[Show abstract][Hide abstract] ABSTRACT: A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or dis-continue antiretroviral therapy (ART) when it is medically indicated (40–45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012–2013. Participants were engaged in structured 1-h assessments with reliable/valid measures on barriers to ART. We found that recruitment through peers (63.2%, 60/95) was more fea-sible than in clinics (36.8%, 35/90). Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1%) were male and African-American (76.8%), and 23.2% were Latino/Hispanic. Peer-recruited par-ticipants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct), and there were no differences in attitudes toward ART (e.g., mistrust), which were in the neu-tral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B = −10.4) and positively associated with self-efficacy (B = 5.5), pos-itive outcome expectancies (B = 6.3), beliefs about personal necessity of ART (B = 17.5), and positive internal norms (B = 7.9). This study demonstrates the feasibility of engaging this vulnerable population through peer-referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared to those in hospital clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.
[Show abstract][Hide abstract] ABSTRACT: African American/Black and Hispanic persons
living with HIV/AIDS (‘‘AABH-PLHA’’) are under-represented
in HIV/AIDS medical studies (HAMS). This
paper evaluates the efficacy of a social/behavioral intervention
to increase rates of screening for and enrollment
into HAMS in these populations. Participants (N = 540)
were enrolled into a cluster randomized controlled trial of
an intervention designed to overcome multi-level barriers
to HAMS. Primary endpoints were rates of screening for
and enrollment into therapeutic/treatment-oriented and
observational studies. Intervention arm participants were
30 times more likely to be screened than controls
(49.3 % vs. 3.7 %; p\.001). Half (55.5 %) of those
screened were eligible for HAMS, primarily observational
studies. Nine out of ten found eligible enrolled (91.7 %),
almost all into observational studies (95.2 %), compared to
no enrollments among controls. Achieving appropriate
representation of AABH-PLHA in HAMS necessitates
modification of study inclusion criteria to increase the proportion found eligible for therapeutic HAMS, in addition
to social/behavioral interventions.
[Show abstract][Hide abstract] ABSTRACT: AIDS clinical trials (ACTs) are critical to the development of new treatments for HIV infection. However, people of color living with HIV/AIDS are involved in ACTs at disproportionally low rates, with African-Americans experiencing the greatest under-representation. In this article, we describe the core elements and key characteristics of a highly efficacious multi-component peer-driven intervention (PDI) designed to increase rates of screening for and enrollment into ACTs among African-American and Latino/Hispanic individuals, by addressing the main complex, multi-level barriers they experience to ACTs. We discuss the process of developing the intervention, the theoretical models guiding its delivery format and content, and provide an overview of the intervention's components. We then use brief case studies to illustrate a number of key issues that may arise during intervention implementation. Finally, we describe lessons learned and provide recommendations for the PDI's uptake in clinical and clinical trials settings.
Health Education Research 05/2013; · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: African-American and Latino/Hispanic persons living with HIV/AIDS are underrepresented in AIDS clinical trials (ACTs). The aim of this paper was to uncover factors, either unmodifiable or not directly targeted for change, that predicted screening for ACTs during an efficacious peer-driven intervention (N = 540 total; N = 351 in an intervention arm, N = 189 control). This paper focused on participants assigned to an intervention arm, 56 % of whom were screened for ACTs. We found a decreased odds of screening was associated with closer proximity to the screening site, gay/lesbian orientation, lower mental health symptoms, current injection drug use, more recent HIV diagnosis, lack of prior screening experience, and failure to attend all intervention sessions, but there were no gender or racial/ethnic differences. Efforts to reduce racial/ethnic disparities in ACTs can be enhanced by attending to these specific factors, which may interfere with programmatic efforts to increase African-American and Latino/Hispanic representation in ACTs.
[Show abstract][Hide abstract] ABSTRACT: We examined the efficacy of a peer-driven intervention to increase rates of screening for AIDS clinical trials among African Americans and Hispanics living with HIV/AIDS.
We used a randomized controlled trial design to examine the efficacy of peer-driven intervention (6 hours of structured sessions and the opportunity to educate 3 peers) compared with a time-matched control intervention. Participants were recruited using respondent-driven sampling (n = 342; 43.9% female; 64.9% African American, 26.6% Hispanic). Most participants (93.3%) completed intervention sessions and 64.9% recruited or educated peers. Baseline and post-baseline interviews (94.4% completed) were computer-assisted. A mixed model was used to examine intervention effects on screening.
Screening was much more likely in the peer-driven intervention than in the control arm (adjusted odds ratio [AOR] = 55.0; z = 5.49, P < .001); about half of the participants in the intervention arm (46.0%) were screened compared with 1.6% of controls. The experience of recruiting and educating each peer also increased screening odds among those who were themselves recruited and educated by peers (AOR = 1.4; z = 2.06, P < .05).
Peer-driven intervention was highly efficacious in increasing AIDS clinical trial screening rates among African Americans and Hispanics living with HIV/AIDS.
American Journal of Public Health 02/2011; 101(6):1096-102. · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Persons living with HIV/AIDS (PLHA) of color are under-represented in AIDS clinical trials (ACTs), which may limit the generalizability of research findings and denies many individuals access to high levels of care and new treatments available through ACTs. Disproportionately low rates of recruitment in health care settings and by providers are a major barrier to ACTs for this group. Moreover, PLHA of color are more likely than their white peers to decline to participate, mainly due to fear and mistrust (although willingness is also high), negative social norms about ACTs, and difficulty navigating the unfamiliar ACT system. We describe a small number of successful behavioral and structural interventions to increase the participation of PLHA of color in screening for and enrollment into ACTs. HIV care settings, clinical trials sites, and trial sponsors are uniquely positioned to develop procedures, supports, and trials to increase the proportion of PLHA of color in ACTs.
[Show abstract][Hide abstract] ABSTRACT: This article evaluates the efficacy of a 14-session social-cognitive behavioral intervention on problem drinking (and where applicable, drug use) among urban HIV-infected and uninfected mothers, in comparison to a single-session social/motivational intervention, and explores the relationships of initial substance use problem severity and HIV status to efficacy. A randomized controlled trial design was used. Participants (N = 118) were mothers with problem drinking, both HIV-infected (55%) and uninfected, and primarily from racial/ethnic minority and low socioeconomic status backgrounds. Participants were interviewed five times over 18 months. Both intervention arms yielded reductions in alcohol and drug use frequency, alcohol quantity, and alcohol/drug problems, with moderate effect sizes. Those with greater initial substance use maintained reductions over a longer period of time in response to the more intensive social-cognitive intervention. Treatment efficacy did not vary by HIV status. The utility of targeting intervention intensity to the level of substance use is supported.
[Show abstract][Hide abstract] ABSTRACT: Individuals from racial/ethnic minority backgrounds and women have not been proportionately represented in AIDS clinical trials (ACTs). There have been few intervention efforts to eliminate this health disparity. This paper reports on a brief behavioral intervention to increase rates of screening for ACTs in these groups. The study was exploratory and used a single-group pre/posttest design. A total of 580 persons living with HIV/AIDS (PLHA) were recruited (39% female; 56% African-American, 32% Latino/Hispanic). The intervention was efficacious: 25% attended screening. We identified the primary junctures where PLHA are lost in the screening process. Both group intervention sessions and an individual contact were associated with screening. Findings provide preliminary support for the intervention's efficacy and the utility of combining group and individual intervention formats. Interventions of greater duration and intensity, and which address multiple levels of influence (e.g., social, structural), may be needed to increase screening rates further.
AIDS and Behavior 04/2009; 14(3):639-48. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The abuse of alcohol and other substances by mothers raising adolescent children has serious adverse effects on family functioning
and youth outcomes, and on mothers’ own health and adaptation. Mothers who are also HIV-infected face additional challenges.
In the present report, we describe a multi-session intervention conducted in individual sessions for mothers with alcohol
and other substance use problems who are raising adolescent children. We outline the primary components of the intervention
and include case studies and examples of exercises and tools. We found that engagement with the intervention and high rates
of attendance were facilitated by tapping into mothers’ desires to improve their relationships with their adolescent children,
the use of a harm reduction approach toward substance use, and intensive outreach. We also discuss lessons learned in the
course of implementing and evaluating the intervention.
Journal of Child and Family Studies 01/2007; 16(4):531-544. · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this article, the authors evaluate the effects of a behavioral intervention for mothers with problem drinking who were infected with, or at risk for, HIV. They randomly selected 25 mothers from a larger longitudinal randomized controlled intervention trial for a qualitative interview. The authors found that mothers' participation in the program was facilitated by the development of a strong therapeutic alliance with the intervention facilitator and the use of a harm reduction approach toward alcohol and/or drug abuse. Mothers also reported that training in coping skills and the emphasis on parent-adolescent relationships were beneficial for program engagement and behavior change. The authors conclude from these results that treatment approaches that take into account the complexity of urban mothers' lives and substance use patterns can successfully engage and treat these women at high risk for adverse outcomes.
Qualitative Health Research 12/2006; 16(9):1252-66. · 2.19 Impact Factor