Retention in Care and Health Outcomes of Transgender Persons Living With HIV

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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The Impact of Psychosocial Factors on Health and Retention Outcomes for People Living With HIV: Implications for Rehabilitation Counselors and Educators

Rehabilitation Counseling Bulletin ◽

10.1177/0034355218755304 ◽

2018 ◽

Vol 62 (2) ◽

pp. 94-107

Author(s):

Yung-Chen Jen Chiu ◽

K. B. Boomer ◽

Liza M. Conyers

Keyword(s):

Mental Health ◽

Immune System ◽

Case Management ◽

Health Outcomes ◽

Retention In Care ◽

Rehabilitation Counselors ◽

People Living With Hiv ◽

Management Service ◽

Living With Hiv ◽

The Impact

Despite medical advancements that have significantly improved the health outcomes of people living with HIV (PLWH), many do not achieve optimal health outcomes due to psychosocial barriers. This 5-year retrospective longitudinal study draws upon the International Classification of Functioning, Disability, and Health (ICF) framework to conceptualize the relationships between personal and environmental factors and health and retention outcomes among a sample of 704 PLWH in Pennsylvania. A generalized estimated equations (GEE) model was used to model retention in care outcomes (at least one medical visit every 6 months) and a general linear mixed (GLM) model was used to analyze immune system health outcomes (CD4%). This exploratory study reveals that gender, age, race, use of antiretroviral (ARV) medications, use of case management service, mental health diagnosis, and alcohol use were significantly associated with retention in care, whereas race, ethnicity, gender, mental health treatment, use of ARV medications, use of case management services, and retention in care status were significantly associated with the immune system health outcome of CD4%. The results suggest a need for rehabilitation interventions to address key psychosocial issues, as rehabilitation counselors have a unique skill set to address the medical case management needs of individuals with HIV. Implications for rehabilitation counselors and educators are discussed.

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Is Social Isolation Related to Emotion Dysregulation and Retention in Care Among Older Persons Living with HIV?

AIDS and Behavior ◽

10.1007/s10461-020-02957-4 ◽

2020 ◽

Author(s):

Moka Yoo-Jeong ◽

Regine Haardörfer ◽

Marcia Holstad ◽

Kenneth Hepburn ◽

Drenna Waldrop-Valverde

Keyword(s):

Social Isolation ◽

Emotion Dysregulation ◽

Older Persons ◽

Retention In Care ◽

Persons Living With Hiv ◽

Living With Hiv

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High Incidence, Re-Infections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study

10.21203/rs.3.rs-559014/v2 ◽

2021 ◽

Author(s):

Omar David Tumalán-Gil ◽

Verónica Ruiz-González ◽

Santa García-Cisneros ◽

Andrea González-Rodríguez ◽

Antonia Herrera-Ortiz ◽

...

Keyword(s):

Vulnerable Groups ◽

People Living With Hiv ◽

Chi Square ◽

Voluntary Counseling And Testing ◽

Transgender Persons ◽

Persons Living With Hiv ◽

High Incidence ◽

Chi Square Test ◽

Living With Hiv ◽

Active Syphilis

Abstract Background. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015. Methods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. Results. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. Conclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk.

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The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz029.40 ◽

2019 ◽

Vol 34 (7) ◽

pp. 1273-1273

Author(s):

E Santana ◽

J Gonzalez ◽

D Byrd ◽

M Rivera Mindt

Keyword(s):

Mental Health ◽

Decision Making ◽

Health Literacy ◽

Health Outcomes ◽

Physical Functioning ◽

Patient Relationship ◽

Physician Patient Relationship ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Physician Patient

Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p < 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps < .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = <.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = <.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study

JMIR Public Health and Surveillance ◽

10.2196/16061 ◽

2020 ◽

Vol 6 (2) ◽

pp. e16061

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

Background HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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High Incidence, Re-Infections, and Active Syphilis in Populations Attending A Specialized HIV Clinic in Mexico, A Dynamic Cohort Study.

10.21203/rs.3.rs-559014/v1 ◽

2021 ◽

Author(s):

Omar David Tumalan-Gil ◽

Veronica Ruiz-González ◽

Santa García-Cisneros ◽

Andrea González-Rodríguez ◽

Antonia Herrera-Ortiz ◽

...

Keyword(s):

Vulnerable Groups ◽

People Living With Hiv ◽

Chi Square ◽

Voluntary Counseling And Testing ◽

Transgender Persons ◽

Persons Living With Hiv ◽

High Incidence ◽

Chi Square Test ◽

Living With Hiv ◽

Active Syphilis

Abstract Background. Syphilis has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011-2015.Methods. Databases from the laboratory were analyzed and four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH) and patients from primary care clinics (others). Syphilis diagnosis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data was analyzed, and with follow-up information, a retrospective dynamic cohort was formed. Factors associated with seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. Results. A total of 81,863 baseline individuals were analyzed. Syphilis seroprevalence was 9.9% in VCT, 8.2% in PPr, 37.0% in PLWH, and 8.7% in others; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed-up; the incidence (cases per 100 years people) was 3.5 among VCT and 16.0 among PLWH; moreover, the frequency of re-infections was 11.1-24.4%. Men, transgender, persons between 20-39 years old, and individuals with a history of HIV or hepatitis B had a higher risk of syphilis. Conclusions. Several vulnerable groups have exhibited a reemergence of syphilis, with high prevalence of active syphilis, high incidence, and re-infections. Persons living with HIV had the highest risk.

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Health Literacy and Health Outcomes in Persons Living with HIV Disease: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-019-02432-9 ◽

2019 ◽

Vol 23 (11) ◽

pp. 3024-3043 ◽

Cited By ~ 4

Author(s):

Raquel Reynolds ◽

Sara Smoller ◽

Anna Allen ◽

Patrice K. Nicholas

Keyword(s):

Systematic Review ◽

Health Literacy ◽

Health Outcomes ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

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Stigma towards clients in HIV/AIDS care settings

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n12p60 ◽

2020 ◽

Vol 10 (12) ◽

pp. 60

Author(s):

James Whyte IV ◽

Maria Whyte ◽

Sabrina Dickey

Keyword(s):

Retention In Care ◽

The United States ◽

Care Seeking ◽

Care Providers ◽

Persons Living With Hiv ◽

The Us ◽

Significant Barrier ◽

And Behaviors ◽

Quantitative Descriptive ◽

Living With Hiv

Stigmatizing behaviors engaged by care providers in clinical settings represent a significant barrier to care seeking on the part of persons living with HIV. The majority of studies addressing stigma by healthcare workers has been reported in the developing world. The current study sought to determine the presence of stigmatizing thoughts and behaviors in Ryan White Care Act funded clinics across the United States. The study used a quantitative descriptive design, and included all such sights in the US and its territories. The results indicated that paraprofessional personnel were more likely to engage in thoughts and behaviors that reflect stigma. This finding is significant since these individuals are the first people who patients contact when seeking care, establishing a significant barrier to retention in care. The study reflects a need to engage education and training designed to minimize these behaviors in paraprofessionals.

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