Factors associated with readiness to start antiretroviral therapy (ART) among young people (15-24 years) at four HIV clinics in Mulago Hospital, Uganda

Introduction: Globally, the HIV burden continues to rise among young people despite the discovery of ART. This study assessed demographic and psycho-social factors among young people associated with readiness to be initiated on ART. Methods: A quantitative cross-sectional study was conducted among newly diagnosed HIV positive young people aged 15-24 years at 4 HIV clinics at Mulago Hospital. Readiness was measured as a self-report by the individual to the question,“How ready do you feel to start ART? Results: Of the 231 young people enrolled, the mean age (SD) was 20.7years (+/-2.8) and most were female (66.2%). Majority were very ready (53.3%) and very motivated (51.1%) to start ART. Higher treatment readiness was associated with being female (95% CI [5.62, 8.31], p=0.003), thinking that ART cures HIV (95% CI [0.43, 0.86], p=0.005), history of having unprotected sex (95% CI [0.79, 0.87], p=<0.001), anticipating negative HIV results (95% CI [0.26, 0.88], p=0.017), internalized stigma (95% CI [0.83, 0.98], p=0.018) and knowledge of positive ART effects for others (95% CI [0.84, 0.93], p=<0.001). Conclusions: Understanding the underlying factors associated with ART readiness among young people can inform strategiesto support and increase individuals’ readiness to initiate ART and early engagement in care. Keywords: Antiretroviral therapy Readiness; Young people; Sub-Saharan Africa.

Victim empathy-based content in aggression treatment: exploring impact within a secure forensic hospital

Purpose This study aims to explore the impact of inclusion of victim empathy-based content in offender treatment. Design/methodology/approach This study first presents a systematic review of 20 papers before proceeding to consider qualitative interviews with therapists (n = 7) and forensic patients (n = 5), who had completed a long-term violence therapy (Life Minus Violence – Enhanced, LMV-E©). The research explored perceptions of forensic patients and treatment facilitators when completing victim empathy work and explored any negative effects this may have. Findings Findings from the systematic review indicated five themes: interventions incorporating victim empathy can be effective; there are positive risk-understanding consequences from completing victim empathy work; offenders perceive victim empathy positively; the emotional impact of victim empathy work on offenders’ is poorly explored; and completing victim empathy in treatment groups receives mixed evaluations from offenders. The systematic review was used to inform the interview themes for the resulting qualitative study with facilitators and forensic patients. This study indicated six themes: victim empathy content facilitates change; victim empathy content can be difficult for patients; victim empathy content can lead to an emotional response; victim empathy content can be beneficial, with the process important; victim empathy content can help understand risk, and patients’ experience of treatment begins before attending sessions. Practical implications The potential impact of victim empathy content needs to be evaluated before sessions are completed, accounting for client expectations and treatment readiness. This should include ensuring that appropriate support is in place. Any support provided to patients should be regularly reviewed. Originality/value The study represents the first to apply detailed analysis to this topic area and with a complex group.

An Integrative Review of Arts-Based Strategies for Addressing Pain and Substance Use Disorder During the Opioid Crisis

In October 2017, the U.S. Department of Health & Human Services declared the opioid crisis a national public health emergency and prioritized identifying effective, evidence-based strategies for pain management and the prevention and treatment of substance use disorder (SUD). Increasingly, the arts have become more widely established and accepted as health-promoting practices in the United States and around the world. As the U.S. health care system moves toward greater integration of physical and behavioral health, arts-based interventions should be considered among potential complementary approaches for managing pain and preventing and treating SUD. We conducted an integrative literature review to summarize and synthesize the evidence on the role of the arts in the management of pain and in the prevention and treatment of SUD, including opioid use disorder. The available evidence suggests that music interventions may reduce participants’ pain, reduce the amount of pain medication they take, improve their SUD treatment readiness and motivation, and reduce craving. Few studies examined art forms other than music, limiting the ability to draw conclusions for those art forms. Given the critical need to identify effective strategies for managing pain and preventing and treating SUD, future research on arts-based interventions should examine maintenance of pain management and SUD treatment benefits over time and outcomes related to SUD prevention.

Effectiveness of same-day antiretroviral therapy initiation in retention outcomes among people living with human immunodeficiency virus in Ethiopia: empirical evidence

Background In August 2016, Ethiopia endorsed a universal “test and treat” strategy for people living with human immunodeficiency virus (PLHIV) based on World Health Organization recommendation. However, there is limited evidence on the routine application of the same-day “test and treat” recommendation in low-income settings. This study assessed the effect of same-day treatment initiation on individual-level retention at 6- and 12-months follow-up. Methods A multicenter facility-based retrospective cohort study was conducted to compare retention-in-care between PLHIV who started antiretroviral therapy (ART) on the same-day and those started ART > 7 days following HIV diagnoses. Participants were at least 15 years-old and were newly diagnosed and started on ART between October 2016 and July 2018 in 11 health facilities in the Amhara region of Ethiopia. Multivariable logistic regression controlling for potential confounders and Kaplan-Meier survival analysis were used to assess differences in outcomes between the groups. Results In total, 433 PLHIV started ART on the same-day of diagnosis and 555 PLHIV who started ART > 7 days after HIV diagnosis were included in the study. At 6-months, 82.0% (355) in the same-day group vs 89.4% (496) in the > 7 days group were retained-in-care (absolute risk difference (RD) = 7.4%; 95% confidence interval (CI): 2.9–11.8%). At 12-months, 75.8% (328) in the same-day group vs 82.0% (455) in the > 7 days group were retained-in-care (absolute RD = 6.2%; 95% CI: 1.1, 11.4%). The major drop in retention was in the first 30 days following ART initiation among same-day group. After adjusting for baseline and non-baseline covariates, the same-day group was less likely to be retained-in-care at 6- and 12-months (adjusted risk ratio (RR) = 0.89; 95% CI: 0.87, 0.90 and adjusted RR = 0.86; 95% CI: 0.83, 0.89, respectively). Conclusions Reduced retention-in-care can threaten the benefit of the same-day “test and treat” policy. The policy needs to be implemented cautiously with greater emphasis on assessment and preparation of PLHIV for ART to ensure treatment readiness before starting them on same-day ART and close monitoring of patients during early follow-up periods.

Effects of Criminogenic Risk–Needs Assessment Feedback During Prerelease Correctional Rehabilitation

This pre–post follow-up randomized trial investigated the receptiveness and responsiveness of 82 incarcerated men undergoing reentry to feedback (discussion-based, form-based, or none–minimal) regarding their criminogenic risk–needs assessment results. Both short-term outcomes (self-perceived risk–needs, motivation for change, treatment readiness, and feedback satisfaction) and longer-term outcomes (intuitional conduct, rearrest, or halfway house return) were examined. As hypothesized, among study completers ( n = 67), motivation for change was significantly higher following discussion feedback, and both feedback formats were rated favorably by participants. Contrary to hypotheses, feedback recipients, including those who showed gains at post, did not appear reliably distinct from others on longer-term outcomes; nor were most outcomes significantly associated with baseline risk scores. Feedback about risk and needs may be useful in correctional treatment for motivation enhancement and treatment orienting, but special attention to measurement, contextual, and intensity factors is warranted.

“I’ve Got the Energy to Change, But I Haven’t Got the Energy for This Kinda Therapy”: A Qualitative Analysis of the Motivations Behind Democratic Therapeutic Community Drop-Out for Men With Sexual Convictions

Prison-based democratic therapeutic communities (TCs) provide an alternative to mainstream prison, where prisoners can work on psychological difficulties and address offending behavior. Research demonstrates TCs are effective at reducing reoffending rates for residents who stay in therapy 18+ months, and those who drop out of TCs offend at a significantly higher rate than those who complete therapy. Thus, it is important to reduce attrition in TCs. No research has yet explored the explanations for TC drop out offered by those with sexual convictions. The present study uses Interpretive Phenomenological Analysis to qualitatively explore the accounts of men with sexual convictions ( n = 7) who dropped out of a TC in a UK prison. Results highlight that issues surrounding external responsivity, therapeutic relationships, and treatment readiness were salient in the participants’ accounts of drop out. This research has implications for TCs seeking to better understand and address attrition of people with sexual convictions.

A six-step brief intervention to reduce distress and increase treatment readiness in problem gamblers

Objective: The majority of people with gambling problems contact helplines when they are in crisis, hampering their capacity to explore suitable treatment options. To date, there has been limited research identifying the best way to support individuals to reduce distress and maximise further treatment-seeking. In this paper, we describe the development and piloting of the resulting six-step brief intervention. Method: A six-step brief intervention was developed based on a literature review of existing interventions for crisis management, semi-structured interviews with 19 participants comprising gambling and crisis support counsellors and consumers, as well as experts in the addiction field. Results: The resulting six-step brief-intervention focusses on (1) acknowledging and measuring distress; (2) normalising and reducing distress; (3) optimising motivation for change; (4) providing a sense of hope; (5) re-measuring distress and, if reduced; (6) exploring options for treatment and support. Conclusion: Whilst developed primarily for helpline counsellors, the intervention has potential application for health practitioners working across telephone, online and face-to-face services. Further research is required to determine its effectiveness in improving treatment engagement amongst people with gambling problems.