Factors associated with engaging socially marginalized HIV-positive persons in primary care
ABSTRACT This paper examines factors associated with engaging socially marginalized HIV-positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12-month follow-up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV-positive persons in HIV primary care.
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ABSTRACT: Multiple studies have shown that subtherapeutic appointment adherence and medication adherence are associated with worse clinical outcomes for people living with HIV disease. Thus, poor appointment and medication adherence diminish individual and community HIV control and transmission. Yet not enough is known about interventions that can improve retention in HIV care. The purpose of this study was to test an intervention to improve retention and/or medication adherence in a public clinic in the Deep South. One hundred participants with retention or medication adherence difficulties were randomized to either a six-month intervention or usual care, and followed longitudinally for one year. The intervention was multidimensional, based on the Information-Motivation-Behavioral Skills (IMB) model. The intervention addressed information about HIV and the importance of retention/adherence, motivation to be retained and/or adhere to medications, and the behavioral skills needed to manage and maintain these healthy behaviors in a combination of face-to-face and telephone sessions. The proportion of those with at least one visit in each four-month block (third) of the year increased in those with minimal exposure to the intervention (three out of eight intervention contacts) as compared to those with less intervention exposure (p = 0.098). Those with at least this minimal exposure averaged a significantly higher number of thirds that included a clinic visit as compared to those with less intervention exposure (p = 0.013). The intervention did not demonstrate a significant effect on medication adherence, though this is contradictory to a previous study testing a version of this intervention designed to address only medication adherence. Further study to increase uptake of the intervention is needed to increase its efficacy.AIDS Care 10/2013; 26(6). DOI:10.1080/09540121.2013.845283 · 1.60 Impact Factor
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ABSTRACT: Low access to HIV care and support has led to survival rates for transwomen that are half that of other populations at risk for HIV. Within the population, HIV disproportionately impacts African American transwomen. Interventions to increase access to HIV care and support are needed to better serve those most affected and vulnerable within the population. We conducted a study of barriers and facilitators to care and support services for African American transwomen to fill a gap in the literature to improve access for this particularly impacted population. A total of 10 in-depth interviews were conducted with African American transwomen living with HIV who lived outside the metro area of San Francisco. Three overarching thematic topics emerged-gender stigma, peer, and institutional distrust - giving insight into African American transwomen's barriers to HIV care and support services. A number of factors within these themes impacted access, such as whether organizations offered gender-related care, the geography of organizations as it relates to safe transportation and location, confidentiality and trust of peers and organizations, and trauma. Specific instrumental, institutional and emotional supports are provided that that may increase access to care and support services for African American transwomen living with HIV.International Journal of Transgenderism 10/2013; 14(4):182-195. DOI:10.1080/15532739.2014.890090
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ABSTRACT: AimsTo understand the environmental and contextual influences of illicit cocaine and heroin use and craving using mobile health (mHealth) methods.DesignInteractive mHealth methods of ecological momentary assessment (EMA) were utilized in the Exposure Assessment in Current Time (EXACT) study to assess drug use and craving among urban drug users in real-time. Participants were provided mobile devices and asked to self-report every time they either craved (without using) or used heroin or cocaine for 30-days from November 2008 through May 2013.SettingBaltimore, Maryland, USAParticipants109 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) studyMeasurementsFor each drug use or crave event, participants answered questions concerning their drug use, current mood, and their social, physical and activity environments. Odds ratios of drug use versus craving were obtained from logistic regression models with generalized estimating equations of all reported events.FindingsParticipants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Participants were significantly more likely to report use rather than craving drugs if they were with someone who was using drugs (aOR=1.45, 95% CI: 1.13,1.86), in an abandoned space (aOR=6.65, 95% CI: 1.78, 24.84) or walking/wandering (aOR=1.68, 95% CI: 1.11,2.54). Craving drugs was associated with being with a child (aOR=0.26, 95% CI: 0.12,0.59), eating (aOR=0.54, 95% CI: 0.34,0.85) or being at the doctor's office (aOR=0.31, 95% CI: 0.12, 0.80).Conclusions There are distinct drug using and craving environments among urban drug users, which may provide a framework for developing real-time context-sensitive interventions.Addiction 10/2014; 110(2). DOI:10.1111/add.12768 · 4.60 Impact Factor