Article

Development of an easy to use tool to assess HIV treatment readiness in adolescent clinical care settings

Public Health and Preventive Medicine, College of Osteopathic Medicine, Nova Southeastern University, Miami, FL, USA.
AIDS Care (Impact Factor: 1.6). 11/2011; 23(11):1492-9. DOI: 10.1080/09540121.2011.565020
Source: PubMed

ABSTRACT Optimal management of HIV disease requires high levels of lifelong adherence once a patient initiates highly active antiretroviral therapy (HAART). Because suboptimal adherence to HAART is associated with adverse consequences, many providers are hesitant to prescribe HAART for patients whom they perceive as not being ready to initiate treatment. Accurately predicting HIV treatment readiness is challenging. Despite the importance of this construct, few reliable and valid instruments to assess HIV treatment readiness have been developed; none of these have been validated with adolescents and young adults, who comprise an increasing proportion of new HIV cases diagnosed. As a first step to achieve this goal, we developed the HIV Treatment-Readiness Measure (HTRM) for administration by way of audio computer-assisted self-interview (ACASI) and conducted a study to examine its internal consistency, test-retest reliability, acceptability, and preliminary factor structure. We recruited 201 adolescents and young adults living with HIV from 15 adolescent medicine clinics that were part of the Adolescent Trials Network for HIV Interventions. Youth completed the initial assessment and two weeks later the retest assessment. The refined HTRM had high internal consistency (α = 0.84). Test-retest reliability using both sum scores and mean scores were high. The HTRM was also highly acceptable and feasible to use in routine clinical practice. In exploratory factor analysis we found that a five-factor solution was the best fit; each of the subscales (Disclosure, Psychosocial Issues, Connection with Care, HIV Medication Beliefs, and Alcohol and Drugs) had good to acceptable alphas and eigenvalues greater than 2.0. Our findings support conducting a future study to examine the tool's predictive validity.

Download full-text

Full-text

Available from: Robin J Jacobs, Aug 29, 2015
2 Followers
 · 
227 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known of the experience of Latino youth with HIV infection in the United States, especially with respect to stressors and how these youth cope with said stressors. This study reports on a subset (Latino/Hispanic self-identified youth, n=14) of qualitatively interviewed youth (n=30), both in individual interviews and in focus group discussion settings, aware of their HIV diagnosis for 12-24 months (mean: 16.7 months; standard deviation [SD], 4.89) Youth were 16-24 years old (M=21.5 years), female (43%) and males (57%). Youth were recruited from three cities: Chicago, New York, and San Juan (Puerto Rico). Interviews of Latinos (n=14) were reviewed for sources of stressors and support. Seven themes emerged in analyzing stated sources of stressors: (1) initial psychosocial responses to HIV diagnosis, (2) disclosure to family and friends, (3) stigma related to receiving an HIV diagnosis, (4) body image and concerns of the physical changes associated with HIV and antiretroviral medications, (5) taking antiretroviral medications and side effects, (6) the disruption of their future life goals, and (7) reproductive health concerns. Identified sources of support and coping were described including; gaining appreciation for what matters in life, adapting and developing achievable goals, reordering priorities and relying on religion and spiritual beliefs for health outcomes. The information gathered is from individual interviews and from focus group discussions can be used to increase the understanding of this understudied population while improving services to engage and retain these youth in care.
    AIDS patient care and STDs 05/2012; 26(5):281-90. DOI:10.1089/apc.2011.0317 · 3.58 Impact Factor
  • JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; 63:S155-S160. DOI:10.1097/QAI.0b013e31829871fb · 4.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Young people with behaviorally acquired HIV (BHIV) are less likely than adults to initiate antiretroviral therapy (ART) despite meeting treatment criteria. We explored critical factors involved in healthcare providers' decision making regarding ART initiation for young people with BHIV (aged 12-24 years). Semistructured interviews were conducted with 23 HIV providers from diverse training backgrounds caring for youth with BHIV at four adult clinics and one pediatric clinic in a high prevalence urban city. Interview domains probed clinical and nonclinical patient characteristics, the role of adherence, and provider attitudes working with youth to establish decision-making priorities for ART initiation. The constant comparative approach was used to develop grounded theory on providers' decision making on ART initiation. Clinical criteria, particularly the CD4 count, and the public health implications of HIV transmission determined the urgency for ART initiation. However, patient-related concerns regarding treatment readiness and adherence hampered the decision to initiate, especially at higher CD4 counts. Providers who acknowledged developmental characteristics of youth (e.g., evolving adult identity and self-efficacy around health management) appeared more cautious in assessing future ART adherence and responded with intensive clinical support. Extensive involvement of multidisciplinary teams was identified as an important strategy to retain youth in care, whereas strengthening youth-targeted approaches may be an unmet need in adult clinics. Evaluation of providers' awareness of the developmental features of youth and characteristics of youth-targeted approaches in clinics caring for youth with BHIV may inform interventions to increase youth engagement in care and subsequent decisions to successfully initiate ART.
    Journal of Adolescent Health 04/2014; 55(3). DOI:10.1016/j.jadohealth.2014.03.006 · 2.75 Impact Factor
Show more