus group discussions with ALHIV, caregivers, and healthcare providers on self-care. The data were collected as part of formative research in the development of a self-management intervention for Ugandan ALHIV. Participants’ discussions on self-care strategies and intervention approaches provide valuable insights to guide the development of interventions to promote positive HIV care outcomes among Ugandan ALHIV.

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Factors influencing HIV care outcomes among adolescents living with HIV in rural South Africa

10.31899/hiv12.1024 ◽

2021 ◽

Author(s):

Lindsey Filiatreau ◽

Audrey Pettifor ◽

Jess Edwards ◽

Nkosinathi Masilela ◽

Rhian Twine ◽

...

Keyword(s):

South Africa ◽

Hiv Care ◽

Rural South ◽

Factors Influencing ◽

Care Outcomes ◽

Living With Hiv ◽

Rural South Africa

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Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) (Preprint)

10.2196/preprints.12837 ◽

2018 ◽

Author(s):

Cathy J. Reback ◽

Jesse B. Fletcher ◽

Anne E. Fehrenbacher ◽

Kimberly Kisler

Keyword(s):

Health Outcomes ◽

Text Messaging ◽

Text Message ◽

Transgender Women ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Intervention Delivery ◽

Trans Women ◽

Living With Hiv

BACKGROUND Many transgender women in the U.S. experience numerous cofactors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, high rates of sex work, as well as non-prescribed hormone injections and/or medically unsupervised soft-tissue filler injections, HIV risk factors specific to this population. In addition, trans women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically on young trans women under the age of 35 years old, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older trans women and non-trans young adult counterparts. Young trans women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. OBJECTIVE Text Me, Girl! was a randomized controlled trial to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV Care Continuum among young (18 to 34 years) transgender women (N=130) living with HIV/AIDS. METHODS Participants were randomized into either Group A) Immediate Text Message Intervention Delivery (ID: n=61); or, Group B) Delayed Text Message Intervention Delivery (DD: n=69) whereby participants were delivered the text-messaging intervention after a 90-day delay period. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received three messages per day in real-time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on Social Support Theory, Social Cognitive Theory, and Health Belief Model. The desired outcome of Text Me, Girl! was virological suppression. RESULTS Recruitment began on November 18, 2016 and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on August 31, 2019. Primary outcome analyses began immediately following the conclusion of the follow-up evaluations. CONCLUSIONS Text messaging is the ideal communication platform for engaging young trans women in HIV care because it is easily accessible, private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV Care Continuum outcomes among young trans women by providing culturally responsive text messages to promote linkage, retention, and adherence with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.

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Perceived Need and Acceptability of a Community-Based Peer Navigator Model to Engage Key Populations in HIV Care in Tijuana, Mexico

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958220919276 ◽

2020 ◽

Vol 19 ◽

pp. 232595822091927

Author(s):

Eileen V. Pitpitan ◽

Maria Luisa Mittal ◽

Laramie R. Smith

Keyword(s):

Hiv Care ◽

Key Populations ◽

Community Based ◽

Perceived Need ◽

Community Stakeholders ◽

Key Stakeholders ◽

Community Forum ◽

Care Outcomes ◽

Living With Hiv ◽

Depth Interviews

Introduction: Prior work found <4% of key populations living with HIV (KPLWH) in Tijuana, Mexico, were on antiretroviral therapy (ART). The goal of this pilot study was to examine community stakeholders’ perceived need and acceptability of a peer-navigator program to improve ART coverage. Methods: We held a community forum and measured perspectives of key stakeholders in local organizations that serve KPLWH using online surveys, and in-depth interviews (with select key informants). Results: Univariate descriptive statistics and emergent thematic analysis illustrated that there was general consensus that the program could improve ART coverage for KPLWH by helping to overcome geographic, transportation, and sociostructural barriers to HIV care. Police harassment, mobility, and non-HIV comorbidities were identified as challenges the program would need to navigate. Conclusions: Community stakeholders expressed perceived need and acceptability of a program to improve HIV care outcomes among KPLWH in Tijuana. The program should address the challenges identified by community stakeholders.

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Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

AIDS and Behavior ◽

10.1007/s10461-018-2194-2 ◽

2018 ◽

Vol 23 (2) ◽

pp. 433-444 ◽

Cited By ~ 4

Author(s):

Kwame S. Sakyi ◽

Margaret Y. Lartey ◽

Julie A. Dension ◽

Caitlin E. Kennedy ◽

Luke C. Mullany ◽

...

Keyword(s):

Low Birthweight ◽

Hiv Care ◽

Postpartum Women ◽

Women Living With Hiv ◽

Retention In Hiv Care ◽

Living With Hiv

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Successful implementation of isoniazid preventive therapy at a pediatric HIV clinic in Tanzania

BMC Infectious Diseases ◽

10.1186/s12879-020-05471-z ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Olivia F. Hunter ◽

Furaha Kyesi ◽

Amrit Kaur Ahluwalia ◽

Zeinabou Niamé Daffé ◽

Patricia Munseri ◽

...

Keyword(s):

Treatment Completion ◽

Preventive Therapy ◽

Pediatric Hiv ◽

Isoniazid Preventive Therapy ◽

Hiv Care ◽

Successful Implementation ◽

Completion Rates ◽

Community Based ◽

Symptom Screening ◽

Living With Hiv

Abstract Background In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed IPT implementation and adherence at a pediatric HIV clinic in Tanzania. Methods In this prospective cohort study, eligible children living with HIV aged 1–15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease were offered a 6-month regimen of daily isoniazid. Patients could choose to receive IPT via facility- or community-based care. Parents/caregivers and children provided informed consent and verbal assent respectively. Isoniazid was dispensed with the child’s antiretroviral therapy every 1–3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. Results We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n = 43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, 11 had IPT discontinued by their provider due to adverse drug reactions, 5 lacked documentation of completion, and 1 had unknown outcomes due to missing paperwork. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. Conclusions High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania.

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