scholarly journals Practical and Ethical Concerns in Implementing Enhanced Surveillance Methods to Improve Continuity of HIV Care: Qualitative Expert Stakeholder Study (Preprint)

2020 ◽  
Author(s):  
Mara Buchbinder ◽  
Colleen Blue ◽  
Stuart Rennie ◽  
Eric Juengst ◽  
Lauren Brinkley-Rubinstein ◽  
...  
Keyword(s):  
A Priori ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Ethical Concerns ◽  
Retention In Hiv Care ◽  
Semistructured Interviews ◽  
Privacy And Confidentiality ◽  
Living With Hiv

BACKGROUND Retention in HIV care is critical to maintaining viral suppression and preventing further transmission, yet less than 50% of people living with HIV in the United States are engaged in care. All US states have a funding mandate to implement Data-to-Care (D2C) programs, which use surveillance data (eg, laboratory, Medicaid billing) to identify out-of-care HIV-positive persons and relink them to treatment. OBJECTIVE The purpose of this qualitative study was to identify and describe practical and ethical considerations that arise in planning for and implementing D2C. METHODS Via purposive sampling, we recruited 43 expert stakeholders—including ethicists, privacy experts, researchers, public health personnel, HIV medical providers, legal experts, and community advocates—to participate in audio-recorded semistructured interviews to share their perspectives on D2C. Interview transcripts were analyzed across a priori and inductively derived thematic categories. RESULTS Stakeholders reported practical and ethical concerns in seven key domains: permission and consent, government assistance versus overreach, privacy and confidentiality, stigma, HIV exceptionalism, criminalization, and data integrity and sharing. CONCLUSIONS Participants expressed a great deal of support for D2C, yet also stressed the role of public trust and transparency in addressing the practical and ethical concerns they identified. CLINICALTRIAL

scholarly journals Practical and Ethical Concerns in Implementing Enhanced Surveillance Methods to Improve Continuity of HIV Care: Qualitative Expert Stakeholder Study

10.2196/19891 ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e19891
Author(s):  
Mara Buchbinder ◽  
Colleen Blue ◽  
Stuart Rennie ◽  
Eric Juengst ◽  
Lauren Brinkley-Rubinstein ◽  
...  
Keyword(s):  
A Priori ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Ethical Concerns ◽  
Retention In Hiv Care ◽  
Semistructured Interviews ◽  
Privacy And Confidentiality ◽  
Living With Hiv

Background Retention in HIV care is critical to maintaining viral suppression and preventing further transmission, yet less than 50% of people living with HIV in the United States are engaged in care. All US states have a funding mandate to implement Data-to-Care (D2C) programs, which use surveillance data (eg, laboratory, Medicaid billing) to identify out-of-care HIV-positive persons and relink them to treatment. Objective The purpose of this qualitative study was to identify and describe practical and ethical considerations that arise in planning for and implementing D2C. Methods Via purposive sampling, we recruited 43 expert stakeholders—including ethicists, privacy experts, researchers, public health personnel, HIV medical providers, legal experts, and community advocates—to participate in audio-recorded semistructured interviews to share their perspectives on D2C. Interview transcripts were analyzed across a priori and inductively derived thematic categories. Results Stakeholders reported practical and ethical concerns in seven key domains: permission and consent, government assistance versus overreach, privacy and confidentiality, stigma, HIV exceptionalism, criminalization, and data integrity and sharing. Conclusions Participants expressed a great deal of support for D2C, yet also stressed the role of public trust and transparency in addressing the practical and ethical concerns they identified.

scholarly journals eHealth Literacy in People Living with HIV: Systematic Review (Preprint)

2017 ◽  
Author(s):  
Hae-Ra Han ◽  
Hyejeong Hong ◽  
Laura E Starbird ◽  
Song Ge ◽  
Athena D Ford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Health ◽  
Transmission Risk ◽  
Hiv Care ◽  
Future Research ◽  
People Living With Hiv ◽  
Study Variable ◽  
Ehealth Literacy ◽  
Living With Hiv

BACKGROUND In the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome. OBJECTIVE The objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH. METHODS This systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable. RESULTS We identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed. CONCLUSIONS Understanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures.

scholarly journals Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV

2020 ◽  
Vol 8 ◽  
pp. 205031212091540
Author(s):  
Lisa Fleischer ◽  
Ann Avery
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
Qualitative Analysis ◽  
The United States ◽  
Care Team ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Clinic ◽  
Main Motivation ◽  
Living With Hiv

Objectives: Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy. Methods: We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States. Results: We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team. Conclusion: Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.

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

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.

scholarly journals Social determinants of health and care outcomes among people living with HIV in the United States

2021 ◽  
Author(s):  
Timothy W Menza ◽  
Lindsay K Hixson ◽  
Lauren Lipira ◽  
Linda Drach
Keyword(s):  
United States ◽  
Social Determinants ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
Economic Disadvantage ◽  
People Living With Hiv ◽  
Care Outcomes ◽  
Durable Viral Suppression ◽  
Living With Hiv

Abstract Background Fewer than 70% of people living with HIV (PLHIV) in the United States have achieved durable viral suppression. To end the HIV epidemic in the United States, clinicians, researchers, and public health practitioners must devise ways to remove barriers to effective HIV treatment. To identify PLHIV who experience challenges to accessing healthcare, we created a simple assessment of social determinants of health (SDOH) among PLHIV and examined the impact of cumulative social and economic disadvantage on key HIV care outcomes. Methods We used data from the 2015-2019 Medical Monitoring Project, a yearly cross-sectional survey of PLHIV in the United States (N=15,964). We created a ten-item index of SDOH and assessed differences in HIV care outcomes of missed medical appointments, medication adherence, and durable viral suppression by SDOH using this index using prevalence ratios with predicted marginal means. Results Eighty-three percent of PLHIV reported at least one SDOH indicator. Compared to PLHIV who experienced none of the SDOH indicators, people who experienced one, two, three, and four or more SDOH indicators, were 1.6, 2.1, 2.6 and 3.6 as likely to miss a medical appointment in the prior year; 11%, 17%, 20% and 31% less likely to report excellent adherence in the prior 30 days; and, 2%, 4%, 10% and 20% less likely to achieve durable viral suppression in the prior year, respectively. Conclusions Among PLHIV, cumulative exposure to social and economic disadvantage impacts care outcomes in a dose-dependent fashion. A simple index may identify PLHIV experiencing barriers to HIV care, adherence, and durable viral suppression in need of critical supportive services.

scholarly journals 1316. Gathering Trauma Narratives: A Qualitative Study on the Impact of Traumas on People Living with HIV (PLWH)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S475-S475
Author(s):  
Doris Pierson ◽  
Vaidehi Mujumdar ◽  
Brittany Briceño ◽  
Elaina Cummer ◽  
Kshipra Hemal ◽  
...  
Keyword(s):  
United States ◽  
Reproductive Health ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Reproductive Intentions ◽  
Living With Hiv ◽  
The Impact

Abstract Background Trauma—emotional, physical, and psychological—is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). In the United States, there are limited data on how trauma affects reproductive health beliefs for PLWH and even less data on HIV providers’ understanding and consideration of these experiences in their approach to patients. Methods Fifteen semi-structured interviews were conducted with PLWH and nine semi-structured interviews were conducted with HIV care and service providers at an academic medical center in the Southeastern United States. Transcripts were analyzed using thematic analysis. Each transcript was coded by two investigators and discussed to ensure consensus. Results Participants’ narratives described diverse traumas, including sexual abuse (n = 6), the loss of a loved one (n = 8), and personal illness (n = 7). Types of trauma shared with providers included physical, sexual, illness, loss, and psychological. For patients, trauma was both a motivation for having children and a reason to stop having children. Providers perceived a variety of effects of trauma on both sexual behaviors and reproductive intentions. Reproductive counseling by HIV care providers (n = 5) focused on maintaining a healthy pregnancy and less on reproductive intentions prior to pregnancy. Reproductive discussions with pregnant female patients typically centered on reducing the risk of transmission in utero (including the importance of medication adherence to maintain viral suppression), what will happen during delivery, and breastfeeding risks. Reproductive discussions with males typically centered on preventing infection or re-infection of the mother. Conclusion PLWH interpret their trauma experiences differently, particularly when considering reproduction. Providers may not incorporate this information in counseling around reproductive health, highlighting the need fora trauma-informed healthcare practice that promotes awareness, education on the effect of past traumas on health, and access to appropriate resources. Disclosures All authors: No reported disclosures.

A systematic review of the geospatial barriers to antiretroviral initiation, adherence and viral suppression among people living with HIV

Sexual Health ◽  
2019 ◽  
Vol 16 (1) ◽  
pp. 1 ◽  
Author(s):  
Kiffer G. Card ◽  
Nathan J. Lachowsky ◽  
Keri N. Althoff ◽  
Katherine Schafer ◽  
Robert S. Hogg ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Clinical Care ◽  
The United States ◽  
Hiv Care ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Pubmed Database ◽  
Barriers To Art Initiation ◽  
Living With Hiv

Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing – an essential antecedent to clinical care – to date, no reviews have summarised the research with respect to other ART-related outcomes. Methods: Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies. Results: In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes. Conclusions: Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas – particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH).

scholarly journals Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 168
Author(s):  
Alina Cernasev ◽  
Michael P. Veve ◽  
Theodore J. Cory ◽  
Nathan A. Summers ◽  
Madison Miller ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Patient Outcomes ◽  
The United States ◽  
Neurocognitive Disorders ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Addictive Disorders ◽  
Living With Hiv ◽  
Hiv Aids

The opioid epidemic has had a significant, negative impact in the United States, and people living with HIV/AIDS (PLWHA) represent a vulnerable sub-population that is at risk for negative sequela from prolonged opioid use or opioid use disorder (OUD). PLWHA are known to suffer from HIV-related pain and are commonly treated with opioids, leading to subsequent addictive disorders. PLWHA and OUD are at an increased risk for attrition in the HIV care continuum, including suboptimal HIV laboratory testing, delayed entry into HIV care, and initiation or adherence to antiretroviral therapy. Barriers to OUD treatment, such as medication-assisted therapy, are also apparent for PLWHA with OUD, particularly those living in rural areas. Additionally, PLWHA and OUD are at a high risk for serious drug–drug interactions through antiretroviral-opioid metabolic pathway-related inhibition/induction, or via the human ether-a-go-go-related gene potassium ion channel pathways. HIV-associated neurocognitive disorders can also be potentiated by the off-target inflammatory effects of opioid use. PLWHA and OUD might require more intensive, individualized protocols to sustain treatment for the underlying opioid addiction, as well as to provide proactive social support to aid in improving patient outcomes. Advancements in the understanding and management of PLWHA and OUD are needed to improve patient care. This review describes the effects of prescription and non-prescription opioid use in PLWHA.

scholarly journals The Role of Health Education Specialists in Conducting Rapid HIV Testing

2020 ◽  
Vol 29 (1) ◽  
Author(s):  
Anthony Santella ◽  
Jacquie Fraser ◽  
Angela Prehn
Keyword(s):  
United States ◽  
Health Education ◽  
Hiv Testing ◽  
The United States ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Rapid Hiv Testing ◽  
Testing Strategies ◽  
Living With Hiv

There are over one million people living with HIV in the United States; an estimated 16% are unaware of their status. More innovative testing strategies are needed, as evidence suggests that persons most at risk for HIV, or who may present with early infections, are not being reached. Expanding the role of health education specialists can make HIV testing routine and more accessible, and help achieve the national goals of decreasing HIV infection and increasing knowledge of HIV status. This paper focuses on the role of Certified Health Education Specialists (CHES)/Master CHES as being professionally prepared to conduct HIV testing.

scholarly journals Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Kathleen A. McManus ◽  
Carolyn L. Engelhard ◽  
Rebecca Dillingham
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
The United States ◽  
Lessons Learned ◽  
State Funding ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Assistance Program ◽  
The Affordable Care Act ◽  
Living With Hiv

AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

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