Psychological and social determinants of health, antiretroviral therapy (ART) adherence, and viral suppression among HIV-positive black women in care

BACKGROUND The suboptimal rate of viral suppression among persons aged 13 years and older and residing in 37 states and the District of Columbia leaves considerable opportunities for onward transmission and contributes to poor health outcomes. Men who have sex with men (MSM) represent one of the most at-risk groups in the United States. There is a clear and continued need for innovative adherence support programs to optimize viral suppression. To address this gap, we designed and are implementing a randomized controlled trial (RCT) to test the efficacy of the Thrive with Me intervention for MSM living with HIV. Critical components of the protocol are presented. OBJECTIVE The aim of this study is to describe the protocol for rigorously testing the efficacy of Thrive with Me to improve antiretroviral therapy (ART) adherence among HIV-positive MSM residing in New York City. METHODS A community advisory board and beta testing were used to obtain feedback from HIV-positive MSM on the overall look and feel of Thrive with Me and problems with navigation to finalize intervention components and content. We will enroll 400 HIV-positive MSM residing in the New York City area into a two-arm prospective RCT and follow them for 17 months. Men in the Thrive with Me experimental intervention arm will have access to Thrive with Me for 5 months. Thrive with Me has three primary components: (1) a private social networking feature; (2) tailored HIV and ART adherence information; and (3) medication reminders, self-monitoring, and reflection. Gamification components include badges and leveling up to increase intrinsic motivation to engage with the intervention. Men randomized to the control condition will view a weekly newsletter for 5 months. The newsletter will be delivered via email and contains information on topics related to HIV with the exception of ART adherence. Study assessments will occur at enrollment and 5, 11, and 17 months post enrollment. The primary study outcome is HIV viral load, which is considered an objective indicator of ART adherence. RESULTS Participant recruitment for the RCT began in October 2016, and the data collection period is anticipated to end in the Fall of 2019. CONCLUSIONS The efficacy trial of Thrive with Me will help to fill gaps in understanding about the utility of multicomponent, technology-based interventions to improve ART adherence among HIV-positive MSM. Of importance is the ability for the results of the Thrive with Me trial to inform best practices for conducting technology-based interventions that incorporate social media features. CLINICALTRIAL ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/ct2/show/NCT02704208 (Archived by WebCite at http://www.webcitation.org/6zQ8WPra6) REGISTERED REPORT IDENTIFIER RR1-10.2196/10182

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Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

PLoS ONE ◽

10.1371/journal.pone.0242817 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242817

Author(s):

Jessica E. Long ◽

Barbra A. Richardson ◽

George Wanje ◽

Kate S. Wilson ◽

Juma Shafi ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Alcohol Use ◽

Sex Workers ◽

Female Sex Workers ◽

Viral Suppression ◽

Hiv Positive ◽

Art Adherence ◽

Detectable Viral Load ◽

Harmful Alcohol

Background Excessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs. Methods A prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Results This analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7–15) in 14.3%, harmful alcohol use (AUDIT 16–19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63–1.92) or late ART refill (aRR 1.13, 95%CI 0.82–1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42–3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84–3.71). Conclusions In this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.

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Addressing Social Determinants of Health Among HIV Positive Men Who Have Sex with Men (MSM): The Need for Synergy

Understanding Prevention for HIV Positive Gay Men ◽

10.1007/978-1-4419-0203-0_14 ◽

2017 ◽

pp. 327-347 ◽

Cited By ~ 1

Author(s):

Y. Omar Whiteside ◽

Jordan J. White ◽

Kenneth T. Jones

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Hiv Positive ◽

Sex With Men ◽

Hiv Positive Men

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Exploring Social Determinants of Health as Predictors of Mortality During 2012–2016, Among Black Women with Diagnosed HIV Infection Attributed to Heterosexual Contact, United States

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-019-00589-6 ◽

2019 ◽

Vol 6 (5) ◽

pp. 892-899 ◽

Cited By ~ 1

Author(s):

Lakeshia Watson ◽

Zanetta Gant ◽

Xiaohong Hu ◽

Anna Satcher Johnson

Keyword(s):

United States ◽

Black Women ◽

Hiv Infection ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Heterosexual Contact ◽

Predictors Of Mortality

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Outpatient Portal Use in Prenatal Care: Differential Use by Race, Risk, and Area Social Determinants of Health Factors

10.1101/2021.05.25.21257657 ◽

2021 ◽

Author(s):

Priti Singh ◽

Pallavi Jonnalagadda ◽

Evan Morgan ◽

Naleef Fareed

Keyword(s):

Black Women ◽

Pregnant Women ◽

Social Determinants Of Health ◽

Social Determinants ◽

White Women ◽

Determinants Of Health ◽

Patient Portal ◽

Risk Area ◽

Clinical Risk ◽

Risk Pregnancy

Objective: To report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Methods: Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using logfiles and clinical data. Results: Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like the Visit (scheduling) and My Record (test results). We also found significant interactive associations between race, clinical risk, and SDoH. Non-Hispanic Black women living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. Conclusion: More research must be conducted to learn of OPP implications for pregnant women with specific clinical diagnoses.

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Wealth and the health of older Black women in the United States

Health Promotion International ◽

10.1093/heapro/day053 ◽

2018 ◽

Vol 34 (5) ◽

pp. 1055-1068

Author(s):

Andy Sharma

Keyword(s):

United States ◽

Health Care ◽

Black Women ◽

Social Determinants Of Health ◽

Social Determinants ◽

Panel Study ◽

Well Being ◽

The United States ◽

Determinants Of Health ◽

The Impact

Summary Public health scholars and policy-makers are concerned that the United States continues to experience unmanageable health care costs while struggling with issues surrounding access and equity. To addresses these and other key issues, the National Academy of Medicine held a public symposium, Vital Directions for Health and Health Care: A National Conversation during September 2016, with the goal of identifying clear priorities for high-value health care and improved well-being. One important area was addressing social determinants of health. This article contributes to this objective by investigating the impact of wealth on older Black women’s health. Employing the 2008/2010 waves of the RAND Health and Retirement Study on a sample of 906 older Black women, this panel study examined self-assessed health ratings of very good/good/fair/poor within a relaxed random effects framework, thereby controlling for both (i) observed and (ii) unobserved individual-level heterogeneity. This analysis did not find a statistically significant association with wealth despite a difference of approximately $75 000 in its valuation from very good to poor health. This also occurred after wealth was (i) readjusted for outliers and (ii) reformulated as negative, no change or positive change from 2008. This finding suggests that wealth may not play as integral a role. However, the outcome was significant for earnings and education, particularly higher levels of education. Scholars should further this inquiry to better understand how earnings/education/wealth operate as social determinants of health for minority populations.

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