Introduction This study set out to identify gaps between policy and practice of HIV and AIDS workplace interventions in the University of Malawi, in particular College of Medicine in line with the UNIMA HIV and AIDS policy. Objectives The main objective was to establish whether the HIV and AIDS workplace interventions at ...
Tso, Lai Sze; Tang, Weiming; Li, Haochu; Yan, H Yanna; Tucker, Joseph D
Persistent new HIV infections and risky behaviors underscore the need for enhanced HIV prevention. Social media interventions may promote safe sexual behaviors, increase HIV testing uptake, and promote safe injection behaviors. This review discusses how social media interventions tap into the wisdom of crowds through crowdsourcing, build peer-mentored communities, and deliver interventions through social networks. Social media HIV prevention interventions are constrained by ethical issues, low social media usage among some key populations, and implementation issues. Comprehensive measurement of social media interventions to prevent HIV is necessary, but requires further development of metrics.
Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital's general paediatric wards between ...
Lemieux, Anthony F; Fisher, Jeffrey D; Pratto, Felicia
This research examines the process of conducting and evaluating a music-based HIV prevention intervention among urban adolescents, and is informed by the information, motivation, behavioral skills (IMB) model. Musically talented opinion leaders were recruited to write, record, and distribute HIV prevention themed music to their peers to increase HIV prevention motivation, behavioral skills, and behaviors. In this 3-month field experiment, participants were 306 students enrolled in health classes at each of three large multiracial urban high schools (one treatment school; two control schools). Measures of HIV prevention information, motivation, behavioral skills, and behaviors, both pre- and postintervention. Results indicate that the intervention influenced several aspects of HIV prevention motivation, behavioral skills, and condom use and HIV testing behaviors. This research demonstrates that the incorporation of music into HIV prevention interventions for adolescents has the potential to be effective.
Poteat, Tonia; Wirtz, Andrea L; Radix, Anita; Borquez, Annick; Silva-Santisteban, Alfonso; Deutsch, Madeline B; Khan, Sharful Islam; Winter, Sam; Operario, Don
Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. PMID:25059941
Montgomery, C.M.; Watts, C.; Pool, R.
Background The most common form of HIV transmission in sub-Saharan Africa is heterosexual sex between two partners. While most HIV prevention interventions are aimed at the individual, there is mounting evidence of the feasibility, acceptability, and efficacy of dyadic interventions. However, the
South Africa urgently needs HIV prevention interventions that can be disseminated for use in clinical and community settings. A brief theory-based HIV risk reduction counselling intervention originally developed in the USA has recently been adapted for use in a South African sexually transmitted infection clinic.
... HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY...: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive Award To... services for persons living with HIV/AIDS, HRSA will provide a one-time noncompetitive Ryan White HIV/AIDS...
Interventions to support adherence to antiretroviral therapy (ART) can be classified into four categories: cognitive, behavioural and affective interventions and (modified) directly observed therapy (DOT.) Cognitive interventions improve HIV- and ART-related knowledge, but this is not consistently associated with better ...
The aim of the study was to evaluate a motivation-based HIV risk reduction intervention for economically disadvantaged urban women in South Africa. Women were recruited through radio and information pamphlets. At baseline 119 women completed a survey regarding HIV-related knowledge, risk perceptions, ...
Medical Journal of Zambia ... Abstract. Aim and Objectives: To sequentially assess the levels of Knowledge, Attitudes and Practices of HIV and AIDS among students at the University of Zambia and the extent to which this information can be used in HIV programming on Campus to plan for appropriate interventions. Design: ...
... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive... care services for persons living with HIV/AIDS, HRSA will provide a one-time noncompetitive Ryan White...
... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive... care services for persons living with HIV/AIDS, HRSA will provide one-time noncompetitive Ryan White...
... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program (Part C) Early Intervention Services One-Time... primary care services for persons living with HIV/AIDS, HRSA will provide one-time noncompetitive Part C...
Perreau, Matthieu; Banga, Riddhima; Pantaleo, Giuseppe
Combination antiretroviral therapy (cART) induces durable suppression of virus replication but is unable to eradicate HIV. Invariably, virus rebound follows treatment interruption and life-long cART is thus required. Advances have been made in our understanding of HIV latency, identification of HIV cell reservoirs, regulation of HIV-specific immune responses, as well as in the development of broad neutralizing antibodies and putative therapeutic vaccines. These have provided a scientific basis to explore alternative strategies that achieve durable suppression of viremia in the absence of cART, the so-called functional cure. Single intervention strategies have shown promise, albeit with limited efficacy. Consequently, a combination of interventions aiming to stimulate the immune response and prevent new rounds of viral infection and spreading may render the HIV functional cure a feasible goal. Copyright © 2017 Elsevier Ltd. All rights reserved.
Banks, Bahby; Jonas, Dan; Miles, Margaret Shandor; Smith, Giselle Corbie
We reviewed the literature to determine the effectiveness of HIV-related interventions in reducing HIV/AIDS stigma. Studies selected had randomized controlled trial (RCT), pretest–posttest with a non-randomized control group, or pretest–posttest one group study designs in which HIV-related interventions were being evaluated, and in which HIV/AIDS stigma was one of the outcomes being measured. A checklist was used to extract data from accepted studies, assess their internal validity, and overall quality. Data were extracted from 19 studies, and 14 of these studies demonstrated effectiveness in reducing HIV/ AIDS stigma. Only 2 of these 14 effective studies were considered good studies, based on quality, the extent to which the intervention focused on reducing HIV/AIDS stigma, and the statistics reported to demonstrate effectiveness. Future studies to reduce HIV/AIDS stigma could improve by designing interventions that pay greater attention to internal validity, use validated HIV/AIDS stigma instruments, and achieve both statistical and public health significance. PMID:21088989
Li, Li; Liang, Li-Jung; Lin, Chunqing; Wu, Zunyou; Rotheram-Borus, Mary Jane
The National Institute of Mental Health Collaborative HIV/Sexually Transmitted Disease Prevention Trial provided a unique opportunity to test whether, with the community-based diffusion of HIV/sexually transmitted disease prevention information and an elevated understanding of HIV, the level of stigmatizing attitudes toward people living with HIV/AIDS in the community would be reduced. A total of 4510 market workers in Fuzhou, China, participated in the study, and longitudinal analyses included study samples of 3785 participants in the 12-month follow-up and 3716 participants in the 24-month follow-up. We graphically examined the change in HIV-related stigma indicators over time between control and intervention groups using boxplot and kernel density estimation. A logistic regression analysis with proportional odds model was further used to examine the intervention effect on HIV-related stigmatizing attitudes. Compared with no change over time for the control group, the intervention successfully reduced the level of HIV-related stigmatizing attitudes among the target population at the 12-month follow-up, and the effect increased by two-fold (with respect to odds ratios) at the 24-month follow-up. The intervention demonstrated positive attitude changes associated with HIV-related stigma. Our results show the importance of social norms, rather than simply individual behaviors, in developing and implementing stigma reduction campaigns.
Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a ...
Full Text Available Despite significant advances in antiretroviral therapy, increasing drug resistance and toxicities observed among many of the current approved human immunodeficiency virus (HIV drugs indicate a need for discovery and development of potent and safe antivirals with a novel mechanism of action. Maturation inhibitors (MIs represent one such new class of HIV therapies. MIs inhibit a late step in the HIV-1 Gag processing cascade, causing defective core condensation and the release of non-infectious virus particles from infected cells, thus blocking the spread of the infection to new cells. Clinical proof-of-concept for the MIs was established with betulinic acid derived bevirimat, the prototype HIV-1 MI. Despite the discontinuation of its further clinical development in 2010 due to a lack of uniform patient response caused by naturally occurring drug resistance Gag polymorphisms, several second-generation MIs with improved activity against viruses exhibiting Gag polymorphism mediated resistance have been recently discovered and are under clinical evaluation in HIV/AID patients. In this review, current understanding of HIV-1 MIs is described and recent progress made toward elucidating the mechanism of action, target identification and development of second-generation MIs is reviewed.
Walker, Dilys; Gutierrez, Juan Pablo; Torres, Pilar; Bertozzi, Stefano M
OBJECTIVE: To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. DESIGN: Cluster randomised controlled trial. SETTING: 40 public high schools in the state of Morelos, Mexico. PARTICIPANTS: 10 954 first year high school students. INTERVENTION: Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contr...
Walker, Dilys; Gutierrez, Juan Pablo; Torres, Pilar; Bertozzi, Stefano M
To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. Cluster randomised controlled trial. 40 public high schools in the state of Morelos, Mexico. 10 954 first year high school students. Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm. Primary outcome measure was reported condom use. Other outcomes were reported sexual activity; knowledge and attitudes about HIV and emergency contraception; and attitudes and confidence about condom use. Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group. A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception.
Full Text Available Abstract Background Nef is a 27 KDa HIV-1 accessory protein. It downregulates CD4 from infected cell surface, a mechanism critical for efficient viral replication and pathogenicity. Agents that antagonize the Nef-mediated CD4 downregulation may offer a new class of drug to combat HIV infection and disease. TPCK (N-α-p-tosyl-L-phenylalanine chloromethyl ketone and TLCK (N-α-p-tosyl-L-lysine chloromethyl ketone are alkylation reagents that chemically modify the side chain of His or Cys residues in a protein. In search of chemicals that inhibit Nef function, we discovered that TPCK and TLCK alkylated HIV Nef. Methods Nef modification by TPCK was demonstrated on reducing SDS-PAGE. The specific cysteine residues modified were determined by site-directed mutagenesis and mass spectrometry (MS. The effect of TPCK modification on Nef-CD4 interaction was studied using fluorescence titration of a synthetic CD4 tail peptide with recombinant Nef-His protein. The conformational change of Nef-His protein upon TPCK-modification was monitored using CD spectrometry Results Incubation of Nef-transfected T cells, or recombinant Nef-His protein, with TPCK resulted in mobility shift of Nef on SDS-PAGE. Mutagenesis analysis indicated that the modification occurred at Cys55 and Cys206 in Nef. Mass spectrometry demonstrated that the modification was a covalent attachment (alkylation of TPCK at Cys55 and Cys206. Cys55 is next to the CD4 binding motif (A56W57L58 in Nef required for Nef-mediated CD4 downregulation and for AIDS development. This implies that the addition of a bulky TPCK molecule to Nef at Cys55 would impair Nef function and reduce HIV pathogenicity. As expected, Cys55 modification reduced the strength of the interaction between Nef-His and CD4 tail peptide by 50%. Conclusions Our data suggest that this Cys55-specific alkylation mechanism may be exploited to develop a new class of anti HIV drugs.
Describes the modes of transmission of HIV and the course of the disease in infants and toddlers. Information is provided on its effects on early development, medical screening and treatments, therapies, psychosocial assistance, and interventions, including nutritional therapy, occupational and physical therapies, and speech and language therapy.…
Charles Msisuka a , Ikuma Nozaki b email@example.com@hsph.harvard.edu, Kazuhiro Kakimoto c , Motoko Seko d & Mercy M S Ulaya e
to evaluate the refresher training intervention for HIV lay counsellors in the rural district of Chongwe in Zambia. ..... Salaried employee. Homemaker. CDE in health facility. Other. Median educational level (Grade). Median experience as counsellor (years). Median number of ... The importance of refresher training courses.
Oct 16, 2017 ... The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and ... étudier l'effet des composantes du programme de prévention du VIH/SIDA sur le lieu de travail sur les connaissances sur le. VIH/SIDA, l'accessibilité perçue ...
Dageid, Wenche; Govender, Kaymarlin; Gordon, Sarah F
Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.
Robinson, Rachel; Okpo, Emmanuel; Mngoma, Nomusa
The vast majority of people infected with human immunodeficiency virus (HIV) are adults of working age. Therefore unemployment and job loss resulting from HIV infection are major public health and economic concerns. Return to work (RTW) after diagnosis of HIV is a long and complex process, particularly if the individual has been absent from work for long periods. There have been various efforts to improve the RTW of persons living with HIV (HIV+), and many of these have been assessed formally in intervention studies. To evaluate the effect of interventions aimed at sustaining and improving employment in HIV+ persons. We conducted a comprehensive search from 1981 until December 2014 in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, OSH UPDATE databases (CISDOC, HSELINE, NIOSHTIC, NIOSHTIC-2, RILOSH), and PsycINFO. We considered for inclusion all randomized controlled trials (RCTs) or controlled before-after (CBA) studies assessing the effectiveness of pharmacological, vocational and psychological interventions with HIV+ working-aged (16 years or older) participants that had used RTW or other indices of employment as outcomes. Two review authors independently screened all potential references for inclusion. We determined final selection of studies by consensus. We performed data extraction and management, as well as Risk of bias assessment, in duplicate. We measured the treatment effect using odds ratio (OR) for binary outcomes and mean difference (MD) for continuous outcomes. We applied the GRADE approach to appraise the quality of the evidence. We found one RCT with 174 participants and five CBAs with 48,058 participants assessing the effectiveness of vocational training (n = 1) and antiretroviral therapy (ART) (n = 5). We found no studies assessing psychological interventions. The one RCT was conducted in the United States; the five CBA studies were conducted in South Africa, India, Kenya, and Uganda. We
Zhao, Yuqin; Wood, Daniel T; Kojouharov, Hristo V; Kuang, Yang; Dimitrov, Dobromir T
Mechanistic mathematical models are increasingly used to evaluate the effectiveness of different interventions for HIV prevention and to inform public health decisions. By focusing exclusively on the impact of the interventions, the importance of the demographic processes in these studies is often underestimated. In this paper, we use simple deterministic models to assess the effectiveness of pre-exposure prophylaxis in reducing the HIV transmission and to explore the influence of the recruitment mechanisms on the epidemic and effectiveness projections. We employ three commonly used formulas that correspond to constant, proportional and logistic recruitment and compare the dynamical properties of the resulting models. Our analysis exposes substantial differences in the transient and asymptotic behavior of the models which result in 47 % variation in population size and more than 6 percentage points variation in HIV prevalence over 40 years between models using different recruitment mechanisms. We outline the strong influence of recruitment assumptions on the impact of HIV prevention interventions and conclude that detailed demographic data should be used to inform the integration of recruitment processes in the models before HIV prevention is considered.
Catherine M Montgomery
Full Text Available The most common form of HIV transmission in sub-Saharan Africa is heterosexual sex between two partners. While most HIV prevention interventions are aimed at the individual, there is mounting evidence of the feasibility, acceptability, and efficacy of dyadic interventions. However, the mechanisms through which dyadic-level interventions achieve success remain little explored. We address this gap by using Lewis et al's interdependence model of couple communal coping and behaviour change to analyse data from partners participating in an HIV prevention trial in Uganda and Zambia.We conducted a comparative qualitative study using in-depth interviews. Thirty-three interviews were conducted in total; ten with couples and twenty-three with staff members at the two sites. The Ugandan site recruited a sero-discordant couple cohort and the Zambian site recruited women alone. Spouses' transformation of motivation is strong where couples are recruited and both partners stand to gain considerably by participating in the research; it is weaker where this is not the case. As such, coping mechanisms differ in the two sites; among sero-discordant couples in Uganda, communal coping is evidenced through joint consent to participate, regular couple counselling and workshops, sharing of HIV test results, and strong spousal support for adherence and retention. By contrast, coping at the Zambian site is predominantly left to the individual woman and occurs against a backdrop of mutual mistrust and male disenfranchisement. We discuss these findings in light of practical and ethical considerations of recruiting couples to HIV research.We argue for the need to consider the broader context within which behaviour change occurs and propose that future dyadic research be situated within the framework of the 'risk environment'.
Ma, Angela; Chen, David M; Chau, Fern M; Saberi, Parya
Human immunodeficiency virus (HIV) positive individuals who adhere to their antiretroviral (ARV) regimens are more likely to achieve suppressed HIV viral load and improved immunologic response; however, for most patients, medication adherence remains a challenge. Prior studies have shown that clinical pharmacists contribute to the management of HIV-infected patients; but due to variability in clinical responsibilities and study limitations, their value has not been fully realized. The objective of this study was to investigate clinical outcomes of an HIV clinical pharmacist's interventions at Kaiser Permanente Medical Care Program, who utilizes medication expertise to provide recommendations for ARV regimen changes. The pharmacist suggests new ARV regimens in order to attain virologic suppression, improve immunologic response, or minimize ARV adverse effects, while aiming to optimize patients' adherence by decreasing pill burden and/or dosing frequency. This retrospective study assessed the effectiveness of the pharmacist's interventions that occurred between 11 September 2006 and 30 September 2008 on pill burden, dosing frequency, and medication adherence. Additionally, CD4+ cell count and HIV viral load pre- and post-intervention were evaluated. Medication adherence was assessed utilizing electronic pharmacy refill records and calculated based on the formula: [(pills dispensed/pills prescribed per day)/days between refills] x 100. From a cohort of 75 patients, mean daily pill quantity and dosing frequency decreased from 7.2 pills/day and 2.0 times/day in the control phase to 5.4 pills/day and 1.5 times/day in the study phase, respectively ( p pill burden and dosing frequency, increasing medication adherence, and improving clinical outcomes.
Michele L Ybarra
Full Text Available The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The feasibility and accessibility of Internet-based health interventions in resource-limited settings, where cost-effective interventions are most needed, is unknown. To determine the utility of developing technology-based interventions in resource-limited settings, availability and patterns of usage of the Internet first need to be assessed.The Uganda Media and You Survey was a cross-sectional survey of Internet use among adolescents (ages 12-18 years in Mbarara, Uganda, a municipality mainly serving a rural population in sub-Saharan Africa. Participants were randomly selected among eligible students attending one of five participating secondary day and boarding schools in Mbarara, Uganda. Of a total of 538 students selected, 93% (500 participated. Of the total respondents, 45% (223 reported ever having used the Internet, 78% (175 of whom reported going online in the previous week. As maternal education increased, so too did the odds of adolescent Internet use. Almost two in five respondents (38%  reported already having used a computer or the Internet to search for health information. Over one-third (35%  had used the computer or Internet to find information about HIV/AIDS, and 20% (102 had looked for sexual health information. Among Internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the Internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology. If Internet access were free, 66% (330 reported that they would search for information about HIV/AIDS prevention online.Both the desire to use, and the actual use of, the Internet to seek sexual health and HIV
Ybarra, Michele L; Kiwanuka, Julius; Emenyonu, Nneka; Bangsberg, David R
Background The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The feasibility and accessibility of Internet-based health interventions in resource-limited settings, where cost-effective interventions are most needed, is unknown. To determine the utility of developing technology-based interventions in resource-limited settings, availability and patterns of usage of the Internet first need to be assessed. Methods and Findings The Uganda Media and You Survey was a cross-sectional survey of Internet use among adolescents (ages 12–18 years) in Mbarara, Uganda, a municipality mainly serving a rural population in sub-Saharan Africa. Participants were randomly selected among eligible students attending one of five participating secondary day and boarding schools in Mbarara, Uganda. Of a total of 538 students selected, 93% (500) participated. Of the total respondents, 45% (223) reported ever having used the Internet, 78% (175) of whom reported going online in the previous week. As maternal education increased, so too did the odds of adolescent Internet use. Almost two in five respondents (38% ) reported already having used a computer or the Internet to search for health information. Over one-third (35% ) had used the computer or Internet to find information about HIV/AIDS, and 20% (102) had looked for sexual health information. Among Internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the Internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology. If Internet access were free, 66% (330) reported that they would search for information about HIV/AIDS prevention online. Conclusions Both the desire to use, and the actual use of, the Internet to
West African Platform for HIV Intervention Research (WAPHIR) : plateforme de recherche interventionnelle en matière de VIH en Afrique de l'Ouest. Grâce à cette subvention, on appuiera l'établissement d'un partenariat dirigé par des Africains de l'Ouest, en collaboration avec des partenaires canadiens et européens, afin ...
The aim of this study is to evaluate HIV/AIDS/STD prevention intervention messages on a rural adult (25-49 years) sample in South Africa over a period of 15 months. A representative community sample of 398 adults at time 1 and 382 at time 2 (25-49 years) participated in the study using a three-stage cluster sampling ...
Botros, Diana; Somarriba, Gabriel; Neri, Daniela; Miller, Tracie L
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
Full Text Available Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa.A cohort study that included HIV-uninfected pregnant women was performed. Lay community-based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition.The 1356 women included (median age 22.5 years received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74-2.40. Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64-2.93 and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33-3.19. 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR = 32.7 (95% CI: 3.8-282.2 and aHR = 126.4 (95% CI: 33.8-472.2 had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03-1.86.Maternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high
Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F; Miner, Sarah; Irarrazabal, Lisette; Bernales, Margarita; Peragallo, Nilda; Levy, Judith; Norr, James L; McElmurry, Beverly
The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.
Krishnaratne, Shari; Hensen, Bernadette; Cordes, Jillian; Enstone, Joanne; Hargreaves, James R
Much progress has been made in interventions to prevent HIV infection. However, development of evidence-informed prevention programmes that translate the efficacy of these strategies into population effect remain a challenge. In this systematic review, we map current evidence for HIV prevention against a new classification system, the HIV prevention cascade. We searched for systematic reviews on the effectiveness of HIV prevention interventions published in English from Jan 1, 1995, to July, 2015. From eligible reviews, we identified primary studies that assessed at least one of: HIV incidence, HIV prevalence, condom use, and uptake of HIV testing. We categorised interventions as those seeking to increase demand for HIV prevention, improve supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV. For each specific intervention, we assigned a rating based on the number of randomised trials and the strength of evidence. From 88 eligible reviews, we identified 1964 primary studies, of which 292 were eligible for inclusion. Primary studies of direct prevention mechanisms showed strong evidence for the efficacy of pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision. Evidence suggests that interventions to increase supply of prevention methods such as condoms or clean needles can be effective. Evidence arising from demand-side interventions and interventions to promote use of or adherence to prevention tools was less clear, with some strategies likely to be effective and others showing no effect. The quality of the evidence varied across categories. There is growing evidence to support a number of efficacious HIV prevention behaviours, products, and procedures. Translating this evidence into population impact will require interventions that strengthen demand for HIV prevention, supply of HIV prevention technologies, and use of and adherence to HIV prevention methods. Bill & Melinda Gates Foundation
Hosek, Sybil G.; Lemos, Diana; Harper, Gary W.; Telander, Kyle
Given the potential for negative psychosocial and medical outcomes following an HIV diagnosis, Project ACCEPT, a 12-session behavioral intervention, was developed and pilot-tested for youth (aged 16-24) newly diagnosed with HIV. Fifty participants recently diagnosed with HIV were enrolled from 4 sites selected through the Adolescent Medicine…
Jacobson, Stephanie A.
According to the Centers for Disease Control and Prevention (CDC), 25 percent of people living with HIV in the United States in 2006 were age 50 and older. HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. Scholarly research has identified the need for HIV/AIDS interventions in the…
... HIV/AIDS Part C Early Intervention Services (EIS) Program AGENCY: Health Resources and Services...: Critical funding for HIV/AIDS care and treatment to the target populations in Orange County, Orlando..., 2010). The Orange County Health Department is known Statewide as an exceptional site for HIV/AIDS care...
The aim of the study was to develop an HIV and AIDS training manual, and to evaluate the knowledge, attitudes and management of faith healers of Apostolic churches regarding HIV and AIDS, before and after they attended an HIV and AIDS training programme. A quasi-experimental intervention design was used with faith ...
Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol
The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services...
Gibbs, Andrew; Jacobson, Jessica; Kerr Wilson, Alice
Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV. We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours. Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes. The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.
This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges ...
Richardson, Kelly K; Bokhour, Barbara; McInnes, D Keith; Yakovchenko, Vera; Okwara, Leonore; Midboe, Amanda M; Skolnik, Avy; Vaughan-Sarrazin, Mary; Asch, Steven M; Gifford, Allen L; Ohl, Michael E
Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities. Published by Elsevier Inc.
Kumar G Anil
Full Text Available Abstract Background Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India. Methods Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY saved as a measure of cost-effectiveness of each type of HIV prevention intervention. Results The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions. Conclusions The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.
Peltzer, Karl; Tabane, Cily; Matseke, Gladys; Simbayi, Leickness
Objective: To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. Methods: A total of 488 HIV-infected patients, aged 18 years and older,…
To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention, and how the content was shaped by culturally congruent concepts to address the needs of the study target population. The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual-, interpersonal-, and community-level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couple-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afrocentric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from 4 urban sites (Atlanta, Los Angeles, New York, and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements, and content of each session are described and lessons learned from this intervention trial are discussed. An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV-serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well
Grewe, Mary E; Ma, Yuntong; Gilbertson, Adam; Rennie, Stuart; Tucker, Joseph D
Women are underrepresented in HIV cure research. In this paper we discuss the rationale for including women and propose multilevel strategies to improve sex equity in HIV cure research. The inadequate inclusion of women in HIV cure research is concerning for both scientific and ethical reasons. Biological responses to HIV and HIV treatment, as well as social contexts, differ between men and women, and this may affect the efficacy of curative interventions. Strategies for improving sex equity in HIV cure research include addressing eligibility criteria, adapting recruitment strategies, engaging community members early in the research process, and promoting funder policy changes. We conclude by describing the Gender, Race, and Clinical Experience (GRACE) study, which is one example of how women can be effectively recruited into HIV-related clinical trials. While HIV cure research is currently in the early stages, as it continues to develop it is important to mobilise for adequate inclusion of women.
Caine, Vera; Mill, Judy; O’Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean
We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019
Chaudhury, Sumona; Kirk, Catherine M.; Ingabire, Charles; Mukunzi, Sylvere; Nyirandagijimana, Beatha; Godfrey, Kalisa; Brennan, Robert T.; Betancourt, Theresa S.
Introduction Few evidence-based interventions exist to support parenting and child mental health during the process of caregiver HIV status disclosure in sub-Saharan Africa. A secondary analysis of a randomized-controlled trial was conducted to examine the role of family-based intervention versus usual social work care (care as usual) in supporting HIV status disclosure within families in Rwanda. Method Approximately 40 households were randomized to family-based intervention and 40...
Objective To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention and how the content was shaped by culturally congruent concepts to address the needs of the study target population. Design The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual, interpersonal and community level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. Methods The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couples-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afro-centric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from four urban sites (Atlanta, Los Angeles, New York and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements and content of each session are described and lessons learned from this intervention trial are discussed. Results An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the
Chidrawi, Helena Christa
This study forms part of a larger SANPAD project focusing on a comprehensive community-based HIV stigma reduction and wellness enhancement intervention, responding to the continuous burden of HIV stigma on both national and international levels and the paucity of research in sustainable HIV stigma reduction interventions. HIV stigma is considered all over the world as a complex, far-reaching and powerful phenomenon that continues to affect people living with HIV (PLWH) and also people living ...
The Amagugu Intervention: A conceptual framework for increasing HIV disclosure and parent-led communication about health and HIV prevention among HIV-infected parents with HIV-uninfected primary school-aged children
Tamsen Jean Rochat
Full Text Available Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalisation, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counsellors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement and custody planning. An uncontrolled pre-post evaluation study with 281 families showed the intervention was feasible, acceptable and effective in increasing maternal disclosure. The aim of this manuscript is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms and activities; and to present a summary of results from the large scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for
Eisenberg, Marlene M; Hennessy, Michael; Coviello, Donna; Hanrahan, Nancy; Blank, Michael B
To determine if an escalating HIV treatment adherence intervention would be considered by participants from a caring or coercive perspective, perceived coercion was examined in 238 community-based dually diagnosed individuals (HIV+ and a serious mental illness) randomized to a treatment-as-usual (TAU) control group or preventing AIDS through health for HIV+ persons (PATH+) Intervention that increased intervention intensity when adherence fell below 80 %. Minor differences were observed in perceived coercion between the PATH+ Intervention and Control groups with perceived coercion marginally higher in the PATH+ group. Latent growth curve analyses indicate that perceived coercion was not related to duration of the intervention for either the PATH+ or Control group. The experience of coercion by HIV+ individuals receiving community-based mental health services was not related to the intensity or duration of delivered services.
Pérez-Jiménez, David; Orengo-Aguayo, Rosaura E
This qualitative analysis elucidates the potential elements of the intervention that may be effective in terms of a) increasing knowledge about HIV/ AIDS in the members of this population; b) increasing the use of male condoms and the practice of mutual masturbation; and c) changing opinions toward male condom use and mutual masturbation. Five heterosexual HIV-discordant couples participated in the adapted intervention, which consisted of four three-hour-long sessions. One month after the intervention, we conducted a qualitative semi-structured interview with every participant to evaluate issues related to the process and content of the activities comprising the intervention, the impact of the intervention, logistics, and recruitment and retention as well as to make a more general evaluation. The information was submitted to qualitative content analysis. After the intervention, participants reported having better attitudes regarding safer sex, particularly in terms of condom use. A reason given by the participants to feel more positive toward condom use and mutual masturbation was that these practices could prevent the infection of the HIV-negative partner. This study provides important evidence of an intervention that promises to be efficacious in preventing some high-risk sexual behaviors among Latino HIV-discordant heterosexual couples. The evidence presented seems to suggest that an intervention that includes basic relevant information about HIV/AIDS, that explains the benefits of condom use and other safer sex options, and that provides effective negotiation and communication strategies could significantly reduce HIV transmission among these couples.
Rios-Ellis, Britt; Becker, Davida; Espinoza, Lilia; Nguyen-Rodriguez, Selena; Diaz, Gaby; Carricchi, Ana; Galvez, Gino; Garcia, Melawhy
Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). From pretest to posttest, HIV/AIDS stigma scores decreased significantly (pstigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.
Belenko, Steven; Visher, Christy; Pearson, Frank; Swan, Holly; Pich, Michele; O'Connell, Daniel; Dembo, Richard; Frisman, Linda; Hamilton, Leah; Willett, Jennifer
This article presents findings from a multisite cluster randomized trial of a structured organizational change intervention for improving HIV testing services in jails and prisons. Matched pairs of prison and jail facilities were randomized to experimental and control conditions; all facilities received baseline training about best practices in HIV testing and other HIV services and selected an area of HIV services on which to focus improvement efforts. The experimental facilities formed local change teams and were provided external coaching based on the Network for the Improvement of Addiction Treatment (NIATx) process improvement model. Difference-indifference analyses indicate a significant relative increase in HIV testing in the experimental compared to the control condition. Meta-analyses across the matched pairs indicated a small to medium effect of increased testing overall. The results indicate that the local change team model can achieve significant increases in HIV testing in correctional facilities. Implications for HIV testing policies and challenges for expanding testing are discussed.
Despite advances in the use of highly active antiretroviral therapy (HAART) in the management of HIV/AIDS, drug-related problems (DRPs) still remain an issue, particularly in developing countries. This study evaluated the incidence of DRPs among HIV/AIDS patients in a HIV/AIDS care centre in southern Nigeria and the ...
Chandler, Rasheeta; Anstey, Erica H; Ross, Henry; Morrison-Beedy, Dianne
HIV prevention interventions can help college students engage in safe sexual behaviors. We used the Information, Motivation, Behavioral Skills model to frame four focus group discussions with Black women (n = 32) attending a historically Black college/university or a traditional university to understand their HIV prevention needs. Participants wanted clear information about sexually transmitted infections/HIV and access to contraception. Motivators for practicing safe sex were related to cultural and religious expectations, desire to avoid pregnancy, and conscious efforts to defy racial stereotypes. Barriers to practicing safe sex included issues of accountability, stigma associated with accessing HIV testing/prevention services, and media influences. We found general consensus about the need to develop skill-building HIV prevention interventions focused on communication skills, condom negotiation, access to services, and empowerment. We offer insight into culture- and age-appropriate HIV prevention for Black college women to guide the development of future interventions. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... primary care services for persons living with HIV/AIDS, including primary adult HIV medical care, adult... Medical Center managed the Ryan White HIV/AIDS Program through a contractual agreement with the...
Rochat, Tamsen J; Arteche, Adriane X; Stein, Alan; Mkwanazi, Ntombizodumo; Bland, Ruth M
Sub-Saharan Africa has large populations of HIV-infected parents who need support to raise their HIV-uninfected children. This research evaluates the 'Amagugu Intervention' aimed at supporting mothers to disclose their own HIV diagnosis to their HIV-uninfected children. Uncontrolled pre and post-intervention evaluation. Africa Centre for Health and Population Studies, South Africa. Two hundred and eighty-one HIV-infected women and their HIV-uninfected children aged 6-10 years. This lay counsellor-led intervention included six sessions conducted with mothers at home, providing printed materials and child-friendly activities to support disclosure of their diagnosis. The primary outcome was disclosure to the child (full, partial, none). The secondary outcomes included maternal mental health (General Health Questionnaire) and child mental health (Child Behaviour Checklist). One hundred and seventy-one (60%) women 'fully' disclosed and 110 (40%) women 'partially' disclosed their HIV status to their child. Women who perceived their health to be excellent were less likely to 'fully' disclose compared to those considering their health to be poorer [adjusted odds ratio 0.50 (0.26-0.98), P = 0.042]. [corrected]. Compared to those not in a current partnership, those with a current partner were almost three times more likely to 'fully' disclose [adjusted odds ratio 2.92 (1.33-6.40), P = 0.008]. Mothers reported that most children reacted calmly to 'full' (79%) or 'partial' disclosure (83%). Compared to 'partial' disclosure, 'full' disclosure was associated with more children asking questions about maternal death (18 versus 8%). This intervention is acceptable in resource-limited settings and shows promise. Further research using a controlled design is needed to test this intervention.
Frye, Victoria; Bonner, Sebastian; Williams, Kim; Henny, Kirk; Bond, Keosha; Lucy, Debbie; Cupid, Malik; Smith, Stephen; Koblin, Beryl A
In the United States, racial disparities in HIV/AIDS are stark. Although African Americans comprise an estimated 14% of the U.S. population, they made up 52% of new HIV cases among adults and adolescents diagnosed in 2009. Heterosexual transmission is now the second leading cause of HIV in the United States. African Americans made up a full two-thirds of all heterosexually acquired HIV/AIDS cases between 2005 and 2008. Few demonstrated efficacious HIV prevention interventions designed specifically for adult, African-American heterosexual men exist. Here, we describe the process used to design a theory-based HIV prevention intervention to increase condom use, reduce concurrent partnering, and increase HIV testing among heterosexually active African-American men living in high HIV prevalence areas of New York City. The intervention integrated empowerment, social identity, and rational choices theories and focused on four major content areas: HIV/AIDS testing and education; condom skills training; key relational and behavioral turning points; and masculinity and fatherhood.
Owczarzak, Jill; Phillips, Sarah D.; Filippova, Olga; Alpatova, Polina; Mazhnaya, Alyona; Zub, Tatyana; Aleksanyan, Ruzanna
The current dominant model of HIV prevention intervention dissemination involves packaging interventions developed in one context, training providers to implement that specific intervention, and evaluating the extent to which providers implement it with fidelity. Research shows that providers rarely implement these programs with fidelity due to…
French, H.; Greeff, M.; Watson, M.J.; Doak, C.M.
We describe the implementation of a comprehensive HIV stigma-reduction and wellness-enhancement community intervention that focused on people living with HIV (PLWH), as well as people living close to them (PLC) from six designated groups. A holistic multiple case study design was used in urban and
Chao, Li-Wei; Gow, Jeff; Akintola, Olagoke; Pauly, Mark
The purpose of this study was to compare two different methods to teach educators about HIV/AIDS. Sixty educators were selected from eight schools in KwaZulu-Natal Province, South Africa, to undergo HIV/AIDS training using an interactive CD-ROM intervention. Another sixty educators from other schools were selected to undergo a two-day Life Skills…
Stewart, Clarence, M., Jr.
This article deals with a service-learning program focused on human sexuality and HIV/AIDS prevention and intervention at the Howard University Department of Health, Human Performance and Leisure Studies. Topics discussed include how this program was created, an overview of peer education, HIV/AIDS peer education training, and services provided to…
Merlin, Jessica S; Young, Sarah R; Johnson, Mallory O; Saag, Michael; Demonte, William; Kerns, Robert; Bair, Matthew J; Kertesz, Stefan; Turan, Janet M; Kilgore, Meredith; Clay, Olivio J; Pekmezi, Dorothy; Davies, Susan
Chronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.
Villegas, Natalia; Santisteban, Daniel; Cianelli, Rosina; Ferrer, Lilian; Ambrosia, Todd; Peragallo, Nilda; Lara, Loreto
The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is high among young Chilean women, and there are no STI or HIV prevention interventions available to them that incorporate technology. The purpose of this study was to investigate the preliminary efficacy of an Internet-based STI and HIV prevention intervention (I-STIPI) for Chilean young women on measures of STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors. This is a pretest-posttest study. Forty young Chilean women between 18 and 24 years of age participated in an investigation of the I-STIPI's preliminary efficacy on STI and HIV prevention-related outcomes between baseline and a postintervention assessment. The intervention consisted of four online modules. Data collection was conducted in Santiago, Chile. Paired-samples t test analysis was used to determine whether there were significant differences in each of the outcome variables. After receiving I-STIPI, women reported a significant increase in levels of STI- and HIV-related knowledge, attitudes toward the use of condoms and perceived self-efficacy, and a reduction of risky sexual behaviors with uncommitted partners. The I-STIPI showed promise as an Internet-based intervention that can reduce barriers to accessing preventive interventions and increase STI and HIV preventive behaviors in young Chilean women. The study provided important information about the ability of an Internet-based intervention to reduce young women's risk factors and to provide positive preliminary efficacy on STI- and HIV-related outcomes. Internet-based interventions can eliminate many barriers to receiving prevention interventions and may prove to be cost effective. © 2014 Sigma Theta Tau International.
Villegas, Natalia; Santisteban, Daniel; Cianelli, Rosina; Ferrer, Lilian; Ambrosia, Todd; Peragallo, Nilda; Lara, Loreto
Purpose The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is high among young Chilean women, and there are no STI or HIV prevention interventions available to them that incorporate technology. The purpose of this study was to investigate the preliminary efficacy of an Internet-based STI and HIV prevention intervention (I-STIPI) for Chilean young women on measures of STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors. Design This is a pretest-posttest study. Forty young Chilean women between 18 and 24 years of age participated in an investigation of the I-STIPI’s preliminary efficacy on STI and HIV prevention-related outcomes between baseline and a postintervention assessment. The intervention consisted of four online modules. Data collection was conducted in Santiago, Chile. Paired-samples t test analysis was used to determine whether there were significant differences in each of the outcome variables. Findings After receiving I-STIPI, women reported a significant increase in levels of STI- and HIV-related knowledge, attitudes toward the use of condoms and perceived self-efficacy, and a reduction of risky sexual behaviors with uncommitted partners. Conclusions The I-STIPI showed promise as an Internet-based intervention that can reduce barriers to accessing preventive interventions and increase STI and HIV preventive behaviors in young Chilean women. Clinical Relevance The study provided important information about the ability of an Internet-based intervention to reduce young women’s risk factors and to provide positive preliminary efficacy on STI- and HIV-related outcomes. Internet-based interventions can eliminate many barriers to receiving prevention interventions and may prove to be cost effective. PMID:25410132
Claborn, Kasey R.; Fernandez, Anne; Wray, Tyler; Ramsey, Susan
Researchers have instituted a range of methodologies to increase access to HIV adherence interventions. This article reviews studies published through January 2014 utilizing computer-based delivery of such interventions to persons living with HIV. A systematic review of five databases identified ten studies (three RCTs, three pilot studies, three feasibility studies, and one single-group trial) that met the inclusion criteria. Descriptions of the interventions’ content and characteristics are...
Hergenrather, Kenneth C; Emmanuel, Diona; Durant, Sarah; Rhodes, Scott D
Men who have sex with men (MSM) represent 64.0% of people living with HIV (PLWH) over the age of 13 years. Young men who have sex with men (YMSM) are particularly affected by HIV/AIDS; the rate of HIV infection for YMSM between the ages of 13 and 24 represents 72.0% of new infections among youth. To understand the current state of the science meant to prevent HIV for YMSM, we reviewed studies of HIV behavioral prevention interventions for YMSM. Five literature databases were searched, from their inception through October 2015, using key words associated with HIV prevention intervention evaluation studies for YMSM. The review criteria included behavioral HIV/AIDS prevention interventions, articles published in English-language peer-reviewed journals, YMSM between 13 and 24 years of age, and longitudinal repeated measures design. A total of 15 YMSM behavioral HIV prevention intervention studies were identified that met inclusion criteria and reported statistically significant findings. Common outcomes included unprotected sexual intercourse, HIV/AIDS risk behavior, condom use, HIV testing, safer sex attitude, and HIV prevention communication. Participant age, representation of Black/African American YMSM, application of theoretical and model underpinnings, congruence of assessment measures used, follow-up assessment times, and application of process evaluation were inconsistent across studies. To advance HIV prevention intervention research for YMSM, future studies should be theory-based, identify common constructs, utilize standard measures, include process evaluation, and evaluate sustained change over standard periods of time. HIV prevention interventions should incorporate the needs of the diverse, well-educated, web-connected millennial generation and differentiate between adolescent YMSM (13 to 18 years of age) and young adulthood YMSM (19 to 24 years of age). Because Black/African American YMSM represent more than 50% of new HIV infections, future HIV
Cianelli, Rosina; Lara, Loreto; Villegas, Natalia; Bernales, Margarita; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda
Background Worldwide, an in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low income Chilean women. Depressed people are less willing to participate in behaviors that protect them against HIV. Objectives To analyze the impact of Mano a Mano-Mujer (MM-M) on depressive symptoms among Chilean women. Methods A quasi-experimental design was used to test the impact of MM-M, an HIV prevention intervention. The research was conducted in Santiago- Chile, a total of 400 women participated in the study (intervention group, n = 182; control group, n = 218). The intervention was guided by the social-cognitive model and the primary health model. The intervention consists of six two-hour sessions delivered in small groups. Sessions covered: HIV prevention, depression, partner's communication, and substance abuse. Face to face interviews were conducted at baseline and at 3 months follow-up Results At 3 months post-intervention, Chilean women who participated in MM-M significantly decreased their reported depressive symptoms. Conclusions MM-M provided significant benefits for women's depression symptoms. This study offers a model that address depression, a risk factor for HIV. It uses nurses as leaders for the screening of depressive symptoms and as facilitators of community interventions. PMID:22452388
Full Text Available ABSTRACTIntroduction:Scientific evidence supports the sinergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS.Objective:To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission.Methods:Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT. Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP and antiretroviral post-exposure prophylasis (PEP for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP.Results:counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18 at 12 months and 34 (95%CI 23 - 54 in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67 individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT.Conclusion:The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.
M. L. Armstrong
Full Text Available Alcohol use disorders (AUDs are highly prevalent among people living with HIV/AIDS (PLWHA and are associated with increased HIV risk behaviors, suboptimal treatment adherence, and greater risk for disease progression. We used the ADAPT-ITT strategy to adapt an evidence-based intervention (EBI, the Holistic Health Recovery Program (HHRP+, that focuses on secondary HIV prevention and antiretroviral therapy (ART adherence and apply it to PLWHA with problematic drinking. Focus groups (FGs were conducted with PLWHA who consume alcohol and with treatment providers at the largest HIV primary care clinic in New Orleans, LA. Overall themes that emerged from the FGs included the following: (1 negative mood states contribute to heavy alcohol consumption in PLWHA; (2 high levels of psychosocial stress, paired with few adaptive coping strategies, perpetuate the use of harmful alcohol consumption in PLWHA; (3 local cultural norms are related to the permissiveness and pervasiveness of drinking and contribute to heavy alcohol use; (4 healthcare providers unanimously stated that outpatient options for AUD intervention are scarce, (5 misperceptions about the relationships between alcohol and HIV are common; (6 PLWHA are interested in learning about alcohol’s impact on ART and HIV disease progression. These data were used to design the adapted EBI.
Yu, Jun; Zhang, Yi; Jiang, Junjun; Lu, Qinglin; Liang, Bingyu; Liu, Deping; Fang, Keyong; Huang, Jiegang; He, Yang; Ning, Chuanyi; Liao, Yanyan; Lai, Jingzhen; Wei, Wudi; Qin, Fengxiang; Ye, Li; Geng, Wenkui; Liang, Hao
In China, rural areas are a weak link of HIV/AIDS prevention and control. From September 2011, an innovative "county-township-village" allied intervention was implemented in Longzhou County, Guangxi, which assigned the tasks of HIV/AIDS prevention and control to the county Centers for Disease Control and Prevention (CDC), township hospitals, and village clinics, respectively, instead of traditional intervention in which the county CDC undertook the entire work. A 6-year consecutive cross-sectional survey, including 3-year traditional intervention (2009-2011) and 3-year innovative intervention (2012-2014), was conducted to evaluate the effects of the new intervention. Compared to traditional intervention, the innovative intervention achieved positive effects in decreasing risky behaviors. Among female sex workers, condom use rate in the last month increased from 72.06% to 96.82% (p risk ratio of HIV infection during innovative intervention was 0.631 (95% confidence interval 0.549-0.726) compared with traditional one. Cost-effectiveness analysis indicates that innovative intervention restores each disability-adjusted life year costing an average of $124.26. Taken together, Longzhou's innovative intervention has achieved good effects on HIV/AIDS prevention and control and provides a good reference for rural China.
Vergidis, Paschalis I; Falagas, Matthew E
Different behavioral interventions have found to be efficacious in reducing high-risk sexual activity. Interventions have been evaluated in both original research and meta-analytic reviews. Most of the studies have shown that interventions are efficacious among different study populations. In adolescents, both in- and out-of-the classroom interventions showed a decrease in the risk of unprotected sex. In African Americans, greater efficacy was found for interventions including peer education. For Latinos, effect was larger in interventions with segmentation in the same gender. Geographic and social isolation are barriers in approaching MSM. For IDUs, interventions provided within a treatment program have an impact on risk reduction above that produced by drug treatment alone. Finally, people diagnosed with HIV tend to reduce their sexual risk behavior. However, adherence to safe sex practices for life can be challenging. Relentless efforts for implementation of behavioral interventions to decrease high-risk behavior are necessary to decrease HIV transmission.
Grossman, Cynthia I; Forsyth, Andrew; Purcell, David W; Allison, Susannah; Toledo, Carlos; Gordon, Christopher M
HIV continues to exact an enormous toll on society and to disproportionately affect gay and bisexual men and other men who have sex with men (MSM). Innovative prevention interventions are needed to reverse this trend. In August 2009, the U.S. National Institute of Mental Health and the Centers for Disease Control and Prevention convened a meeting of scientists, community representatives, advocates, and federal partners to discuss innovative prevention-intervention science. The meeting was structured to maximize discussion of (1) healthy sex interventions, (2) community and structural interventions, (3) integrated biomedical and behavioral interventions, and (4) interventions to improve uptake of HIV testing. Presentations and discussion focused on research gaps in designing risk-reducing and sexual health-promoting interventions for MSM, including interventions to address mental health, substance use, disclosure, and stigma. This article summarizes the meeting proceedings, highlights key points, and outlines future directions.
Ismail, Salwa Muddthir; Eisa, Ammar Abobakre; Ibrahim, Faisal
We sought to identify the socioeconomic impact on people living with HIV (PLWH) in Sudan. Focus group discussions were used to collect data and identify the most outstanding domains of HIV impact on PLWH and the survival mechanisms that may be common to a group of diverse HIV-infected persons (n = 30). The findings indicated that the most striking financial and social impacts were due to stigma associated with HIV in the conservative Sudanese society, which led to loss of work with all its consequences (e.g., children's education and health care expenses were affected). The socioeconomic impacts of HIV on infected populations are discussed, and suggestions for possible interventions to mitigate harmful impacts and stigma within the society, the workplace, and health care settings are highlighted. We concluded that HIV has intensified the existing problems of infected people, contributing to their vulnerability to poverty. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Chaudhury, Sumona; Kirk, Catherine M; Ingabire, Charles; Mukunzi, Sylvere; Nyirandagijimana, Beatha; Godfrey, Kalisa; Brennan, Robert T; Betancourt, Theresa S
Few evidence-based interventions exist to support parenting and child mental health during the process of caregiver HIV status disclosure in sub-Saharan Africa. A secondary analysis of a randomized-controlled trial was conducted to examine the role of family-based intervention versus usual social work care (care as usual) in supporting HIV status disclosure within families in Rwanda. Approximately 40 households were randomized to family-based intervention and 40 households to care as usual. Parenting, family unity, and child mental health during the process of disclosure were studied using quantitative and qualitative research methods. Many of the families had at least one caregiver who had not disclosed their HIV status at baseline. Immediately post-intervention, children reported lower parenting and family unity scores compared with those in the usual-care group. These changes resolved at 3-month follow-up. Qualitative reports from clinical counselor intervention sessions described supported parenting during disclosure. Overall findings suggest adjustments in parenting, family unity, and trust surrounding the disclosure process. Family-based intervention may support parenting and promote child mental health during adjustment to caregiver HIV status disclosure. Further investigation is required to examine the role of family-based intervention in supporting parenting and promoting child mental health in HIV status disclosure.
Full Text Available “The Fire is Coming” film is an innovative HIV-prevention intervention contextualized to the Maasai people of Tanzania through use of a traditional Maasai story. The intervention was developed and implemented in partnership with Maasai Pastoralists for Education and Development (MAPED. Although there have been numerous Knowledge-Attitude-Practice (KAP surveys conducted among the Maasai, this is the first control-group comparison study designed to measure the effectiveness of an HIV-prevention intervention contextualized specifically to the Maasai people of Tanzania. We will first discuss the background and context in which the intervention was developed and methods used to develop the intervention. We will then discuss the evaluation methods, results, and implications of a retrospective Knowledge, Attitudes, Practices (KAP two-village comparison survey (n=200 for “The Fire is Coming” HIV-prevention intervention among Maasai people. There was a significant effect for HIV-related attitudes, t(16 = 2.77, p 0.05. Implications: Belief in one’s ability to do something is often the pivotal point for behavior change. The results of the survey denote a highly effective intervention in changing HIV-related attitudes and behaviors. It is promising for replication among other Maasai communities and for adaptation with indigenous people groups in other regions.
Herbst, Jeffrey H; Painter, Thomas M; Tomlinson, Hank L; Alvarez, Maria E
This report summarizes published findings of a community-based organization in New York City that evaluated and demonstrated the efficacy of the Many Men, Many Voices (3MV) human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevention intervention in reducing sexual risk behaviors and increasing protective behaviors among black men who have sex with men (MSM). The intervention addressed social determinants of health (e.g., stigma, discrimination, and homophobia) that can influence the health and well-being of black MSM at high risk for HIV infection. This report also highlights efforts by CDC to disseminate this evidence-based behavioral intervention throughout the United States. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion to provide an example of a program that might be effective for reducing HIV infection- and STD-related disparities in the United States. 3MV uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM. Since its dissemination by CDC in 2004, 3MV has been used in many settings, including health department- and community-based organization programs. The 3MV intervention is an important component of a comprehensive HIV and STD prevention portfolio for at-risk black MSM. As CDC continues to support HIV prevention programming consistent with the National HIV/AIDS Strategy and its high-impact HIV prevention approach, 3MV will remain an important tool for addressing the needs of black MSM at high risk for HIV infection and other STDs.
Daniel-Ulloa, Jason; Ulibarri, M; Baquero, B; Sleeth, C; Harig, H; Rhodes, S D
Compared to White women, Latinas are 4 times more likely to contract HIV. In an effort to determine the overall state of the science meant to address this disparity, we reviewed the current HIV prevention intervention literature for U.S. Latinas. We searched 5 online electronic databases from their inception through July, 2014, for HIV prevention interventions including a majority sample of Latinas. Of 1041 articles identified, 20 studies met inclusion criteria. We documented study designs, participant characteristics, outcomes, theories used, and other intervention characteristics. Overall, HIV knowledge and attitudes were the predominant outcome; a small minority of studies included self-reported condom use or STD incidence. Strategies used to address cultural factors specific to Latinas and HIV included; lay health advisors, using ethnographic narratives, or using the Theory of Gender and Power, however few of the interventions adopted these strategies. This study identified several gaps in the intervention literature that need to be addressed. In addition to including more direct measures of decreased HIV risk (ex. condom use), more systematic use of strategies meant to address gender and cultural factors that may place Latinas at increased risk (e.g., gender inequity, traditional gender role norms such as machismo and marianismo, and relationship power dynamics).
Young, Sean D; Cumberland, William G; Nianogo, Roch; Menacho, Luis A; Galea, Jerome T; Coates, Thomas
Social media technologies offer new approaches to HIV prevention and promotion of testing. We examined the efficacy of the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru. In this cluster randomised controlled trial, Peruvian MSM from Greater Lima (including Callao) who had sex with a man in the past 12 months, were 18 years of age or older, were HIV negative or serostatus unknown, and had a Facebook account or were willing to create one (N=556) were randomly assigned (1:1) by concealed allocation to join intervention or control groups on Facebook for 12 weeks. For the intervention, Peruvian MSM were trained and assigned to be HIV prevention mentors (peer-leaders) to participants in Facebook groups. The interventions period lasted 12 weeks. Participants in control groups received an enhanced standard of care, including standard offline HIV prevention available in Peru and participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants also completed questionnaires on HIV risk behaviours and social media use at baseline and 12 week follow-up. The primary outcome was the number of participants who received a free HIV test at a local community clinic. The facebook groups were analysed as clusters to account for intracluster correlations. This trial is registered with ClinicalTrials.gov, number NCT01701206. Of 49 peer-leaders recruited, 34 completed training and were assigned at random to the intervention Facebook groups. Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted
Oct 16, 2017 ... A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18–24 years), controlling for their ...
Background: The diagnosis of HIV is life-changing that requires people not only to deal with the disease but also to cope with the stigma attached to HIV. People living with HIV (PLWH) as well as their close family members (CFM) are stigmatised; however, CFM also stigmatise PLWH. This interaction affects the relationship ...
Senn, Theresa E; Braksmajer, Amy; Coury-Doniger, Patricia; Urban, Marguerite A; Carey, Michael P
HIV positive Black men who have sex with men (MSM) are retained in HIV medical care at suboptimal rates. Interventions targeted to Black MSM are needed to help to improve their retention in care. The purposes of this study were to investigate the use of mobile technology among HIV+ Black MSM and to explore participants' thoughts about the use of mobile technology for HIV retention in care interventions. Twenty-two HIV+ Black MSM completed a technology use survey and participated in a qualitative interview regarding technology-based interventions. The majority of participants (95%) had access to a cell phone, and used their phones frequently (median 3 hours/day). Men preferred interventions that would allow for anonymous participation and that would provide individually tailored support. Mobile technology is a promising approach to intervention delivery for both younger and older HIV+ Black MSM. These interventions should incorporate features that are desirable to men (i.e., anonymous participation and individual tailoring).
Stewart, Jennifer M
To assess the barriers and facilitators to using African American churches as sites for implementation of evidence-based HIV interventions among young African American women. Mixed methods cross-sectional design. African American churches in Philadelphia, PA. 142 African American pastors, church leaders, and young adult women ages 18 to 25. Mixed methods convergent parallel design. The majority of young adult women reported engaging in high-risk HIV-related behaviors. Although church leaders reported willingness to implement HIV risk-reduction interventions, they were unsure of how to initiate this process. Key facilitators to the implementation of evidence-based interventions included the perception of the leadership and church members that HIV interventions were needed and that the church was a promising venue for them. A primary barrier to implementation in this setting is the perception that discussions of sexuality should be private. Implementation of evidence-based HIV interventions for young adult African American women in church settings is feasible and needed. Building a level of comfort in discussing matters of sexuality and adapting existing evidence-based interventions to meet the needs of young women in church settings is a viable approach for successful implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Hernandez, Julieta P.; Macgowan, Mark J.
Objective: Recent research on psychosocial interventions addressing the well-being of women with HIV/AIDS has brought new options for practitioners. This study critically reviews the treatment features, methodological quality, and efficacy of these interventions. Methods: A comprehensive search between 2000 and 2011 identified 19 studies employing…
Kaponda, Chrissie P. N.; Norr, Kathleen F.; Crittenden, Kathleen S.; Norr, James L.; McCreary, Linda L.; Kachingwe, Sitingawawo I.; Mbeba, Mary M.; Jere, Diana L. N.; Dancy, Barbara L.
This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention.…
Owczarzak, Jill; Dickson-Gomez, Julia
Since 1999, the Centers for Disease Control and Prevention have trained over 10,000 service providers from more than 5,000 agencies to implement evidence-based HIV prevention interventions through its Diffusion of Effective Behavioral Interventions DEBI) program. Based on in-depth, semistructured interviews with a convenience sample of 22 HIV…
Kapungu, Chisina T.; Nappi, Carla N.; Thakral, Charu; Miller, Steven A.; Devlin, Catharine; McBride, Cami; Hasselquist, Emily; Coleman, Gloria; Drozd, Derek; Barve, Chinmayee; Donenberg, Geri; DiClemente, Ralph; Brown, Larry
The purpose of this study was to examine the effectiveness of evidence-based recruitment and retention strategies for a longitudinal, family-based HIV prevention intervention study targeting adolescents in psychiatric care by (1) determining consent rate (recruitment), rate of participation at the first intervention session (retention), and…
Full Text Available individuals without taking into account society's discourses, such as racism, moralism, denial and male chauvinism in Zaire, which impact on, and contribute to the spread of HIV. In short, the majority of interventions used have sought in one way or another...
Geanuracos, Catherine G; Cunningham, Shayna D; Weiss, George; Forte, Draco; Reid, Lisa M Henry; Ellen, Jonathan M
Geographic information system (GIS) analysis is an emerging tool for public health intervention planning. Connect to Protect, a researcher-community collaboration working in 15 cities to reduce HIV infection among youths, developed GIS databases of local health, crime, and demographic data to evaluate the geographic epidemiology of sexually transmitted infections and HIV risk among adolescents. We describe the process and problems of data acquisition, analysis, and mapping in the development of structural interventions, demonstrating how program planners can use this technology to inform and improve planning decisions. The Connect to Protect project's experience suggests strategies for incorporating public data and GIS technology into the next generation of public health interventions.
Chu, Carissa; Ananworanich, Jintanat; Excler, Jean-Louis; Tucker, Joseph D.
Abstract Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders. PMID:26061668
Lo, Ying-Ru; Chu, Carissa; Ananworanich, Jintanat; Excler, Jean-Louis; Tucker, Joseph D
Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders.
Tsai, Alexander C.; Hatcher, Abigail M.; Bukusi, Elizabeth A.; Weke, Elly; Hufstedler, Lee Lemus; Dworkin, Shari L.; Kodish, Stephen; Cohen, Craig R.; Weiser, Sheri D.
The scale-up of effective treatment has partially reduced the stigma attached to HIV, but HIV still remains highly stigmatized throughout sub-Saharan Africa. Most studies of anti-HIV stigma interventions have employed psycho-educational strategies such as information provision, counseling, and testimonials, but these have had varying degrees of success. Theory suggests that livelihood interventions could potentially reduce stigma by weakening the instrumental and symbolic associations between HIV and premature morbidity, economic incapacity, and death, but this hypothesis has not been directly examined. We conducted a longitudinal qualitative study among 54 persons with HIV participating in a 12-month randomized controlled trial of a livelihood intervention in rural Kenya. Our study design permitted assessment of changes over time in the perspectives of treatment-arm participants (N=45), as well as an understanding of the experiences of control arm participants (N=9, interviewed only at follow-up). Initially, participants felt ashamed of their seropositivity and were socially isolated (internalized stigma). They also described how others in the community discriminated against them, labeled them as being “already dead,” and deemed them useless and unworthy of social investment (perceived and enacted stigma). At follow-up, participants in the treatment arm described less stigma and voiced positive changes in confidence and self-esteem. Concurrently, they observed that other community members perceived them as active, economically productive, and contributing citizens. Participants in the control arm described continued stigma with none of these changes. In summary, our findings suggest a theory of stigma reduction: livelihood interventions may reduce internalized stigma among persons with HIV and also, by targeting core drivers of negative attitudes toward persons with HIV, positively change attitudes toward persons with HIV held by others. Further research is
Silva P. Kouyoumjian
Full Text Available Objectives: The aim of this study was to assess HIV modes of exposure in Morocco at the national level and also for Souss-Massa-Drâa, the region most affected by HIV. Another aim was to assess the impact of different scenarios of select intervention packages. Methods: The Modes of Transmission Model was adapted and used, and was parameterized using quality bio-behavioral surveillance data among key populations, routine data sources, and literature reviews. Results: Nationally in 2013, the largest number of new infections occurred among clients of female sex workers (FSWs (25%; 95% confidence interval (CI 14–37%, followed by men who have sex with men (MSM (22%; 95% CI 12–35%, HIV serodiscordant couples (22%; 95% CI 12–34%, FSWs (11%; 95% CI 6–18%, and people who inject drugs (5%; 95% CI 2–9%. A similar pattern of results was observed in Souss-Massa-Drâa, but the HIV incidence rate was four-fold that at the national level. Different scenarios of feasible intervention packages reduced HIV incidence by 8–44%. Conclusions: Commercial heterosexual sex networks continue as the leading driver of the epidemic, with half of HIV incidence. A quarter of new infections occurred among MSM, a third of which in Souss-Massa-Drâa. Feasible expanded coverage of interventions could lead to large reductions in incidence. Keywords: Mathematical model, Modes of transmission, Interventions, Morocco, Middle East and North Africa
Heidi van Rooyen
Full Text Available Introduction: Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents and adults who are not accessing health facilities. While home based counseling and testing has been succesfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated. Methods: The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention. Results: The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed and older families. There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored. Conclusion: This paper
Salam, Rehana A; Haroon, Sarah; Ahmed, Hashim H; Das, Jai K; Bhutta, Zulfiqar A
In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.
Wu, Feng; Zhang, Kong-lai; Shan, Guang-liang
The prevalence of HIV/AIDS in Chinese ethnic minorities is an important component of China's AIDS issues. In this study, we launched an intervention programme in Yunnan Province of China, where the Dai people live, to carry out the community-based HIV/AIDS health education and behavioral interventions on ordinary Dai farmers. The Dai people believe in Theravada Buddhism. Four rural communities were randomly divided into two groups. In one group (Buddhist group), HIV/AIDS health education and behavioral intervention were carried out by monks. The other group (women group) was instructed by women volunteers. The intervention continued for one year and the data were collected before and after the intervention project. In the Buddhist group, the villagers' AIDS related knowledge score was boosted from 3.11 to 3.65 (P Buddhist group, the villager's attitude score towards the people living with HIV and AIDS (PLWHA) also increased significantly from 1.51 to 2.16 (P Buddhist organization has limited success in promoting the use of condoms, but plays an important role in eliminating HIV/AIDS related discrimination.
Jaimie P. Meyer
Full Text Available The criminal justice system bears a disproportionate burden of the HIV epidemic. Continuity of care is critical for HAART-based prevention of HIV-related morbidity and mortality. This paper describes four major challenges to successful management of HIV in the criminal justice system: relapse to substance use, homelessness, mental illness, and loss of medical and social benefits. Each of these areas constitutes a competing priority upon release that demands immediate attention and diverts time, energy, and valuable resources away from engagement in care and adherence to HAART. Numerous gaps exist in scientific knowledge about these issues and potential solutions. In illuminating these knowledge deficits, we present a contemporary research agenda for the management of HIV in correctional systems. Future empirical research should focus on these critical issues in HIV-infected prisoners and releasees while interventional research should incorporate evidence-based solutions into the criminal justice setting.
Meyer, Jaimie P; Chen, Nadine E; Springer, Sandra A
The criminal justice system bears a disproportionate burden of the HIV epidemic. Continuity of care is critical for HAART-based prevention of HIV-related morbidity and mortality. This paper describes four major challenges to successful management of HIV in the criminal justice system: relapse to substance use, homelessness, mental illness, and loss of medical and social benefits. Each of these areas constitutes a competing priority upon release that demands immediate attention and diverts time, energy, and valuable resources away from engagement in care and adherence to HAART. Numerous gaps exist in scientific knowledge about these issues and potential solutions. In illuminating these knowledge deficits, we present a contemporary research agenda for the management of HIV in correctional systems. Future empirical research should focus on these critical issues in HIV-infected prisoners and releasees while interventional research should incorporate evidence-based solutions into the criminal justice setting.
Dolcini, M. Margaret; Harper, Gary W.; Boyer, Cherrie B.; Pollack, Lance M.
There is an urgent need for continued innovation in the design of HIV/STI prevention interventions for African American females, a group at high risk for STIs and HIV. In particular, attention to social development and to culture is needed. The present study reports on a group randomized controlled trial of a friendship-based HIV/STI prevention…
... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... White HIV/AIDS Program, Part C Funds for the Tutwiler Clinic. SUMMARY: HRSA will award non-competitively Ryan White HIV/AIDS Program, Part C funds to the Tutwiler Clinic, Tutwiler, Mississippi, to support...
... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... Part C funds under The Ryan White HIV/AIDS Program to support comprehensive primary care services for persons living with HIV/AIDS, including primary medical care, laboratory testing, oral health care...
... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... services for persons living with HIV/AIDS, including primary medical care, laboratory testing, oral health... continue providing services after March 31, 2010. HRSA's HIV/AIDS Bureau identified the Rural Health Group...
Belgrave, Faye Z.; Corneille, Maya; Hood, Kristina; Foster-Woodson, Julia; Fitzgerald, Angela
The enormous HIV/AIDS disparity among African American women and women in other ethnic groups dictates the need to implement the most effective HIV prevention interventions. This study examined the impact of perceived group support on HIV protective behaviors (i.e., attitudes and behaviors related to condom use, alcohol, and drugs) of African…
Burbelo, Peter D; Bayat, Ahmad; Rhodes, Craig S; Hoh, Rebecca; Martin, Jeffrey N; Fromentin, Rémi; Chomont, Nicolas; Hütter, Gero; Kovacs, Joseph A; Deeks, Steven G
Quantitative humoral profiling of recent samples from a human immunodeficiency virus (HIV)-infected adult who was cured following a delta32/delta32 CCR5 stem cell transplant in 2007 revealed no antibodies against p24, matrix, nucleocapsid, integrase, protease, and gp120, but low levels of antibodies against reverse transcriptase, tat, and gp41. Antibody levels to these HIV proteins persisted at high and stable levels in most noncontrollers, elite controllers, and antiretroviral-treated subjects, but a rare subset of controllers had low levels of antibodies against matrix, reverse transcriptase, integrase, and/or protease. Comprehensive HIV antibody profiles may prove useful for monitoring curative interventions.
Valentine, J.; Sanders, A E; Saladyanant, T; Ramsey, K; Blake, J; Morelli, T; Southerland, J; Quinlivan, E B; Nelson, J; DeParis, K; Webster-Cyriaque, J
Objective Periodontal disease resolution was hypothesized to impact systemic HIV measures. Methods In this longitudinal cohort study, 73 HIV-positive subjects received comprehensive dental care. AAP, CDC/AAP and biofilm gingival interface case definitions determined periodontal classification. In a subset, IL-6 was measured. Multivariable binary logistic regression models estimated odds of periodontitis development for comparisons between HIV and NHANES (2009–12) groups. Results In both groups, moderate/severe periodontitis was positively associated with non-white race, smoking, male gender, low income and increased pro-inflammatory cytokines. Likelihood of HIV periodontitis was higher across demographic variables. Subjects with severe periodontitis on antiretroviral therapy demonstrated high plasma viral loads at baseline (median= 464 co/ml; mean 65,773 co/ml). Post intervention, HIV periodontitis distribution became similar to NHANES and IL-6 levels decreased 2-fold (p=0.07). Subjects with suppressed viral load at baseline demonstrated increased CD4 counts at 12 months post intervention (P=0.027) (n=26). Conclusions Smoking, being non-white and low income were associated with periodontitis in HIV and NHANES. Higher Il-6, higher HIV VL and lower CD4 were associated with moderate/severe periodontal disease. Periodontitis decreased significantly with treatment producing periodontal profiles mirroring the national norm. In a subset of suppressed subjects, decreased oral inflammation, and associated microbial translocation, yielded improved CD4 counts. PMID:27109277
de Boer, Rebecca; Musgrave, Jeffrey; Andersson, Neil; Lutscher, Frithjof
Despite massive investment in HIV control programs, HIV incidence rates in countries with generalized epidemics have not fallen for most of the last decade. It appears that those at risk are not adopting effective prevention strategies. Those who are unable to implement their prevention preferences are referred to as choice disabled. We examined how and to what extent structural intervention measures that support choice-disabled individuals can reduce HIV transmission and prevalence. A mathematical model was developed to describe HIV transmission among and between choice-disabled and choice-enabled individuals. Data were available from field trials identifying factors and effects of choice disability. The model was used to estimate the potential impact of an intervention strategy in which choice-disabled individuals are enabled to make prevention choices. Several scenarios were considered and compared: supporting only one or both genders; supporting only HIV- individuals or also HIV+ choice-disabled individuals. Substantial declines in HIV incidence and prevalence are observed when supportive interventions are included in the model. The magnitude of these declines depends on the scope of the intervention program. The largest positive effect occurs when the support program is offered regardless of HIV status. Addressing the effects of choice disability in any HIV intervention program could be crucial to the program's success. Structural intervention programs to support choice-disabled individuals in implementing prevention strategies greatly reduce HIV incidence and prevalence in mathematical models.
Ibañez, Gladys E; Whitt, Elaine; Rosa, Mario de la; Martin, Steve; O'Connell, Daniel; Castro, Jose
The population within the criminal justice system suffers from various health disparities including HIV and hepatitis C virus (HCV). African American and Latino offenders represent the majority of the offender population. Evidence-based interventions to prevent HIV and HCV among criminal justice clients are scant and usually do not take cultural differences into account. Toward this end, this study describes the process of culturally adapting an HIV/HCV prevention intervention for Latino criminal justice clients in Miami, Florida, by using the ecological validity model. Recommendations for culturally adapting an intervention for Latinos include an emphasis on language and integrating cultural themes such as familism and machismo. © The Author(s) 2016.
Steven A Yukl
Full Text Available There is intense interest in developing curative interventions for HIV. How such a cure will be quantified and defined is not known. We applied a series of measurements of HIV persistence to the study of an HIV-infected adult who has exhibited evidence of cure after allogeneic hematopoietic stem cell transplant from a homozygous CCR5Δ32 donor. Samples from blood, spinal fluid, lymph node, and gut were analyzed in multiple laboratories using different approaches. No HIV DNA or RNA was detected in peripheral blood mononuclear cells (PBMC, spinal fluid, lymph node, or terminal ileum, and no replication-competent virus could be cultured from PBMCs. However, HIV RNA was detected in plasma (2 laboratories and HIV DNA was detected in the rectum (1 laboratory at levels considerably lower than those expected in ART-suppressed patients. It was not possible to obtain sequence data from plasma or gut, while an X4 sequence from PBMC did not match the pre-transplant sequence. HIV antibody levels were readily detectable but declined over time; T cell responses were largely absent. The occasional, low-level PCR signals raise the possibility that some HIV nucleic acid might persist, although they could also be false positives. Since HIV levels in well-treated individuals are near the limits of detection of current assays, more sensitive assays need to be developed and validated. The absence of recrudescent HIV replication and waning HIV-specific immune responses five years after withdrawal of treatment provide proof of a clinical cure.
Full Text Available Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300 were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ2 = 86.34, p = 0.00, and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4% and post-test (66.6% (χ2 = 73.2, p = 0.00. When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly
Niakan, Sharareh; Mehraeen, Esmaeil; Noori, Tayebeh; Gozali, Elahe
With the increasing growth of HIV positive people the use of information and communication technologies (ICT) can play an important role in controlling the spread of the AIDS. Web and Mobile are the new technologies that young people take advantage from them. In this study a review to investigate the web and mobile based HIV prevention and intervention programs was carried out. A scoping review was conducted including PubMed, Science direct, Web of Science and Proquest to find relevant sources that published in 2009 to 2016. To identify published, original research that reported the web and mobile-based HIV prevention and intervention programs, an organized search was conducted with the following search keywords in combination: HIV, AIDS, m-Health, Mobile phone, Cell phone, Smartphone, Mobile health, internet, and web. Using the employed strategies, 173 references retrieved. Searched articles were compared based on their titles and abstracts. To identify duplicated articles, the title and abstracts were considered and 101 duplicated references were excluded. By going through the full text of related papers, 35 articles were found to be more related to the questions of this paper from which 72 final included. The advantages of web and mobile-based interventions include the possibility to provide constancy in the delivery of an intervention, impending low cost, and the ability to spread the intervention to an extensive community. Online programs such as Chat room-based Education program, Web-based therapeutic education system, and Online seek information can use for HIV/AIDS prevention. To use of mobile for HIV/AIDS prevention and intervention, programs including in: Health system focused applications, Population health focused applications, and Health messaging can be used.
Noar, Seth M; Black, Hulda G; Pierce, Larson B
To conduct a meta-analysis of computer technology-based HIV prevention behavioral interventions aimed at increasing condom use among a variety of at-risk populations. Systematic review and meta-analysis of existing published and unpublished studies testing computer-based interventions. Meta-analytic techniques were used to compute and aggregate effect sizes for 12 randomized controlled trials that met inclusion criteria. Variables that had the potential to moderate intervention efficacy were also tested. The overall mean weighted effect size for condom use was d = 0.259 (95% confidence interval = 0.201, 0.317; Z = 8.74, P partners, and incident sexually transmitted diseases. In addition, interventions were significantly more efficacious when they were directed at men or women (versus mixed sex groups), utilized individualized tailoring, used a Stages of Change model, and had more intervention sessions. Computer technology-based HIV prevention interventions have similar efficacy to more traditional human-delivered interventions. Given their low cost to deliver, ability to customize intervention content, and flexible dissemination channels, they hold much promise for the future of HIV prevention.
Kennedy, Caitlin E; Fonner, Virginia A; O'Reilly, Kevin R; Sweat, Michael D
Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these
Rochat, Tamsen J; Mitchell, Joanie; Stein, Alan; Mkwanazi, Ntombizodumo Brilliant; Bland, Ruth M
Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalization, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counselors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement, and custody planning. An uncontrolled pre-post-evaluation study with 281 families showed that the intervention was feasible, acceptable, and effective in increasing maternal disclosure. The aim of this paper is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms, and activities; and to present a summary of results from the large-scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for the child. The
Li, Alan Tai-Wai; Fung, Kenneth Po-Lun; Maticka-Tyndale, Eleanor; Wong, Josephine Pui-Hing
Racialized diasporic communities in Canada experience disproportionate burden of HIV infection. Their increased vulnerabilities are associated with interlocking challenges, including barriers in accessing resources, migration and settlement stress, and systemic exclusion. Further, people living with HIV (PLHIV) in these diasporic communities face stigma and discrimination in both mainstream Canadian society as well as their own ethno-racial communities. HIV stigma negatively impacts all aspects of HIV care, from testing to disclosure to treatment and ongoing care. In response to these challenges, a Toronto based community organization developed and implemented the CHAMP project to engage people living with HIV/AIDS (PLHIV) and leaders from different service sectors from the African/Caribbean, Asian and Latino communities to explore challenges and strategies to reduce HIV stigma and build community resilience. The study engaged 66 PLHIV and ethno-racial leaders from faith, media and social justice sectors in two stigma-reduction training programs: Acceptance Commitment Therapy Training (ACT) and Social Justice Capacity Building (SJCB). Data collection included pre-and post- intervention surveys, focus groups and monthly activity logs. Participants were followed for a year and data on changes in the participants' attitudes and behaviors as well as their actual engagement in HIV prevention, PLHIV support and stigma reduction activities were collected. CHAMP results showed that the interventions were effective in reducing HIV stigma and increasing participants' readiness to take action towards positive social change. Participants' activity logs over a period of 9 months after completing the training showed they had engaged in 1090 championship activities to advocate for HIV related health equity and social justice issues affecting racialized and newcomer PLHIV and communities.
Lazarus, Jeff; Sihvonen-Riemenschneider, Henna; Laukamm-Josten, Ulrich
To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union.......To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union....
Camlin, Carol S; Charlebois, Edwin D; Geng, Elvin; Semitala, Fred; Wallenta, Jeanna; Getahun, Monica; Kampiire, Leatitia; Bukusi, Elizabeth A; Sang, Norton; Kwarisiima, Dalsone; Clark, Tamara D; Petersen, Maya L; Kamya, Moses R; Havlir, Diane V
The concept of "therapeutic citizenship" has drawn attention to ways in which public testimony, the "story-telling in the public sphere" undertaken by people living with HIV (PLHIV), has shaped the global response to the epidemic. This paper presents qualitative findings from two large studies in eastern Africa that reveal how the advent of population-based HIV testing campaigns and efforts to accelerate antiretroviral "treatment for all" has precipitated a rapidly expanding therapeutic citizenship "project," or social movement. The title of this paper refers to Goffman's original conceptualization of stigma as a social process through which a person's identity is rendered "spoiled." Data were derived from qualitative studies embedded within two clinical trials, Sustainable East African Research in Community Health (SEARCH) (NCT# 01864603) in Kenya and Uganda, and START-ART (NCT# 01810289) in Uganda, which aimed to offer insights into the pathways through which outcomes across the HIV care continuum can be achieved by interventions deployed in the studies, any unanticipated consequences, and factors that influenced implementation. Qualitative in-depth semi-structured interviews were conducted among cohorts of adults in 2014 through 2015; across both studies and time periods, 217 interviews were conducted with 166 individuals. Theoretically informed, team-based analytic approaches were used for the analyses. Narratives from PLHIV, who have not always been conceptualized as actors but rather usually as targets of HIV interventions, revealed strongly emergent themes related to these individuals' use of HIV biomedical resources and discourses to fashion a new, empowered subjecthood. Experiencing the benefits of antiretroviral therapy (ART) emboldens many individuals to transform their "spoiled" identities to attain new, valorized identities as "advocates for ART" in their communities. We propose that the personal revelation of what some refer to as the "gospel of ARVs
SAHARA-J: Journal of Social Aspects of HIV/AIDS. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 4 (2011) >. Log in or Register to get access to full text downloads.
To address a severe shortage of human resources for health, the Zambian Ministry of Health has begun to make use of lay counsellors for HIV counselling and testing. However, their skills and knowledge rarely have been reviewed or refreshed. We conducted a two-day refresher workshop for lay counsellors to review their ...
SAHARA-J: Journal of Social Aspects of HIV/AIDS. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 2 (2005) >. Log in or Register to get access to full text downloads.
SAHARA-J: Journal of Social Aspects of HIV/AIDS. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2017) >. Log in or Register to get access to full text downloads.
Brown, Emma J; Smith, Frances B
Preventing HIV transmission is a major world health goal. The international nursing shortage and the cost of educational and healthcare require innovative approaches to meet this goal. The initiative described provided HIV education at three levels: to students in an R.N. to BSN program, lay health advisors (LHA's), and participants in a high-risk community. Students completed the traditional community needs assessment and teaching plans. Additionally, they contributed to funding proposals, implemented and evaluated their plan. They prepared LHA's as peer group educators. This was cost-effective and increased credibility in an African-American community. Using tested materials tailored to this population, six LHA's conducted 24 sessions in two months. Of the 168 community participants, 151 completed the pre-and post-test of HIV knowledge. Correct responses increased significantly overall from 81.9% to 88.3 (t = 4.88, df = 150; p = .001). The three items with the greatest change in correct responses related to African American HIV exposure, female condoms, and lubricants. Rationale for the project and recommendations for improvement are included.
A computerized literature search of the Chinese National Knowledge Infrastructure, Wan Fang, and PubMed databases was conducted to collect related articles published in China. Only self-control intervention studies or studies containing sections regarding self-control interventions wherein the method of intervention was ...
Murphy, Debra A.; Armistead, Lisa; Marelich, William D.; Payne, Diana L.; Herbeck, Diane M.
Objective The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLH) to disclose their serostatus to their young children (age 6 – 12 years). Method MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had three individual sessions and one follow-up phone call. The sessions focused on preparing MLH for disclosure through behavioral exercises utilizing Derlaga’s model of HIV-disclosure. Both MLH and their child were assessed across multiple time-points (baseline, 3-, 6-, and 9-months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother’s health, child’s mental health, and family outcomes). Results MLH in the intervention group were six times more likely to disclose their HIV status than those in the control group (O.R. 6.33, 95% C.I.: 1.64 – 24.45), with 33% disclosing in the intervention group compared to 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness. Conclusions TRACK was found to be successful in helping MLH disclose their HIV status to their children, with positive outcomes noted for both MLH and their children. PMID:21355637
Aldridge, Robert W; Iglesias, David; Cáceres, Carlos F; Miranda, J Jaime
Background The HIV epidemic in Peru is still regarded as concentrated - sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. Methods HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. Results Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to $US 5,928 (per DALY averted) for prevention of mother to child transmission. Conclusion The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country plans to amplify its
Cáceres Carlos F
Full Text Available Abstract Background The HIV epidemic in Peru is still regarded as concentrated - sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. Methods HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. Results Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to $US 5,928 (per DALY averted for prevention of mother to child transmission. Conclusion The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country
Hanefeld, Johanna; Bond, Virginia; Seeley, Janet; Lees, Shelley; Desmond, Nicola
Increasing attention is being paid to the potential of anti-retroviral treatment (ART) for HIV prevention. The possibility of eliminating HIV from a population through a universal test and treat intervention, where all people within a population are tested for HIV and all positive people immediately initiated on ART, as part of a wider prevention intervention, was first proposed in 2009. Several clinical trials testing this idea are now in inception phase. An intervention which relies on universally testing the entire population for HIV will pose challenges to human rights, including obtaining genuine consent to testing and treatment. It also requires a context in which people can live free from fear of stigma, discrimination and violence, and can access services they require. These challenges are distinct from the field of medical ethics which has traditionally governed clinical trials and focuses primarily on patient researcher relationship. This paper sets out the potential impact of a population wide treatment as prevention intervention on human rights. It identifies five human right principles of particular relevance: participation, accountability, the right to health, non-discrimination and equality, and consent and confidentiality. The paper proposes that explicit attention to human rights can strengthen a treatment as prevention intervention, contribute to mediating likely health systems challenges and offer insights on how to reach all sections of the population. © 2013 John Wiley & Sons Ltd.
Peragallo, Nilda; Gonzalez-Guarda, Rosa M; McCabe, Brian E; Cianelli, Rosina
Culturally-specific HIV risk reduction interventions for Hispanic women are needed. SEPA (Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/Self-care) is a culturally-specific and theoretically-based group intervention for Hispanic women. The SEPA intervention consists of five sessions covering STI and HIV prevention; communication, condom negotiation and condom use; and violence prevention. A randomized trial tested the efficacy of SEPA with 548 adult U.S. Hispanic women (SEPA n = 274; delayed intervention control n = 274) who completed structured interviews at baseline and 3, 6, and 12 months post-baseline. Intent-to-treat analyses indicated that SEPA decreased positive urine samples for Chlamydia; improved condom use, decreased substance abuse and IPV; improved communication with partner, improved HIV-related knowledge, improved intentions to use condoms, decreased barriers to condom use, and increased community prevention attitudes. Culturally-specific interventions have promise for preventing HIV for Hispanic women in the U.S. The effectiveness of SEPA should be tested in a translational community trial.
Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Eaton, Lisa A; Kohler, James J; Montero, Catherine; Schinazi, Raymond F
We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV. A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months. Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission. Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.
Wagner, Anjuli D; Mugo, Cyrus; Bluemer-Miroite, Shay; Mutiti, Peter M; Wamalwa, Dalton C; Bukusi, David; Neary, Jillian; Njuguna, Irene N; O'Malley, Gabrielle; John-Stewart, Grace C; Slyker, Jennifer A; Kohler, Pamela K
To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.
Babasile D. Osunyomi
Objective: The key aim of this article is to explore the status quo of the implementation of information and communication technologies (ICTs in selected intervention programmes in the South African HIV/AIDS care delivery value chain. The contribution of this article is the mapping of key intervention activities along an HIV care value chain and to suggest a roadmap towards the integration of ICTs in service delivery programmes. Method: 20 managers of HIV/AIDS intervention programmes were surveyed, followed by semi-structured in-depth interviews with these respondents. A further five in-depth interviews were conducted with experts in the ICT area for exploring the uses of and barriers to integrating ICTs in the HIV/AIDS care delivery value chain. Results: The researchers mapped the barriers to implementation and ICT tools utilised within the HIV/AIDS care delivery value chain, which proves to be a useful tool to explore the status quo of technology in such service delivery programmes. The researchers then considered the wider policy environment and provided a roadmap based on the analysis and the South Africa eHealth strategy for driving development in this sector. Conclusion: The authors found that South Africa’s eHealth environment is still nascent and that the South African eHealth strategy does not place enough emphasis on systems integration and stakeholder engagement or the planning and process of uptake of ICTs by target audiences.
Varas-Díaz, Nelson; Neilands, Torsten B; Cintrón-Bou, Francheska; Marzán-Rodríguez, Melissa; Santos-Figueroa, Axel; Santiago-Negrón, Salvador; Marques, Domingo; Rodríguez-Madera, Sheilla
Introduction Stigma associated with HIV has been documented as a barrier for accessing quality health-related services. When the stigma manifests in the healthcare setting, people living with HIV receive substandard services or even be denied care altogether. Although the consequences of HIV stigma have been documented extensively, efforts to reduce these negative attitudes have been scarce. Interventions to reduce HIV stigma should be implemented as part of the formal training of future healthcare professionals. The interventions that have been tested with healthcare professionals and published have several limitations that must be surpassed (i.e., lack of comparison groups in research designs and longitudinal follow-up data). Furthermore, Latino healthcare professionals have been absent from these intervention efforts even though the epidemic has affected this population disproportionately. Methods In this article, we describe an intervention developed to reduce HIV stigma among medical students in Puerto Rico. A total of 507 medical students were randomly introduced into our intervention and control conditions. Results The results show statistically significant differences between the intervention and control groups; intervention group participants had lower HIV stigma levels than control participants after the intervention. In addition, differences in HIV stigma levels between the groups were sustained for a 12-month period. Conclusions The results of our study demonstrate the efficacy of the modes of intervention developed by us and serve as a new training tool for future healthcare professionals with regard to stigma reduction. PMID:24242260
Salmen, Charles R; Hickey, Matthew D; Fiorella, Kathryn J; Omollo, Dan; Ouma, Gor; Zoughbie, Daniel; Salmen, Marcus R; Magerenge, Richard; Tessler, Robert; Campbell, Harold; Geng, Elvin; Gandhi, Monica; Bukusi, Elizabeth A; Cohen, Craig R
In sub-Saharan Africa, failure to initiate and sustain HIV treatment contributes to significant health, psychosocial, and economic impacts that burden not only infected individuals but diverse members of their social networks. Yet, due to intense stigma, the responsibility for managing lifelong HIV treatment rests solely, and often secretly, with infected individuals. We introduce the concept of "HIV risk induction" to suggest that social networks of infected individuals share a vested interest in improving long-term engagement with HIV care, and may represent an underutilized resource for improving HIV/AIDS outcomes within high prevalence populations. In 2012, we implemented a 'microclinic' intervention to promote social network engagement in HIV/AIDS care and treatment. A microclinic is a therapy management collective comprised of a small group of neighbors, relatives, and friends who are trained as a team to provide psychosocial and adherence support for HIV-infected members. Our study population included 369 patients on ART and members of their social networks on Mfangano Island, Kenya, where HIV prevalence approaches 30%. Here we report qualitative data from 18 focus group discussions conducted with microclinic participants (n = 82), community health workers (n = 40), and local program staff (n = 39). Participants reported widespread acceptability and enthusiasm for the microclinic intervention. Responses highlight four overlapping community transformations regarding HIV care and treatment, namely (1) enhanced HIV treatment literacy (2) reduction in HIV stigma, (3) improved atmosphere for HIV status disclosure and (4) improved material and psychosocial support for HIV-infected patients. Despite challenges, participants describe an emerging sense of "collective responsibility" for treatment among HIV-infected and HIV-uninfected members of social networks. The lived experiences and community transformations highlighted by participants enrolled in this social
Matthew Lee Smith
Full Text Available Most universities offer human sexuality courses, although they are not required for graduation. While students in health-related majors may receive sexuality education in formal settings, majority of college students never receive formal sexual health or HIV/AIDS-related education, which may lead to elevated engagement in high-risk sexual behaviors. This study examines perceived knowledge about HIV/AIDS, perceived risk, and perceived consequences among college students by two distinct classifications of academic majors. Data were collected from 510 college students. Binary and multinomial logistic regressions were performed to compare HIV-related covariates by academic major category. Limited differences were observed by Science, Technology, Engineering, and Mathematics (STEM categorization. Relative to health and kinesiology (HK majors, those who self-reported being completely knowledgeable about HIV were less likely to be physical sciences, math, engineering, business (PMEB [OR=0.41, P=0.047] or education, humanities, and social sciences (EHS majors [OR=0.25, P=0.004]. PMEB majors were less likely to report behavioral factors as a risk for contracting HIV [OR=0.86, P=0.004] and perceived acquiring HIV would be more detrimental to their quality of life [OR=2.14, P=0.012], but less detrimental to their mental wellbeing [OR=0.58, P=0.042]. Findings can inform college-wide campaigns and interventions to raise HIV/AIDS awareness and improve college health.
Pearson, Frank S; Shafer, Michael S; Dembo, Richard; Del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L; Belenko, Steven; Frisman, Linda K; Visher, Christy A; Pich, Michele; Patterson, Yvonne
We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.
Jaiantilal, Prafulta; Gutin, Sarah A; Cummings, Beverley; Mbofana, Francisco; Rose, Carol Dawson
Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges such as
Conner, Laneshia R; Engstrom, Malitta; Junious, Eric; Edwards-Knight, Kevin
Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.
Kirby, Douglas; Obasi, Angela; Laris, B A
To review the impact of sex education and HIV education interventions in schools in developing countries on both risk behaviours for HIV and the psychosocial factors that affect them. We conducted a systematic review. Searches identified studies in developing countries that evaluated interventions using either experimental or strong quasi-experimental designs and measured the impact of the intervention on sexual risk behaviours. Each study was summarized and coded, and the results were tabulated by type of intervention. Twenty-two intervention evaluations met the inclusion criteria: 17 were based on a curriculum and 5 were not, and 19 were implemented primarily by adults and 3 by peers. These 22 interventions significantly improved 21 out of 55 sexual behaviours measured. Only one of the interventions (a non-curriculum-based peer-led intervention) increased any measure of reported sexual intercourse; 7 interventions delayed the reported onset of sex; 3 reduced the reported number of sexual partners; and 1 reduced the reported frequency of sexual activity. Furthermore, 16 of the 22 interventions significantly delayed sex, reduced the frequency of sex, decreased the number of sexual partners, increased the use of condoms or contraceptives or reduced the incidence of unprotected sex. Of the 17 curriculum-based interventions, 13 had most of the characteristics believed to be important according to research in developed and developing countries and were taught by adults. Of these 13 studies, 11 significantly improved one or more reported sexual behaviours, and the remaining 2 showed non-significant improvements in reported sexual behaviour. Among these 13 studies, interventions led by both teachers and other adults had strong evidence of positive impact on reported behaviour. Of the 5 non-curriculum-based interventions, 2 of 4 adult-led and the 1 peer-led intervention improved one or more sexual behaviours. A large majority of school-based sex education and HIV
Valera, Pamela; Chang, Yvonne; Lian, Zi
HIV prevalence in correctional populations is approximately five times that of the general adult population. This systematic review examines the broad question of HIV prevention and interventions to reduce inmate HIV-related risk behaviors in U.S. federal and state prisons. We conducted a systematic review of multiple databases and Google Scholar to identify behavioral, biomedical, social, and policy studies related to HIV among U.S. prison populations from 1980-2014. Studies were excluded if they did not focus on HIV, prison inmates, if they were conducted outside of the U.S., if they involved juvenile offenders, or if they included post-release outcomes. Twenty-seven articles met the study criteria. Evidence suggests that research related to the HIV care continuum, risk behaviors, gender, prevention (e.g., peer education), and policy are key topics to enhance HIV prevention interventions in the criminal justice system. This review provides a prison-specific overview of HIV in U.S. correctional populations and highlight effective interventions, including inmate peer education. There is an urgent need to continue to implement HIV prevention interventions across all prisons and improve the quality of life among those at heightened risk of HIV infection.
Bradley, Erin L P; Sutton, Madeline Y; Cooks, Eric; Washington-Ball, Brittney; Gaul, Zaneta; Gaskins, Susan; Payne-Foster, Pamela
Human immunodeficiency virus (HIV) disproportionately affects Blacks/African Americans, particularly those residing in the southern United States. HIV-related stigma adversely affects strategies to successfully engage people in HIV education, prevention, and care. Interventions targeting stigma reduction are vital as additional tools to move toward improved outcomes with HIV prevention and care, consistent with national goals. Faith institutions in the South have been understudied as partners in HIV stigma-reduction efforts, and some at-risk, Black/African American communities are involved with southern faith institutions. We describe the collaborative effort with rural, southern faith leaders from various denominations to develop and pilot test Project Faith-based Anti-stigma Initiative Towards Healing HIV/AIDS (FAITHH), an HIV stigma-reduction intervention that built on strategies previously used with other nonrural, Black/African American faith communities. The eight-module intervention included educational materials, myth-busting exercises to increase accurate HIV knowledge, role-playing, activities to confront stigma, and opportunities to develop and practice delivering a sermon about HIV that included scripture-based content and guidance. Engaging faith leaders facilitated the successful tailoring of the intervention, and congregation members were willing participants in the research process in support of increased HIV awareness, prevention, and care.
McCain, Nancy L.; Gray, D. Patricia; Elswick, R. K., Jr.; Robins, Jolynne W.; Tuck, Inez; Walter, Jeanne M.; Rausch, Sarah M.; Ketchum, Jessica McKinney
Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of…
Ng, Brian E; Butler, Lisa M; Horvath, Tara; Rutherford, George W
The transmission of sexually transmitted infections (STIs) is closely related to the sexual transmission of human immunodeficiency virus (HIV). Similar risk behaviours, such as frequent unprotected intercourse with different partners, place people at high risk of HIV and STIs, and there is clear evidence that many STIs increase the likelihood of HIV transmission. STI control, especially at the population or community level, may have the potential to contribute substantially to HIV prevention.This is an update of an existing Cochrane review. The review's search methods were updated and its inclusion and exclusion criteria modified so that the focus would be on one well-defined outcome. This review now focuses explicitly on population-based biomedical interventions for STI control, with change in HIV incidence being an outcome necessary for a study's inclusion. To determine the impact of population-based biomedical STI interventions on the incidence of HIV infection. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science/Social Science, PsycINFO, and Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS), for the period of 1 January1980 - 16 August 2010. We initially identified 6003 articles and abstracts. After removing 776 duplicates, one author (TH) removed an additional 3268 citations that were clearly irrelevant. Rigorously applying the inclusion criteria, three authors then independently screened the remaining 1959 citations and abstracts. Forty-six articles were chosen for full-text scrutiny by two authors. Ultimately, four studies were included in the review.We also searched the Aegis database of conference abstracts, which includes the Conference on Retroviruses and Opportunistic Infections (CROI), the International AIDS Conference (IAC), and International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS) meetings from their inception dates (1993, 1985 and
Harper, Gary W.; Dolcini, M. Margaret; Benhorin, Shira; Watson, Susan E.; Boyer, Cherrie B.
This article presents findings from a qualitative evaluation of an HIV/STI (sexually transmitted infection) prevention intervention for urban African American youth (Project ÒRÉ), which was delivered to groups of 3 to 8 adolescents who were members of the same friendship network. Sixteen focus groups (N = 63) were conducted with youth following…
The aim of this study was to evaluate the effect of a 24-week support group intervention programme, which was designed to enhance adaptive behaviour of latent-phase children affected by maternal HIV/AIDS as reported by the mother participants. The study was embedded in a concurrent nested mixed-method design, ...
Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.
Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…
McCabe, Brian E; Gonzalez-Guarda, Rosa M; Peragallo, Nilda P; Mitrani, Victoria B
The objective of this study was to test whether partner communication about HIV and/or alcohol intoxication mediated reductions in intimate partner violence (IPV) in SEPA (Salud [health], Educación [education], Promoción [promotion], y [and] Autocuidado [self-care]), a culturally specific, theoretically based group HIV-risk reduction intervention for Hispanic women. SEPA had five sessions covering sexually transmitted infection (STI)/HIV prevention, partner communication, condom negotiation and use, and IPV. SEPA reduced IPV and alcohol intoxication, and improved partner communication compared with controls in a randomized trial with adult U.S. Hispanic women (SEPA, n = 274; delayed intervention control, n = 274) who completed structured interviews at baseline and 3, 6, and 12 months post-baseline. Parallel process latent growth curve models indicated that partner communication about HIV mediated the reduction in male-to-female IPV in SEPA, B = -0.78, SE = 0.14, p< .001, but alcohol intoxication did not, B = -0.15, SE = 0.19, p = .431. Male-to-female IPV mediated the intervention effect on female-to-male IPV, B = -1.21, SE = 0.24, p< .001. Skills building strategies originally designed to enhance women's communication with their partners about sexual risk behaviors also worked to reduce male-to-female IPV, which in turn reduced female-to-male IPV. These strategies could be integrated into other types of health promotion interventions. © The Author(s) 2015.
Glassman, Jill R.; Franks, Heather M.; Baumler, Elizabeth R.; Coyle, Karin K.
Most interventions designed to prevent HIV/STI/pregnancy risk behaviours in young people have multiple components based on psychosocial theories (e.g. social cognitive theory) dictating sets of mediating variables to influence to achieve desired changes in behaviours. Mediation analysis is a method for investigating the extent to which a variable…
Mavegam, Bertille Octavie; Pharr, Jennifer R; Cruz, Patricia; Ezeanolue, Echezona E
HIV/AIDS remains a major public health problem despite the efforts to prevent and decrease its spread. Sub-Saharan Africa (SSA) represents 70% of the global number of people living with HIV and 73% of all HIV/AIDS-related deaths. Young adults age 15-24 years are disproportionately impacted by HIV/AIDS in SSA with 34% of people living with HIV (PLWHIV) and 37% of newly diagnosed individuals being in this age group. It is important that PLWHIV be linked to care to facilitate antiretroviral therapy (ART) initiation and limit the spread of infection. We conducted a systematic literature review to identify effective interventions designed to improve linkage to care among HIV-infected young adults in SSA. One hundred and forty-six titles and abstracts were screened, 28 full-texts were reviewed, and 6 articles met the inclusion and exclusion criteria. Home-based HIV counseling and testing, home-based HIV self-testing, and mobile HIV counseling and testing followed by proper referral of HIV-positive patients to HIV care were effective for improving linkage of young adults to care. Other factors such as referral forms, transportation allowance, home initiation of HIV care, and volunteer escort to the HIV treatment clinic were effective in reducing time to linkage to care. There is a vast need for research and interventions that target HIV-positive young adults in SSA which aim to improve their linkage and access to HIV care. The results of this study illustrate effective interventions in improving linkage to care and reducing time to linkage to care of young adults in SSA.
Foss Anna M
Full Text Available Abstract Background Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme. Methods A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW surveys. Uncertainty analysis was used to obtain different model fits to the HIV/STI epidemiological data, producing a range for the HIV impact of the project. Financial and economic costs of the intervention were estimated from the provider's perspective for the same time period. The cost per HIV-infection averted was estimated. Results Over 51 months, projections suggest that the intervention averted 624 and 5,131 HIV cases among the CSWs and their clients, respectively. This equates to a 54% and 51% decrease in the HIV infections that would have occurred among the CSWs and clients without the intervention. In the absence of intervention, the model predicts that the HIV prevalence amongst the CSWs in 2003 would have been 26%, almost twice that with the intervention. Cost per HIV infection averted, excluding and including peer educator economic costs, was USD 59 and USD 98 respectively. Conclusion This study demonstrated that targeted CSW interventions in India can be cost-effective, and highlights the importance of replicating this effort in other similar settings.
Mitchell, Jason; Lee, Ji-Young; Stephenson, Rob
Background As interest increases in the development of eHealth human immunodeficiency virus (HIV)-preventive interventions for gay male couples, Web-based methods must also be developed to help increase the likelihood that couples enrolled and data collected from them represent true unique dyads. Methods to recruit and collect reliable and valid data from both members of a couple are lacking, yet are crucial for uptake of novel sexual health and HIV-prevention eHealth interventions. Methods t...
Muessig, Kathryn E; LeGrand, Sara; Horvath, Keith J; Bauermeister, José A; Hightow-Weidman, Lisa B
We describe recent mobile health (mHealth) interventions supporting antiretroviral therapy (ART) medication adherence among HIV-positive MSM. Keyword searches (1 January 2016-13 May 2017) identified 721 citations. Seven publications reporting on six studies met inclusion criteria. Five studies focused on MSM. Interventions primarily employed text messaging (n = 4), whereas two focused on smartphone apps and one on social media. Three studies measured intervention impact on adherence and found increased ART use intentions (n = 1), self-reported adherence (n = 1), and viral suppression (n = 1, no control group). Other mHealth interventions for HIV-positive MSM focused on status disclosure and reducing sexual risk. mHealth interventions to support ART adherence among MSM show acceptability, feasibility, and preliminary efficacy. No recent mHealth interventions for MSM measured impact on viral suppression compared with a control condition despite earlier (pre-2015) evidence for efficacy. Studies are underway that include multiple features designed to improve adherence within complex smartphone or internet-based platforms. Areas for future growth include overcoming measurement and engagement challenges, developing tools for coordinating patient and provider adherence data, testing combination interventions, and adapting efficacious interventions for new languages and geographic settings.
Kennedy, David P; Hunter, Sarah B; Chan Osilla, Karen; Maksabedian, Ervant; Golinelli, Daniela; Tucker, Joan S
Individuals transitioning from homelessness to housing face challenges to reducing alcohol, drug and HIV risk behaviors. To aid in this transition, this study developed and will test a computer-assisted intervention that delivers personalized social network feedback by an intervention facilitator trained in motivational interviewing (MI). The intervention goal is to enhance motivation to reduce high risk alcohol and other drug (AOD) use and reduce HIV risk behaviors. In this Stage 1b pilot trial, 60 individuals that are transitioning from homelessness to housing will be randomly assigned to the intervention or control condition. The intervention condition consists of four biweekly social network sessions conducted using MI. AOD use and HIV risk behaviors will be monitored prior to and immediately following the intervention and compared to control participants' behaviors to explore whether the intervention was associated with any systematic changes in AOD use or HIV risk behaviors. Social network health interventions are an innovative approach for reducing future AOD use and HIV risk problems, but little is known about their feasibility, acceptability, and efficacy. The current study develops and pilot-tests a computer-assisted intervention that incorporates social network visualizations and MI techniques to reduce high risk AOD use and HIV behaviors among the formerly homeless. CLINICALTRIALS. NCT02140359.
mothers. Seventy-one percent (70.9% of HIV positive mothers practiced “on demand” breastfeeding. Twenty nine percent of infants aged 6–11 months and 47.8% of infants aged ≥12 months were no longer breastfed. The mean (± standard deviation duration of breastfeeding was 7.8 (±3.1 months (95% confidence interval: 6.9–8.7. Conclusion: The 2010 WHO guidelines and recommendations on breastfeeding duration for HIV positive mothers was not adhered to after 6 months of age. Promotion and counseling of optimal breastfeeding practice for HIV positive mothers based on the updated WHO guideline is an appropriate intervention. However, further research is recommended to evaluate the acceptance of the new 2010 WHO guideline by the health professionals and HIV positive mothers. Keywords: HIV-exposed, infants, breastfeeding, initiation
Norr, Kathleen F; Ferrer, Lilian; Cianelli, Rosina; Crittenden, Kathleen S; Irarrázabal, Lisette; Cabieses, Báltica; Araya, Alejandra; Bernales, Margarita
We tested the impacts of a professionally assisted peer-group intervention on Chilean health workers' HIV-related knowledge, attitudes, and behaviors using a quasi-experimental design with a pretest and 3-month posttest. Two Santiago suburbs were randomly assigned to the intervention or delayed intervention control condition. Five community clinics per suburb participated. Interested workers at the intervention (n = 262) and control (n = 293) clinics participated and completed both evaluations. At posttest, intervention clinic workers had higher knowledge and more positive attitudes regarding HIV, condoms, stigmatization, and self-efficacy for prevention. They reported more partner discussion about safer sex, less unprotected sex, and more involvement in HIV prevention activities in the clinic and the community, but they did not report fewer sexual partners or more standard precautions behaviors. Because of these positive impacts, the program will become a regular continuing education unit that can be used to meet health-worker licensing requirements. Copyright © 2012 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
McBride, Cami K.; Baptiste, Donna; Traube, Dorian; Paikoff, Roberta L.; Madison-Boyd, Sybil; Coleman, Doris; Bell, Carl C.; Coleman, Ida; McKay, Mary M.
SUMMARY Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth’s exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth’s best hope to grow up and survive multiple-dangers in urban neighborhoods (Pequegnat & Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided. PMID:20852742
Geanuracos, Catherine G.; Cunningham, Shayna D.; Weiss, George; Forte, Draco; Henry Reid, Lisa M.; Ellen, Jonathan M.
Geographic information system (GIS) analysis is an emerging tool for public health intervention planning. Connect to Protect, a researcher–community collaboration working in 15 cities to reduce HIV infection among youths, developed GIS databases of local health, crime, and demographic data to evaluate the geographic epidemiology of sexually transmitted infections and HIV risk among adolescents. We describe the process and problems of data acquisition, analysis, and mapping in the development of structural interventions, demonstrating how program planners can use this technology to inform and improve planning decisions. The Connect to Protect project’s experience suggests strategies for incorporating public data and GIS technology into the next generation of public health interventions. PMID:17901452
Mashamba, Tshilidzi; Peltzer, Karl; Maluleke, Thelma X; Sodi, Tholene
The aim of the study was to develop an HIV and AIDS training manual, and to evaluate the knowledge, attitudes and management of faith healers of Apostolic churches regarding HIV and AIDS, before and after they attended an HIV and AIDS training programme. A quasi-experimental intervention design was used with faith healers affiliated with the United African Apostolic Church (UAAC) in the Thulamela and Musina municipalities of Vhembe District, Limpopo Province, South Africa. A total of 103 faith healers were included in this study, 58 were systematically assigned to an intervention and 45 to a control group. The intervention group received training for 2 days. At follow-up after 2 months, intervention effects were significant for HIV knowledge and to a lesser extent TB knowledge. No significant improvement was found in HIV/STI (sexually transmitted infection) management strategies such as HIV/STI risk behaviour counselling, referral of clients for HIV testing, keeping condoms at stock in church, and church community HIV/AIDS/STI education. It is important to note that faith healers address some of the major known behavioural risk and protective factors such as partner reduction and condom use. Therefore, faith healers could be more widely utilized in HIV prevention programmes as risk reduction counsellors, in particular on matters of community-level education.
Cioe, Patricia A
Cigarette smoking is more prevalent in HIV-infected adults when compared to the general population (50-70%) and is linked to increased morbidity and mortality in this population. Of important clinical relevance, however, 40% of HIV-infected smokers express a willingness to attempt smoking cessation and two-thirds are interested in or considering quitting when asked. The purpose of this paper is to provide a state of the science review of the extant literature on smoking cessation interventions in HIV-infected adults. A comprehensive search of a computerized database for articles appearing in peer-reviewed journals was conducted. The integrative review included 10 articles from medical and nursing journals. Smoking cessation rates ranged from 6%-50% across studies employing pharmacologic and behavioral approaches. Samples sizes were frequently small and the effect was often not sustained over time. Emotional distress was related to smoking behaviors and may have been a barrier to successful smoking cessation. Adherence to pharmacologic therapy often declined over time and may have contributed to low cessation rates. Nicotine replacement therapy combined with a cell phone-delivered intensive counseling intervention showed promising results. Given the high prevalence of smoking among adults infected with HIV, this review supports the need for the development and implementation of innovative and effective interventions tailored to this population that will ultimately result in lower smoking prevalence and improved overall health.
Crittenden, Kathleen S; Kaponda, Chrissie P N; Jere, Diana L; McCreary, Linda L; Norr, Kathleen F
This paper examines whether a peer group intervention that reduced self-reported risky behaviors for rural adults in Malawi also had impacts on non-participants in the same communities. We randomly assigned two districts to the intervention and control conditions, and conducted surveys at baseline and 18 months post-intervention using unmatched independent random samples of intervention and control communities in 2003-2006. The six-session peer group intervention was offered to same-gender groups by trained volunteers. In this analysis, we divided the post-intervention sample into three exposure groups: 243 participants and 170 non-participants from the intervention district (total n = 415) and 413 control individuals. Controlling for demographics and participation, there were significant favorable diffusion effects on five partially overlapping behavioral outcomes: partner communication, ever used condoms, unprotected sex, recent HIV test, and a community HIV prevention index. Non-participants in the intervention district had more favorable outcomes on these behaviors than survey respondents in the control district. One behavioral outcome, community HIV prevention, showed both participation and diffusion effects. Participating in the intervention had a significant effect on six psychosocial outcomes: HIV knowledge (two measures), hope, condom attitudes, and self-efficacy for community HIV prevention and for safer sex; there were no diffusion effects. This pattern of results suggests that the behavioral changes promoted in the intervention spread to others in the same community, most likely through direct contact between participants and non-participants. These findings support the idea that diffusion of HIV-related behavior changes can occur for peer group interventions in communities, adding to the body of research supporting diffusion of innovations theory as a robust approach to accelerating change. If diffusion occurs, peer group intervention may be more
Trad, P V; Kentros, M; Solomon, G E; Greenblatt, E R
Pediatric acquired immunodeficiency syndrome (AIDS) is becoming more common. Moreover, human immunodeficiency virus (HIV) positive status in multiple family members is common and complicates disease management. Practitioners treating these children are often unaware of the effect of the virus on the child's psychological, cognitive, and emotional functioning. In addition, children with AIDS frequently come from families facing pressing social problems, including homelessness, poverty, and drug addiction. HIV-positive children thus confront such diverse issues as the deterioration of developmental skills, social ostracism, and the possibility of imminent death, placing them in a socioemotional crisis. This paper presents a comprehensive psychotherapeutic intervention for such children.
Ojo, Olumuyiwa; Verbeek, Jos H; Rasanen, Kimmo; Heikkinen, Jarmo; Isotalo, Leena K; Mngoma, Nomusa; Ruotsalainen, Eija
The workplace provides an important avenue to prevent HIV. To evaluate the effect of behavioral interventions for reducing HIV on high risk sexual behavior when delivered in an occupational setting. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO up until March 2011 and CINAHL, LILACS, DARE, OSH Update, and EPPI database up until October 2010. Randomised control trials (RCTs) in occupational settings or among workers at high risk for HIV that measured HIV, sexual transmitted diseases (STD), Voluntary Counseling and Testing (VCT), or risky sexual behaviour. Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias. We pooled studies that were similar. We found 8 RCTs with 11,164 participants but one study did not provide enough data. Studies compared VCT to no VCT and education to no intervention and to alternative education.VCT uptake increased to 51% when provided at the workplace compared to a voucher for VCT (RR=14.0 (95% CI 11.8 to16.7)). After VCT, self-reported STD decreased (RR = 0.10 (95% CI 0.01 to 0.73)) but HIV incidence (RR=1.4 (95% CI 0.7 to 2.7)) and unprotected sex (RR=0.71 (0.48 to 1.06)) did not decrease significantly. .Education reduced STDs (RR = 0.68 (95%CI 0.48 to 0.96)), unprotected sex (Standardised Mean Difference (SMD)= -0.17 (95% CI -0.29 to -0.05), sex with a commercial sex worker (RR = 0.88 (95% CI 0.81 to 0.96) but not multiple sexual partners (Mean Difference (MD) = -0.22 (95% CI -0.52 to 0.08) nor use of alcohol before sex (MD = -0.01 (95% CI of -0.11 to 0.08). Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually
Chidrawi, H Christa; Greeff, Minrie; Temane, Q Michael
Abstract All over the world, health behaviour is considered a complex, far reaching and powerful phenomenon. People's lives are influenced by their own or others' health behaviour on a daily basis. Whether it has to do with smoking, drinking, pollution, global warming or HIV management, it touches lives and it challenges personal and community responses. Health behaviour, and health behaviour change, probably holds the key to many a person's immediate or prolonged life or death outcomes. The same can be said about communities, culture groups and nations. This SANPAD-funded study focused on research questions relating to health behaviour change for people living with HIV (PLWH) in the North-West Province in South Africa. It investigated whether a comprehensive community-based HIV stigma reduction intervention caused health behaviour change in PLWH. An quantitative single system research design with one pre- and four repetitive post-tests utilizing purposive sampling was used to test change-over-time in the health behaviour of 18 PLWH. The results of the study indicated statistical and/or practical significant change-over-time. The intervention not only addressed the health behaviour of PLWH, but also their HIV stigma experiences, HIV signs and symptoms and their quality of life in the context of being HIV positive. The recommendations include popularization of the comprehensive community-based HIV stigma reduction intervention and extending it to include a second intervention to strengthen health behaviour and quality of life for PLWH in the community at large.
Aral, S O; Fransen, L
This study was initiated to assess which mix of early STD/HIV prevention interventions would potentially be effective, cost-effective and sustainable in Turkey; and to program an intervention sequence to maximize synergy among the interventions. During rapid assessment we: 1) reviewed past issues of 3 leading newspapers; 2) collected information on TV coverage; 3) interviewed key informants including taxicab drivers, hotel employees, grocery store owners, academicians in public health and law, investigators of STD/HIV and reproductive tract infections, and officials in the ministry of health; 4) reviewed available evidence on STD/HIV morbidity, sexual behavior patterns, migration patterns and same/opposite gender sex trade. We found: 1) discrepancies between decision makers' perceptions and social realities with respect to the epidemiology of sexual behavior and STDs, and the state of public health programs; 2) discrepancies between sexual practices and public expression regarding sexual practices; 3) economic, demographic, and political pressures in Turkey and in surrounding countries for the expansion of prostitution; 4) a sexual double standard and gender specific migration patterns which sustain a high demand for commercial sex; 5) patterns of health care seeking behaviors and provision of STD clinical services which indicate other STDs may play a very important role in spread of HIV infection; 6) an important mass media role in opinion formation; 7) consensual denial of risk for the majority based on beliefs embedded in machismo, nationalism and religion, and a resulting marginalization and externalization of STD/HIV risk; 8) high prevalence of syphilis among both Turkish and immigrant female prostitutes in Istanbul (early latent 8 and 13%; late latent 0 and 4%; previous history 9 and 22%) 9) and high rates of syphilis among male prostitutes (early latent 11%, late latent 21% and previous history 58%). We concluded that interventions should initially include
Wirtz, Andrea L.; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R.; Sherman, Susan G.; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna
Introduction Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5–65% in Kenya and Ukraine; 10–70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012–2016 and, compared to status quo when all interventions are held constant. Results Optimistic but feasible coverage (65%–70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion A community empowerment approach to HIV prevention and
Andrea L Wirtz
Full Text Available INTRODUCTION: Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. METHODS: We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil, while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. RESULTS: Optimistic but feasible coverage (65%-70% of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. DISCUSSION: A community empowerment approach to HIV
Zunza, Moleen; Mercer, Gareth D; Thabane, Lehana; Esser, Monika; Cotton, Mark F
Guidelines in resource-poor settings have progressively included interventions to reduce postnatal HIV transmission through breast milk. In addition to HIV-free survival, infant growth and non-HIV infections should be considered. Determining the effect of these interventions on infant growth and non-HIV infections will inform healthcare decisions about feeding HIV-exposed infants. We synthesize findings from studies comparing breast to formula feeding, early weaning to standard-duration breastfeeding, breastfeeding with extended antiretroviral (ARV) to short-course ARV prophylaxis, and alternative preparations of infant formula to standard formula in HIV-exposed infants, focusing on infant growth and non-HIV infectious morbidity outcomes. The review objectives were to collate and appraise evidence of interventions to reduce postnatal vertical HIV transmission, and to estimate their effect on growth and non-HIV infections from birth to two years of age among HIV-exposed infants. We searched PubMed, SCOPUS, and Cochrane CENTRAL Controlled Trials Register. We included randomized trials and prospective cohort studies. Two authors independently extracted data and evaluated risk of bias. Rate ratios and mean differences were used as effect measures for dichotomous and continuous outcomes, respectively. Where pooling was possible, we used fixed-effects meta-analysis to pool results across studies. Quality of evidence was assessed using the GRADE approach. Prospective cohort studies comparing breast- versus formula-fed HIV-exposed infants found breastfeeding to be protective against diarrhoea in early life [risk ratio (RR)=0.31; 95% confidence interval (CI)=0.13 to 0.74]. The effect of breastfeeding against diarrhoea [hazard ratio (HR)=0.74; 95% CI=0.57 to 0.97] and respiratory infections (HR=0.65; 95% CI=0.41 to 1.00) was significant through two years of age. The only randomized controlled trial (RCT) available showed that breastfeeding tended to be protective against
Gilbert, Jennifer A; Long, Elisa F; Brooks, Ralph P; Friedland, Gerald H; Moll, Anthony P; Townsend, Jeffrey P; Galvani, Alison P; Shenoi, Sheela V
The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40%) 18% HIV (95% CI 13-24%), 60% MDR-TB (95% CI 34-83%), 69% XDR-TB (95% CI 34-90%), and 16% TB/HIV deaths (95% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%), 5% HIV (23% total; 95% CI 17-29%), 8% MDR-TB (68% total; 95% CI 40-88%), 4% XDR-TB (73% total; 95% CI 38-91%), and 8% TB/HIV deaths (24% total; 95% CI 16-39%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV
Jennifer A Gilbert
Full Text Available The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40% 18% HIV (95% CI 13-24%, 60% MDR-TB (95% CI 34-83%, 69% XDR-TB (95% CI 34-90%, and 16% TB/HIV deaths (95% CI 12-29. Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%, 5% HIV (23% total; 95% CI 17-29%, 8% MDR-TB (68% total; 95% CI 40-88%, 4% XDR-TB (73% total; 95% CI 38-91%, and 8% TB/HIV deaths (24% total; 95% CI 16-39%. In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and
Jesson, Julie; Coulibaly, Aba; Sylla, Mariam; NʼDiaye, Clémentine; Dicko, Fatoumata; Masson, David; Leroy, Valériane
We assessed a nutritional support intervention in malnourished HIV-infected children in a HIV-care program of the University Hospital Gabriel Touré, Bamako, Mali. All HIV-infected children younger than 15 years were diagnosed for malnutrition between 07 and 12, 2014. Malnutrition was defined according to the WHO growth standards with Z-scores. Two types were studied: acute malnutrition (AM) and chronic malnutrition (CM). All participants were enrolled in a 6-month prospective interventional cohort, receiving Ready-To-Use Therapeutic Food, according to type of malnutrition. The nutritional intervention was offered until child growth reached -1.5 SD threshold. Six-month probability to catch up growth (>-2 SD) was assessed for AM using Kaplan-Meier curves and Cox model. Among the 348 children screened, 198 (57%) were malnourished of whom 158 (80%) children were included: 97 (61%) for AM (35 with associated CM) and 61 (39%) with CM. Fifty-nine percent were boys, 97% were on antiretroviral therapy, median age was 9.5 years (Interquartile Range: 6.7-12.3). Among children with AM, 74% catch-up their growth at 6-month; probability to catch-up growth was greater for those without associated CM (adjusted Hazard Ratio = 1.97, CI 95%: 1.13 to 3.44). Anemia decreased significantly from 40% to 12% at the end of intervention (P intervention showed 6-month benefits for weight gain and reduced anemia among these children mainly on antiretroviral therapy for years and aged greater than 5 years at inclusion. Associated CM slows down AM recovery and needs longer support. Integration of nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders.
The project will involve constructing a unified database, reinforcing the existing laboratory infrastructure, providing training in clinical trial support, and applying social science research in support of intervention preparedness and evaluation. The project will also offer specialized postgraduate training with a view to building ...
Vamos, Szonja; Mumbi, Miriam; Cook, Ryan; Chitalu, Ndashi; Weiss, Stephen Marshall; Jones, Deborah Lynne
The scale-up of HIV treatment programs in sub-Saharan Africa necessitates creative solutions that do not further burden the health system to meet global initiatives in prevention and care. This study assessed the work environment and impact of providing a behavioral risk reduction intervention in six community health centers (CHCs) in Lusaka, Zambia; opportunities and challenges to long-term program sustainability were identified. CHC staff participants (n = 82) were assessed on perceived clinic burden, job satisfaction, and burnout before and after implementation of the intervention. High levels of clinic burden were identified; however, no increase in perceived clinic burden or staff burnout was associated with providing the intervention. The intervention was sustained at the majority of CHCs and also adopted at additional clinics. Behavioral interventions can be successfully implemented and maintained in resource-poor settings. Creative strategies to overcome structural and economic challenges should be applied to enhance translation research.
Full Text Available African American women have among the highest HIV/AIDS and hepatitis B and C incidence rates in the United States, especially among those homeless or incarcerated. The objective of this study was to evaluate the Health Enlightenment, Awareness and Living Intervention, designed to decrease HIV/AIDS, hepatitis and related risky behaviors. The thirteen-session intervention was implemented among homeless and formerly incarcerated low-income African American women, ages 18 to 55, in Atlanta, Georgia from 2006 to 2010. A single group repeated measures study design was employed and consisted of a pre-test (n = 355 group, an immediate post-test (n = 228 group with a response rate of 64%, and a six-month follow up (n = 110 group with response rate of 48%, completing a 135-item survey. Paired-sample t-tests, McNemar tests, and repeated measures ANOVA were applied to compare survey results. Participants demonstrated statistically significant increases in hepatitis B and C knowledge over time (p < 0.001. Statistically significant decreases were also reported for unprotected sex in exchange for money, drugs or shelter (p = 0.008, and sex under the influence of drugs or alcohol (p < 0.001. Reported substance use decreased with statistical significance for alcohol (p = 0.011, marijuana (p = 0.011, illegal drugs (p = 0.002, and crack/cocaine (p = 0.003. Findings broaden the evidence base related to the effectiveness of HIV/AIDS and hepatitis risk reduction interventions designed for homeless and previously incarcerated African American women.
Côté, José; Rouleau, Geneviève; Ramirez-Garcia, Pilar; Bourbonnais, Anne
Persons living with HIV (PLHIV) must adhere optimally to antiretroviral therapy (ART) on a daily basis and for their lifetime to maintain an undetectable viral load, allowing them to preserve their health. Taking advantage of the opportunity that information and communication technologies provide to broaden intervention modalities and intensify clinical follow-up, a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. Compared with other types of information and communication technologies-assisted interventions such as text messages, HIV Treatment, Virtual Nursing Assistance and Education (VIH-TAVIE) requires a certain degree of active engagement on the part of the user to develop and strengthen the self-management skills to optimize adherence. After the intervention's impact on ART adherence was measured quantitatively, a qualitative study was undertaken to describe how users experience the intervention. Understanding how PLHIV perceive being assisted asynchronously by a virtual nurse was of particular interest. The objective of the study was to explore and describe how PLHIV experience VIH-TAVIE, that is, receiving customized asynchronous accompaniment via a virtual nurse. A qualitative study was conducted with 26 PLHIV (20 men, 6 women) who received all four VIH-TAVIE sessions. Participants had been diagnosed with HIV 14 years earlier on average and had been on ART for a mean period of 10 years. The sessions lasted 20-30 minutes each and were received two weeks apart. They are hosted by a virtual nurse who engages the user in a self-management skills-learning process for the purpose of treatment adherence. Semistructured interviews were conducted lasting 30-40 minutes to get participants to share their experience of the intervention through personal stories and what they thought and felt during their participation. Data were analyzed using Miles and Huberman
El-Bassel, Nabila; Jemmott, John B; Landis, J Richard; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Bellamy, Scarlett L
Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy. To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each other's serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups. Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison
... Intervention Services Grant under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services.../AIDS Program, Part C funds for the Louisiana State University, Health Sciences Center, Viral Disease... HIV/AIDS, including primary medical care, laboratory testing, oral health care, outpatient mental...
Full Text Available This article examines the dynamics between HIV/Aids gender policy strategies and the socio-political demands on HIV/Aids interventions in sub-Saharan Africa. Gender in HIV/Aids intervention seems inescapable. Nowhere else is this more marked than in the social dimensions of HIV/Aids prevention in sub-Saharan Africa. This has resulted in prevention strategies, which are encumbered by the reality of poverty, gender, access, power and the various debates on behavioural change. The social constructions of gender roles and power relations play a significant role in the region’s HIV /Aids dynamic. To this end, the mainstreaming of gender issues into national political, social and economic agenda and policies has been championed by international development and economic institutions. In developing HIV/Aids intervention policies, gender has also been mainstreamed, especially where epidemiological data show the disparity in infection rates between men and women, where women are seen as more susceptible to infection. The gendered approach to HIV/Aids appears to typecast women as the vulnerable and suffering face of HIV/Aids, while men, as ‘the other’, are generally regarded as the perpetuators and spreaders of the virus. While there is no doubt that women’s vulnerability in this milieu has been proven within known research evidence to exist, the neglect of institutional (social, cultural and economic and historical vulnerabilities of African men’s realities are sometimes overlooked. Recently, greater focus has shifted to curbing infection rates in men based on new scientific evidence that shows that risk of transmission in circumcised men is reduced. The article argues that such movement towards showing areas of men’s vulnerability as a focus in HIV/Aids policy interventions may have the potential to shift the observed burden that current HIV/Aids policy thrusts inadvertently place on African women. The article will put forward an argument for
Wenzel, Suzanne L; Cederbaum, Julie A; Song, Ahyoung; Hsu, Hsun-Ta; Craddock, Jaih B; Hantanachaikul, Wichada; Tucker, Joan S
Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.
Eric A. Ratliff
Full Text Available In the past decade, Tanzania has seen a rapid rise in the number of people who inject drugs (PWID, specifically heroin. While the overall HIV prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV prevalence among PWID remains alarmingly high at 35%. In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP, Médecins du Monde France (MdM-F, and other organisations have been at the forefront of addressing this public health issue in Africa, implementing a wide array of harm reduction interventions including medication-assisted treatment (MAT, needle and syringe programs (NSP, and “sober houses” for residential treatment in the capital, Dar es Salaam, and in Zanzibar. Looking toward the future, we discuss the need to (1 extend existing services and programs to reach more PWID and others at risk for HIV, (2 develop additional programs to strengthen existing programs, and (3 expand activities to include structural interventions to address vulnerabilities that increase HIV risk for all Tanzanians.
Ravaoarimalala, C; Andriamahenina, R; Ravelojaona, B; Rabeson, D; Andriamiadana, J; May, J F; Behets, F; Rasamindrakotroka, A
The HIV seroprevalence per 100,000 adults Malagasy rose from 20 in 1989, to 30 in 1992, and to 70 in 1995. In that year, the total number of HIV infected people in the Big Island was estimated at 5,000, the number of people sick with AIDS at 130, and the people at risk at more than 1,000,000. The latter are the persons infected with other STDs and individuals (or their partners) with risky sexual behaviour (e.g. numerous sexual partners, occasional sexual partners, and/or sexual contacts with commercial sex workers). The HIV prevalence rate is low as compared with those of other countries. Nevertheless, the spread of the HIV infection is alarming in some parts of the country and the risk factors are also present, namely: the high prevalence of STDs, numerous sexual partners, the low use of condoms in all groups, the development of tourism, the development of prostitution associated with social and economical problems, and internal and international migrations (with risky sexual contacts). Therefore, the still low but rising HIV prevalence in 1995 does not warrant complacency. To estimate the trend of HIV prevalence within the population, it is useful to know two different assumptions, as follows: firstly, a controlled evolution of the epidemic (low epidemic) and secondly, a very fast spread of the epidemic (high epidemic). If we consider the 5,000 individuals seropositive in July 1995, the Aids Impact Model (AIM) projection model shows that HIV seroprevalence rates among adults in 2015 might be between 3% (when the progression course of HIV epidemic is low) and 15% (when the progression course of HIV epidemic is high). By 2015 AIDS could have severe demographic, social, and economic impacts. Then, it is necessary to take measures to prevent contamination. Five major interventions are required: public information about AIDS, HIV transmission mechanism, and its prevention, communities education via the respected people and the notabilities to promote moral values
Operario, Don; Gamarel, Kristi E; Iwamoto, Mariko; Suzuki, Sachico; Suico, Sabrina; Darbes, Lynae; Nemoto, Tooru
HIV risk among transgender women has been attributed to condomless sex with primary male partners. This study pilot tested a couples-focused HIV intervention program for transgender women and their primary male partners. We analyzed data from 56 transgender women and their male partners (n = 112 participants) who were randomized as a couple to one of two groups. Participants in the intervention group (27 couples) received 3 counseling sessions: 2 couples-focused sessions, which discussed relationship dynamics, communication, and HIV risk, and 1 individual-focused session on HIV prevention concerns. Participants in the control group (29 couples) received 1 session on general HIV prevention information delivered to both partners together. At 3-month follow-up, participants in the intervention reported lower odds of condomless sex with primary partners (OR 0.5, 95 % CI 0.3-1.0), reduced odds of engaging in sex with a casual partner (OR 0.3, 95 % CI 0.1-1.0), and reduction in the number of casual partners (B = -1.45, SE = 0.4) compared with the control group. Findings provide support for the feasibility and promise of a couples-focused HIV prevention intervention for transgender women and their primary male partners.
Brandon D L Marshall
Full Text Available HIV transmission among injecting and non-injecting drug users (IDU, NIDU is a significant public health problem. Continuing propagation in endemic settings and emerging regional outbreaks have indicated the need for comprehensive and coordinated HIV prevention. We describe the development of a conceptual framework and calibration of an agent-based model (ABM to examine how combinations of interventions may reduce and potentially eliminate HIV transmission among drug-using populations.A multidisciplinary team of researchers from epidemiology, sociology, geography, and mathematics developed a conceptual framework based on prior ethnographic and epidemiologic research. An ABM was constructed and calibrated through an iterative design and verification process. In the model, "agents" represent IDU, NIDU, and non-drug users who interact with each other and within risk networks, engaging in sexual and, for IDUs, injection-related risk behavior over time. Agents also interact with simulated HIV prevention interventions (e.g., syringe exchange programs, substance abuse treatment, HIV testing and initiate antiretroviral treatment (ART in a stochastic manner. The model was constructed to represent the New York metropolitan statistical area (MSA population, and calibrated by comparing output trajectories for various outcomes (e.g., IDU/NIDU prevalence, HIV prevalence and incidence against previously validated MSA-level data. The model closely approximated HIV trajectories in IDU and NIDU observed in New York City between 1992 and 2002, including a linear decrease in HIV prevalence among IDUs. Exploratory results are consistent with empirical studies demonstrating that the effectiveness of a combination of interventions, including syringe exchange expansion and ART provision, dramatically reduced HIV prevalence among IDUs during this time period.Complex systems models of adaptive HIV transmission dynamics can be used to identify potential collective benefits
Carrico, Adam W; Nation, Austin; Gómez, Walter; Sundberg, Jeffrey; Dilworth, Samantha E; Johnson, Mallory O; Moskowitz, Judith T; Rose, Carol Dawson
Among men who have sex with men (MSM), the co-occurrence of trauma and stimulant use has negative implications for HIV/AIDS prevention. HIV-positive, methamphetamine-using MSM were recruited to pilot test a 7-session, multicomponent resilient affective processing (RAP) intervention that included expressive writing exercises targeting HIV-related traumatic stress. An open-phase pilot with 10 participants provided support for feasibility of intervention delivery such that 99% of the RAP sessions were completed in a 1-month period. Subsequently, 23 additional participants were enrolled in a pilot randomized controlled trial of the RAP intervention (n = 12) versus an attention-control condition that included writing exercises about neutral topics (n = 11). Acceptability was evidenced by participants randomized to RAP expressing significantly more negative emotions in their writing and reporting greater likelihood of recommending expressive writing exercises to a friend living with HIV. Over the 3-month follow-up period, attention-control participants reported significant decreases in HIV-related traumatic stress while RAP intervention participants reported no significant changes. Compared to attention-control participants, those in the RAP intervention reported significant reductions in the frequency of methamphetamine use immediately following the 1-month RAP intervention period. Thematic analyses of RAP expressive writing exercises revealed that multiple negative life events characterized by social stigma or loss contribute to the complex nature of HIV-related traumatic stress. Findings support the feasibility and acceptability of an exposure-based intervention targeting HIV-related traumatic stress. However, more intensive intervention approaches that simultaneously target trauma and stimulant use will likely be needed to optimize HIV/AIDS prevention efforts with this population. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Côté, José; Godin, Gaston; Ramirez-Garcia, Pilar; Rouleau, Geneviève; Bourbonnais, Anne; Guéhéneuc, Yann-Gaël; Tremblay, Cécile; Otis, Joanne
Living with human immunodeficiency virus (HIV) necessitates long-term health care follow-up, particularly with respect to antiretroviral therapy (ART) management. Taking advantage of the enormous possibilities afforded by information and communication technologies (ICT), we developed a virtual nursing intervention (VIH-TAVIE) intended to empower HIV patients to manage their ART and their symptoms optimally. ICT interventions hold great promise across the entire continuum of HIV patient care but further research is needed to properly evaluate their effectiveness. The objective of the study was to compare the effectiveness of two types of follow-up--traditional and virtual--in terms of promoting ART adherence among HIV patients. A quasi-experimental study was conducted. Participants were 179 HIV patients on ART for at least 6 months, of which 99 were recruited at a site offering virtual follow-up and 80 at another site offering only traditional follow-up. The primary outcome was medication adherence and the secondary outcomes were the following cognitive and affective variables: self-efficacy, attitude toward medication intake, symptom-related discomfort, stress, and social support. These were evaluated by self-administered questionnaire at baseline (T0), and 3 (T3) and 6 months (T6) later. On average, participants had been living with HIV for 14 years and had been on ART for 11 years. The groups were highly heterogeneous, differing on a number of sociodemographic dimensions: education, income, marital status, employment status, and living arrangements. Adherence at baseline was high, reaching 80% (59/74) in the traditional follow-up group and 84% (81/97) in the virtual follow-up group. A generalized estimating equations (GEE) analysis was run, controlling for sociodemographic characteristics at baseline. A time effect was detected indicating that both groups improved in adherence over time but did not differ in this regard. Improvement at 6 months was significantly
Full Text Available In Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention in 12 county-level hospitals.To determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC.Health System.1-, 5-and 25-years.We adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056, China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs, and the incremental cost-effectiveness ratio (ICER of the One4All intervention compared to SOC.The One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846, but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness
Arrivillaga, Marcela; Salcedo, Juan Pablo
The aim of this study is to describe the scope of microfinance-based interventions for HIV/AIDS prevention. A systematic review was carried out of literature published between 1986 and 2012 from EBSCO, ProQuest, Science Direct, Emerald, and JSTOR. The search included original research articles that presented evaluated interventions. Books, dissertations, gray literature, and theoretical reviews were excluded. Findings revealed a total of fourteen studies focused on the evaluation of: the IMAGE project, female sex workers, life skills and risk behavior reduction, adherence to treatment, and children and their families. Most of these interventions have shown to have beneficial effects, although results depend on: the type of program, monitoring, sustainability of microcredits, and contextual conditions. The findings of this review should be complemented with interventions carried out by various NGOs and microfinance institutions in different countries that present their results in a dissimilar way.
Washington, Thomas Alex; Applewhite, Sheldon; Glenn, Wendell
A randomized control pilot study was conducted with Black men who have sex with men (BMSM; N = 42) aged 18-30 years to examine the feasibility of implementing a video intervention delivered using Facebook to motivate HIV testing. At baseline, participants were unaware of their HIV status and had not tested for HIV in the past 6 months, residing in Los Angeles County. The intervention content included topics such as social influence, HIV knowledge, stigma, HIV positive knowledge, and benefits of knowing one's HIV status. Logistic regression revealed that those receiving the video intervention were 7 times more likely to have tested for HIV than those in the control group at 6-week follow-up (odds ratio [ OR ] = 7.00, 95% confidence interval [1.72, 28.33], p = .006). Data suggest that the intervention was feasible for motivating HIV testing.
Brandt, Laura; Beima-Sofie, Kristin; Hamunime, Ndapewa; Shepard, Mark; Ferris, Larissa; Ingo, Paulina; John-Stewart, Grace; O'Malley, Gabrielle
To facilitate replication and adaptation of pediatric HIV disclosure interventions, we identified key components of a child-friendly cartoon book used to guide Namibian caregivers and healthcare workers (HCWs) through a gradual, structured disclosure process. Qualitative interviews were conducted with caregivers and HCWs from four high-volume pediatric HIV clinics in Namibia. Semi-structured in-depth interviews with 35 HCWs and 64 caregivers of HIV+ children aged 7-15 were analyzed using constant comparative and modified grounded theory analysis. Major barriers to disclosure were compared to accounts of intervention success, and themes related to key components were identified. The disclosure book overcomes barriers to disclosure by reducing caregiver resistance, increasing HIV and disclosure knowledge, and providing a gradual, structured framework for disclosure. The delayed mention of HIV-specific terminology overcomes caregiver fears associated with HIV stigma, thus encouraging earlier uptake of disclosure initiation. Caregivers value the book's focus on staying healthy, keeping the body strong, and having a future 'like other kids', thus capitalizing on evidence of the positive benefits of resilience and hopefulness rather than the negative consequences of HIV. The book's concepts and images resonate with children who readily adopt the language of 'body soldiers' and 'bad guys' in describing how important it is for them to take their medicine. Discussion cues ease communication between HCWs, caregivers, and pediatric patients. Given the urgent need for available pediatric HIV disclosure interventions, easily implementable tools like the Namibian disclosure book should be evaluated for utility in similar settings.
Full Text Available Sara D Pullen,1 Nnenna Nina Chigbo,2 Emmanuel Chukwudi Nwigwe,2 Chinwe J Chukwuka,3 Christopher Chim Amah,4 Stanley C Idu21Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA; 2Department of Physiotherapy, 3Department of Medicine, 4Paediatric Surgery Division, Department of Surgery, College of Medicine, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: The advent of highly active antiretroviral therapy has dramatically extended the life expectancy of people living with human immunodeficiency virus (HIV/acquired immunodeficiency syndrome. Despite this increased longevity, HIV disease and its pharmacological treatment can cause long-term and acute health complications, many of which can be treated successfully by physiotherapy. The purpose of this paper is to report the effect of a 12-week rehabilitation program on several health-related markers in a 43-year-old woman living with HIV.Methods: This case study examined the effect of a 12-week exercise and manual therapy intervention on morphology, pain, cardiopulmonary fitness, strength, neurological balance, immune markers (CD4 cell count, and quality of life in a 43-year-old woman living with HIV.Results: The results showed complete elimination of pain and shortness of breath on exertion. There was also a reduction in resting heart rate, waist circumference, exercise duration, muscle strength, and endurance. The patient showed an increase in peak expiratory flow rate, maximal heart rate attained, upper arm, forearm, and thigh circumference, and CD4+ cell count. The patient also showed improvements in the quality of life domains of general health, pain, energy/fatigue, social and physical functioning, and emotional well-being.Conclusion: Physiotherapy interventions consisting of exercise and manual therapy appear beneficial in several areas as an adjunct therapy in HIV management.Keywords: exercise, manual therapy, quality of life
Gentry, Sarah; van-Velthoven, Michelle H M M T; Tudor Car, Lorainne; Car, Josip
This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the
Yilma, Daniel; Kæstel, Pernille; Olsen, Mette F
daily allowance of vitamin D (10 μg/200 g). The level of serum 25(OH)D before nutritional intervention and ART initiation was compared with serum 25(OH)D of HIV-negative individuals. A total of 348 HIV-positive and 100 HIV-negative persons were recruited. The median baseline serum 25(OH)D level......Low vitamin D level in HIV-positive persons has been associated with disease progression. We compared the levels of serum 25-hydroxyvitamin D (25(OH)D) in HIV-positive and HIV-negative persons, and investigated the role of nutritional supplementation and antiretroviral treatment (ART) on serum 25......(OH)D levels. A randomised nutritional supplementation trial was conducted at Jimma University Specialized Hospital, Ethiopia. The trial compared 200 g/d of lipid-based nutrient supplement (LNS) with no supplementation during the first 3 months of ART. The supplement provided twice the recommended...
Zeglin, Robert J
HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.
Zeglin, Robert J.
HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: 1) Number of partners, 2) Attitudes toward condoms, 3) Drug use, 4) Sexual positioning, 5) Condom decision-making, 6) Attitudes toward testing, and 7) Treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a Masculinity Model of Community HIV Transmission. Opportunities for counseling interventions include identifying how masculinity informs a client’s cognitions, emotions, and behaviors as well as adapting gender transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence. PMID:25917411
Rotheram-Borus, Mary Jane; Swendeman, Dallas; Chovnick, Gary
In the past 25 years, the field of HIV prevention research has been transformed repeatedly. Today, effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. Risk of transmitting or acquiring HIV is reduced by consistent male and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, male circumcision, and treatment with antiretroviral medications. At least 144 behavioral prevention programs have been found effective in reducing HIV transmission acts; however, scale up of these programs has not occurred outside of the United States. A series of recent failures of HIV-prevention efficacy trials for biomedical innovations such as HIV vaccines, treating herpes simplex 2 and other sexually transmitted infections, and diaphragm and microbicide barriers highlights the need for behavioral strategies to accompany biomedical strategies. This challenges prevention researchers to reconceptualize how cost-effective, useful, realistic, and sustainable prevention programs will be designed, delivered, tested, and diffused. The next generation of HIV prevention science must draw from the successes of existing evidence-based interventions and the expertise of the market sector to integrate preventive innovations and behaviors into everyday routines. PMID:19327028
Huedo-Medina, Tania B; Boynton, Marcy H; Warren, Michelle R; Lacroix, Jessica M; Carey, Michael P; Johnson, Blair T
This meta-analysis synthesized 37 HIV prevention interventions (from 28 studies) that were evaluated in Latin American and Caribbean nations. These studies were obtained through systematic searches of English, Spanish, and Portuguese-language databases available as of January 2009. Overall, interventions significantly increased knowledge (d = 0.40) and condom use (d = 0.25) but the effects varied widely. Interventions produced more condom use when they focused on high-risk individuals, distributed condoms, and explicitly addressed social-cultural components. The best-fitting models utilized factors related to geography, especially indices of a nations' human development index (HDI) and income inequality (i.e., Gini index). Interventions that provided at least 3 h of content succeeded better when HDI and income inequality were lower, suggesting that intensive HIV prevention activities succeed best where the need is greatest. Implications for HIV intervention development in Latin America and the Caribbean are discussed.
da Silveira, Mariângela Freitas; dos Santos, Iná Silva
Promoting the secondary prevention of HIV transmission is essential. An intervention. aimed at increasing condom use by partners. was delivered to HIV positive women attending a Brazilian clinic. It included educational advice delivered by doctors. and unlimited access to free condoms. A pre-post design was used: 170 control group women were recruited. the intervention was implemented. and 170 intervention group women were then enrolled. All were interviewed at baseline. 30 and 60 days. After training. doctors were more likely to provide advice on condom use. Reported use increased by 8.8% points (a 14.2% increase) in the intervention group after 30 days. and by 5.7 points (9.5%) in the control group (P = 0.52). The reasons why the intervention failed to reach a significant effect are discussed. as are the possible Public Health impact of a 14.2% increase in condom use among HIV positive women.
Cao, Bolin; Gupta, Somya; Wang, Jiangtao; Hightow-Weidman, Lisa B; Muessig, Kathryn E; Tang, Weiming; Pan, Stephen; Pendse, Razia; Tucker, Joseph D
Social media is increasingly used to deliver HIV interventions for key populations worldwide. However, little is known about the specific uses and effects of social media on human immunodeficiency virus (HIV) interventions. This systematic review examines the effectiveness of social media interventions to promote HIV testing, linkage, adherence, and retention among key populations. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane guidelines for this review and registered it on the International Prospective Register of Systematic Reviews, PROSPERO. We systematically searched six databases and three conference websites using search terms related to HIV, social media, and key populations. We included studies where (1) the intervention was created or implemented on social media platforms, (2) study population included men who have sex with men (MSM), transgender individuals, people who inject drugs (PWID), and/or sex workers, and (3) outcomes included promoting HIV testing, linkage, adherence, and/or retention. Meta-analyses were conducted by Review Manager, version 5.3. Pooled relative risk (RR) and 95% confidence intervals were calculated by random-effects models. Among 981 manuscripts identified, 26 studies met the inclusion criteria. We found 18 studies from high-income countries, 8 in middle-income countries, and 0 in low-income countries. Eight were randomized controlled trials, and 18 were observational studies. All studies (n=26) included MSM; five studies also included transgender individuals. The focus of 21 studies was HIV testing, four on HIV testing and linkage to care, and one on antiretroviral therapy adherence. Social media interventions were used to do the following: build online interactive communities to encourage HIV testing/adherence (10 studies), provide HIV testing services (9 studies), disseminate HIV information (9 studies), and develop intervention materials (1 study). Of the
Gupta, Somya; Wang, Jiangtao; Hightow-Weidman, Lisa B; Muessig, Kathryn E; Tang, Weiming; Pan, Stephen; Pendse, Razia; Tucker, Joseph D
Background Social media is increasingly used to deliver HIV interventions for key populations worldwide. However, little is known about the specific uses and effects of social media on human immunodeficiency virus (HIV) interventions. Objective This systematic review examines the effectiveness of social media interventions to promote HIV testing, linkage, adherence, and retention among key populations. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane guidelines for this review and registered it on the International Prospective Register of Systematic Reviews, PROSPERO. We systematically searched six databases and three conference websites using search terms related to HIV, social media, and key populations. We included studies where (1) the intervention was created or implemented on social media platforms, (2) study population included men who have sex with men (MSM), transgender individuals, people who inject drugs (PWID), and/or sex workers, and (3) outcomes included promoting HIV testing, linkage, adherence, and/or retention. Meta-analyses were conducted by Review Manager, version 5.3. Pooled relative risk (RR) and 95% confidence intervals were calculated by random-effects models. Results Among 981 manuscripts identified, 26 studies met the inclusion criteria. We found 18 studies from high-income countries, 8 in middle-income countries, and 0 in low-income countries. Eight were randomized controlled trials, and 18 were observational studies. All studies (n=26) included MSM; five studies also included transgender individuals. The focus of 21 studies was HIV testing, four on HIV testing and linkage to care, and one on antiretroviral therapy adherence. Social media interventions were used to do the following: build online interactive communities to encourage HIV testing/adherence (10 studies), provide HIV testing services (9 studies), disseminate HIV information (9 studies), and develop
Kaufman, Z A; Spencer, T S; Ross, D A
Interest in sport as a tool for behavioral HIV prevention has grown substantially in the past decade. With dozens of organisations now using sport-based HIV prevention (SBHP) approaches and upcoming randomized controlled trials in South Africa and Zimbabwe, there is a pressing need to synthesize previous evaluation findings and identify gaps in existing research. A systematic review on the effectiveness of SBHP interventions was carried out, identifying both published and unpublished studies on SBHP interventions that measured effectiveness quantitatively. Study quality was scored using an adapted Newcastle-Ottawa Scale. Random-effects meta-analyses were carried out across studies for effects on six categories of HIV-related outcomes. The review identified 952 publications, 21 of which met inclusion criteria. No randomised controlled trials on SBHP interventions and no studies assessing biological outcomes were identified. Mean study quality score was 5.1 (SD 3.1) out of 20 points. Overall strong evidence was observed for positive effects on HIV-related knowledge (RR = 1.26, 95 % CI = 1.15-1.37), stigma (RR = 1.13, 95 % CI = 1.02-1.24), self-efficacy (RR = 1.22, 95 % CI = 1.02-1.41), reported communication (RR = 1.24, 95 % CI = 1.06-1.41), and reported recent condom use (RR = 1.29, 95 % CI = 1.00-1.59). Generally, the review found encouraging evidence for some short-term effects but relied predominantly on low-quality studies. More rigorous research on SBHP is needed to objectively assess effectiveness. Randomised controlled trials could play an important role in guiding policies, strategies, and funding related to SBHP.
Cintrón-Bou, Francheska; Varas-Díaz, Nelson; Marzán-Rodríguez, Melissa; Neilands, Torsten B
HIV-related stigma exists. People with HIV/AIDS have their rights violated and mental/ physical wellbeing hindered. Health professionals (HP) are a primary source of support, however these can also be sources of stigma. Therefore, it is useful to train HP on the consequences of social stigma. We implemented an intervention to reduce stigma related towards HIV/AIDS with 507 medical students. It proved to be an efficacious intervention with reduction in the levels of stigma in our intervention group and significant differences with the control group (p stigma associated with HIV / AIDS is relevant to community psychology because we collaborate in changing attitudes that can adversely affect the prevention of new infection, adherence to antiretroviral treatment and quality of life.
Pérez, Ashley; Santamaria, E Karina; Operario, Don
Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.
Parsons, Jeffrey T; Rendina, H Jonathon; Moody, Raymond L; Gurung, Sitaji; Starks, Tyrel J; Pachankis, John E
Gay and bisexual men (GBM) report high rates of sexual compulsivity (SC), yet no empirically based treatments exist. An intervention based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders was pilot tested in a sample of 13 HIV-positive GBM with SC. Participants completed a baseline interview, and were offered up to ten intervention sessions. Of those, 11 completed a 3-month follow-up assessment. Despite problems with session attendance (only 4 men completed all 10 sessions), improvements were observed in all psychological outcomes, including SC, depression, and anxiety. Decreases were observed in drug use and HIV risk. The Unified Protocol may be useful in improving the health of HIV-positive GBM, however challenges with session attendance must be addressed. Future work should consider if fewer sessions produce similar results, whether barriers to attending all sessions could be alleviated, and how the intervention would perform compared to treatments.
Claborn, Kasey R; Meier, Ellen; Miller, Mary Beth; Leavens, Eleanor L; Brett, Emma I; Leffingwell, Thad
Disease management remains a challenge for many people living with HIV (PLWH). Digital health interventions (DHIs) may assist with overcoming these challenges and reducing burdens on clinical staff; however, there is limited data regarding methods to improve uptake and acceptability of DHIs among PLWH. This qualitative study aimed to assess patient and provider perspectives on the use of DHIs and strategies to promote uptake among PLWH. Eight focus groups with patients (k = 5 groups; n = 24) and providers (k = 3 groups; n = 12) were conducted May through October of 2014. Focus groups (~90 min) followed a semi-structured interview guide. Data were analyzed using thematic analysis on three main themes: (a) perspectives towards the adoption and use of DHIs for HIV management; (b) perceptions of barriers and facilitators to patient usage; and (c) preferences regarding content, structure, and delivery. Analyses highlighted barriers and facilitators to DHI adoption. Patients and providers agreed that DHIs feel "impersonal" and "lack empathy," may be more effective for certain subpopulations, should be administered in the clinic setting, and should use multimodal delivery methods. Emergent themes among the providers included development of DHIs for providers as the target market and the need for culturally adapted DHIs for patient subpopulations. DHIs have potential to improve HIV management and health outcomes. DHIs should be developed in conjunction with anticipated consumers, including patients, providers, and other key stakeholders. DHIs tailored for specific HIV subpopulations are needed. Future studies should evaluate dissemination methods and marketing strategies to promote uptake.
O'Leary, Ann; Jemmott, John B; Jemmott, Loretta S; Bellamy, Scarlett; Icard, Larry D; Ngwane, Zolani
"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.
Bhatta, Dharma Nand; Liabsuetrakul, Tippawan
Prevention and antiretroviral therapy (ART) management for human immunodeficiency virus (HIV) infected people need to have long-term health care. An empowerment focused intervention is a procedure by which HIV infected people obtain combined possession of programs to attain mainly cost-effective HIV outcomes and deal with social and structural difficulties related to their universal health access and human rights. Empowerment is a key approach for addressing HIV related issues that focuses on addressing a broader context. However, the practices of empowerment based approaches are sparse. We assessed the effect of an intervention to empower HIV infected people receiving ART. In this open-label randomized controlled trial, HIV infected people from Nepal who were using ART from 6 to 24 months and were aged 18 years and above were randomly assigned to receive either the intervention or routine care. The intervention was led by two counselors for a period lasting six weeks. Participants were followed up at three and six months after the baseline. The primary outcome was change in empowerment scores, analyzed by using Difference-in-Difference (DiD). Between September and November 2014, 1447 HIV infected people were screened, of whom 132 were randomly assigned to the intervention (n = 66) or control (n = 66) group. All the participants completed the 3- and 6- months follow up. A significant difference in mean empowerment score was found between the groups at 3- (46.77, p-value HIV infected people during ART increased their empowerment. This intervention can be expanded to be utilized in routine services. Thai Clinical Trials Registry, number TCTR20140814002 .
van der Heijden, Ingrid; Abrahams, Naeemah; Sinclair, David
Background Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. Objectives To examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS. Search methods We searched the following electronic databases up to 14 March 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) published in the Cochrane Library (Issue 2, 2016), PubMed (MEDLINE) (1996 to 14 March 2016), Embase (1996 to 14 March 2016), and Clinical Trials.gov. Selection criteria Randomized controlled trials (RCTs) or quasi-RCTs that compared psychosocial group interventions with versus control (standard care or brief educational interventions), with at least three months follow-up post-intervention. We included trials that reported measures of depression, anxiety, stress, or coping using standardized scales. Data collection and analysis Two review authors independently screened abstracts, applied the inclusion criteria, and extracted data. We compared continuous outcomes using mean differences (MD) with 95% confidence intervals (95% CIs), and pooled data using a random-effects model. When the included trials used different measurement scales, we pooled data using standardized mean difference (SMD) values. We reported trials that we could not include in the meta analysis narratively in the text. We assessed the certainty of the evidence using the GRADE approach. Main results We included 16 trials (19 articles) that enrolled 2520 adults living with HIV. All the interventions were multifaceted and included a mix of psychotherapy, relaxation, group support, and education. The included trials were conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial
Paiva, V.; Garcia, J.; Rios, L.F.; Santos, A.O.; Terto, V.; Munõz-Laboy, M.
Religious communities have been a challenge to HIV prevention globally. Focusing on the acceptability component of the right to health, this intervention study examined how local Catholic, Evangelical and Afro-Brazilian religious communities can collaborate to foster young people’s sexual health and ensure their access to comprehensive HIV prevention in their communities in Brazil. This article describes the process of a three-stage sexual health promotion and HIV prevention initiative that used a multicultural human rights approach to intervention. Methods included 27 in-depth interviews with religious authorities on sexuality, AIDS prevention and human rights, and training 18 young people as research-agents, who surveyed 177 youth on the same issues using self-administered questionnaires. The results, analysed using a rights-based perspective on health and the vulnerability framework, were discussed in daylong interfaith workshops. Emblematic of the collaborative process, workshops are the focus of the analysis. Our findings suggest that this human rights framework is effective in increasing inter-religious tolerance and in providing a collective understanding of the sexuality and prevention needs of youth from different religious communities, and also serves as a platform for the expansion of state AIDS programmes based on laical principles. PMID:20373192
Naranbhai, Vivek; Abdool Karim, Quarraisha; Meyer-Weitz, Anna
Homeless youth are at high risk for HIV infection as a consequence of risky sexual behaviour. Interventions for homeless youth are challenging. Assessment of the effectiveness of interventions to modify sexual risk behaviours for preventing HIV in homeless youth is needed. To evaluate and summarize the effectiveness of interventions for modifying sexual risk behaviours and preventing transmission of HIV among homeless youth. We searched electronic databases (CENTRAL, MEDLINE, EMBASE, AIDSearch, Gateway, PsycInfo, LILACS), reference lists of eligible articles, international health agency publication lists, and clinical trial registries. The search was updated January 2010. We contacted authors of published reports and other key role players. Randomised studies of interventions to modify sexual risk behaviour (biological, self-reporting of sexual-risk behaviour or health-seeking behaviour) in homeless youth (12-24 years). Data from eligible studies were extracted by two reviewers. We assessed risk of bias per the Cochrane Collaborations tool. None of the eligible studies reported any primary biological outcomes for this review. Reports of self-reporting sexual risk behaviour outcomes varied across studies precluding calculation of summary measures of effect; we present the outcomes descriptively for each study. We contacted authors for missing or ambiguous data. We identified three eligible studies after screening a total of 255 unique records. All three were performed in the United States of America and recruited substance-abusing male and female adolescents (total N=615) through homeless shelters into randomised controlled trials of independent and non-overlapping behavioural interventions. The three trials differed in theoretical background, delivery method, dosage (number of sessions,) content and outcome assessments. Overall, the variability in delivery and outcomes precluded estimation of summary of effect measures. We assessed the risk of bias to be high for
Anderson, Sarah-Jane; Ghys, Peter D; Ombam, Regina; Hallett, Timothy B
A strategic approach to the application of HIV prevention interventions is a core component of the UNAIDS Fast Track strategy to end the HIV epidemic by 2030. Central to these plans is a focus on high-prevalence geographies, in a bid to target resources to those in greatest need and maximize the reduction in new infections. Whilst this idea of geographical prioritization has the potential to improve efficiency, it is unclear how it should be implemented in practice. There are a range of prevention interventions which can be applied differentially across risk groups and locations, making allocation decisions complex. Here, we use mathematical modelling to compare the impact (infections averted) of a number of different approaches to the implementation of geographical prioritization of prevention interventions, similar to those emerging in policy and practice, across a range of prevention budgets. We use geographically specific mathematical models of the epidemic and response in 48 counties and major cities of Kenya to project the impact of the different geographical prioritization approaches. We compare the geographical allocation strategies with a nationally uniform approach under which the same interventions must be applied across all modelled locations. We find that the most extreme geographical prioritization strategy, which focuses resources exclusively to high-prevalence locations, may substantially restrict impact (41% fewer infections averted) compared to a nationally uniform approach, as opportunities for highly effective interventions for high-risk populations in lower-prevalence areas are missed. Other geographical allocation approaches, which intensify efforts in higher-prevalence areas whilst maintaining a minimum package of cost-effective interventions everywhere, consistently improve impact at all budget levels. Such strategies balance the need for greater investment in locations with the largest epidemics whilst ensuring higher-risk groups in lower
Harper, Gary W; Lemos, Diana; Hosek, Sybil G
This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma-personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV-as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women.
Medley, Amy; Bachanas, Pamela; Grillo, Michael; Hasen, Nina; Amanyeiwe, Ugochukwu
Introduction This review assesses the impact of prevention interventions for people living with HIV on HIV-related mortality, morbidity, retention in care, quality of life, and prevention of ongoing HIV transmission in resource-limited settings (RLSs). Methods We conducted a systematic review of studies reporting the results of prevention interventions for people living with HIV in RLS published between January 2000 and August 2014. Standardized methods of searching and data abstraction were used. Results Ninety-two studies met the eligibility criteria: 24 articles related to adherence counseling and support, 13 on risk reduction education and condom provision, 19 on partner HIV testing and counseling, 14 on provision of family planning services, and 22 on assessment and treatment of other sexually transmitted infections. Findings indicate good evidence that adherence counseling and sexually transmitted infection treatment can have a high impact on morbidity, whereas risk reduction education, partner HIV testing and counseling, and family planning counseling can prevent transmission of HIV. More limited evidence was found to support the impact of these interventions on retention in care and quality of life. Most studies did not report cost information, making it difficult to draw conclusions about the cost-effectiveness of these interventions. Conclusions This evidence suggests that these prevention interventions, if brought to sufficient scale and coverage, can help support and optimize the impact of core treatment and prevention interventions in RLS. Further operational research with more rigorous study designs, and ideally with biomarkers and costing information, is needed to determine the best model for providing these interventions in RLS. PMID:25768868
Chander, Geetanjali; Stanton, Cassandra; Hutton, Heidi E; Abrams, David B; Pearson, Jennifer; Knowlton, Amy; Latkin, Carl; Holtgrave, David; Moore, Richard D; Niaura, Raymond
Smoking is highly prevalent among persons living with HIV/AIDS (PLWHA) and associated with adverse outcomes including malignancy and cardiovascular disease. Information and communication technology (ICT) may be effective in disseminating cessation interventions among PLWHA. This study examines the prevalence of ICT use among 492 PLWHA attending an urban clinic and characteristics associated with ICT use. Participants completed a survey of demographics, smoking status, and ICT use. Factors associated with ICT use were examined with logistic regression. Overall, 63% of participants smoked with 73% of smokers owning their own cell phone. Use of other modalities was lower, with 48% of smokers reporting any internet use, 39% text messaging, and 31% using email. Higher education was associated with the use of all modalities. Cell phone interventions may have the broadest reach among PLWHA, though with almost half using the internet, this may also be a low-cost means of delivering cessation interventions.
Gollub, Erica L; Morrow, Kathleen M; Mayer, Kenneth H; Koblin, Beryl A; Peterside, Pamela Brown; Husnik, Marla J; Metzger, David S
New intervention models are needed for HIV prevention among drug-using women. The Women Fighting Infection Together (Women FIT) feasibility study enrolled 189 women in three U.S. cities (Providence, New York, Philadelphia) with drug-using histories, who also reported risky sexual behavior. Eligible women had participated previously in a yearlong study of HIV Counseling and Testing (HIV-CT) and limited case management. Two thirds of the sample were black, most were unemployed, and about two thirds reported prior or current crack use. Women were randomized into two groups. In one group, women participated in a manualized, four-session, peer-led, interactive group intervention that stressed body knowledge, woman-initiated HIV/sexually transmitted infection (HIV/STI) prevention, including a focus on women's health (reproductive health screening, sexual violence, self-breast examination, STI signs, symptoms), which aimed to increase comfort with and pride in their bodies. Control group women received HIV-CT enriched by female condom counseling. Outcomes included study retention, session attendance and ratings, changes in knowledge, and use of protection methods. The study successfully retained 95% of the participants for a 2-month follow-up. Positive assessments from participants and peer leaders exceeded preset thresholds for success. Pre-post changes in body knowledge (p empowerment model deserves further elaboration in interventions focusing on women at high risk of HIV/STI acquisition.
Bogale, Gebeyehu W.; Boer, Henk; Seydel, Erwin R.
In Ethiopia the level of illiteracy in rural areas is very high. In this study, we investigated the effects of an audio HIV/AIDS prevention intervention targeted at rural illiterate females. In the intervention we used social-oriented presentation formats, such as discussion between similar females and role-play. In a pretest and posttest…
Medley, Amy; Kennedy, Caitlin; O'Reilly, Kevin; Sweat, Michael
Peer education for HIV prevention has been widely implemented in developing countries, yet the effectiveness of this intervention has not been systematically evaluated. We conducted a systematic review and meta-analysis of peer education interventions in developing countries published between January 1990 and November 2006. Standardized methods of…
Gardner, Lytt I.; Marks, Gary; Craw, Jason A.; Wilson, Tracey E.; Drainoni, Mari-Lynn; Moore, Richard D.; Mugavero, Michael J.; Rodriguez, Allan E.; Bradley-Springer, Lucy A.; Holman, Susan; Keruly, Jeanne C.; Sullivan, Meg; Skolnik, Paul R.; Malitz, Faye; Metsch, Lisa R.; Raper, James L.; Giordano, Thomas P.
Background. Retention in care for human immunodeficiency virus (HIV)–infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project. Methods. Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10 018 patients in 2008–2009 (preintervention period) and 11 039 patients in 2009–2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation methods. Results. Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0% for keeping 2 consecutive visits and 3.0% for the mean proportion of all visits kept (P < .0001). Larger relative improvement for both outcomes was observed for new or reengaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or reengaging patients was consistent across the 6 clinics, and less consistent across clinics for active patients. Conclusion. Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated
Full Text Available BACKGROUND. “Project Protect” aims to find highly infectious individuals through screening for acute/recent infection cases and prevent HIV transmission in the risk networks of these cases through contact tracing of these networks` participants, distributing community alerts about risk of acute infection among them and accurate post-test counseling.METHODS. An ongoing pilot phase of the intervention began in Kriviy Rig and Lviv, Ukraine in November, 2011. Participants are recruited through: 1 screening for cases of acute/recent infection at voluntary counseling and testing (VCT sites and in partner organizations (including AIDS-Centers which conduct VCT; 2 visits to drug use venues, chain-referral and contact tracing. Genscreen ultra HIV Ag-Ab “special-tests” are used to detect cases of acute infection. Recent infection is defined as positive test result and preceding negative result within 6 months and/or age younger than 21 years old.RESULTS. In the two cities 173 respondents were recruited to the project, 118 special tests were done. No cases of acute infection and eleven cases of recent infection were found (8 injection drug users (IDUs with preceding negative result within 6 months, 2 IDUs younger than 21 recruited by project team; one non-IDU with preceding negative result within 6 months referred from AIDS-Center. Six recent cases were recruited through screening at VCT sites, 5 others through contact tracing. Psychologists conducted 41 interviews with recent infection cases and their risk networks` members; 176 community alert flyers were distributed to members of risk networks during the interview by psychologist, at the venue by social worker and by participants themselves; 3 drug use venues were visited by project team with concomitant HIV-testing of people present at the venue. CONCLUSIONS. Network tracing seems to be feasible and to help find recently infected people. Further research is needed to tell whether this
Webel, Allison R; Moore, Shirley M; Hanson, Jan E; Patel, Sanjay R; Schmotzer, Brian; Salata, Robert A
The aim of this study was to test the feasibility of a novel, evidence-based intervention SystemCHANGE-HIV on sleep outcomes. Insomnia and sleep disturbances affect an estimated 74% of people living with HIV (PLWH) and is a distressing consequence of HIV disease. We conducted a two-group randomized control study with 40 PLWH. Outcomes included change in: sleep duration, sleep fragmentation index, sleep efficiency, and self-reported sleep quality. Participants rated the intervention as highly feasible. The intervention group experienced a 10minute/night increase in sleep time, a 2.3%-point increase in sleep efficiency, a 2.0%-point decrease in sleep fragmentation, relative to the control group, based on the model estimates of the treatment effect. A behavioral change intervention focusing on sleep is feasible in PLWH. The intervention group had improved sleep compared to the control group. Future work should test the efficacy of a refined SystemCHANGE-HIV on sleep. Copyright © 2013 Elsevier Inc. All rights reserved.
Manuel, Jennifer K.; Paula, J. Lum; Hengl, Nicholas S.; Sorensen, James L.
Smoking among people living with HIV, particularly women living with HIV, is associated with higher morbidity and mortality rates when compared to non-smoking individuals with HIV. Despite patients’ higher risk of adverse health outcomes, in particular preventable smoking-related diseases for smokers living with HIV, few smoking cessation interventions have been examined with this population. The aim of the current study was to test the potential efficacy of a brief motivational intervention for smoking cessation with HIV infected women smokers. Participants (N = 30) were randomly assigned to receive a single session of Motivational Interviewing or Prescribed Advice. The primary outcome was 7-day point prevalence abstinence at the one-month follow-up interview. Secondary outcome measures included mean cigarettes smoked per day, desire to quit smoking, perceived difficulty in quitting smoking, and expectation of success. We detected no significant differences between intervention and control groups in self-reported 7-day point prevalence abstinence at the one-month follow-up. However, participants in the MI condition reported a significant decrease in the mean cigarettes smoked per day when compared to the Prescribed Advice condition. There were no significant between-group differences in participants’ desire to quit, perceived difficulty and expectation of success. The results of this pilot study indicate that MI may be an effective smoking cessation intervention for HIV positive women smokers and should be studied further in a larger clinical trial. PMID:23116051
Full Text Available Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38. A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm
Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction-which removes judgment and operates at the patient's stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen's Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction interventions from
Thapa, Subash; Hannes, Karin; Cargo, Margaret; Buve, Anne; Aro, Arja R; Mathei, Catharina
A scoping review of grey and peer-reviewed literature was conducted to develop a conceptual framework to illustrate mechanisms involved in reducing HIV stigma and increasing HIV test uptake. We followed a three-step approach to exploring the literature: developing concepts, organizing and categorizing concepts, and synthesizing concepts into a framework. The framework contains four types of intervention strategies: awareness creation, influencing normative behavior, providing support, and developing regulatory laws. The awareness creation strategy generally improves knowledge and the influencing normative behavior strategy changes stigmatizing attitudes and behaviors, and subsequently, increases HIV test uptake. Providing support and development of regulatory law strategies changes actual stigmatizing behaviors of the people, and subsequently, increases HIV test uptake. The framework further outlines that the mechanisms described are influenced by the interaction of various social-contextual and individual factors. The framework sheds new light on the effects of HIV stigma-reduction intervention strategies and HIV test uptake. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Balogun Joseph A
below the age of 20 years perceived themselves as not having any chance of being infected with HIV. Predictors of moderate/good perception of HIV risk were drug and alcohol use, inconsistent condom use, and multiple partnerships. Conclusion Students in the study sample engaged in various HIV risk behaviors but have a poor appreciation of their risk of HIV infection. While low rates of condom use was a problem among older students (30 years and older, multiple partnerships were more common among younger students, and marijuana and alcohol use were related to low condom use among females. Our findings support the need for targeted HIV prevention interventions on college campuses.
Parriault, Marie-Claire; van Melle, Astrid; Basurko, Célia; Gaubert-Marechal, Emilie; Macena, Raimunda Hermelinda Maia; Rogier, Stéphanie; Kerr, Ligia Regina Franco Sansigolo; Nacher, Mathieu
The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. One third (31.5%) of the interviewed had never tested for HIV. Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, to be 30 or older, feeling at risk of HIV, not evaluating one's own risk towards HIV, and living in Oiapoque. These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.
Full Text Available The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. One third (31.5% of the interviewed had never tested for HIV. Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, to be 30 or older, feeling at risk of HIV, not evaluating one's own risk towards HIV, and living in Oiapoque. These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.
Vance, David E; Gakumo, C Ann; Childs, Gwendolyn D; Enah, Comfort; Fazeli, Pariya L
Nearly 50% of adult persons living with HIV (PLWH) experience HIV-associated neurocognitive disorder (HAND), which is associated with deteriorating brain health and cognitive functioning. Multimodal interventions that simultaneously improve physical activity, nutrition, and sleep hygiene may be of value for adult PLWH, especially as they age and become vulnerable to HAND. We used four focus groups of PLWH (N = 30; ages ≥ 50 years) to solicit feedback about Cognitive Prescriptions, a multimodal cognitive intervention. Lifestyle and health behaviors pertaining to Cognitive Prescriptions were assessed, including: (a) physical activity, (b) mental activity, (c) nutrition, (d) social engagement, (e) emotional health, (f) sleep hygiene, and (g) substance use. When presented a template of the intervention, participants expressed favorable opinions and remarked they would want to work with a clinician, paraprofessional, or peer to implement such a program into their own daily routines. From this, implications for practice and research are provided. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
de Boer, Rebecca; Lutscher, Frithjof
Even though medical intervention measures against HIV transmission are available, the epidemic continues to spread in several sub-Saharan African countries. Empirical studies indicate that many people are unable to implement prevention strategies because of individual factors, such as extreme poverty or lack of education, but also because or relational factors, such as gender-based violence or transactional sex. This phenomenon, known as choice disability, may be such a large obstacle in the effectiveness of medical interventions that several field trials of structural (non-medical) interventions are underway that address these issues. While dynamical-systems models are frequently used to advise management and policy around infectious diseases, they typically assume that individuals are free to make optimal choices. We derive and analyze a novel model where individuals have a certain choice status, based on which they are more or less likely to transmit or receive the infection. Choice status is affected by social interactions. When studying the model in the absence of an infectious disease, we find that structural interventions aimed at raising the status of one group can have the unintended side effect of lowering the status of another group. When combined with an epidemic model, we find that the same structural interventions can even increase the total prevalence of a disease in the population. Our model provides a framework to evaluate the possible effectiveness of structural intervention in an epidemic. Copyright © 2018 Elsevier Inc. All rights reserved.
Kelly V Ruggles
Full Text Available To inform the design of a combination intervention strategy targeting HIV-infected unhealthy alcohol users in Maharashtra, India, that could be tested in future randomized control trials.Using probabilistic compartmental simulation modeling we compared intervention strategies targeting HIV-infected unhealthy alcohol users on antiretroviral therapy (ART in Maharashtra, India. We tested interventions targeting four behaviors (unhealthy alcohol consumption, risky sexual behavior, depression and antiretroviral adherence, in three formats (individual, group based, community and two durations (shorter versus longer. A total of 5,386 possible intervention combinations were tested across the population for a 20-year time horizon and intervention bundles were narrowed down based on incremental cost-effectiveness analysis using a two-step probabilistic uncertainty analysis approach.Taking into account uncertainty in transmission variables and intervention cost and effectiveness values, we were able to reduce the number of possible intervention combinations to be used in a randomized control trial from over 5,000 to less than 5. The most robust intervention bundle identified was a combination of three interventions: long individual alcohol counseling; weekly Short Message Service (SMS adherence counseling; and brief sex risk group counseling.In addition to guiding policy design, simulation modeling of HIV transmission can be used as a preparatory step to trial design, offering a method for intervention pre-selection at a reduced cost.
Ruggles, Kelly V; Patel, Anik R; Schensul, Stephen; Schensul, Jean; Nucifora, Kimberly; Zhou, Qinlian; Bryant, Kendall; Braithwaite, R Scott
To inform the design of a combination intervention strategy targeting HIV-infected unhealthy alcohol users in Maharashtra, India, that could be tested in future randomized control trials. Using probabilistic compartmental simulation modeling we compared intervention strategies targeting HIV-infected unhealthy alcohol users on antiretroviral therapy (ART) in Maharashtra, India. We tested interventions targeting four behaviors (unhealthy alcohol consumption, risky sexual behavior, depression and antiretroviral adherence), in three formats (individual, group based, community) and two durations (shorter versus longer). A total of 5,386 possible intervention combinations were tested across the population for a 20-year time horizon and intervention bundles were narrowed down based on incremental cost-effectiveness analysis using a two-step probabilistic uncertainty analysis approach. Taking into account uncertainty in transmission variables and intervention cost and effectiveness values, we were able to reduce the number of possible intervention combinations to be used in a randomized control trial from over 5,000 to less than 5. The most robust intervention bundle identified was a combination of three interventions: long individual alcohol counseling; weekly Short Message Service (SMS) adherence counseling; and brief sex risk group counseling. In addition to guiding policy design, simulation modeling of HIV transmission can be used as a preparatory step to trial design, offering a method for intervention pre-selection at a reduced cost.
Cianelli, R; Lara, L; Villegas, N; Bernales, M; Ferrer, L; Kaelber, L; Peragallo, N
Worldwide, and in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low-income Chilean women. Depressed people are less willing to participate in behaviours that protect them against HIV. The aim of this study is to analyze the impact of Mano a Mano-Mujer (MM-M), and HIV prevention intervention, on depressive symptoms among Chilean women. A quasi-experimental design was used for this study. The research was conducted in Santiago, Chile; a total of 400 women participated in the study (intervention group, n=182; control group, n=218). The intervention was guided by the social-cognitive model and the primary health care model. The intervention consists of six 2-h sessions delivered in small groups. Sessions covered: HIV prevention, depression, partner's communication, and substance abuse. Face-to-face interviews were conducted at baseline and at 3-month follow-up. Chilean women who participated in MM-M significantly decreased, at 3 months follow up, their reported depressive symptoms. MM-M provided significant benefits for women's depression symptoms. In this study nurses participated as leaders for the screening of depressive symptoms and as facilitators of community interventions. © 2012 Blackwell Publishing.
Dale, Sannisha K; Grimes, Tiffany; Miller, Lauren; Ursillo, Alyssa; Drainoni, Mari-Lynn
A qualitative study among women living with HIV assessed the aspects of an evidence-based intervention targeting HIV transmission risk reduction (Women Involved in Life Learning from Other Women [WiLLOW]) that women valued and how their lives were impacted. Thirty-one women (80.6% African American) completed interviews. Women valued the personal stories and positive group dynamics (i.e. safety, trust, openness, getting feedback, bonding, and socializing). As a result of WiLLOW, women embraced a strong woman image, joined groups, changed behaviors, accepted their HIV status, became optimistic, and spoke up/advocated in their relationships and communities. Interventions for HIV-positive women may benefit from incorporating the sharing of stories in their curricula and factors that build positive group dynamics.
Cody, Shameka L; Vance, David E
The medications used to treat HIV have reduced the severity of cognitive deficits; yet, nearly half of adults with HIV still exhibit some degree of cognitive deficits, referred to as HIV-associated neurocognitive disorder or HAND. These cognitive deficits interfere with everyday functioning such as emotional regulation, medication adherence, instrumental activities of daily living, and even driving a vehicle. As adults are expected to live a normal lifespan, the process of aging in this clinical population may exacerbate such cognitive deficits. Therefore, it is important to understand the neurobiological mechanisms of HIV on cognitive reserve and develop interventions that are either neuroprotective or compensate for such cognitive deficits. Within the context of cognitive reserve, this article delivers a state of the science perspective on the causes of HAND and provides possible interventions for addressing such cognitive deficits. Suggestions for future research are also provided. Published by Elsevier Inc.
Ambia, Julie; Mandala, Justin
The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I(2)=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I(2)=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I(2)=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake
Lemos, Diana; Hosek, Sybil G.
Abstract This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma—personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV—as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women. PMID:25216106
Schneider, J A; Dude, A; Dinaker, M; Kumar, V; Laumann, E O; Holloway-Beth, A; Oruganti, G; Saluja, G S; Chundi, V; Yeldandi, V; Mayer, K H
The relationships between hygiene, sexual behaviour and HIV infection are poorly understood. We examine these relationships in Indian truck drivers, a group at high risk for HIV infection. Truck drivers (n = 189) were recruited into an integrated HIV and hygiene Information Motivation (IM) programme. Sociodemographic characteristics, sexual and hygiene behaviour and HIV prevalence were determined. Multivariate logistic regression and linear generalized estimating equation models were utilized. At baseline, 2.1% of drivers were HIV infected and 34% who reported having contact with female sex workers (FSWs) had contact within the previous six months. Those who washed their hands postdefecation were less likely to report genital symptoms (OR 0.02; P = 0.01) and have sex with an FSW (OR [odds ratio] 0.21; P = 0.05). After an IM intervention, there were no changes in sexual risk-taking behaviour (coefficient -0.15 to -0.02; P = 0.13-0.75); however, hygiene behaviour improved from baseline (coefficient 0.09-0.31; P hygiene habits, like handwashing, seem to be a modifiable behaviour after a modest intervention, whereas HIV risk-taking behaviour was not. The association between hygiene and HIV risk-taking suggests the need for further evaluation of the relationship and that of other hygiene practices in high-risk men in India.
Henry Akintobi, Tabia; Trotter, Jennie; Zellner, Tiffany; Lenoir, Shelia; Evans, Donoria; Rollins, Latrice; Miller, Assia
African Americans comprise nearly half of people in the United States living with the human immunodeficiency virus (HIV) but compose one tenth of the population. Infection rate among young African American adults is 11 times that of Whites. The Color It Real Program was a seven-session, weekly administered, age-specific, and culturally tailored intervention designed to provide HIV education and address behavioral motivations (risk awareness, decisional balance exercises, partner negotiation, and attitudes) associated with HIV risk among African Americans ages 18 to 24 years in Atlanta, Georgia. Effectiveness was assessed through a quasi-experimental study design that consisted of intervention (n = 88) and control (n = 52) groups completing a 45-item survey. When controlling for gender and education, repeated measures analysis of variance revealed that the intervention group had significant increases in HIV transmission knowledge (F = 4.84, p = .0305), condom use, and intentions to use condoms (F = 4.38, p = .0385). Risky sexual behavior means did not significantly differ between groups (F = 1.44, p = .2331). Results indicate the value of culturally tailored educational strategies toward improved HIV knowledge and adoption of risk reduction strategies. Future studies investigating the differential impact of programs by gender and sexual orientation are also critical. Continued innovation and tailoring of risk reduction strategies for minority young adults will contribute to reducing HIV incidence and prevalence over the life course. © 2016 Society for Public Health Education.
Knudsen, Hannah K; Staton-Tindall, Michele; Oser, Carrie B; Havens, Jennifer R; Leukefeld, Carl G
Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven "thinking myths" about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.
Mkwanazi, Ntombizodumo B; Rochat, Tamsen J; Bland, Ruth M
The World Health Organization recommends disclosure of parental HIV to children aged 6-12 years. The maternal HIV-disclosure intervention (Amagugu), a lay counsellor-led, home-based intervention with six sessions, was implemented. The intervention included provision of disclosure tools, training and support for mothers, a family session and health promotion clinic visit for mothers and children. Amagugu demonstrated success as a maternal disclosure support programme but less is known about the experiences of participants. A sub-sample of HIV-infected mothers (n = 20) with primary school-aged HIV-uninfected children, from Amagugu, was purposely selected. Using semi-structured interviews and interview-guide, we explored maternal perceptions of disclosure prior to participation and experiences of participating in Amagugu. Audio-recorded interviews conducted in participants' homes, in isiZulu, were transcribed, and content analysis was undertaken. The most common reasons for prior non-disclosure were concerns about children's developmental capacity to understand HIV, fear of HIV-related stigma towards mothers and their families, and lack of skills to undertake disclosure. Intervention materials, rapport with counsellors, and flexibility of the proposed disclosure process motivated mothers to participate. While expressing satisfaction with the intervention, some mothers remained concerned about their children's understanding of HIV and ability to maintain confidentiality. Mothers also requested support in discussing sex-related topics with their children. Despite prior high rates of disclosure to other adults, mothers had little awareness about the importance of disclosure to children and lacked skills to undertake this. The intervention approach, rapport with counsellors, and practicality of the materials, helped overcome child disclosure barriers. Mothers reported their children as very supportive following disclosure and stated they would advise other women to
Martin, C Andrew; Upvall, Michele J
We present the findings of a qualitative pilot study designed to describe the experience of HIV medication adherence using a mobile phone application. Nine semi-structured focus group discussions were conducted over a 3-month period at an AIDS Services Organization in Central Texas. The data were analyzed following the principles of thematic analysis. During analysis, four themes were identified, and relations between these themes were delineated to reflect the experiences of the 23 participants. The mobile phone application, Care4Today™ Mobile Health Manager, was the intervention tool. Collection of focus group discussion outcomes over a 3-month period with baseline versus end-of-study data determined the feasibility and acceptability of this medication adherence intervention. The findings suggest that when individuals are offered the necessary resources, such as a mobile phone medication reminder application, they may have greater success in performing the behavior. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Maiorana, Andre; Koester, Kimberly A; Myers, Janet J; Lloyd, Karen C; Shade, Starley B; Dawson-Rose, Carol; Morin, Stephen F
Disclosure of HIV serostatus by HIV-infected individuals is considered a prevention strategy, under the assumption that disclosure will prompt risk reduction practices among sex partners. We examined patients' self-reports regarding disclosure messages they found relevant as part of prevention with positives (PwP) interventions in clinical settings. We conducted 52 in-depth interviews with patients participating in 13 PwP interventions. We found that the opportunity to reflect about living with HIV, explore fears of stigma and rejection, develop communication skills and strategies to disclose, and explore a sense of responsibility influenced patients' intention to disclose and their disclosure practices. PwP interventions need to include a combination of messages about disclosure strategies, stigma, and communication, as well as helping patients frame disclosure as a process that includes situations and interactions to consider post-disclosure. PwP disclosure counseling can help influence a shift in patients' risk towards safer sex practices.
Full Text Available Behailu Merdekios1, Adebola A Adedimeji2 1College of Medicine and Health Sciences, Arba Minch University, Ethiopia; 2Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, New York, USA Background: In Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT of human immunodeficiency virus (HIV is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women. Methods: A multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained. Results: Of the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1% had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001 and voluntary counseling and testing for pregnant women (P < 0.05. Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination. Conclusion: In the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels. Keywords: human immunodeficiency virus, mother-to-child transmission, pregnant women, Ethiopia
Vidrine, Damon J.; Kypriotakis, George; Li, Liang; Arduino, Roberto C.; Fletcher, Faith E.; Tamí-Maury, Irene; Gritz, Ellen R.
Background Cigarette smoking among persons living with HIV (PLWH) is a pressing public health concern, and efforts to evaluate cessation treatments are needed. The purpose of the present study was to assess potential mechanisms of a cell phone-delivered intervention for HIV-positive smokers. Methods Data from 350 PLWH enrolled in a randomized smoking cessation treatment trial were utilized. Participants were randomized to either usual care (UC) or a cell phone intervention (CPI) group. The independent variable of interest was treatment group membership, while the dependent variable of interest was smoking abstinence at a 3-month follow-up. The hypothesized treatment mechanisms were depression, anxiety, social support, quit motivation and self-efficacy change scores. Results Abstinence rates in the UC and CPI groups were 4.7% (8 of 172) and 15.7% (28 of 178), respectively. The CPI group (vs. UC) experienced a larger decline in depression between baseline and the 3-month follow-up, and a decline in anxiety. Self-efficacy increased for the CPI group and declined for the UC group. Quit motivation and social support change scores did not differ by treatment group. Only self-efficacy met the predefined criteria for mediation. The effect of the cell phone intervention on smoking abstinence through change in self-efficacy was statistically significant (p<.001) and accounted for 17% of the total effect of the intervention on abstinence. Conclusions The findings further emphasize the important mechanistic function of self-efficacy in promoting smoking cessation for PLWH. Additional efforts are required to disentangle the relationships between emotional, distress motivation, and efficacious smoking cessation treatment. PMID:25542824
Hosek, Sybil G.; Lemos, Diana; Hotton, Anna L.; Fernandez, M. Isabel; Telander, Kyle; Bell, Margo; Footer, Dana
Black young men who have sex with men (BYMSM) are the group most disproportionately impacted by HIV in the United States and most in need of efficacious interventions to address community-level factors that increase their vulnerability to HIV. The House Ball Community (HBC) is a distinct social network within the larger BYMSM community that may be particularly vulnerable to social norms and stigma around HIV. This study tailored an evidence-based, community-level popular opinion leader (OL) intervention for use within the HBC. The intervention, called POSSE, was then piloted to evaluate feasibility, acceptability and preliminary efficacy. Recruiting opinion leaders from the community and training them to deliver risk reduction messages was found to be feasible and highly acceptable. Community-level surveys (n=406) were completed over 5 waves of data collection. Overall exposure to the intervention increased across waves. Statistically significant (p < .05) declines were observed for multiple sexual partners, condomless anal intercourse with any male partners and with male partners of unknown HIV status. HIV stigma declined as well, but the trend was not statistically significant. PMID:25300319
Ray, Amita; Ray, Sujoy; George, Aneesh Thomas; Swaminathan, Narasimman
trial with three arms of comparison;Clotrimazole,Lactobacillus and Placebo gave no definitive results in preventing an episode of VVC. Clotrimazole against placebo (RR 0.49; 95% CI 0.22 to 1.09), Clotrimazole against lactobacillus (RR 1.11; 95% CI 0.45 to 2.76) and lactobacillus against placebo (RR 0.54 ;95% CI 0.26 to 1.13). Implications for practiceNo trials were found addressing treatment of VVC in HIV positive women.In comparison to placebo,Fluconazole was found to be an effective preventative intervention. However, the potential for resistant Candida organisms to develop might impact the feasibility of implementation.Direction of findings suggests that Clotrimazole and Lactobacillus improved the prophylactic outcomes when compared to placebo.Implications for research There is a need to evaluate drugs and drug regimens for VVC treatment and prophylaxis in HIV positive women through randomised clinical trials. Development of resistance to azoles remains under-studied and more work must be done in this area, so as to determine whether routine prophylaxis for VVC is at all needed or whether adequate ART would be sufficient to prevent recurrent VVC. The viral load in vaginal secretions with or without treatment or prophylaxis has not been studied, this is very relevant to the spread of HIV.
Full Text Available Background. Ethiopia has one of the lowest HIV prevalence rates in East Africa, but there are still more than one million people estimated to be living with HIV in Ethiopia. This study was aimed at assessing the comprehensive HIV/AIDS knowledge and sexual behavior among university students. Methodology. A cross-sectional comparative study was done with quantitative and qualitative data collection with a stratified sampling technique. The quantitative data were edited, coded, entered, and analyzed using SPSS software version 20. Result. Both comprehensive knowledge of HIV/AIDS transmission and prevention method were higher in the intervention group (75.8% and 48.5% than comparative group (68.6% and 42.5% which had a significant difference (P<0.05. Life time sexual intercourse was higher in the intervention group (40.8% as compared to the comparative group (34.6%. But sexual condom utilization in the past 12 months was higher in the intervention group (73.2% as compared to the comparative group (56.9% which had a significant difference (P<0.05. Similarly, history of sexual transmitted disease report was higher in the comparative group (6.3% as compared to the intervention (4.6%. Among sexual experience respondents in the last 12 months, 32% of them in the intervention and 35.5% of them in the comparative group have had multiple sexual partners. Conclusion. The intervention group had higher comprehensive knowledge of HIV/AIDS and condom utilization. But a higher percentage of students were engaged in risky sexual behavior. Therefore, emphasis should be given on designing different strategy to reduce risky sexual behavior and increase comprehensive HIV/AIDS knowledge.
Perlman, David C; Jordan, Ashly E
This article reviews the case for recognizing (1) the epidemics of opioid misuse, overdose, hepatitis C virus, and HIV as a syndemic and (2) the importance of examining and addressing structural factors in responses to this syndemic. We focus on the current syndemic in the US, but also consider data from other locations to highlight the issues existing and arising in various contexts. Advances in multi-level theory and statistical methods allow sound ecologic and multi-level analyses of the impact of structural factors on the syndemic. Studies of opioid misuse, overdoses, hepatitis C virus, and HIV demonstrate that area-level access to healthcare, medication-assisted treatment of opioid use disorders, sterile injection equipment, and overdose prevention with naloxone, as well as factors such as opioid marketing, income inequality, intensity of policing activities, and health care policies, are related to the prevalence of substance misuse, overdoses, infection risk, and morbidity. Structural variables can predict area-level vulnerability to the syndemic. The implementation of combined prevention and treatment interventions can control and reverse components of the syndemic. Recognizing and monitoring potent structural factors can facilitate the identification of areas at risk of vulnerability to the syndemic. Further, many structural factors are modifiable through intervention and policy to reduce structural vulnerability and create health-enabling environments. Evidence supports the immediate implementation of broader HCV and HIV testing and substance use screening, medication-assisted treatment, needle/syringe exchange programs, naloxone programs, increased population-level implementation of HCV treatment, and further attention to structural-level factors predicting, and contributing to, area-level vulnerability, such as degrees of opioid marketing, distribution, and prescribing.
Full Text Available Carrie Ann Gakumo,1 Comfort C Enah,1 David E Vance,1,2 Efe Sahinoglu,3 Jim L Raper1,3,4 1School of Nursing, 2Center for Nursing Research, 3School of Medicine, 41917 HIV/AIDS Outpatient Clinic, University of Alabama at Birmingham, Birmingham, AL, USA Purpose: Health literacy is lower in minorities and older adults, and has been associated with nonadherence to medications, treatment, and care in people living with human immunodeficiency virus (HIV. Likewise, African Americans with HIV are more likely to be nonadherent to their HIV medications, less likely to keep their clinic appointments related to HIV treatment and care, and more likely to die during hospitalizations than their ethnic counterparts. The present study explored the preferences of older African Americans with HIV for a health literacy intervention to promote HIV management.Patients and methods: In this qualitative study, 20 older adult African Americans living with HIV were recruited from an HIV/acquired immunodeficiency syndrome outpatient clinic in the southeastern region of the US. Using patient-centered participatory design methods, semi-structured individual interviews were conducted to determine patient preferences for intervention development and design. Health literacy was also measured using the Rapid Estimate of Adult Literacy in Medicine – Revised (REALM-R.Results: Four major themes emerged related to intervention development and design: keep health information simple; use a team-based approach for health education; tailor teaching strategies to patients’ individual needs; and account for patients’ low experience, but high interest, in technology. Forty-five percent of the study population had low health literacy based on the revised Rapid Estimate of Adult Literacy in Medicine.Conclusion: Future interventions that target minorities and older adults living with HIV should consider patients’ learning needs, sex-specific and mental health needs, and delivery
Tobin, Karin; Kuramoto, Satoko J.; German, Danielle; Fields, Errol; Spikes, Pilgrim S.; Patterson, Jocelyn; Latkin, Carl
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older,…
Carolyn M Audet
Full Text Available Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV or tuberculosis are rarely referred to the health system in a timely fashion.We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province.The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0-0.54 compared with a post-intervention rate of 0.34 patients (IQR: 0-0.71, a 35% increase (p=0.046. A median HIV knowledge score of 67% (IQR: 59-78 was noted 4-months pre-intervention and a median score of 81% (IQR: 74-89 was recorded 2½ months post-intervention (p<0.001. One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children and/or malaria (15% adults; 37% children. Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis.We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.
Verhey, Ruth; Chibanda, Dixon; Brakarsh, Jonathan; Seedat, Soraya
Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries. © 2016 John Wiley & Sons Ltd.
Full Text Available BACKGROUND: Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. METHODS AND FINDINGS: A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 - RR. The trial was stopped at the interim analysis, and the mean (interquartile range follow-up was 18.1 mo (13.0-21.0 when the data were analyzed. There were 20 HIV infections (incidence rate = 0.85 per 100 person-years in the intervention group and 49 (2.1 per 100 person-years in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001. This RR corresponds to a protection of 60% (95% CI: 32%-76%. When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%-77%. CONCLUSION: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa. (Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Rio de Janeiro, Brazil..
Chitalu, Ndashi; Mumbi, Mirriam; Cook, Ryan; Weiss, Stephen M; Jones, Deborah
Behavioral interventions have utilized a variety of strategies and components to reduce HIV risk. This article describes the partner intervention, a couple-based group HIV risk reduction intervention implemented in 6 urban community health clinics in Lusaka, Zambia, and examines the components of the intervention and their relationship with condom use. Couple members completed assessments on condom use, acceptability, willingness to use condoms, communication, intimate partner violence (IPV), self-efficacy, and HIV information at baseline and 6 months' follow-up. This study examined the relative impact of elements of the intervention as predictors of condom use. Changes in acceptability had the greatest overall influence on condom use, followed by social support, relationship consensus, and willingness to use condoms. Changes in self-efficacy, IPV, negotiation, and information had no influence. Results support the use of multidimensional approaches in behavioral interventions and highlight the importance of identifying critical elements of interventions to maximize risk reduction outcomes. © The Author(s) 2014.
Dalseth, Natasha; Reed, Regina Szucs; Hennessy, Michael; Eisenberg, Marlene M; Blank, Michael B
The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. clinicaltrials.gov 29 identifier NCT00264823.
Bhatta, Dharma Nand; Liabsuetrakul, Tippawan
Human immunodeficiency virus (HIV) infection affects the quality of life of infected people. It is well known that empowerment is important for appropriate access to health care and quality of care. However, there is currently limited availability of explicit methods to increase the empowerment of HIV-infected people. This study aimed to develop and test the feasibility of a social self-value package as an empowerment intervention method for HIV-infected people. One group included 8-10 participants and each session lasted for one and half hours. Six sessions in total were developed and one session was conducted in one week. A total of 66 participants were randomly selected for participating in the package, assessed its feasibility both quantitatively and qualitatively. Attitudes towards HIV-related issues significantly and positively changed after each session. Client satisfaction and acceptability of the intervention was very high indicating high feasibility with good design. The qualitative findings also supported the quantitative findings where both participants and counselors accepted and were satisfied with the structure and contents of the package. This study revealed that providing an inclusive six-week social self-value package for HIV-infected Nepali people appears to be feasible. Its effect on empowerment intervention will be measured by a randomized controlled trial.
Yilma, Daniel; Kæstel, Pernille; Olsen, Mette Frahm
-supplemented group had a 10·8 (95 % CI 7·8, 13·9) nmol/l decrease in serum 25(OH)D level after 3 months of ART. Nutritional supplementation that contained vitamin D prevented a reduction in serum 25(OH)D levels in HIV-positive persons initiating ART. Vitamin D replenishment may be needed to prevent reduction......Low vitamin D level in HIV-positive persons has been associated with disease progression. We compared the levels of serum 25-hydroxyvitamin D (25(OH)D) in HIV-positive and HIV-negative persons, and investigated the role of nutritional supplementation and antiretroviral treatment (ART) on serum 25...... daily allowance of vitamin D (10 μg/200 g). The level of serum 25(OH)D before nutritional intervention and ART initiation was compared with serum 25(OH)D of HIV-negative individuals. A total of 348 HIV-positive and 100 HIV-negative persons were recruited. The median baseline serum 25(OH)D level...
Frye, Victoria; Paige, Mark Q; Gordon, Steven; Matthews, David; Musgrave, Geneva; Kornegay, Mark; Greene, Emily; Phelan, Jo C; Koblin, Beryl A; Taylor-Akutagawa, Vaughn
HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming. Copyright © 2017. Published by Elsevier Ltd.
Jemmott, John B; Jemmott, Loretta S; Fong, Geoffrey T; Morales, Knashawn H
We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.
Serovich, Julianne M; Laschober, Tanja C; Brown, Monique J; Kimberly, Judy A
Disclosure is important in human immunodeficiency virus (HIV) transmission risk reduction. This randomized controlled intervention assessed changes in and predictors of disclosure and risky sexual behavior among Black men who have sex with men (BMSM) living with HIV in the U.S. BMSM were randomly assigned to either the disclosure intervention or attention control case management group. Predictors of three disclosure types (behavior, beliefs, intentions) and condomless anal intercourse (CAI) included disclosure consequences (rewards and costs), disclosure readiness, and safer sex readiness. Mixed-effect results showed no differences between the groups in any of the outcomes; although disclosure behavior increased over time. Relationships were found between readiness to change and CAI; disclosure consequences and different disclosure types; and disclosure behavior and receptive CAI. When working with BMSM living with HIV, practitioners and prevention specialists should consider the importance of disclosure pertaining to receptive CAI and factors that support overall disclosure and safer sex.
Kanamori, Mariano; De La Rosa, Mario; Diez, Stephanie; Weissman, Jessica; Trepka, Mary Jo; Sneij, Alicia; Schmidt, Peter; Rojas, Patria
Throughout the past decade, HIV rates in Florida-particularly South Florida, where many Latina seasonal farmworkers reside and work-have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health). Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings.
Full Text Available Throughout the past decade, HIV rates in Florida—particularly South Florida, where many Latina seasonal farmworkers reside and work—have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health. Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings.
Full Text Available Developing interventions that address psychosocial wellbeing of people living with HIV is critical to ensure strong linkages to and retention in HIV care. This paper describes the development of Sondela, an HIV adjustment and coping intervention for heterosexual men and women living with HIV, and its relevance and feasibility in the South African context. Sondela is a six three-hour, small group-based, participatory workshop series. We followed an iterative, multi-phased process of curriculum development that involved research, theoretical frameworks and piloting. A systematic review highlighted the absence of psychosocial interventions targeting heterosexual HIV positive populations living in high HIV prevalence and resource-poor settings. Formative studies demonstrated risk and social factors associated with adjustment and coping with HIV, emphasising the need for interventions that acknowledge gendered experiences. Our pilot of Sondela demonstrated high levels of relevance and feasibility. Men appreciated the workshop "space" to openly talk about their HIV positive status and what is means for their role as partners and fathers and friends. Women valued the skills and approaches because they were relevant to "real life" situations and not just about HIV. Sondela promises to be valuable in supporting health system initiatives and psychosocial support to strengthen linkages to and retention in HIV care, and this suggests a need for rigorous evaluation of Sondela to establish evidence for its effectiveness in a general population.
Aboud, Frances; Huq, Nafisa Lira; Larson, Charles P; Ottisova, Livia
Efforts to prevent HIV from becoming widespread among the youth population 15-24 years in Bangladesh are in the early stages. However, conservative religious and cultural norms may curtail the dissemination of needed information about sexuality and condoms. The community-readiness stages model was adopted as a framework for assessing the level of preparedness of community leaders to facilitate planned HIV prevention efforts. Six focus group discussions with three professional groups (teachers, businessmen, drugshop vendors) in Hobiganj district were conducted in late 2005, and a single multi-professional group made up of teachers, imams, and drugshop vendors was convened in early 2007 to assess changes. The audio recordings in Bangla were coded as were English translations. Everyone had heard of AIDS and regarded it as a potential catastrophe for the health, economy and social fabric of Bangladesh. Remarks concerning Stage 1-Vulnerability indicated that most did not believe their community to be at risk, though Bangladesh was. Remarks at Stage 2-Knowledge of Transmission were mostly vague but accurately identified sex, blood and needles as the main means of spread; however sex with sex workers was also mentioned in each group. Remarks at Stage 3-Prevention showed strong opposition to condoms for unmarried males and a preference for current means of forbidding sex outside of marriage. A few in each group recognized the importance of condoms for wayward youth. Stage 4-Planning discussions centered on raising awareness and fear, and a desire for government and media to take the lead. By 2007 participants articulated more realistic strategies that they themselves could, and had, implemented, but also raised barriers that authorities should help them overcome. The findings provide formative information on the constraints and opportunities of community groups as partners in HIV preventive interventions and strategies to help them move to a higher stage of readiness
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of noncompetitive award of Part C funds for Saint Michael's Medical...
Hatleberg, Camilla I; Ryom, Lene; El-Sadr, Wafaa
INTRODUCTION: There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study. METHODS: Participant...
Graham, Susan M.; Micheni, Murugi; Kombo, Bernadette; van der Elst, Elisabeth M.; Mugo, Peter M.; Kivaya, Esther; Aunon, Frances; Kutner, Bryan; Sanders, Eduard J.; Simoni, Jane M.
In many African settings, MSM are a stigmatized group whose access to and engagement in HIV care may be challenging. Our aim was to design a targeted, culturally appropriate intervention to promote care engagement and antiretroviral therapy (ART) adherence for MSM in coastal Kenya, and describe
Amirkhanian, Yuri A; Kelly, Jeffrey A; Takacs, Judit; McAuliffe, Timothy L; Kuznetsova, Anna V; Toth, Tamas P; Mocsonaki, Laszlo; DiFranceisco, Wayne J; Meylakhs, Anastasia
To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections. A two-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling. St. Petersburg, Russia and Budapest, Hungary. Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size = 35 members, n = 626) were recruited. Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members. Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes. There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P = 0.04); UAI with a nonmain partner (P = 0.04); and UAI with multiple partners (P = 0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P = 0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P = 0.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks. Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.
Rachakulla Hari Kumar
Full Text Available Abstract Background Avahan, the India AIDS initiative began HIV prevention interventions in 2003 in Andhra Pradesh (AP among high-risk groups including female sex workers (FSWs, to help contain the HIV epidemic. This manuscript describes an assessment of this intervention using the published Avahan evaluation framework and assesses the coverage, outcomes and changes in STI and HIV prevalence among FSWs. Methodology Multiple data sources were utilized including Avahan routine program monitoring data, two rounds of cross-sectional survey data (in 2006 and 2009 and STI clinical quality monitoring assessments. Bi-variate and multivariate analyses, Wald Chi-square tests and multivariate logistic regressions were used to measure changes in behavioural and biological outcomes over time and their association. Results Avahan scaled up in conjunction with the Government program to operate in all districts in AP by March 2009. By March 2009, 80% of the FSWs were being contacted monthly and 21% were coming to STI services monthly. Survey data confirmed an increase in peer educator contacts with the mean number increasing from 2.9 in 2006 to 5.3 in 2009. By 2008 free and Avahan-supported socially marketed condoms were adequate to cover the estimated number of commercial sex acts, at 45 condoms/FSW/month. Consistent condom use was reported to increase with regular (63.6% to 83.4%; AOR=2.98; p Conclusions The absence of control groups is a limitation of this study and does not allow attribution of changes in outcomes and declines in HIV and STI to the Avahan program. However, the large scale implementation, high coverage, intermediate outcomes and association of these outcomes to the Avahan program provide plausible evidence that the declines were likely associated with Avahan. Declining HIV prevalence among the general population in Andhra Pradesh points towards a combined impact of Avahan and government interventions.
Fisher, Jeffrey D; Amico, K Rivet; Fisher, William A; Cornman, Deborah H; Shuper, Paul A; Trayling, Cynthia; Redding, Caroline; Barta, William; Lemieux, Anthony F; Altice, Frederick L; Dieckhaus, Kevin; Friedland, Gerald
We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.
Dawson Rose, Carol; Cuca, Yvette P; Kamitani, Emiko; Eng, Shannon; Zepf, Roland; Draughon, Jessica; Lum, Paula
Substance use among people living with HIV is high, and screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to addressing the issue. We examined whether patients would participate in a technology-based SBIRT program in an urban HIV clinic. An SBIRT intervention was programmed into the clinic's web-based patient portal linked to their personal health record. We examined: demographic, health, HIV, and substance use characteristics of participants who completed the web-based intervention compared to those who did not. Fewer than half of the 96 participants assigned to the web-based SBIRT completed it (n = 39; 41 %). Participants who completed the web-based intervention had significantly higher amphetamine SSIS scores than those who did not complete the intervention. Participants whose substance use is more harmful may be more motivated to seek help from a variety of sources. In addition, it is important that technology-based approaches to behavioral interventions in clinics take into consideration feasibility, client knowledge, and comfort using technology.
Joseph Davey, Dvora; Farley, Elise; Gomba, Yolanda; Coates, Thomas; Myer, Landon
HIV acquisition in pregnancy and breastfeeding contributes significantly toward pediatric HIV infection. However, little is known about how sexual behavior changes during pregnancy and postpartum periods which will help develop targeted HIV prevention and transmission interventions, including pre-exposure prophylaxis (PrEP). Cross-sectional study in HIV-infected and uninfected pregnant and postpartum women in Cape Town, South Africa. Interviewers collected survey data on demographic, sexual behaviors, and alcohol use among pregnant and post-partum women. We report descriptive results of sexual behavior by trimester and postpartum period, and results of multivariable logistic regression stratified by pregnancy status. We enrolled 377 pregnant and postpartum women (56% pregnant, 40% HIV-infected). During pregnancy, 98% of women reported vaginal sex (8% anal sex, 44% oral sex) vs. 35% and 88% during the periods 0-6 and 7-12 months postpartum, respectively (p1 partner in the past 12-months compared to postpartum women (18% vs. 13%, respectively, p6-months postpartum (13 mean sex acts in first trimester; 17 mean sex acts >6-months postpartum). Pregnant women had increased odds of reporting condomless sex at last sex (aOR = 2.96;95%CI = 1.84-4.78) and ever having condomless sex in past 3-months (aOR = 2.65;95%CI = 1.30-5.44) adjusting for age, HIV status, and sex frequency compared to postpartum women. We identified that sexual behaviors and risk behaviors were high and changing during pregnancy and postpartum periods, presenting challenges to primary and secondary HIV prevention efforts, including PrEP delivery to pregnant and breastfeeding women.
Loeliger, Kelsey B; Marcus, Ruthanne; Wickersham, Jeffrey A; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L
Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders. To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia. A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities. One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77). Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mbwambo, Jessie; McCurdy, Sheryl A; Myers, Bronwyn; Lambdin, Barrot; Kilonzo, Gad Paul; Kaduri, Pamela
The rapid increase in communication and transportation between Africa and other continents as well as the erosion of social fabric attended by poverty, ethnic conflicts, and civil wars has led to increased trafficking and consumption of illicit drugs. Cannabis dominates illicit trade and accounts for as much as 40% of global interdiction. Due to escalating seizures in recent years, the illicit trade in heroin and cocaine has become a concern that has quickly spread from West Africa to include Eastern and Southern Africa in the past 10 years. All regions of Africa are characterized by the use of cannabis, reflecting its entrenched status all over Africa. Most alarming though is the use of heroin, which is now being injected frequently and threatens to reverse the gain made in the prevention of HIV/AIDS. The prevalence of HIV infection and other blood-borne diseases among injection drug users is five to six times that among the general population, calling for urgent intervention among this group. Programs that aim to reduce the drug trafficking in Africa and needle syringe programs as well as medication-assisted treatment (MAT) of heroin dependence while still in their infancy in Africa show promise and need to be scaled up.
Taggart, Tamara; Taboada, Arianna; Stein, Judith A; Milburn, Norweeta G; Gere, David; Lightfoot, Alexandra F
AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). Thus, AMP!'s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.
Johnson, Wayne D; Diaz, Rafael M; Flanders, William D; Goodman, Michael; Hill, Andrew N; Holtgrave, David; Malow, Robert; McClellan, William M
Men who have sex with men (MSM) remain at great risk for HIV infection. Program planners and policy makers need descriptions of interventions and quantitative estimates of intervention effects to make informed decisions concerning prevention funding and research. The number of intervention strategies for MSM that have been examined with strong research designs has increased substantially in the past few years. 1. To locate and describe outcome studies evaluating the effects of behavioral HIV prevention interventions for MSM.2. To summarize the effectiveness of these interventions in reducing unprotected anal sex.3. To identify study characteristics associated with effectiveness.4. To identify gaps and indicate future research, policy, and practice needs. We searched electronic databases, current journals, manuscripts submitted by researchers, bibliographies of relevant articles, conference proceedings, and other reviews for published and unpublished reports from 1988 through December 2007. We also asked researchers working in HIV prevention about new and ongoing studies. Studies were considered in scope if they examined the effects of behavioral interventions aimed at reducing risk for HIV or STD transmission among MSM. We reviewed studies in scope for criteria of outcome relevance (measurement of at least one of a list of behavioral or biologic outcomes, e.g., unprotected sex or incidence of HIV infections) and methodologic rigor (randomized controlled trials or certain strong quasi-experimental designs with comparison groups). We used fixed and random effects models to summarize rate ratios (RR) comparing intervention and control groups with respect to count outcomes (number of occasions of or partners for unprotected anal sex), and corresponding prevalence ratios (PR) for dichotomous outcomes (any unprotected anal sex vs. none). We used published formulas to convert effect sizes and their variances for count and dichotomous outcomes where necessary. We accounted
Yilma, Daniel; Kæstel, Pernille; Olsen, Mette F; Abdissa, Alemseged; Tesfaye, Markos; Girma, Tsinuel; Krarup, Henrik; Mølgaard, Christian; Michaelsen, Kim F; Ritz, Christian; Kirk, Ole; Andersen, Åse B; Friis, Henrik
Low vitamin D level in HIV-positive persons has been associated with disease progression. We compared the levels of serum 25-hydroxyvitamin D (25(OH)D) in HIV-positive and HIV-negative persons, and investigated the role of nutritional supplementation and antiretroviral treatment (ART) on serum 25(OH)D levels. A randomised nutritional supplementation trial was conducted at Jimma University Specialized Hospital, Ethiopia. The trial compared 200 g/d of lipid-based nutrient supplement (LNS) with no supplementation during the first 3 months of ART. The supplement provided twice the recommended daily allowance of vitamin D (10 μg/200 g). The level of serum 25(OH)D before nutritional intervention and ART initiation was compared with serum 25(OH)D of HIV-negative individuals. A total of 348 HIV-positive and 100 HIV-negative persons were recruited. The median baseline serum 25(OH)D level was higher in HIV-positive than in HIV-negative persons (42·5 v. 35·3 nmol/l, P17 kg/m2 were randomised to either LNS supplementation (n 189) or no supplementation (n 93) during the first 3 months of ART. The supplemented group had a 4·1 (95 % CI 1·7, 6·4) nmol/l increase in serum 25(OH)D, whereas the non-supplemented group had a 10·8 (95 % CI 7·8, 13·9) nmol/l decrease in serum 25(OH)D level after 3 months of ART. Nutritional supplementation that contained vitamin D prevented a reduction in serum 25(OH)D levels in HIV-positive persons initiating ART. Vitamin D replenishment may be needed to prevent reduction in serum 25(OH)D levels during ART.
Swan, Holly; Hiller, Matthew L; Albizu-García, Carmen E; Pich, Michele; Patterson, Yvonne; O'Connell, Daniel J
The prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies cooperative tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. For this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n=28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n=1253) and follow-up (n=1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Differences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant. Taken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates' awareness and perceptions of HIV services.
Ruiz-Perez, Isabel; Murphy, Matthew; Pastor-Moreno, Guadalupe; Rojas-García, Antonio; Rodríguez-Barranco, Miguel
Surveys in the United States and Europe have shown a plateau of new HIV cases, with certain regions and populations disproportionately affected by the disease. Ethnic minority women and socioeconomically disadvantaged groups are disproportionately affected by HIV. Previous reviews have focused on prevention interventions targeting ethnic minority men who have sex with men, have not accounted for socioeconomic status, or have included only interventions carried out in clinical settings. To review and assess the effectiveness of HIV prevention interventions targeting socioeconomically disadvantaged ethnic minority women in member states of the Organisation for Economic Co-operation and Development (OECD). On March 31, 2014, we executed a search using a strategy designed for the MEDLINE (Ovid), CINAHL, Embase, Scopus, and Web of Knowledge databases. Additional searches were conducted through the Cochrane Library, CRD Databases, metaRegister of Controlled Trials, EURONHEED, CEA Registry, and the European Action Program for Health Inequities as well as in gray literature sources. No language or date restrictions were applied. We selected studies assessing the effectiveness of interventions to prevent HIV among ethnic minority women of low socioeconomic status in which at least 80% of participants were reported to belong to an ethnic minority group and to have a low income or be unemployed. We included only studies that were conducted in OECD member states and were randomized controlled trials or quasi-experimental investigations with a comparison group. A data extraction form was developed for the review and used to collect relevant information from each study. We summarized results both qualitatively and quantitatively. The main outcomes were categorized into 3 groups: improved knowledge regarding transmission of HIV, behavior changes related to HIV transmission, and reductions in the incidence of sexually transmitted infections (STIs). We then performed meta
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Ryan White... AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of Ryan White HIV/AIDS..., HIV/AIDS Bureau, Health Resources and Services Administration, by email at [email protected] , or by...
Wechsberg, Wendee M; Luseno, Winnie K; Kline, Tracy L; Browne, Felicia A; Zule, William A
This article presents the results of a randomized trial in South Africa of an adapted evidence-based Woman-Focused intervention on condom use with primary sex partners. The preliminary findings show that regardless of HIV status, condom negotiation was significantly associated with condom use at the 3- and 6-month follow-ups. By intervention group, significant intervention effects were found at 6-month follow-up for HIV-positive and HIV-unknown status women in the Woman-Focused intervention who were more likely than women in the Standard intervention to report condom use with a primary male partner. Among HIV-positive women, those in the Woman-Focused group and those with greater sexual control were more likely to report condom use at the 6-month follow-up. The findings indicate that gender-based interventions for women may result in increased condom negotiation skills.
The prototype of a safer-sex comic book was designed in response to the need for HIV intervention material targetting gay male youth in Toronto. This prototype depicted three separate stories, each based on recorded interviews, and each revolving around the negotiation of condom use between a different pair of characters. The characters were based on observations of respondents. The prototype's plausibility, relevance and attractiveness were assessed through focus groups and an evaluation questionnaire. Results indicated that most readers found the depicted stories pleasing, realistic and personally relevant. Readers found fault with the transitions between the stories and with certain character elements. Suggested solutions and comments about condom use served as directions for further development of the prototype into a finished product.
Full Text Available As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM. Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts.A randomized controlled trial (RCT conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631. No participant incentives were provided.Follow-up was completed by 1,631 (53% of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure ('asked and told' with their last sexual partner (OR 1.32, 95% CI 1.01-1.74. Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54-0.91 and webpage condition (OR 0.43, 95% CI 0.25-0.72 significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20-0.67 and serodiscordant UAI (OR 0.53, 95% CI 0.28-0.96 at follow-up.Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms.ClinicalTrials.gov NCT
Mason-Jones, Amanda J; Sinclair, David; Mathews, Catherine; Kagee, Ashraf; Hillman, Alex; Lombard, Carl
sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland). Sexual and reproductive health educational programmes Six trials evaluated school-based educational interventions. In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; low certainty evidence), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; moderate certainty evidence; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; low certainty evidence). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; moderate certainty evidence). Material or monetary incentive-based programmes to promote school attendance Two trials evaluated incentive-based programmes to promote school attendance. In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; low certainty evidence). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; very low certainty evidence). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; very low certainty evidence). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; low certainty evidence). Combined educational and incentive
On average, 2,500 young people (15-24 years) get infected with HIV every day; 80% of which live in sub-Saharan Africa. Since no cure or vaccine is available, reducing sexual risk behaviour in this group is crucial in tackling the epidemic. The general objective of this doctoral study was to improve the effectiveness of HIV prevention interventions for young people in sub-Saharan Africa. First, we assessed the overall effectiveness of such interventions (systematic literature review, meta-analysis). Secondly, we evaluated a school-based peer-led HIV prevention interventions in Rwanda (longitudinal, non-randomized controlled trial), to get insight into how interventions are developed, implemented and evaluated. While the first two objectives demonstrated limited effectiveness, the third objective aimed to identify reasons for this limited effectiveness: a) baseline characteristics of respondents that predict participation were identified (using data from objective 2); b) we studied determinants of young people’s sexual behavior using a qualitative ‘mailbox study’ that assessed the spontaneous thoughts of Rwandan adolescents on sexuality; c) we assessed the role of one specific structural factor: education (literature review and analysis of existing datasets); d) we assessed the theoretical underpinnings of existing HIV prevention interventions for young people in sub-Saharan Africa (literature review). Based on these studies, we discuss two main reasons for the observed limited effectiveness: factors associated with the intervention (strong focus on cognitions and moral, and implementation issues), and with evaluation (design, power, indicators). Recommendations for improving interventions, evaluations and for further research are provided. PMID:24753945
Full Text Available Wendee M Wechsberg1, Felicia A Browne1, Winona Poulton1, Rachel Middlesteadt Ellerson1, Ashley Simons-Rudolph1, Deborah Haller2, 1RTI International,* Research Triangle Park, NC, USA; 2Columbia University College of Physicians and Surgeons, New York, NY, USA, *RTI International is a trade name of Research Triangle InstituteAbstract: An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.Keywords: African-American woman, HIV prevention pregnancy, drug use, violence, sexual
Garett, Renee; Menacho, Luis; Young, Sean D
Social media technologies have become increasingly useful tools for research-based interventions. However, participants and social media users have expressed ethical concerns with these studies, such as risks and benefits of participation, as well as privacy, confidentiality, and informed consent issues. This study was designed to follow up with and assess experiences and perceptions of ethics-related issues among a sample of 211 men who have sex with men who participated in the Harnessing Online Peer Education (HOPE) Peru study, a randomized controlled HIV prevention intervention conducted in Peru. We found that after adjusting for age, highest educational attainment, race, sexual orientation, and prior HIV research experience, participants in the intervention group were more likely than those in the control group to have safe sex (p = 0.0051) and get tested for HIV regularly (p = 0.0051). As a result of their participation, those in the intervention group benefited more positively than participants in the control group in improving HIV care (p = 0.0077) and learning where to receive sexual health services (p = 0.0021). Participants in the intervention group expressed higher levels of comfort than those in the control group in joining and seeing other people in the Facebook group (p = 0.039), seeing other people's posts (p = 0.038) and having other group members talk to them online (p = 0.040). We discuss the implications of these results as they relate to social media-based HIV research.
Pretorius, Leandri; Gibbs, Andrew; Crankshaw, Tamaryn; Willan, Samantha
A growing number of young people (ages 10-24) are living with HIV (YPLWH) in sub-Saharan Africa (SSA). These YPLWH have particular needs and challenges related to their sexual and reproductive health and rights (SRHR). Contextual factors including gender inequalities, violence, stigma, and discrimination and lack of tailored services undermine YPLWH's SRHR. Understand the scope and impact of interventions targeting YPLWH to improve SRH-related outcomes in SSA. We undertook a review to synthesise evaluated interventions (qualitative, quantitative, or mixed methods) aimed at improving the SRH outcomes of YPLWH in SSA with outcomes based on a World Health Organization framework of comprehensive SRHR approaches for women living with HIV. Using inclusion criteria, only six interventions were identified. Interventions sought to improve a range of direct and indirect SRH outcomes, including sexual behaviour, adherence, disclosure, and mental health. Four overarching issues emerged: 1) all interventions were structured according to cognitive behavioural therapy theories of behaviour change - while showing promise they do not tackle the wider gender, social, and economic contexts that shape YPLWH's SRH; 2) 'significant others' were included in two of the interventions, but further work needs to consider how to leverage parental/guardian support appropriately; 3) interventions only accessed young people who were already linked to care, participants were likely to have better SRH outcomes than those potentially more vulnerable YPLWH; and 4) none of the interventions explored the sexuality of young people. There have been a limited number of evaluated interventions to strengthen SRH of YPLWH in SSA, and gaps exist in addressing the SRHR needs of YPLWH. Intervention approaches require greater scope and depth, including the need to address structural and contextual challenges.
Full Text Available Background: A growing number of young people (ages 10–24 are living with HIV (YPLWH in sub-Saharan Africa (SSA. These YPLWH have particular needs and challenges related to their sexual and reproductive health and rights (SRHR. Contextual factors including gender inequalities, violence, stigma, and discrimination and lack of tailored services undermine YPLWH's SRHR. Objective: Understand the scope and impact of interventions targeting YPLWH to improve SRH-related outcomes in SSA. Design: We undertook a review to synthesise evaluated interventions (qualitative, quantitative, or mixed methods aimed at improving the SRH outcomes of YPLWH in SSA with outcomes based on a World Health Organization framework of comprehensive SRHR approaches for women living with HIV. Using inclusion criteria, only six interventions were identified. Results: Interventions sought to improve a range of direct and indirect SRH outcomes, including sexual behaviour, adherence, disclosure, and mental health. Four overarching issues emerged: 1 all interventions were structured according to cognitive behavioural therapy theories of behaviour change – while showing promise they do not tackle the wider gender, social, and economic contexts that shape YPLWH's SRH; 2 ‘significant others’ were included in two of the interventions, but further work needs to consider how to leverage parental/guardian support appropriately; 3 interventions only accessed young people who were already linked to care, participants were likely to have better SRH outcomes than those potentially more vulnerable YPLWH; and 4 none of the interventions explored the sexuality of young people. Conclusions: There have been a limited number of evaluated interventions to strengthen SRH of YPLWH in SSA, and gaps exist in addressing the SRHR needs of YPLWH. Intervention approaches require greater scope and depth, including the need to address structural and contextual challenges.
Urada, Lianne A; Simmons, Janie; Wong, Betty; Tsuyuki, Kiyomi; Condino-Enrera, Gerlita; Hernandez, Laufred I; Simbulan, Nymia Pimentel; Raj, Anita
This study evaluated a brief human rights-focused HIV community mobilization intervention for sex workers in the Philippines, a country with one of the fastest rising number of HIV cases worldwide. Five single-session group interventions to reduce sexual risk and increase HIV testing among 86 sex workers in Manila were evaluated with pre-post-test data via Wilcoxon's signed-ranks and Mann-Whitney tests. The 4-h intervention, Kapihan (August-November, 2013), integrated human rights with HIV skill-building. Demographic data, violence/trafficking victimization, human rights knowledge, and intentions to HIV test and treat were collected. Participants were median aged 23; female (69 %); had children (55; 22 % had 3+ children); used drugs (past 3 months: 16 %); sexually/physically abused by clients (66 %); 20 % street sex workers ever took an HIV test. Pre-post-test scores significantly improved in knowledge of HIV (z = -8.895, p human rights (z = -4.391, p rights of research participants (z = -5.081, p human rights into HIV interventions may empower sex workers to address their health and human rights and test for HIV.
Marvel, Francoise; Rowe, Cynthia L; Colon-Perez, Lissette; DiClemente, Ralph J; Liddle, Howard A
Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/ STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/ STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.
Kennedy, Caitlin E; Brahmbhatt, Heena; Likindikoki, Samuel; Beckham, Sarah W; Mbwambo, Jessie K; Kerrigan, Deanna
Cash transfer programs seek to alter structural determinants of HIV risk such as poverty and gender inequality. We sought to explore the feasibility and potential effectiveness of a cash transfer intervention for young women as part of combination HIV prevention in Iringa, Tanzania. Qualitative, in-depth interviews were conducted with 116 stakeholders and residents from the region, including key informants, service delivery users, and members of key populations. Most respondents felt a cash transfer program would assist young women in Iringa to have more control over sexual decision-making and reduce poverty-driven transactional sex. Respondents were divided on who should receive funds: young women themselves, their parents/guardians, or community leaders. Cash amounts and suggested target groups varied, and several respondents suggested providing microcredit or small business capital instead of cash. Potential concerns included jealousy, dependency, and corruption. However, most respondents felt that some intervention was needed to address underlying poverty driving some sexual risk behavior. A cash transfer program could fill this role, ultimately reducing HIV, sexually transmitted infections, and unintended pregnancies. As increased attention is given to economic and structural interventions for HIV prevention, local input and knowledge should be considered in a program design.
Rhodes, Scott D; Hergenrather, Kenneth C; Montaño, Jaime; Remnitz, Ivan M; Arceo, Ramiro; Bloom, Fred R; Leichliter, Jami S; Bowden, W Patrick
Although the Latino community living in the United States has been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs), the development, implementation, and evaluation of HIV and STD prevention interventions designed to reduce infection among Latinos lags behind prevention efforts targeting other communities. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables is a sexual risk reduction intervention designed to reduce HIV and STD infection among recently arrived, non-English-speaking Latino men who are members of a multicounty Latino soccer league in central North Carolina, a region of the United States with both the fastest growing Latino population and disproportionate HIV and STD infection rates. HoMBReS was developed in partnership with the local Latino community using community-based participatory research (CBPR). We describe (a) the CBPR partnership history and further expansion; (b) the development of the intervention through the integration of collected formative data, theoretical considerations, and findings from the scientific literature; and (c) lessons learned while using a CBPR approach to develop HoMBReS.
Martinez, Omar; Isabel Fernandez, M; Wu, Elwin; Carballo-Diéguez, Alex; Prado, Guillermo; Davey, Adam; Levine, Ethan; Mattera, Brian; Lopez, Nikki; Valentin, Omar; Murray, Ashley; Sutton, Madeline
Latino men who have sex with men (MSM) experienced a 13% increase in HIV diagnoses from 2010 to 2014, more than any other racial/ethnic subgroup of MSM in the United States. If current HIV diagnoses rates persist, about one in four Latino MSM in the United States will be diagnosed with HIV during their lifetime. Although some efficacious HIV prevention interventions for Latino MSM exist, none have focused on couples. This paper describes the protocol of a randomized controlled trial (RCT) to test the preliminary efficacy of a couple-based HIV prevention intervention that is culturally tailored for Latino men and their same-sex partners. The RCT will determine the preliminary efficacy of Connecting Latinos en Pareja (CLP) to increase the proportion of anal sex acts that are HIV protected (i.e., anal sex acts in which condoms, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), or a combination thereof, are used to reduce risk of HIV transmission). CLP builds upon previous couple-based interventions with white and black MSM by incorporating biomedical prevention techniques, such as PrEP and TasP, implementing a framework responsive to the couple's serostatus, and addressing the socio-cultural factors that influence HIV risk among Latino MSM. We also include input from community stakeholders, members of the target population, and a community advisory board as part of intervention development. Assessments will be conducted at baseline, and 3- and 6-months post-intervention to examine the intervention effects on outcomes (HIV-protected sex acts), and factors potentially mediating or moderating intervention effects. This paper describes an innovative RCT that incorporates multiple HIV prevention techniques for Latino MSM in couples, regardless of serostatus. The ongoing involvement of community stakeholders, members of the target population, and a community advisory board is emphasized, and plans for widespread dissemination and application of findings into
Kaufman, Z A; Welsch, R L; Erickson, J D; Craig, S; Adams, L V; Ross, D A
Previous observational and quasi-experimental studies in sub-Saharan Africa have suggested the effectiveness of youth-targeted HIV prevention interventions using sport as an educational tool. No studies have yet assessed the effect of similar programs in the Caribbean. A quasi-experimental trial was conducted to assess the effectiveness of a sports-based intervention in six migrant settlements in the Puerto Plata Province of the Dominican Republic. A total of 397 structured interviews were conducted with 140 adolescents prior to, immediately following, and four months following 10-hour interventions using the Grassroot Soccer curriculum. Interview responses were coded, aggregated into composite scores, and analyzed using logistic regression, adjusting for baseline differences as well as age, sex, community, and descent. At post-intervention, significant differences were observed between groups in HIV-related knowledge (adjOR = 13.02, 95% CI = 8.26, 20.52), reported attitudes (adjOR = 12.01, 95% CI = 7.61, 18.94), and reported communication (adjOR = 3.13, 95% CI = 1.91, 5.12). These differences remained significant at four-month follow-up, though declines in post-intervention knowledge were observed in the Intervention group while gains in knowledge and reported attitudes were observed in the Control group. Results suggest that this sports-based intervention could play a valuable role in HIV prevention efforts in the Caribbean, particularly those targeting early adolescents. Further evaluation of sports-based interventions should include indicators assessing behavioral and biological outcomes, longer-term follow-up, a larger sample, randomization of study participants, and strenuous efforts to minimize loss-to-follow-up.
Full Text Available A set of mediation analyses were carried out in this study using data from It’s Your Game. . .Keep It Real (IYG, a successful HIV/STI/pregnancy prevention program. The IYG study evaluated a skill and normbased. HIV/STI/pregnancy prevention program that was implemented from 2004 to 2007 among 907 urban low-income middle school youth in Houston, TX, USA. Analyses were carried out to investigate the degree to which a set of proposed psychosocial measures of behavioral knowledge, perceived self-efficacy, behavioral, and normative beliefs, and perceived risky situations, all targeted by the intervention, mediated the intervention’s effectiveness in reducing initiation of sex. The mediation process was assessed by examining the significance and size of the estimated effects from the mediating pathways. The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. Two of the psychosocial mediators significantly mediated the intervention effect, knowledge of STI signs and symptoms and refusal self-efficacy. This study suggests that the underlying causal mechanisms of action of these interventions are complex and warrant further analyses.
Sikkema, Kathleen J; Anderson, Eileen S; Kelly, Jeffrey A; Winett, Richard A; Gore-Felton, Cheryl; Roffman, Roger A; Heckman, Timothy G; Graves, Kristi; Hoffmann, Raymond G; Brondino, Michael J
Youth are increasingly at risk for contracting HIV infection, and community-level interventions are needed to reduce behavioral risk. A randomized, controlled, multi-site community-level intervention trial was undertaken with adolescents living in 15 low-income housing developments in five US cities. Baseline (n = 1172), short-term follow-up (n = 865), and long-term follow-up (n = 763) risk assessments were conducted among adolescents, ages 12-17, in all 15 housing developments. The developments were randomly assigned in equal numbers to each of three conditions: experimental community-level intervention (five developments); "state-of-the-science" skills training workshops (five developments); and, education-only delayed control intervention (five developments). At long-term follow-up, adolescents living in the housing developments receiving the community-level intervention were more likely to delay onset of first intercourse (85%) than those in the control developments (76%), while those in the workshop developments (78%) did not differ from control condition adolescents. Adolescents in both the community-level intervention (77%) and workshop (76%) developments were more likely to use a condom at last intercourse than those in control (62%) developments. Community-level interventions that include skills training and engage adolescents in neighborhood-based HIV prevention activities can produce and maintain reductions in sexual risk behavior, including delaying sexual debut and increasing condom use.
Newcomb, Michael E; Macapagal, Kathryn R; Feinstein, Brian A; Bettin, Emily; Swann, Gregory; Whitton, Sarah W
Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.
Wilson, Kristina; Durantini, Marta R.; Albarracín, Julia; Crause, Candi; Albarracín, Dolores
Aspects of Latino culture (e.g., machismo, marianism) can act as barriers to enrollment in HIV-prevention programs. To lift these barriers, a culturally appropriate meta-intervention was designed to increase intentions to enroll in HIV-prevention counseling by Latinos. Latino participants (N = 41) were recruited from the community and randomly assigned to either an experimental or control meta-intervention condition that varied the introduction to a HIV-prevention counseling program. Following the meta-intervention, participants were issued an invitation to take part in HIV-prevention counseling. The outcome measure was the intention to enroll in a HIV-prevention counseling session. Findings indicated that enrollment intentions were higher in the experimental meta-intervention condition (96%) than in the control meta-intervention condition (53%). In addition, the effects of the meta-intervention were comparable across genders and participant ages. Findings suggest that the use of a culturally appropriate meta-intervention may be an effective strategy for increasing Latino enrollment in HIV-prevention programs. These promising findings warrant further investigation into the efficacy and effectiveness of this meta-intervention. PMID:23398305
Wilson, Kristina; Durantini, Marta R; Albarracín, Julia; Crause, Candi; Albarracín, Dolores
Aspects of Latino culture (e.g., machismo, marianism) can act as barriers to enrollment in HIV-prevention programs. To lift these barriers, a culturally appropriate meta-intervention was designed to increase intentions to enroll in HIV-prevention counseling by Latinos. Latino participants (N=41) were recruited from the community and randomly assigned to either an experimental or control meta-intervention condition that varied the introduction to a HIV-prevention counseling program. Following the meta-intervention, participants were issued an invitation to take part in HIV-prevention counseling. The outcome measure was the intention to enroll in a HIV-prevention counseling session. Findings indicated that enrollment intentions were higher in the experimental meta-intervention condition (96%) than in the control meta-intervention condition (53%). In addition, the effects of the meta-intervention were comparable across genders and participant ages. Findings suggest that the use of a culturally appropriate meta-intervention may be an effective strategy for increasing Latino enrollment in HIV-prevention programs. These promising findings warrant further investigation into the efficacy and effectiveness of this meta-intervention.
Logie, Carmen H.; Daniel, CarolAnn; Newman, Peter A.; Weaver, James; Loutfy, Mona R.
BACKGROUND: Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo) (Women Taking Action For Their Health) study examined the effectiveness of a peer health worker (PHW) delivered psycho-educational HIV/STI ...
Full Text Available BACKGROUND: Early infant male circumcision (EIMC is simpler, safer and more cost-effective than adult circumcision. In sub-Saharan Africa, there are concerns about acceptability of EIMC which could affect uptake. In 2009 a quantitative survey of 2,746 rural Zimbabweans (aged 18-44 indicated that 60% of women and 58% of men would be willing to have their newborn son circumcised. Willingness was associated with knowledge of HIV and male circumcision. This qualitative study was conducted to better understand this issue. METHODS: In 2010, 24 group discussions were held across Zimbabwe with participants from seven ethnic groups. Additionally, key informant interviews were held with private paediatricians who offer EIMC (n = 2 plus one traditional leader. Discussions were audio-recorded, transcribed, translated into English (where necessary, coded using NVivo 8 and analysed using grounded theory principles. RESULTS: Knowledge of the procedure was poor. Despite this, acceptability of EIMC was high among parents from most ethnic groups. Discussions suggested that fathers would make the ultimate decision regarding EIMC although mothers and extended family can have (often covert influence. Participants' concerns centred on: safety, motive behind free service provision plus handling and disposal of the discarded foreskin. Older men from the dominant traditionally circumcising population strongly opposed EIMC, arguing that it separates circumcision from adolescent initiation, as well as allowing women (mothers to nurse the wound, considered taboo. CONCLUSIONS: EIMC is likely to be an acceptable HIV prevention intervention for most populations in Zimbabwe, if barriers to uptake are appropriately addressed and fathers are specifically targeted by the programme.
Muessig, Kathryn E; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana; Hightow-Weidman, Lisa B
eHealth, mHealth and "Web 2.0" social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013-2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy.
Holtgrave, David R; Wolitski, Richard J; Pals, Sherri L; Aidala, Angela; Kidder, Daniel P; Vos, David; Royal, Scott; Iruka, Nkemdiri; Briddell, Kate; Stall, Ron; Bendixen, Arturo Valdivia
We present a cost-utility analysis based on data from the Housing and Health (H&H) Study of rental assistance for homeless and unstably housed persons living with HIV in Baltimore, Chicago and Los Angeles. As-treated analyses found favorable associations of housing with HIV viral load, emergency room use, and perceived stress (an outcome that can be quantitatively linked to quality of life). We combined these outcome data with information on intervention costs to estimate the cost-per-quality-adjusted-life-year (QALY) saved. We estimate that the cost-per-QALY-saved by the HIV-related housing services is $62,493. These services compare favorably (in terms of cost-effectiveness) to other well-accepted medical and public health services.
Arnold, Robert; Maticka-Tyndale, Eleanor; Tenkorang, Eric; Holland, Daniel; Gaspard, Adeline; Luginaah, Isaac
This study examined the impact of two interventions delivered in rural communities and schools in Edo State, Nigeria designed to decrease youth vulnerability to HIV infection. The Ministry of Education approved Family Life and HIV Education (FLHE) programme delivered in Junior Secondary Schools and a community-based initiative to raise AIDS Competency of rural communities were evaluated using a clustered randomized control trial and mixed qualitative-quantitative methods. Ten schools were assigned to each of three research arms: FLHE programme only, FLHE and community programme, and control. Results demonstrated positive effects on rejection of myths, attitudes related to abstinence and use of condoms, and sexual activity. Confidence in these results is supported by both levels of statistical significance and consistency in patterns of results across different levels of schooling. Results support expansion of delivery of the FLHE programme and development of community-based initiatives as effective methods of reducing youth vulnerability to HIV infection.
Witte, Susan S.; Batsukh, Altantsetseg; Chang, Mingway
SUMMARY This study examines HIV/STI risk behaviors, alcohol abuse, intimate partner violence, and psychological distress among 48 female sex workers in Mongolia to inform the design of a gender-specific, HIV/STI prevention intervention for this population. Quantitative findings demonstrate that over 85% of women reported drinking alcohol at harmful levels; 70% reported using condoms inconsistently with any sexual partner; 83% reported using alcohol before engaging in sex with paying partners, and 38% reported high levels of depression. Focus group findings provide contextual support and narrative descriptions for the ways that poverty, alcohol abuse, interpersonal violence, and cultural norms that stigmatize and marginalize women are intertwined risk factors for STIs, including HIV, among these vulnerable women. PMID:20391057
Wagman, Jennifer A; Gray, Ronald H; Nakyanjo, Neema; McClendon, Katherine A; Bonnevie, Erika; Namatovu, Fredinah; Kigozi, Grace; Kagaayi, Joseph; Wawer, Maria J; Nalugoda, Fred
The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE's motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa. Copyright © 2018 Elsevier Ltd. All rights reserved.
Evans, C; Turner, K; Suggs, L S; Occa, A; Juma, A; Blake, H
HIV-related mHealth interventions have demonstrable efficacy in supporting treatment adherence, although the evidence base for promoting HIV testing is inconclusive. Progress is constrained by a limited understanding of processes used to develop interventions and weak theoretical underpinnings. This paper describes a research project that informed the development of a theory-based mHealth intervention to promote HIV testing amongst city-dwelling African communities in the conditions. A community-based participatory social marketing design was adopted. Six focus groups (48 participants in total) were undertaken and analysed using a thematic framework approach, guided by constructs from the Health Belief Model. Key themes were incorporated into a set of text messages, which were pre-tested and refined. The focus groups identified a relatively low perception of HIV risk, especially amongst men, and a range of social and structural barriers to HIV testing. In terms of self-efficacy around HIV testing, respondents highlighted a need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities which would in turn enhance confidence in, and support for, HIV testing activities of health professionals. Findings suggested that messages should: avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits. HIV remains a stigmatized and de-prioritized issue within African migrant communities in the UK, posing barriers to HIV testing initiatives. A community-based participatory social marketing design can be successfully used to develop a culturally appropriate text messaging HIV intervention. Key challenges involved turning community research recommendations into brief text messages of only 160 characters. The intervention needs to be evaluated in a randomized control trial. Future research should explore the
Full Text Available Abstract Background HIV-related mHealth interventions have demonstrable efficacy in supporting treatment adherence, although the evidence base for promoting HIV testing is inconclusive. Progress is constrained by a limited understanding of processes used to develop interventions and weak theoretical underpinnings. This paper describes a research project that informed the development of a theory-based mHealth intervention to promote HIV testing amongst city-dwelling African communities in the UK. Methods A community-based participatory social marketing design was adopted. Six focus groups (48 participants in total were undertaken and analysed using a thematic framework approach, guided by constructs from the Health Belief Model. Key themes were incorporated into a set of text messages, which were pre-tested and refined. Results The focus groups identified a relatively low perception of HIV risk, especially amongst men, and a range of social and structural barriers to HIV testing. In terms of self-efficacy around HIV testing, respondents highlighted a need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities which would in turn enhance confidence in, and support for, HIV testing activities of health professionals. Findings suggested that messages should: avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits. Conclusions HIV remains a stigmatized and de-prioritized issue within African migrant communities in the UK, posing barriers to HIV testing initiatives. A community-based participatory social marketing design can be successfully used to develop a culturally appropriate text messaging HIV intervention. Key challenges involved turning community research recommendations into brief text messages of only 160 characters. The intervention needs to be evaluated in a
Sivaram, Sudha; Zelaya, Carla; Srikrishnan, A. K.; Latkin, Carl; Go, V. F.; Solomon, Suniti; Celentano, David
Stigma against persons living with HIV/AIDS (PLHA) is a barrier to seeking prevention education, HIV testing, and care. Social capital has been reported as an important factor influencing HIV prevention and social support upon infection. In the study, we explored the associations between social capital and stigma among men and women who are…
Frye, Victoria; Bonner, Sebastian; Williams, Kim; Henny, Kirk; Bond, Keosha; Lucy, Debbie; Cupid, Malik; Smith, Stephen; Koblin, Beryl A.
In the United States, racial disparities in HIV/AIDS are stark. Although African Americans comprise an estimated 14% of the U.S. population, they made up 52% of new HIV cases among adults and adolescents diagnosed in 2009. Heterosexual transmission is now the second leading cause of HIV in the United States. African Americans made up a full…
Green, Shana M.; Lockhart, Elizabeth; Marhefka, Stephanie L.
Within recent years public health interventions have become technologically based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions. The US National HIV/AIDS Strategy states that people living with HIV should have access to effective behavioral interventions like Healthy Relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based Healthy Relationships Video Groups (HR-VG) delivered at home or community based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages, disadvantages and overall preference for home or agency delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective. PMID:26357907
Genberg, Becky L; Shangani, Sylvia; Sabatino, Kelly; Rachlis, Beth; Wachira, Juddy; Braitstein, Paula; Operario, Don
Improving patient engagement in HIV care is critical for maximizing the impact of antiretroviral therapy (ART). We conducted a systematic review of studies that used HIV-positive peers to bolster linkage, retention, and/or adherence to ART. We searched articles published and indexed in Pubmed, PsycINFO, and CINAHL between 1996 and 2014. Peers were required to be HIV-positive. Studies were restricted to those published in English. Nine studies with n = 4658 participants met the inclusion criteria. Peer-based interventions were predominantly focused on improving adherence to ART, or evaluations of retention and adherence via viral suppression. Five (56 %) were conducted in sub-Saharan Africa. Overall findings were mixed on the impact of peers on ART adherence, viral suppression, and mortality. While positive effects of peer interventions on improving linkage and retention were found, there were limited studies assessing these outcomes. Additional research is warranted to demonstrate the impact of peers on linkage and retention in diverse populations.
Harrison, Sayward E.; Li, Xiaoming; Zhang, JiaJia; Zhao, Junfeng; Zhao, Guoxiang
Children of parents with human immunodeficiency virus (HIV) are at-risk for a variety of negative outcomes, including poor educational achievement. The multi-level, resilience-based "ChildCARE" intervention has been found to yield short-term improvement in a number of school-related variables for children affected by parental HIV.…
X. Liu (Xiaona); V. Erasmus (Vicky); Q. Wu (Qing); J.H. Richardus (Jan Hendrik)
textabstractBackground: Floating populations have been repeatedly characterized as "the tipping point" for the HIV epidemic in China. This study aims to systematically summarize and assess the effectiveness of HIV prevention interventions in floating populations in China over the past decade.
Ingersoll, Karen S.; Farrell-Carnahan, Leah; Cohen-Filipic, Jessye; Heckman, Carolyn J.; Ceperich, Sherry D.; Hettema, Jennifer; Marzani-Nissen, Gabrielle
Background Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skills model to improve HAART adherence and reduce crack cocaine problems. Methods Participants were 54 adults with crack cocaine use and HIV with viral loads (VL) were detectable (log VL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (MI+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14-day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measures ANOVA assessed main effects of the interventions and interactions by condition. Results Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. Conclusions A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use. PMID:21306837
Ingersoll, Karen S; Farrell-Carnahan, Leah; Cohen-Filipic, Jessye; Heckman, Carolyn J; Ceperich, Sherry D; Hettema, Jennifer; Marzani-Nissen, Gabrielle
Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skill model to improve HAART adherence and reduce crack cocaine problems. Participants were 54 adults with crack cocaine use and HIV with viral loads (VL) were detectable (logVL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (MI+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14-day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measure ANOVA assessed main effects of the interventions and interactions by condition. Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Heidkamp, Rebecca A; Stoltzfus, Rebecca J; Fitzgerald, Daniel W; Pape, Jean W
The integration of nutrition support for infants of HIV-infected mothers is a recognized need; however, the evidence for effective programmatic solutions is weak. The objective of our study was to implement and evaluate a new infant feeding support intervention for HIV-exposed, uninfected, non-breast-fed infants 6-12 mo of age attending the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) pediatric clinic in Port-au-Prince, Haiti. The 24-wk intervention included a lipid-based nutrient supplement, education, promotion of existing clinical services, and social support. We compared growth outcomes among intervention participants (n = 73) at start (wk 0) and end (wk 24) of intervention to a historical control group of HIV-exposed infants seen at the GHESKIO in the year prior to the intervention who would have met the intervention entrance criteria (n = 294). The intervention and historical control groups did not differ significantly at age 6 mo (wk 0). At age 12 mo (wk 24), the intervention group had a lower prevalence of underweight and stunting than the historical control group (weight-for-age Z-score growth faltering in HIV-exposed uninfected children from 6 to 12 mo of age. This is a promising intervention model that can be adapted and scaled-up to other HIV care contexts.
Heat is the most effective method for inactivating HIV: methods for sterilizationa and high-level disinfectionb based ... boiling and it is proboble that HIV, which is very sensitive to' heat, is also inactivated after several minutes of ... tured and protected in storage from heat and light. Dilutions should be prepored just before use.
McNairy, Margaret L; Howard, Andrea A; El-Sadr, Wafaa M
The demonstration of the efficacy of antiretroviral therapy (ART) for HIV prevention in heterosexual HIV serodiscordant couples has resulted in the call for widespread implementation of "Treatment as Prevention" (TasP) to confront the challenge of continued transmission of HIV. In addition, evidence of the possible effect of use of ART on decreasing the incidence of tuberculosis (TB) in persons living with HIV has also contributed further enthusiasm. Mathematical modeling studies evaluating the potential impact of TasP on the trajectory of the HIV and TB epidemics have inspired discussions about a possible future without AIDS. We present the evidence regarding the effect of ART on the incidence of HIV and TB, benefits and risks associated with embracing TasP, and the need for multicomponent prevention strategies and for further research to generate empiric data on the effect of TasP on HIV and TB at a population level.
Individuals motivated to participate in adherence, care and treatment (imPACT: development of a multi-component intervention to help HIV-infected recently incarcerated individuals link and adhere to HIV care
Carol E. Golin
Full Text Available Abstract Background Policy-makers promote a seek, test, treat and retain (STTR strategy to expand HIV testing, support linkage and engagement in care, and enhance the continuous use of antiretroviral therapy for those HIV-infected. This HIV prevention strategy is particularly appropriate in correctional settings where HIV screening and treatment are routinely available yet many HIV-infected individuals have difficulty sustaining sufficient linkage and engagement in care, disease management, and viral suppression after prison release. Methods/design Our research team developed Project imPACT (individuals motivated to Participate in Adherence, Care and Treatment, a multi-component approach for HIV-Infected recently incarcerated individuals that specifically targets their care linkage, retention, and medication adherence by addressing multiple barriers to care engagement after release. The ultimate goals of this intervention are to improve the health of HIV-infected individuals recently released from prison and reduce HIV transmission to their communities by maintaining viral suppression. This paper describes the intervention and technology development processes, based on best practices for intervention development and process evaluation. These processes included: 1 identifying the target population; 2 clarifying the theoretical basis for intervention design; 3 describing features of its foundational interventions; 4 conducting formative qualitative research; 5 integrating and adapting foundational interventions to create and refine intervention content based on target audience feedback. These stages along with the final intervention product are described in detail. The intervention is currently being evaluation and a two arm randomized, controlled trial in two US state prison systems. Discussion Based on a literature review, qualitative research, integration of proven interventions and behavioral theory, the final imPACT intervention focused on
Full Text Available Rapid HIV assays are the mainstay of HIV testing globally. Delivery of effective biomedical HIV prevention strategies such as antiretroviral pre-exposure prophylaxis (PrEP requires periodic HIV testing. Because rapid tests have high (>95% but imperfect specificity, they are expected to generate some false positive results.We assessed the frequency of true and false positive rapid results in the Partners PrEP Study, a randomized, placebo-controlled trial of PrEP. HIV testing was performed monthly using 2 rapid tests done in parallel with HIV enzyme immunoassay (EIA confirmation following all positive rapid tests.A total of 99,009 monthly HIV tests were performed; 98,743 (99.7% were dual-rapid HIV negative. Of the 266 visits with ≥1 positive rapid result, 99 (37.2% had confirmatory positive EIA results (true positives, 155 (58.3% had negative EIA results (false positives, and 12 (4.5% had discordant EIA results. In the active PrEP arms, over two-thirds of visits with positive rapid test results were false positive results (69.2%, 110 of 159, although false positive results occurred at <1% (110/65,945 of total visits.When HIV prevalence or incidence is low due to effective HIV prevention interventions, rapid HIV tests result in a high number of false relative to true positive results, although the absolute number of false results will be low. Program roll-out for effective interventions should plan for quality assurance of HIV testing, mechanisms for confirmatory HIV testing, and counseling strategies for persons with positive rapid test results.
Chamratrithirong, Aphichat; Ford, Kathleen; Punpuing, Sureeporn; Prasartkul, Pramote
Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18-24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.
Full Text Available Modeling count data from sexual behavioral outcomes involves many challenges, especially when the data exhibit a preponderance of zeros and overdispersion. In particular, the popular Poisson log-linear model is not appropriate for modeling such outcomes. Although alternatives exist for addressing both issues, they are not widely and effectively used in sex health research, especially in HIV prevention intervention and related studies. In this paper, we discuss how to analyze count outcomes distributed with excess of zeros and overdispersion and introduce appropriate model-fit indices for comparing the performance of competing models, using data from a real study on HIV prevention intervention. The in-depth look at these common issues arising from studies involving behavioral outcomes will promote sound statistical analyses and facilitate research in this and other related areas.
Green, Shana M; Lockhart, Elizabeth; Marhefka, Stephanie L
Within recent years, public health interventions have become technology based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions (EBIs). The US National HIV/AIDS Strategy states that people living with HIV should have access to EBIs such as healthy relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based healthy relationships video groups (HR-VG) delivered at home or community-based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages and disadvantages of home or CBO delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure, and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall, privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective.
Willis, Leigh A; Kachur, Rachel; Castellanos, Ted J; Nichols, Kristen; Mendoza, Maria C B; Gaul, Zaneta J; Spikes, Pilgrim; Gamayo, Ashley C; Durham, Marcus D; LaPlace, Lisa; Straw, Julie; Staatz, Colleen; Buge, Hadiza; Hogben, Matthew; Robinson, Susan; Brooks, John; Sutton, Madeline Y
In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.
El-Bassel, Nabila; Gilbert, Louisa; Goddard-Eckrich, Dawn; Chang, Mingway; Wu, Elwin; Hunt, Tim; Epperson, Matt; Shaw, Stacey A; Rowe, Jessica; Almonte, Maria; Witte, Susan
This study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women under criminal justice community supervision. We tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision. We randomized 306 women recruited from community supervision settings to receive either: (1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH); (2) a four-session multimedia group-based HIV/STI prevention intervention that covered the same content as traditional WORTH but was delivered in a computerized format; or (3) a four-session group-based Wellness Promotion intervention that served as an attention control condition. The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH. Primary outcomes were assessed over the 12-month post-intervention period and included the number of unprotected sex acts, the proportion of protected sex acts, and consistent condom use. At baseline, 77% of participants reported unprotected vaginal or anal sex (n = 237) and 63% (n = 194) had multiple sex partners. Women assigned to traditional or multimedia WORTH were significantly more likely than women assigned to the control condition to report an increase in the proportion of protected sex acts (β = 0.10; 95% CI = 0.02-0.18) and a decrease in the number of unprotected sex acts (IRR = 0.72; 95% CI = 0.57-0.90). The promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system. Clinical
Renfro, Tiffaney; Johnson, Erin; Lambert, Danielle N; Wingood, Gina; DiClemente, Ralph J
As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.
Wilson, Patrick A; Valera, Pamela; Martos, Alexander J; Wittlin, Natalie M; Muñoz-Laboy, Miguel A; Parker, Richard G
This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: "Black men" "Black gay/bisexual" or "Black men who have sex with men," and "qualitative" and/or "ethnography." We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.
Todd, Catherine S; Nasir, Abdul; Stanekzai, Mohammad R; Scott, Paul T; Close, Nicole C; Botros, Boulos A; Strathdee, Steffanie A; Tjaden, Jeffrey
There is little information about HIV awareness or condom use among female sex workers (FSWs) in Afghanistan. The purpose of this cross-sectional study was to assess HIV awareness, knowledge, and condom use among FSWs in three Afghan cities. FSWs residing in Jalalabad, Kabul, and Mazar-i-Sharif were recruited through outreach programs and completed an interviewer-administered questionnaire and rapid tests for hepatitis B surface antigen, HIV, syphilis, and hepatitis C virus. Logistic regression identified factors associated with HIV awareness, comprehensive HIV knowledge (knowledge that HIV cannot be detected by sight, that condoms prevent HIV, and rejection of local misconceptions about HIV transmission), and consistent condom use (use with every sex act) with clients in the last six months. Of 520 participants, 76.9% had no formal education and 37.7% lived outside Afghanistan in the last five years. Nearly half (44.2%) were aware of HIV but, of these, only 17.4% (N = 40) had comprehensive HIV knowledge. There were significant differences by site; FSWs in Jalalabad were more likely to be aware of HIV but FSWs in Kabul were more likely to have correct HIV knowledge and use condoms consistently with clients. Consistent client condom use was reported by 11.5% (N = 60) and was independently associated with having more clients per month (AOR = 1.99, 95% CI: 1.04-3.81). In conclusion, comprehensive HIV knowledge and consistent condom use with clients are low among Afghan FSWs in these cities. Efforts to reach this population should focus on relaying accurate information and expanding condom use with clients.
Brothers, Jennifer; Harper, Gary W; Fernandez, M Isabel; Hosek, Sybil G
In the United States, youth of 13-24 years account for nearly a quarter of all new HIV infections, with almost 1000 young men and women being infected per month. Young women account for 20% of those new infections.This article describes the design, feasibility, and acceptability of a secondary prevention empowerment intervention for young women living with HIV entitled Young Women Taking Charge and Growing Stronger. The nine session intervention aimed to reduce secondary transmission by enhancing social and behavioral skills and knowledge pertaining to young women's physical, social, emotional, and sexual well-being,while addressing the moderating factors such as sexual inequality and power imbalances. Process evaluation data suggest that EVOLUTION is a highly acceptable and feasible intervention for young women living with HIV. Participants reported enjoying both the structure and comprehensive nature of the intervention. Both participants and interventionists reported that the intervention was highly relevant to the lives of young women living with HIV since it not only provided opportunities for them to broaden their knowledge and risk reduction skills in HIV, but it also addressed important areas that impact their daily lives such as stressors, relationships,and their emotional and social well-being. Thus, this study demonstrates that providing a gender-specific,comprehensive group-based empowerment intervention for young women living with HIV appears to be both feasible and acceptable.
Mustanski, Brian S.; Newcomb, Michael E.; Bois, Steve Nicholas Du; Garcia, Steve C.; Grov, Christian
Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the U.S. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. We conclude that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, we suggest that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors. PMID:21409715
Godbole, Sheela; Sane, Suvarna; Kamble, Pranil; Raj, Yujwal; Dulhani, Nisha; Venkatesh, Srinivasan; Reddy, D. C. S.; Chavan, Laxmikant; Bhattacharya, Madhulekha; Bindoria, Suchitra; Kadam, Dilip; Thakur, Savita; Narwani, Prakash; Pereira, Elmira; Paranjape, Ramesh; Risbud, Arun
Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Methods Between March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Results Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), pbehaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) pbehaviour with other men, could help in reaching this population. PMID:25211511
Joseph D. Tucker
Full Text Available Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.
Tucker, Joseph D; Tso, Lai Sze; Hall, Brian; Ma, Qingyan; Beanland, Rachel; Best, John; Li, Haochu; Lackey, Mellanye; Marley, Gifty; Rich, Zachary C; Sou, Ka-Lon; Doherty, Meg
Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Trott Alexander T
Full Text Available Abstract Background HIV prevention is increasingly focused on people living with HIV (PLWH and the role of healthcare settings in prevention. Emergency Departments (EDs frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH. Methods This retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i linkage to health care, ii linkage to case management, and iii linkage to partner counseling and referral. Results Of 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46% reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%. For those requesting services, 11/15 (73% were linked to healthcare, 4/23 (17% were coordinated with case management, and 1/4 (25% completed partner counseling and referral. Conclusion Given base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.
Dworkin, Shari L; Treves-Kagan, Sarah; Lippman, Sheri A
Emerging out of increased attention to gender equality within HIV and violence prevention programming has been an intensified focus on masculinities. A new generation of health interventions has attempted to shift norms of masculinity to be more gender equitable and has been termed "gender-transformative." We carried out a systematic review of gender-transformative HIV and violence prevention programs with heterosexually-active men in order to assess the efficacy of this programming. After reviewing over 2,500 abstracts in a systematic search, a total of 15 articles matched review criteria. The evidence suggests that gender-transformative interventions can increase protective sexual behaviors, prevent partner violence, modify inequitable attitudes, and reduce STI/HIV, though further trials are warranted, particularly in establishing STI/HIV impacts. In the conclusion, we discuss the promises and limitations of gender-transformative work with men and make suggestions for future research focused on HIV and/or violence prevention.
Full Text Available The Joint United Nations Programme on HIV/AIDS (UNAIDS 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART, and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention.The PopART intervention comprises annual rounds of home-based HIV testing delivered by community HIV-care providers (CHiPs who also support linkage to care, ART retention, and other services. Data from four communities in Zambia receiving the full intervention (including immediate ART for all individuals with HIV were used to determine proportions of participants who knew their HIV status after the CHiP visit; proportions linking to care and initiating ART following referral; and overall proportions of HIV-infected individuals who knew their status (first 90 target and the proportion of these on ART (second 90 target, pre- and post-intervention. We are not able to assess progress towards the third 90 target at this stage of the study. Overall, 121,130 adults (59,283 men and 61,847 women were enumerated in 46,714 households during the first annual round (December 2013 to June 2015. Of the 45,399 (77% men and 55,703 (90% women consenting to the intervention, 80% of men and 85% of women knew their HIV status after the CHiP visit. Of 6,197 HIV-positive adults referred by CHiPs, 42% (95% CI: 40%-43% initiated ART within 6 mo and 53% (95% CI: 52%-55% within 12 mo. In the entire population, the estimated proportion of HIV-positive adults who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated
DiClemente, Ralph J.; Villamizar, Kira; Er, Deja L.; DeVarona, Martina; Taveras, Janelle; Painter, Thomas M.; Lang, Delia L.; Hardin, James W.; Ullah, Evelyn; Stallworth, JoAna; Purcell, David W.; Jean, Reynald
Objectives. We developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. Methods. We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. Results. Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR] = 4.81; P < .001) and 30 (AOR = 3.14; P < .001) days and at last sexual encounter (AOR = 2.76; P < .001), and a higher mean percentage condom use during the past 90 (relative change = 55.7%; P < .001) and 30 (relative change = 43.8%; P < .001) days than did comparison participants. AMIGAS participants reported fewer traditional views of gender roles (P = .008), greater self-efficacy for negotiating safer sex (P < .001), greater feelings of power in relationships (P = .02), greater self-efficacy for using condoms (P < .001), and greater HIV knowledge (P = .009) and perceived fewer barriers to using condoms (P < .001). Conclusions. Our results support the efficacy of this linguistically and culturally adapted HIV intervention among ethnically diverse, predominantly foreign-born Latina women. PMID:22021297
Koblin, Beryl; Hirshfield, Sabina; Chiasson, Mary Ann; Wilton, Leo; Usher, DaShawn; Nandi, Vijay; Hoover, Donald R; Frye, Victoria
HIV testing is a critical component of HIV prevention and care. Interventions to increase HIV testing rates among young black men who have sex with men (MSM) and black transgender women (transwomen) are needed. Personalized recommendations for an individual's optimal HIV testing approach may increase testing. This randomized trial tests the hypothesis that a personalized recommendation of an optimal HIV testing approach will increase HIV testing more than standard HIV testing information. A randomized trial among 236 young black men and transwomen who have sex with men or transwomen is being conducted. Participants complete a computerized baseline assessment and are randomized to electronically receive a personalized HIV testing recommendation or standard HIV testing information. Follow-up surveys are conducted online at 3 and 6 months after baseline. The All About Me randomized trial was launched in June 2016. Enrollment is completed and 3-month retention is 92.4% (218/236) and has exceeded study target goals. The All About Me intervention is an innovative approach to increase HIV testing by providing a personalized recommendation of a person's optimal HIV testing approach. If successful, optimizing this intervention for mobile devices will widen access to large numbers of individuals. ClinicalTrial.gov NCT02834572; https://clinicaltrials.gov/ct2/show/NCT02834572 (Archived by WebCite at http://www.webcitation.org/6vLJWOS1B). ©Beryl Koblin, Sabina Hirshfield, Mary Ann Chiasson, Leo Wilton, DaShawn Usher, Vijay Nandi, Donald R Hoover, Victoria Frye. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 19.12.2017.
Shanaube, Kwame; Schaap, Ab; Chaila, Mwate Joseph; Floyd, Sian; Mackworth-Young, Constance; Hoddinott, Graeme; Hayes, Richard; Fidler, Sarah; Ayles, Helen
To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15-19 years and explore factors associated with HCT uptake. The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial. Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016. Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs. Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing.
Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance.
Full Text Available Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.Between March-May 2011, 4682 men (15-49 years who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7], >30 years [AOR = 6.5, 95% CI(5.5, 7.7]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0, p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1 p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62] were significantly less likely to be bisexual.A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.
Bhana, Arvin; McKay, Mary M; Mellins, Claude; Petersen, Inge; Bell, Carl
Family-based interventions with children who are affected by HIV and AIDS are not well established. The Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) represents one of the few evidence-based interventions tested in low-income contexts in the US, Caribbean and South Africa. This paper provides a description of the theoretical and empirical bases of the development and implementation of CHAMP in two of these countries, the US and South Africa. In addition, with the advent of increasing numbers of children infected with HIV surviving into adolescence and young adulthood, a CHAMP+ family-based intervention, using the founding principles of CHAMP, has been developed to mitigate the risk influences associated with being HIV positive.
Menna, Takele; Ali, Ahmed; Worku, Alemayehu
Worldwide, about 50% of all new cases of HIV occur in youth between age 15 and 24 years. Studies in various sub-Saharan African countries show that both out of school and in school adolescents and youth are engaged in risky sexual behaviors. School-based health education has been a cornerstone of youth-focused HIV prevention efforts since the early 1990s. In addition, peer-based interventions have become a common method to effect important health-related behavior changes and address the HIV/AIDS pandemic. Thus, the aim of this study was to evaluate efficacy of peer education on changing HIV related risky sexual behaviors among school youth in Addis Ababa, Ethiopia. A quasi experimental study with peer education intervention was conducted in purposively selected four secondary schools (two secondary schools for the intervention and other two for the control group) in Addis Ababa, Ethiopia. Five hundred sixty students from randomly selected sections of grade 11 were assessed through anonymous questionnaires conducted in pre- and post-intervention periods. Pertinent data on socio-demographic and sexual behavior related factors were collected. The statistical packages used for data entry and analysis were epi-info version 3.5.4 and SPSS version 20.0 respectively. Chi-square test and multivariable logistic regressions were used for testing association between peer education intervention and sexual behaviors of students. In addition to testing association between dependent and independent variables, multi-variable analysis was employed to control for the effects of confounding variables. When the pre and post intervention data of each group were compared, comprehensive Knowledge of HIV (P-Values =0.004) and willingness to go for HIV counseling and testing (P-value = 0.01) showed significant differences among intervention group students during post intervention period. Moreover, students in the intervention group were more likely to use condoms during post
Cho, Hwayoung; Iribarren, Sarah; Schnall, Rebecca
As HIV/AIDS is considered a chronic disease; quality of life (QoL) has become an important focus for researchers and healthcare providers. Technology-mediated interventions have demonstrated improved clinical effectiveness in outcomes, such as viral suppression, for persons living with HIV/AIDS (PLWH). However, the evidence to support the impact of these interventions on QoL is lacking. The aim of this paper was to assess the impact of technology-mediated interventions on QoL and to identify the instruments used to measure the QoL of PLWH. For this review we followed the PRISMA guidelines. A literature search was conducted in PubMed, CINAHL, Cochrane, and EMBASE databases in April 2016. Inclusion criteria limited articles to those with technology-mediated interventions as compared to usual care; articles with the population defined as HIV-infected patients; and articles with QoL measured as a health outcome in randomized controlled trials. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Of the 1,554 peer-reviewed articles returned in the searches, 10 met the inclusion criteria. This systematic review identified four types of technology-mediated interventions and two types of QoL instruments used to examine the impact of technology-mediated interventions on PLWH. Four studies of technology-mediated interventions resulted in improvement in QoL. Four studies considered QoL as a secondary outcome and resulted in a negative or neutral impact on QoL. Overall, four studies had a low risk of bias, one study had a moderate risk of bias, and the other five studies had a high risk of bias. The evidence to support the improvement of QoL using technology-mediated interventions is insufficient. This lack of research highlights the need for increased study of QoL as an outcome measure and the need for consistent measures to better understand the role of technology-mediated interventions in improving QoL for PLWH.
Martinez, Omar; Wu, Elwin; Levine, Ethan C; Muñoz-Laboy, Miguel; Fernandez, M Isabel; Bass, Sarah Bauerle; Moya, Eva M; Frasca, Timothy; Chavez-Baray, Silvia; Icard, Larry D; Ovejero, Hugo; Carballo-Diéguez, Alex; Rhodes, Scott D
Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition. We collaborated with Latino male couples and providers to adapt Connect 'n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention. The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after
Brawner, Bridgette M; Jemmott, Loretta Sweet; Wingood, Gina; Reason, Janaiya; Mack, Niya
Heterosexually active Black adolescents with mental illnesses are at increased risk for sexually transmitted infections (STIs), including HIV. However, few HIV/STI prevention interventions exist for this demographic. We held seven focus groups (N = 33) to elucidate social, cultural, and psychological factors that influence HIV/STI risk-related sexual behaviors in this understudied population. Seven themes emerged: (a) Blackness and media portrayals, (b) Blackness as a source of cultural resilience and pride, (c) psychosocial determinants of condom use, (d) consequences of engaging in sexual activity, (e) attitudes and beliefs toward sexual behaviors, (f) benefits of sexual activity, and (g) coping mechanisms. Participants also supported the feasibility of and interest in HIV/STI prevention programs integrated with mental health treatment. Transportation, potential breaches of confidentiality, and time were noted barriers to participation. Psychoeducational, skills-based programs are needed to address the sequelae of mental illnesses as they relate to the sexual decision-making process in adolescents. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Ronit, Andreas; Haissman, Judith; Kirkegaard-Klitbo, Ditte Marie; Kristensen, Thomas Skårup; Lebech, Anne-Mette; Benfield, Thomas; Gerstoft, Jan; Ullum, Henrik; Køber, Lars; Kjær, Andreas; Kofoed, Klaus; Vestbo, Jørgen; Nordestgaard, Børge; Lundgren, Jens; Nielsen, Susanne Dam
Modern combination antiretroviral therapy (cART) has improved survival for people living with HIV (PLWHIV). Non-AIDS comorbidities have replaced opportunistic infections as leading causes of mortality and morbidity, and are becoming a key health concern as this population continues to age. The aim of this study is to estimate the prevalence and incidence of non-AIDS comorbidity among PLWHIV in Denmark in the cART era and to determine risk factors contributing to the pathogenesis. The study primarily targets cardiovascular, respiratory, and hepatic non-AIDS comorbidity. The Copenhagen comorbidity in HIV-infection (COCOMO) study is an observational, longitudinal cohort study. The study was initiated in 2015 and recruitment is ongoing with the aim of including 1500 PLWHIV from the Copenhagen area. Follow-up examinations after 2 and 10 years are planned. Uninfected controls are derived from the Copenhagen General Population Study (CGPS), a cohort study including 100,000 uninfected participants from the same geographical region. Physiological and biological measures including blood pressure, ankle-brachial index, electrocardiogram, spirometry, exhaled nitric oxide, transient elastography of the liver, computed tomography (CT) angiography of the heart, unenhanced CT of the chest and upper abdomen, and a number of routine biochemical analysis are uniformly collected in participants from the COCOMO study and the CGPS. Plasma, serum, buffy coat, peripheral blood mononuclear cells (PBMC), urine, and stool samples are collected in a biobank for future studies. Data will be updated through periodical linking to national databases. As life expectancy for PLWHIV improves, it is essential to study long-term impact of HIV and cART. We anticipate that findings from this cohort study will increase knowledge on non-AIDS comorbidity in PLWHIV and identify targets for future interventional trials. Recognizing the demographic, clinical and pathophysiological characteristics of
Cooper, B; Toskin, I; Kulier, R; Allen, T; Hawkes, S
Throughout the last decade substantial research has been undertaken to develop evidence-based behaviour change interventions for sexual health promotion. Primary care could provide an opportunistic entry for brief sexual health communication. We conducted a systematic review to explore opportunistic sexual and reproductive health services for sexual health communication delivered at primary health care level. We searched for studies on PubMed, ProQuest, CINAHL, Jstor, Scopus/Science Direct, Cochrane database of systematic reviews, EBSCO, CINAHL, PsychoInfo, and Web of Knowledge. Both published and unpublished articles were reviewed. All randomised controlled trials and controlled clinical trials were included. Participants of all ages, from adolescence onwards were included. Brief (10-60 minutes) interventions including some aspect of communication on sexual health issues were included. Data were extracted by two reviewers independently using a standardised form. Interventions differed from each other, hence meta-analysis was not performed, and results are presented individually. A total of 247 articles were selected for full-text evaluation, 31 of which were included. Sexually transmitted infections (STIs)/HIV were less often reported in the intervention group compared with the control group. Condom use was higher in most studies in the intervention group. Numbers of sexual partners and unprotected sexual intercourse were lower in the intervention groups. There is evidence that brief counselling interventions have some effect in the reduction and prevention of STIs/HIV. Some questions could not be answered, such as the effect over time and in different settings and population groups. © 2014 Royal College of Obstetricians and Gynaecologists.
Cropsey, Karen L.; Hendricks, Peter S.; Jardin, Bianca; Clark, C. Brendan; Katiyar, Nandan; Willig, James; Mugavero, Michael; Raper, James L.; Saag, Michael; Carpenter, Matthew J.
Introduction PLHIV have higher rates of smoking and lower motivation to quit smoking; thus to impact smoking rates, cessation interventions need to be acceptable to a wider range of PLHIV smokers as well as feasible to implement in a busy clinical setting. The purpose of this study was to evaluate the acceptability, feasibility, and effects of a Screening, Brief Intervention, and Referral for Treatment (SBIRT) model in an HIV/AIDS clinic among a sample of PLHIV. Methods PLHIV smokers (N = 40) were randomized at baseline, irrespective of their self-reported discrete smoking cessation motivation status, to receive either 8-weeks of combination nicotine replacement therapy (NRT) in conjunction with brief counseling (SBIRT framework) (n = 23) or usual care (n = 17). Smoking outcome measures included cigarettes smoked per day, nicotine dependence, smoking urge, and smoking withdrawal symptoms. Results The SBIRT intervention appeared to be acceptable and feasible, and produced medium to large reductions in cigarettes smoked per day, physical nicotine dependence, smoking urge, and smoking withdrawal symptoms, even for smokers not ready to quit within 6 months. Conclusions Findings provide preliminary support for the integration of an SBIRT model in an HIV/AIDS clinic setting to screen and provide active treatment to all smokers, regardless of readiness to quit smoking. Given the high prevalence and incredible health burden of continued smoking in this population, identifying brief and effective interventions that are easily translated into clinical practice represents an enormous challenge that if met, will yield significant improvements to overall patient outcomes. PMID:23787030
Brashers, Dale E; Basinger, Erin D; Rintamaki, Lance S; Caughlin, John P; Para, Michael
HIV creates substantial uncertainty for people infected with the virus, which subsequently affects a host of psychosocial outcomes critical to successful management of the disease. This study assessed the efficacy and durability of a theoretically driven, one-on-one peer support intervention designed to facilitate uncertainty management and enhance psychosocial functioning for patients newly diagnosed with HIV. Using a pretest-posttest control group design, 98 participants received information and training in specific communication strategies (e.g., disclosing to friends and family, eliciting social support, talking to health care providers, using the Internet to gather information, and building social networks through AIDS service organizations). Participants in the experimental group attended six 1-hour sessions, whereas control participants received standard of care for 12 months (after which they received the intervention). Over time, participants in the intervention fared significantly better regarding (a) illness uncertainty, (b) depression, and (c) satisfaction with social support than did those in the control group. Given the utility and cost-effectiveness of this intervention and the uncertainty of a multitude of medical diagnoses and disease experiences, further work is indicated to determine how this program could be expanded to other illnesses and to address related factors, such as treatment adherence and clinical outcomes.
Liu, Xiaona; Erasmus, Vicki; Wu, Qing; Richardus, Jan Hendrik
Floating populations have been repeatedly characterized as "the tipping point" for the HIV epidemic in China. This study aims to systematically summarize and assess the effectiveness of HIV prevention interventions in floating populations in China over the past decade. We conducted a systematic search in three international databases for literature published between 2005 and 2012 with condom use as the primary outcome, and knowledge about HIV transmission and prevention and stigma towards HIV-infected individuals as secondary outcomes. The impact of interventions on changing the primary and secondary outcomes was calculated by risk difference (RD). We also performed subgroup analyses and meta-regression based on different study characteristics, using Stata 12.0, for the primary outcome. Sixteen studies (out of 149) involved 19 different programs and a total of 10,864 participants at entry from 11 provinces in China. The pooled effect estimate of all studies indicated that people participating in HIV-related interventions were 13% more likely to use condoms (95%CI: 0.07, 0.18), however, the effects on increasing condom use exhibited significant heterogeneity across programs (PHIV-related interventions were successful at improving knowledge about HIV transmission and prevention (RD, -0.26; 95%CI: -0.36, -0.16 and RD, -0.25; 95%CI: -0.33, -0.16, respectively), and decreasing stigma (RD, 0.18; 95%CI: 0.09, 0.27). The included studies between 2005 and 2012 indicate that HIV prevention interventions among Chinese floating populations in the past decade were only marginally effective at increasing condom use, but relatively successful at increasing HIV knowledge and decreasing stigma. To avert new infections, novel sexual risk-reduction interventions taking into account the changing socio-economic and cultural situation of Chinese floating populations are urgently needed.
Irving, Stephen L.; Brown, David G.; Anderson, Marie; Bazin, Richard; Cao, Joan; Ciaramella, Giuseppe; Isaacson, Jason; Jackson, Lynn; Hunt, Rachael; Kjerrstrom, Anne; Nieman, James A.; Patick, Amy K.; Perros, Manos; Scott, Andrew D.; Whitby, Kevin; Wu, Hua; Butler, Scott L.
Despite a high current standard of care in antiretroviral therapy for HIV, multidrug-resistant strains continue to emerge, underscoring the need for additional novel mechanism inhibitors that will offer expanded therapeutic options in the clinic. We report a new class of small molecule antiretroviral compounds that directly target HIV-1 capsid (CA) via a novel mechanism of action. The compounds exhibit potent antiviral activity against HIV-1 laboratory strains, clinical isolates, and HIV-2, and inhibit both early and late events in the viral replication cycle. We present mechanistic studies indicating that these early and late activities result from the compound affecting viral uncoating and assembly, respectively. We show that amino acid substitutions in the N-terminal domain of HIV-1 CA are sufficient to confer resistance to this class of compounds, identifying CA as the target in infected cells. A high-resolution co-crystal structure of the compound bound to HIV-1 CA reveals a novel binding pocket in the N-terminal domain of the protein. Our data demonstrate that broad-spectrum antiviral activity can be achieved by targeting this new binding site and reveal HIV CA as a tractable drug target for HIV therapy. PMID:21170360
Maticka-Tyndale, Eleanor; Barnett, Jessica Penwell
One approach in HIV prevention programming targeting youth is to use peer leaders in what is referred to as peer education programming. This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and…
This study investigated the effects of a HIV/AIDS module on teachers' sense of self-efficacy regarding their ability to bring about behaviours in their learners which contribute to responsible living and a reduction of the spread of HIV in their communities. The sample was 128 in-service teachers studying in nine different ...
Gritz, Ellen R; Danysh, Heather E; Fletcher, Faith E; Tami-Maury, Irene; Fingeret, Michelle Cororve; King, Rachel Marks; Arduino, Roberto C; Vidrine, Damon J
People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) have a substantially higher prevalence of cigarette smoking compared to the general population. In addition, PLWHA are particularly susceptible to the adverse health effects of smoking. Our primary objective was to design and test the efficacy over 12 months of a smoking cessation intervention targeting PLWHA. Participants were enrolled from an urban HIV clinic with a multiethnic and economically disadvantaged patient population. Participants received smoking cessation treatment either through usual care (UC) or counseling delivered by a cell phone intervention (CPI). The 7-day point prevalence abstinence was evaluated at 3, 6, and 12 months using logistic regression and generalized linear mixed models. We randomized 474 HIV-positive smokers to either the UC or CPI group. When evaluating the overall treatment effect (7-day abstinence outcomes from 3-, 6-, and 12-month follow-ups), participants in the CPI group were 2.41 times (P = .049) more likely to demonstrate abstinence compared to the UC group. The treatment effect was strongest at the 3-month follow-up (odds ratio = 4.3, P .05). Cell phone-delivered smoking cessation treatment has a positive impact on abstinence rates compared to a usual care approach. Future research should focus on strategies for sustaining the treatment effect in the long term.
Gritz, Ellen R.; Danysh, Heather E.; Fletcher, Faith E.; Tami-Maury, Irene; Fingeret, Michelle Cororve; King, Rachel Marks; Arduino, Roberto C.; Vidrine, Damon J.
Background. People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) have a substantially higher prevalence of cigarette smoking compared to the general population. In addition, PLWHA are particularly susceptible to the adverse health effects of smoking. Our primary objective was to design and test the efficacy over 12 months of a smoking cessation intervention targeting PLWHA. Methods. Participants were enrolled from an urban HIV clinic with a multiethnic and economically disadvantaged patient population. Participants received smoking cessation treatment either through usual care (UC) or counseling delivered by a cell phone intervention (CPI). The 7-day point prevalence abstinence was evaluated at 3, 6, and 12 months using logistic regression and generalized linear mixed models. Results. We randomized 474 HIV-positive smokers to either the UC or CPI group. When evaluating the overall treatment effect (7-day abstinence outcomes from 3-, 6-, and 12-month follow-ups), participants in the CPI group were 2.41 times (P = .049) more likely to demonstrate abstinence compared to the UC group. The treatment effect was strongest at the 3-month follow-up (odds ratio = 4.3, P .05). Conclusions. Cell phone–delivered smoking cessation treatment has a positive impact on abstinence rates compared to a usual care approach. Future research should focus on strategies for sustaining the treatment effect in the long term. PMID:23704120
María J. Fuster-Ruiz de Apodaca
Full Text Available The goal of this study was to assess an intervention program to reduce the impact of stigma on people with HIV and to enable them to cope with it. A quasi-experimental design, with non-equivalent control group and pre- and posttest was used. Participants were 221 people with HIV, of whom 164 received the intervention and 56 made up the nonequivalent control groups. The dependent variables were perception of stigma-enacted and internalized-, self-esteem, perception of selfefficacy, strategies used to cope with stigma-primary control, secondary control, and avoidance-and quality of life. Analysis of variance (MANOVAS and ANOVAS was conducted to determine pretest differences and differential scores in both groups, and analysis of covariance (MANCOVAS and ANCOVAS was performed to assess the efficacy of the program. The results showed reduction of perceived stigma and avoidance strategies and an increase in perceived self-efficacy to cope with stigma, disposition to use approach strategies, self-esteem, and quality of life. These results indicate that it is possible to train people with HIV to cope with stigma.
Shadel, William G.; Galvan, Frank H.; Tucker, Joan S.
This paper describes two phases of formative research that were undertaken to develop a smoking cessation treatment module that has the goal of improving adherence with the nicotine patch in HIV-positive Latino smokers. Each research phase (Phase I and II) was conducted independent of the other and used different methods to inform the development of the intervention. Phase I interviewed n=14 smokers who had previous experience using the nicotine patch to gain detailed understanding of how, when, and why they used it; their perceived barriers to using it; and their perspective on ways to improve adherence to it. Phase II provided n=35 smokers with brief smoking cessation treatment and nicotine patches, then interviewed them in “near real time” over a two month period about their use of the patch during a quit attempt (e.g., perceived barriers and facilitators). Authors of the paper conducted a qualitative analysis of the themes emerging from the interview transcripts across these two phases. Results indicated that consistent use of the nicotine patch was associated with maintaining high motivation for use (i.e., not necessarily motivation to quit, but motivation to continue patch use); linking its use with established daily routines (e.g., with taking other medications, with brushing teeth); and maintaining realistic expectations for patch efficacy (e.g., that users may still experience some level of craving and/or withdrawal). This information will used to develop and pilot test a brief treatment module that focuses on improving nicotine patch adherence. PMID:27070097
Richter, Anke; Loomis, Brett
A community-based intervention program found that the high-risk target population interacts with its surrounding community as a source of drugs and prostitution, creating a measure of co-dependence in the health status of each group. The intervention collected extensive data on sexual and drug use practices in the target population. A dynamic compartment model estimates the epidemiological impact of the intervention, which serves as the basis for the economic assessment comparing intervention costs and lifetime HIV treatment costs. Approximately 2/3 of the new infections arise in the surrounding community. Intervention spillover benefits in the surrounding community are sufficient to make the intervention cost-saving in the first year--a savings of approximately 534,000 dollars. Conducting the intervention results in health benefits and cost-savings not only for the risk group, but for the entire community in which it resides. Quantifying the spillovers is vital to policymakers attempting to allocate scarce public health resources.
Jamner, M S; Wolitski, R J; Corby, N H
To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. Repeated cross-sectional sampling with matched intervention and comparison communities. Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. 3081 injecting drug users who were sexually active and/or shared injection equipment. Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p project exposure had higher stage-of-change scores for using condoms with a main partner (p Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.
Stephenson, Rob; Suarez, Nicolas A; Garofalo, Robert; Hidalgo, Marco A; Hoehnle, Samuel; Thai, Jennie; Mimiaga, Matthew J; Brown, Emily; Bratcher, Anna; Wimbly, Taylor; Sullivan, Patrick
An estimated one- to-two-thirds of new human immunodeficiency virus (HIV) infections among US men who have sex with men (MSM) occur within the context of primary partnerships. Despite this fact, there remains a lack of prevention interventions that focus on male sero-discordant dyads. Interventions that provide male couples with skills to manage HIV risk, and to support each other towards active engagement in HIV prevention and care, are urgently needed. The objective of this paper is to describe the protocol for an innovative dyadic intervention (Stronger Together) that combines couples' HIV testing and dyadic adherence counseling to improve treatment adherence and engagement in care among HIV sero-discordant male couples in the United States. The research activities involve a prospective randomized controlled trial (RCT) of approximately 165 venue- and clinic-recruited sero-discordant male couples (330 individuals: 165 HIV sero-negative and 165 HIV sero-positive). Couples randomized into the intervention arm receive couples' HIV counseling and testing plus dyadic adherence counseling, while those randomized to the control arm receive individual HIV counseling and testing. The study takes place in three cities: Atlanta, GA (study site Emory University); Boston, MA (study site The Fenway Institute); and Chicago, IL (study site Ann & Robert H. Lurie Children's Hospital of Chicago). Cohort recruitment began in 2015. Couples are followed prospectively for 24 months, with study assessments at baseline, 6, 12, 18, and 24 months. Stronger Together was launched in August 2014. To date, 160 couples (97% of the target enrollment) have been enrolled and randomized. The average retention rate across the three sites is 95%. Relationship dissolution has been relatively low, with only 13 couples breaking up during the RCT. Of the 13 couples who have broken up, 10 of the 13 HIV-positive partners have been retained in the cohort; none of these HIV-positive partners have enrolled
Toska, Elona; Pantelic, Marija; Meinck, Franziska; Keck, Katharina; Haghighat, Roxanna; Cluver, Lucie
Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one reporting no
Full Text Available Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa.Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds, included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy, and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted.610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored <50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs, three
Haghighat, Roxanna; Cluver, Lucie
Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10–24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored <50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs
Mitchell, Jason; Lee, Ji-Young; Stephenson, Rob
As interest increases in the development of eHealth human immunodeficiency virus (HIV)-preventive interventions for gay male couples, Web-based methods must also be developed to help increase the likelihood that couples enrolled and data collected from them represent true unique dyads. Methods to recruit and collect reliable and valid data from both members of a couple are lacking, yet are crucial for uptake of novel sexual health and HIV-prevention eHealth interventions. Methods to describe best practices to recruit male couples using targeted advertisements on Facebook are also lacking in the literature, yet could also help in this uptake. The objective of our study was to describe challenges and lessons learned from experiences from two phases (developmental phase and online randomized controlled trial [RCT]) of an eHealth HIV-prevention intervention for concordant HIV-negative male couples in terms of (1) recruiting male couples using targeted advertisements on Facebook, (2) validating that data came from two partners of the couple, and (3) verifying that the two partners of the couple are in a relationship with each other. The developmental phase refined the intervention via in-person focus groups, whereas the pilot-testing phase included an online RCT. For both phases, couples were recruited via targeted Facebook advertisements. Advertisements directed men to a study webpage and screener; once eligible, participants provided consent electronically. A partner referral system was embedded in the consenting process to recruit the relationship partner of the participant. Both men of the couple had to meet all eligibility criteria-individually and as a couple-before they could enroll in the study. Verification of couples' relationships was assessed via the concurrence of predetermined screener items from both partners, done manually in the developmental phase and electronically in the pilot-testing phase. A system of decision rules was developed to assess the
Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried
Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall
Aantjes, C.J.; Rameran, L; Bunders-Aelen, J.G.F.
Objective: This study systematically reviews the literature on self-management interventions provided by health care teams, community partners, patients and families and discusses the potential relevance of these interventions for people living with HIV in sub-Saharan Africa. Methods: We searched
Sikkema, Kathleen J.; Ranby, Krista W.; Meade, Christina S.; Hansen, Nathan B.; Wilson, Patrick A.; Kochman, Arlene
Objective: To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated…
Visser, Maretha; Finestone, Michelle; Sikkema, Kathleen; Boeving-Allen, Alex; Ferreira, Ronel; Eloff, Irma; Forsyth, Brian
This paper describes the process of developing a parallel intervention for HIV-positive mothers and their young children (6-10 years) with a view to strengthening the relationship between them. Strong mother-child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research,…
Sales, J. M.; DiClemente, R. J.; Davis, T. P.; Sullivan, S.
Human immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females' lack of increase in condom use…
To design and evaluate a pilot intervention to promote self-management skills and work transition for persons with HIV/AIDS. The seven-week group intervention consisted of 1.5-hour bi-weekly sessions focused on goal setting and developing strategies to manage health, work and daily life routines while participating in a job skills training program in New York City. Six successive groups received the intervention over the course of two years (n = 53). Existing and newly-developed measures were used to examine key outcomes. Differences between pre-intervention and post-intervention scores on outcome measures were examined using paired-tests and effect sizes. Employment outcomes and participant satisfaction were examined post-intervention. The intervention was feasible to implement and sessions were viewed favorably by the majority of participants. Moderate to large effect sizes were found immediately post-intervention in participants' perceived ability to work and balance health, work and daily life. Fifty two percent of the participants were working part or full time and 41% were actively searching for employment at three to five months follow-up. Small effect sizes demonstrating improved outcomes at follow-up were found in symptom severity, self-advocacy and medication adherence self-efficacy. Small effect sizes demonstrating a potential decrement in outcomes at follow-up were found in participants' need satisfaction and perceived symptom impact on work performance. The results are promising, but further research is needed due to design limitations and the preliminary nature of the intervention and measures used. The potential decrement in outcomes might reflect a shift in participants' needs or view of how their health affected work performance and suggests that ongoing supports were needed post-intervention.
Dahye L Song
Full Text Available Two behavioral HIV prevention interventions for people who inject drugs (PWID infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+, a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+ Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST, to the status quo in the U.S.A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy.Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY, and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone.Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.
Conroy, Amy A.; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O.; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A.
Introduction Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. Methods This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012–2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners’ perceptions of power influences their own (i.e., actor effect) and their partner’s reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). Results For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women’s reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men’s reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women’s reports of intimacy and negatively associated with women’s reports of conflict. Conclusions Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level
Conroy, Amy A; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A
Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict. Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also
Rana, Yashodhara; Haberer, Jessica; Huang, Haijing; Kambugu, Andrew; Mukasa, Barbara; Thirumurthy, Harsha; Wabukala, Peter; Wagner, Glenn J; Linnemayr, Sebastian
This paper presents one of the first qualitative studies to discuss programmatic barriers to SMS-based interventions for HIV-positive youth and discusses pathways through which youth perceive them to work. We conducted six focus groups with 20 male and 19 female HIV-positive youths in two clinics in Kampala, Uganda. We find that youth commonly use SMS as over 90% of this study's youths knew how to read, write and send messages and almost three-fourths of them had phones. Youth strongly felt that the success of this intervention hinged on ensuring confidentiality about their HIV-positive status. Key programmatic challenges discussed where restrictions on phone use and phone sharing that could exclude some youth. Participants felt that the intervention would improve their adherence by providing them with needed reminders and social support. Youths' suggestions about intervention logistics related to content, frequency, timing and two-way messages will be helpful to practitioners in the field.
Ye, Shaodong; Xiao, Yan; Jin, Canrui; Cassell, Holly; Blevins, Meridith; Sun, Jiangping; Vermund, Sten H; Qian, Han-Zhu
To examine the impacts of a multi-city HIV prevention public health program (China Global Fund Round 5 Project) on condom use and HIV infection, we analyzed four yearly cross-sectional surveys from 2006 through 2009 among 20,843 men who have sex with men (MSM) in 16 Chinese cities. Self-reported condom use at last sex with a male partner increased from 58% in 2006 to 81% in 2009 (trend test, P<0.001). HIV prevalence increased from 2.3% in 2006 to 5.3% in 2009 (P<0.001). Multivariable logistic regression analysis showed that self-reported receipt of interventions was an independent predictor of increased condom use at last sex with a male partner over time (adjusted odds ratio [aOR], 1.63 in 2006 to 2.33 in 2009; P<0.001), and lower HIV prevalence (aOR, 1.08 in 2006 to 0.45 in 2009; P<0.001). HIV prevalence increased from 2006-2009 for participants with no self-reported receipt of interventions (2.1% in 2006 to 10.3% in 2009) and less so for those with interventions (2.4% to 4.7%). This Chinese public health program had positive impacts on both behaviors and disease rate among MSM population. Escalation of the coverage and intensity of effective interventions is needed for further increasing condom use and for reversing the rising trend of HIV epidemic.
Full Text Available Abstract Background HIV counselling and testing (HCT is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT. With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa. Methods Trained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake. Results Lay counsellors visited 3,328 households and tested 75% (5,086 of the 6,757 people met. The majority of testers (73.7% were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%, 2,123 (41.7%, and 818 (16.1% were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%; knowing his/her status (22.6%, being HIV-positive (18.5%, and not feeling at risk of having or acquiring HIV (10.1%. The distribution of reasons for refusal differed significantly by gender
Thapa, Subash; Hannes, Karin; Cargo, Margaret; Buve, Anne; Mathei, Catharina
Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries. A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework. This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose
Visher, Christy A; Hiller, Matthew; Belenko, Steven; Pankow, Jennifer; Dembo, Richard; Frisman, Linda K; Pearson, Frank S; Swan, Holly; Wiley, Tisha R A
The National Criminal Justice Drug Abuse Treatment Studies research program conducted cluster randomized trials to test an organizational process improvement strategy for implementing evidence-based improvements in HIV services for preventing, detecting, and/or treating HIV for individuals under correctional supervision. Nine research centers conducted cluster randomized trials in which one correctional facility used a modified Network for Improvement of Addiction Treatment (NIATx) change team approach to implementing improved HIV services and the other facility used their own approach to implement the improved HIV services. This paper examines whether the intervention increased the perceived value of HIV services among staff of correctional and community HIV organizations. Baseline and follow-up measures of the perceived acceptability, feasibility, and organizational support for implementing HIV service improvements were collected from correctional, medical, and community HIV treatment staff. Results indicated that the perceived acceptability and feasibility of implementing HIV services improved among staff in the facilities using the modified NIATx change team approach as compared to staff in the comparison facilities.
Alonzo, Jorge; Mann, Lilli; Tanner, Amanda E.; Sun, Christina J.; Painter, Thomas M.; Freeman, Arin; Reboussin, Beth A.; Song, Eunyoung; Rhodes, Scott D.
Objective The southeastern United States has the fastest-growing Hispanic/Latino population in the country and carries a disproportionate HIV burden. Among Hispanics/Latinos, men, and men who have sex with men (MSM) in particular, are at elevated risk of HIV infection; however, very few efficacious behavioral HIV prevention interventions are available for use with this vulnerable population. To address this shortage of prevention resources, our community-based participatory research (CBPR) partnership developed and is currently evaluating the efficacy of the HOLA en Grupos intervention to increase condom use and HIV testing among Hispanic/Latino MSM. Methods We recruited 304 Hispanic/Latino MSM who were randomized to receive the small group HOLA en Grupos intervention that was implemented during four 4-hour long sessions over four consecutive Sundays, or a 4-session small group general health education comparison intervention. At the end of the fourth session of the HOLA en Grupos intervention, the intervention facilitators asked participants to write down the sexual health-related behaviors they intended to change as a result of their participation. Results Qualitative analysis of the participants’ responses identified six types of intended behavior changes: increasing and maintaining condom use; identifying strategies to support correct and consistent condom use; increasing communication and negotiation with sexual partners about condom use; getting tested for HIV and other sexually transmitted infections; applying other sexual health promotion strategies; and sharing newly learned sexual health information with their peers. Conclusion Most risk-reduction intentions aligned with the intervention’s key messages of using condoms consistently and getting tested for HIV. However, participants’ stated intentions may have also depended on which behavior changes they perceived as most salient after participating in the intervention. Participants’ intentions to
Petersen, I; Hanass Hancock, J; Bhana, A; Govender, K
Co-morbid depression in HIV-positive patients on anti-retroviral (ART) treatment poses a public health threat. It compromises treatment adherence and accelerates disease progression. This study aimed to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care (PHC) in South Africa using a task shifting approach. Using a randomized control design, 76 HIV-positive patients with co-morbid depression were initially recruited. This reduced to 34 in the final cohort. Participants were assessed using the Patient Health Questionnaire (PHQ9), Hopkins Symptom Checklist (HSCL-25) and Multidimensional Scale of Perceived Social Support (MSPSS) at baseline and 3-month follow-up. The intervention was adapted from a local group-based Interpersonal Therapy (IPT) intervention. Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants. Repeated measures ANOVA analysis showed significantly greater improvement on depression scores on the PHQ9 in the intervention group compared to the control group. A significant decline in the mean scores on the HSCL-25 was found for both groups although this was more pronounced for the intervention group. There was no significant improvement in the MSPSS scores. The small sample size of the final cohort affected the power of the study to detect significant differences between the intervention and control groups on the MSPSS. Longer term impact of the intervention is unknown. These preliminary findings suggest that group-based counselling for depression in HIV-positive patients can potentially be effectively delivered by appropriately trained and supported lay HIV counsellors. The need for a larger trial is indicated. Copyright © 2014 Elsevier B.V. All rights reserved.
Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review.
Vrazo, Alexandra C; Firth, Jacqueline; Amzel, Anouk; Sedillo, Rebecca; Ryan, Julia; Phelps, B Ryan
Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low- and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade. Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour. CRD42017063816. Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n = 4) and those using lay cadres (n = 3) were most common. Other interventions included quality improvement (n = 2), mHealth (n = 1), and counselling (n = 1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants. Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are
on copper, aluminium, zinc, or brass. Field guide to sterilisation and High level. Disinfection: Techniques effective against HIV. After thorough cleaning, instruments should be sterilized by heat. (steam or dry heat). If sterilization is not possible, hi;gh-Ievel dis- infection by boiling is acceptable. Chemical disinfection must.
Shiferaw, Yitayal; Alemu, Abebe; Assefa, Abate; Tesfaye, Berihun; Gibermedhin, Etsegenet; Amare, Misiker
The university environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. Despite recently gained decline of the overall incidence of HIV infection, still significant proportion of youth population are at high risk of HIV infection. The aims of this study were to assess the perception of HIV risk and factors associated with risk perception among students at University of Gondar, Northwest Ethiopia. A cross sectional study was conducted between February and April, 2012 among health science students. A total of 384 students were involved in the study using stratified sampling technique. Chi-square test and logistic regression analysis were employed. P-value students, 200(52.1%) were females. Out of the total study respondents, 202(52.6%) were sexually experienced. One hundred and nine (59.2%) out of 184 males and 93(46.5%) out of 200 females had had sexual experience. About 23(57.5%) of those age below 20 years, 70(52.2%) of 20-24 years old, and 13(61.9%) of those ages of 25 years or older were perceived themselves as if they have no chance of acquiring HIV infection. Students initiated sexual intercourse at early age (≤8 years) were significantly associated with having multiple partnerships (crude OR =3.6, p = 0.002 for male and crude OR = 1.7, p = 0.04 for female). Statistically significant difference was observed in the distribution of condom use during sexual intercourse among various age groups (p-value = 0.001). Sexual initiation at younger age, having multiple partnerships, inconsistent condom use and alcohol and/or drug abuse were significantly perceived as predictor for an increased risks for HIV infection. Students were engaged in various HIV risk behaviors. Early sexual initiation and alcohol and/or drug abuse were important factors for having multiple partnerships. Poor agreement between having HIV risk behaviors and perception of HIV risk were observed. Attention has to be
Bhatta, Dharma Nand; Liabsuetrakul, Tippawan
We developed a comprehensive and culturally applicable empowerment intervention social self-value package with an aim to assess its efficacy in order to improve the quality of life (QoL) of HIV infected people receiving antiretroviral treatment. Participants were randomly allocated to receive either six weekly intervention sessions or standard care. Nonlinear mixed-effects models were performed to compare changes in empowerment scores over time. Between September and November 2014, 1447 individuals were screened, of whom 132 were randomly assigned to either the intervention or control group. The mean scores of empowerment, social support and quality of life increased and stigma scores were reduced in the intervention group at 3- and 6-months. An intervention effect on social support, stigma and QoL was significantly increased by time and group with low and high empowerment. No adverse events were reported. The empowerment intervention was efficacious in improving QoL of HIV infected people.
McBride, Cami K.; Baptiste, Donna; Traube, Dorian; Paikoff, Roberta L.; Madison-Boyd, Sybil; Coleman, Doris; Bell, Carl C.; Coleman, Ida; McKay, Mary M.
Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth’s exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smit...
Lightfoot, Alexandra F; Taggart, Tamara; Woods-Jaeger, Briana A; Riggins, Linda; Jackson, Melvin R; Eng, Eugenia
African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY's relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY's core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent-child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities.
Vermund, Sten H; Sheldon, Emily K; Sidat, Mohsin
The global HIV pandemic began to expand rapidly in southern Africa a decade later than was noted in central Africa, Europe, the Caribbean, and North America. Multiple factors played a role in this rapid expansion which led Southern Africa to become the most heavily afflicted region for HIV/AIDS globally. In this issue of Current HIV/AIDS Reports, investigators with active research interests in the region have reviewed key elements of the causes of and responses to the epidemic. Putative causes of the high HIV prevalence in the region are discussed, including host and viral biology, human behavior, politics and policy, structural factors, health services, health workforce, migration, traditional healers' role, and other issues. Regional epidemiological trends are described and forecasted. Issues related to the continuum of HIV care and treatment are highlighted. We hope that the reviews will prove useful to those policymakers, health care workers, and scientists who are striving to reduce the burden of HIV in the southern African region, as well as prove insightful for key issues of broader global relevance.
Magaly M Blas
Full Text Available Although many men who have sex with men (MSM in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing.We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were 'intention to get tested' and 'HIV testing at the clinic.'In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR: 2.77, 95% Confidence Interval (CI: 1.42-5.39. After a mean of 125.5 days of observation (range 42-209 days, 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001. In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the text-based intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74-3.20. At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40-2.85.This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations.Clinicaltrials.gov NCT00751192.
Brown, Darren; Claffey, Austin; Harding, Richard
HIV is characterised by episodes of disability. We report a novel, hospital outpatient rehabilitation intervention, combining physiotherapy-led group exercise and education for people living with HIV (PLWH). This observational study evaluated routine delivery of the 10-week intervention in terms of referral patterns, rehabilitation goals, intervention adherence and change in patient outcomes. Measurements at baseline & 10 weeks included locomotor performance (6 minute walk test; 6MWT), flexibility, upper and lower limb strength and health related quality of life (HRQOL). Adherence was defined as attending ≥8/20 sessions, with reasons for non-adherence identified in retrospective telephone interviews. Goal Attainment Scale measured progression to individual goals. Total 92 referrals were mostly for musculoskeletal (25.0%), oncological (19.6%) or cardio-metabolic (18.5%) reasons, and mostly male (81.5%), Caucasian (70.7%) and older (mean 51.5 years). Common themed rehabilitation goals included improving body image, participation, mobility, health/fitness and function. Adherence was achieved by 42 (46%) patients, with open access utilised by 34 patients, returning (n = 19) or restarting when non-adherent (n = 15). Post-intervention measurements collected for 37 (40%) patients demonstrated improvements in 6MWT distance (p < .001), flexibility (p < .001), strength in triceps (p < .001), biceps (p < .001), Lattisimus Dorsi (p < .001), shoulder-press (p < .001), chest-press (p < 0.001), and leg-press (p < 0.001). HRQOL improved in total score (p < .001), physical (p < .001), emotional (p < .001) and functional (p = .065) subscales. Extent of goal achievement demonstrated 83% of goals was "expected" (n = 57), "somewhat more" (n = 31) or "much more" (n = 14). Reasons for non-adherence from 21 telephone interviews identified physical health challenges, individual factors and time or location issues. This novel rehabilitation approach for PLWH improved function, HRQOL and
Arora, Paul; Nagelkerke, Nico J D; Moineddin, Rahim; Bhattacharya, Madhulekha; Jha, Prabhat
We examined if increased spending and coverage of female sex worker (FSW) interventions were associated with declines in HIV or syphilis risk among young pregnant women (as a proxy for new infections in the general population) in the high-burden southern states of India. Repeated cross-sectional analysis. We used logistic regression to relate district-level spending, number of sexually transmitted infections (STIs) treated, FSWs reached or condoms distributed to the declines in the annual risk of HIV and syphilis from 2003 to 2008 among prenatal clinic attendees in the four high-HIV burden states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. 386 961 pregnant women aged 15-24 years (as a proxy for incident infections in the adult population). We examined National AIDS Control Organisation (NACO) data on 868 FSW intervention projects implemented between 1995 and 2008. HIV or syphilis infection. HIV and syphilis prevalence declined substantially among young pregnant women. Each additional STI treated (per 1000 people) reduced the annual risk of HIV infection by -1.7% (95% CI -3.3 to -0.1) and reduced the annual risk of syphilis infection by -10.9% (95%CI -15.9 to -5.8). Spending, FSWs reached or condoms distributed did not reduce HIV risk, but each was significantly associated with reduced annual risk of syphilis infection. There were no major differences between the NACO-funded and Avahan-funded districts in the annual risk of either STI. Targeted FSW interventions are associated with reductions in syphilis risk and STI treatment is associated with reduced HIV risk. Both more and less costly FSW interventions have comparable effectiveness.
Córdova, David; Mendoza Lua, Frania; Ovadje, Lauretta; Hong, Ethan; Castillo, Berenice; Salas-Wright, Christopher P
HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth. The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth. We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included. Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed. ©David Córdova, Frania Mendoza Lua, Lauretta Ovadje, Ethan Hong, Berenice Castillo, Christopher P Salas-Wright. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 13.12.2017.
Full Text Available Abstract Background While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people’s sexual behavior, HIV knowledge and attitudes. Methods In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention and Rwamagana (control. Students (n = 1950 in eight intervention and six control schools participated in three surveys (baseline, six and twelve months in the intervention. Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score. Results The overall retention rate was 72%. Time trends in sexual risk behavior (being sexually active, sex in last six months, condom use at last sex were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. It did significantly reduce reported stigma. Conclusions Analyzing this and other interventions, we identified several reasons for the observed limited effectiveness of peer education: 1 intervention activities (spreading information are not tuned to objectives (changing behavior; 2 young people prefer receiving HIV information from other sources than peers; 3 outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored. Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators’ role as focal points for sensitization and referral to experts and services. Finally, we argue that a
Lazarus, Jeffrey V; Sihvonen-Riemenschneider, Henna; Laukamm-Josten, Ulrich; Wong, Fiona; Liljestrand, Jerker
To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union. For this systematic review, we examined interventions that aimed at STI risk reduction and health promotion conducted in schools, clinics, and in the community for reported effectiveness (in changing sexual behavior and/or knowledge) between 1995 and 2005. We also reviewed study design and intervention methodology to discover how these factors affected the results, and we compiled a list of characteristics associated with successful and unsuccessful programs. Studies were eligible if they employed a randomized control design or intervention-only design that examined change over time and measured behavioral, biologic, or certain psychosocial outcomes. Of the 19 studies that satisfied our review criteria, 11 reported improvements in the sexual health knowledge and/or attitudes of young people. Ten of the 19 studies aimed to change sexual risk behavior and 3 studies reported a significant reduction in a specific aspect of sexual risk behavior. Two of the interventions that led to behavioral change were peer-led and the other was teacher-led. Only 1 of the 8 randomized controlled trials reported any statistically significant change in sexual behavior, and then only for young females. The young people studied were more accepting of peer-led than teacher-led interventions. Peer-led interventions were also more successful in improving sexual knowledge, though there was no clear difference in their effectiveness in changing behavior. The improvement in sexual health knowledge does not necessarily lead to behavioral change. While knowledge may help improve health-seeking behavior, additional interventions are needed to reduce STIs among young people.
Pires Araujo, Elaine S; Khalili Friedman, Ruth; Bastos Camacho, Luis Antonio; Derrico, Monica; Ismério Moreira, Ronaldo; Amaral Calvet, Guilherme; Santini de Oliveira, Marília; Gonçalves Veloso, Valdilea; Pilotto, José Henrique; Grinsztejn, Beatriz
To describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV) mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009. This is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated. The study population is young (median: 26 years; interquartile range: 22.0-31.0), with low monthly family income (40.4% up to one Brazilian minimum wage) and schooling (62.1% less than 8 years). Only 47.1% (n=469) knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n=289), 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%), with no definite trend in the period. Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country. Copyright © 2014. Published by Elsevier Editora Ltda.
Petersen, Maya; Balzer, Laura; Kwarsiima, Dalsone; Sang, Norton; Chamie, Gabriel; Ayieko, James; Kabami, Jane; Owaraganise, Asiphas; Liegler, Teri; Mwangwa, Florence; Kadede, Kevin; Jain, Vivek; Plenty, Albert; Brown, Lillian; Lavoy, Geoff; Schwab, Joshua; Black, Douglas; van der Laan, Mark; Bukusi, Elizabeth A; Cohen, Craig R; Clark, Tamara D; Charlebois, Edwin; Kamya, Moses; Havlir, Diane
Antiretroviral treatment (ART) is now recommended for all HIV-positive persons. UNAIDS has set global targets to diagnose 90% of HIV-positive individuals, treat 90% of diagnosed individuals with ART, and suppress viral replication among 90% of treated individuals, for a population-level target of 73% of all HIV-positive persons with HIV viral suppression. To describe changes in the proportions of HIV-positive individuals with HIV viral suppression, HIV-positive individuals who had received a diagnosis, diagnosed individuals treated with ART, and treated individuals with HIV viral suppression, following implementation of a community-based testing and treatment program in rural East Africa. Observational analysis based on interim data from 16 rural Kenyan (n = 6) and Ugandan (n = 10) intervention communities in the SEARCH Study, an ongoing cluster randomized trial. Community residents who were 15 years or older (N = 77 774) were followed up for 2 years (2013-2014 to 2015-2016). HIV serostatus and plasma HIV RNA level were measured annually at multidisease health campaigns followed by home-based testing for nonattendees. All HIV-positive individuals were offered ART using a streamlined delivery model designed to reduce structural barriers, improve patient-clinician relationships, and enhance patient knowledge and attitudes about HIV. Primary outcome was viral suppression (plasma HIV RNAHIV-positive individuals, assessed at baseline and after 1 and 2 years. Secondary outcomes included HIV diagnosis, ART among previously diagnosed individuals, and viral suppression among those who had initiated ART. Among 77 774 residents (male, 45.3%; age 15-24 years, 35.1%), baseline HIV prevalence was 10.3% (7108 of 69 283 residents). The proportion of HIV-positive individuals with HIV viral suppression at baseline was 44.7% (95% CI, 43.5%-45.9%; 3464 of 7745 residents) and after 2 years of intervention was 80.2% (95% CI, 79.1%-81.2%; 5666 of 7068 residents), an
Full Text Available Wah Fung Tse,1 Weimin Yang,2 Wenlong Huang1,3 1School of International Pharmaceutical Business, China Pharmaceutical University, 2Editorial Department of Journal of Nanjing University of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, 3Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, People's Republic of China Background: Since its introduction in 1996, highly active antiretroviral therapy (HAART, which involves the combination of antiretroviral drugs, has resulted in significant improvements in the morbidity, mortality, and life expectancy of HIV-infected patients. Numerous studies of the cost-effectiveness of HAART from different perspectives in HIV have been reported.Aim: To investigate the economic outcomes and relevance of HAART for people living with HIV.Materials and methods: A narrative literature review was conducted on 22 peer-reviewed full economic evaluations of people living with HIV treated with different HAART regimens and published in English between January 2005 and December 2014. Information regarding study details, such as interventions, outcomes, and modeling methods, was extracted. The high heterogeneity of the included studies rendered a meta-analysis inappropriate; therefore, we conducted a comparative analysis of studies grouped according to the similarity of the different intervention types and outcomes.Results: Most of the economic evaluations of HAART focused on comparisons between the specific HAART regimens and others from the following perspectives: injecting drug users versus noninjecting drug users, HIV-infected adults without AIDS versus those with AIDS, regimens based on developed world guidelines versus those based on developing world guidelines, self-administered HAART versus directly observed HAART, and “ideal” versus “typical” regimens.Conclusion: In general, HAART is more cost-effective than other therapeutic
Burgos, José L.; Gaebler, Julia A.; Strathdee, Steffanie A.; Lozada, Remedios; Staines, Hugo; Patterson, Thomas L.
Background Previous research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico, cities on Mexico's border with the US. We assessed this intervention's cost-effectiveness. Methodology and Principal Findings A life-time Markov model was developed to estimate HIV cases prevented, changes in quality-adjusted life expectancy (QALE), and costs per additional quality-adjusted life year gained (QALY), comparing (in US$2,009) no intervention to a once-only and annual intervention. Future costs and health benefits were discounted annually at 3%. Sensitivity analyses evaluated model robustness. We found that for a hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV cases prevented and 5.7 months of QALE gained compared to no intervention. The additional cost per QALY gained was US$183. For FSWs receiving the intervention annually, there were 29 additional HIV cases prevented and 4.5 additional months of QALE compared to the once-only intervention. The additional cost per QALY was US$1,075. When highly active antiretroviral therapy (HAART) was included in the model, the annual intervention strategy resulted in net savings and dominated both once-only and no intervention strategies, and remained robust across extensive sensitivity analyses. Even when considering clinical benefits from HAART, ignoring added costs, the cost per QALY gained remained below three times the Mexican GDP per capita, and below established cost-effectiveness thresholds. Conclusions/Significance This brief intervention was shown to be cost-effective among FSWs in two Mexico-US border cities and may have application for FSWs in other resource-limited settings. Trial Registration ClinicalTrials.gov NCT00338845 PMID:20617193
José L Burgos
Full Text Available Previous research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs among female sex workers (FSWs in Tijuana and Ciudad Juarez, Mexico, cities on Mexico's border with the US. We assessed this intervention's cost-effectiveness.A life-time Markov model was developed to estimate HIV cases prevented, changes in quality-adjusted life expectancy (QALE, and costs per additional quality-adjusted life year gained (QALY, comparing (in US$2,009 no intervention to a once-only and annual intervention. Future costs and health benefits were discounted annually at 3%. Sensitivity analyses evaluated model robustness. We found that for a hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV cases prevented and 5.7 months of QALE gained compared to no intervention. The additional cost per QALY gained was US$183. For FSWs receiving the intervention annually, there were 29 additional HIV cases prevented and 4.5 additional months of QALE compared to the once-only intervention. The additional cost per QALY was US$1,075. When highly active antiretroviral therapy (HAART was included in the model, the annual intervention strategy resulted in net savings and dominated both once-only and no intervention strategies, and remained robust across extensive sensitivity analyses. Even when considering clinical benefits from HAART, ignoring added costs, the cost per QALY gained remained below three times the Mexican GDP per capita, and below established cost-effectiveness thresholds.This brief intervention was shown to be cost-effective among FSWs in two Mexico-US border cities and may have application for FSWs in other resource-limited settings.ClinicalTrials.gov NCT00338845.
Irungu, Elizabeth M.; Heffron, Renee; Mugo, Nelly; Ngure, Kenneth; Katabira, Elly; Bulya, Nulu; Bukusi, Elizabeth; Odoyo, Josephine; Asiimwe, Stephen; Tindimwebwa, Edna; Celum, Connie; Baeten, Jared M.
Background Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP would maximize impact and minimize costs. Methods The Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1 prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a ...
Full Text Available Abstract Background China has 76.2 million high school and college students, in which the number of reported HIV/AIDS cases is increasing rapidly. Most of these cases are attributed to male-to-male sexual contact. Few studies have explored HIV prevalence and behavioural characteristics of Chinese male students who have sex with men (MSM. Methods A cross-sectional study of MSM high school and college students in Liaoning Province was conducted. Data were collected through face-to-face interviews and blood specimens were obtained and tested for HIV and syphilis. Results There were 436 eligible participants. HIV and syphilis prevalence was 3.0% and 5.0%, respectively. In multivariate analysis, sexual orientation known by family members (OR: 7.3; 95% CI: 1.5-34.6, HIV/AIDS information obtained from clinical doctors (OR: 6.7; 95% CI: 1.7-25.9, HIV/AIDS information obtained through free educational services and materials such as voluntary counseling and testing (VCT and condom distribution services (OR: 0.2; 95% CI: 0.4-1.0, inconsistent condom use (OR: 5.7; 95%: 1.3-25.3, sexual partner experienced anal bleeding after insertive anal intercourse (OR: 6.8; 95% CI: 1.6-28.4, and history of illegal drug use (OR: 18.9; 95% CI: 2.2-165.3 were found to be significantly associated with HIV infection. Conclusions Greater effort should be made towards stemming the HIV and syphilis epidemics among Chinese student MSM. Immediate screening and comprehensive interventions towards student MSM should be implemented in order to curb the spread of HIV. Family and school-based interventions should be considered to target this educated, yet vulnerable, population.
Rhodes, Scott D.; Hergenrather, Kenneth C.; Bloom, Fred R.; Leichliter, Jami S.; Montaño, Jaime
Background Latinos in the United States are at increased risk for HIV and sexually transmitted disease (STD) infection. We evaluated the efficacy of a pilot, lay health advisor (LHA) intervention designed to increase condom use and HIV testing among Latino men. Methods Fifteen LHAs (mean age=35.6; range 23–60 years) from 15 Latino soccer teams were trained and worked with their teammates for 18 months. Another 15 teams served as the control group. Data were collected at baseline and 18-months post-LHA training from a random sample of teammates from intervention and control teams. Results Data were collected from 222 men (mean age=29 years) who participated in one of the 30 teams. Relative to the control condition, participants in the intervention reported more consistent condom use in the 30 days preceding follow-up (unadjusted analysis, intervention, 65.6% vs. control, 41.3%; P<.001). Participants in the intervention were more likely to report condom use (adjusted odds ratio=2.3; CI=1.2–4.3) and HIV testing (adjusted odds ratio=2.5; CI=1.5–4.3). Conclusions LHA interventions for Latino men that are developed in partnership with community members, rely on male-centered intrapersonal networks, and are culturally congruent can enhance preventive behaviors and may reduce HIV infection. PMID:19824838
Rhodes, Scott D; Hergenrather, Kenneth C; Bloom, Fred R; Leichliter, Jami S; Montaño, Jaime
Latinos in the United States are at increased risk for HIV and sexually transmitted disease (STD) infection. We evaluated the efficacy of a pilot lay health adviser (LHA) intervention designed to increase condom use and HIV testing among Latino men. Fifteen LHAs (mean age = 35.6; range 23-60 years) from 15 Latino soccer teams were trained and worked with their teammates for 18 months. Another 15 teams served as the control group. Data were collected at baseline and at 18 months post-LHA training from a random sample of teammates from intervention and control teams. Data were collected from 222 men (mean age = 29 years) who participated in one of the 30 teams. Relative to the control condition, participants in the intervention reported more consistent condom use in the 30 days preceding follow-up (unadjusted analysis, intervention, 65.6% vs. control, 41.3%; p < .001). Participants in the intervention were more likely to report condom use (adjusted odds ratio [AOR] = 2.3; confidence interval [CI = 1.2-4.3) and HIV testing (AOR = 2.5; CI = 1.5-4.3). LHA interventions for Latino men that are developed in partnership with community members, rely on male-centered intrapersonal networks, and are culturally congruent can enhance preventive behaviors and may reduce HIV infection.
Full Text Available Abstract Background Modern combination antiretroviral therapy (cART has improved survival for people living with HIV (PLWHIV. Non-AIDS comorbidities have replaced opportunistic infections as leading causes of mortality and morbidity, and are becoming a key health concern as this population continues to age. The aim of this study is to estimate the prevalence and incidence of non-AIDS comorbidity among PLWHIV in Denmark in the cART era and to determine risk factors contributing to the pathogenesis. The study primarily targets cardiovascular, respiratory, and hepatic non-AIDS comorbidity. Methods/design The Copenhagen comorbidity in HIV-infection (COCOMO study is an observational, longitudinal cohort study. The study was initiated in 2015 and recruitment is ongoing with the aim of including 1500 PLWHIV from the Copenhagen area. Follow-up examinations after 2 and 10 years are planned. Uninfected controls are derived from the Copenhagen General Population Study (CGPS, a cohort study including 100,000 uninfected participants from the same geographical region. Physiological and biological measures including blood pressure, ankle-brachial index, electrocardiogram, spirometry, exhaled nitric oxide, transient elastography of the liver, computed tomography (CT angiography of the heart, unenhanced CT of the chest and upper abdomen, and a number of routine biochemical analysis are uniformly collected in participants from the COCOMO study and the CGPS. Plasma, serum, buffy coat, peripheral blood mononuclear cells (PBMC, urine, and stool samples are collected in a biobank for future studies. Data will be updated through periodical linking to national databases. Discussion As life expectancy for PLWHIV improves, it is essential to study long-term impact of HIV and cART. We anticipate that findings from this cohort study will increase knowledge on non-AIDS comorbidity in PLWHIV and identify targets for future interventional trials. Recognizing the demographic
Liu, Xiaona; Erasmus, Vicki; Wu, Qing; Richardus, Jan Hendrik
Background Floating populations have been repeatedly characterized as “the tipping point” for the HIV epidemic in China. This study aims to systematically summarize and assess the effectiveness of HIV prevention interventions in floating populations in China over the past decade. Methods We conducted a systematic search in three international databases for literature published between 2005 and 2012 with condom use as the primary outcome, and knowledge about HIV transmission and prevention and stigma towards HIV-infected individuals as secondary outcomes. The impact of interventions on changing the primary and secondary outcomes was calculated by risk difference (RD). We also performed subgroup analyses and meta-regression based on different study characteristics, using Stata 12.0, for the primary outcome. Results Sixteen studies (out of 149) involved 19 different programs and a total of 10,864 participants at entry from 11 provinces in China. The pooled effect estimate of all studies indicated that people participating in HIV-related interventions were 13% more likely to use condoms (95%CI: 0.07, 0.18), however, the effects on increasing condom use exhibited significant heterogeneity across programs (P<0.01, I 2 = 0.93). The meta-regression results suggest that interventions have been significantly less successful in changing condom use in more recent studies (β, 0.14; 95%CI: 0.01, 0.27), adjusted for sexual relationship, study design and follow-up period. Regarding the secondary outcomes, HIV-related interventions were successful at improving knowledge about HIV transmission and prevention (RD, −0.26; 95%CI: −0.36, −0.16 and RD, −0.25; 95%CI: −0.33, −0.16, respectively), and decreasing stigma (RD, 0.18; 95%CI: 0.09, 0.27). Conclusions The included studies between 2005 and 2012 indicate that HIV prevention interventions among Chinese floating populations in the past decade were only marginally effective at increasing condom use, but relatively
Cropsey, Karen L; Hendricks, Peter S; Jardin, Bianca; Clark, C Brendan; Katiyar, Nandan; Willig, James; Mugavero, Michael; Raper, James L; Saag, Michael; Carpenter, Matthew J
PLHIV have higher rates of smoking and lower motivation to quit smoking; thus to impact smoking rates, cessation interventions need to be acceptable to a wider range of PLHIV smokers as well as feasible to implement in a busy clinical setting. The purpose of this study was to evaluate the acceptability, feasibility, and effects of a Screening, Brief Intervention, and Referral for Treatment (SBIRT) model in an HIV/AIDS clinic among a sample of PLHIV. PLHIV smokers (N=40) were randomized at baseline, irrespective of their self-reported discrete smoking cessation motivation status, to receive either 8-weeks of combination nicotine replacement therapy (NRT) in conjunction with brief counseling (SBIRT framework) (n=23) or usual care (n=17). Smoking outcome measures included cigarettes smoked per day, nicotine dependence, smoking urge, and smoking withdrawal symptoms. The SBIRT intervention appeared to be acceptable and feasible, and produced medium to large reductions in cigarettes smoked per day, physical nicotine dependence, smoking urge, and smoking withdrawal symptoms, even for smokers not ready to quit within 6months. Findings provide preliminary support for the integration of an SBIRT model in an HIV/AIDS clinic setting to screen and provide active treatment to all smokers, regardless of readiness to quit smoking. Given the high prevalence and incredible health burden of continued smoking in this population, identifying brief and effective interventions that are easily translated into clinical practice represents an enormous challenge that if met, will yield significant improvements to overall patient outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.
Tsai, Laura Cordisco; Witte, Susan S; Aira, Toivgoo; Altantsetseg, Batsukh; Riedel, Marion
This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women's economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women's capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants' increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia.
Shukla, Anuprita; Teedon, Paul; Cornish, Flora
In global health initiatives, particularly in the context of private philanthropy and its 'business minded' approach, detailed programme data plays an increasing role in informing assessments, improvements, evaluations, and ultimately continuation or discontinuation of funds for individual programmes. The HIV/AIDS literature predominantly treats monitoring as unproblematic. However, the social science of audit and indicators emphasises the constitutive power of indicators, noting that their effects at a grassroots level are often at odds with the goals specified in policy. This paper investigates users' experiences of Monitoring and Evaluation (M&E) systems in the context of HIV interventions in western India. Six focus groups (totalling 51 participants) were held with employees of 6 different NGOs working for government or philanthropy-funded HIV interventions for sex workers in western India. Ten donor employees were interviewed. Thematic analysis was conducted. NGO employees described a major gap between what they considered their "real work" and the indicators used to monitor it. They could explain the official purposes of M&E systems in terms of programme improvement and financial accountability. More cynically, they valued M&E experience on their CVs and the rhetorical role of data in demonstrating their achievements. They believed that inappropriate and unethical means were being used to meet targets, including incentives and coercion, and criticised indicators for being misleading and inflexible. Donor employees valued the role of M&E in programme improvement, financial accountability, and professionalising NGO-donor relationships. However, they were suspicious that NGOs might be falsifying data, criticised the insensitivity of indicators, and complained that data were under-used. For its users, M& E appears an 'empty ritual', enacted because donors require it, but not put to local use. In this context, monitoring is constituted as an instrument of
Bazzi, Angela Robertson; Fergus, Kirkpatrick B; Stephenson, Rob; Finneran, Catherine A; Coffey-Esquivel, Julia; Hidalgo, Marco A; Hoehnle, Sam; Sullivan, Patrick S; Garofalo, Robert; Mimiaga, Matthew J
Background An estimated one- to two-thirds of new human immunodeficiency virus (HIV) infections among US men who have sex with men (MSM) occur within the context of primary partnerships. Thus, HIV interventions that recognize and harness the power of relationships are needed. Increasingly, HIV prevention efforts are being directed toward improving engagement across the HIV care continuum from testing to linkage to care, antiretroviral therapy (ART) adherence, engagement in care, and viral sup...
Su, Puyu; Tao, Fangbiao; Sun, Ying; Hao, Jiahu
To evaluate the effect of intervention project of mental health promotion in paid blood donors with AIDS/HIV infected adults in Anhui countryside. About 41 HIV/AIDS infected adults were invited to take part in the intervention project. The project was put into practice by ways of multimedia course and group participation with the handbook of mental health promotion intervention for HIV/AIDS infected adults. All participants (41 intervention objects and 21 control objects) completed an anonymous questionnaire before and after the intervention. Depression, anxiety, self-esteem and coping style were evaluated by Center for Epidemiologic Studies Depression Scale, Self-Rating Anxiety Scale, Self-Esteem Scale and Simplified Coping Style Questionnaire. There were 35.5% of the 62 blood donors without taking any education. There were 46.7% of them need to partially or completely rely on government grants and loans. Before intervention the rates of depression and anxiety, the scores of positive coping, negative coping and self-esteem were not significantly different between study group and control group (P > 0.05). After intervention the rates of depression and anxiety in study group were lower than those in control group and with significant difference. The scores of positive coping and self-esteem in study group were higher than those in control group, but the score of negative coping was contrary to them (P self-esteem (P Age was the influence factor for the intervention on depression, negative coping. Level of education was the influence factor for the intervention on depression, anxiety and self-esteem intervention. Gender was the influence factor for the intervention on positive coping. All objects reported that they liked the intervention project of mental health promotion and liked the interactive form of education. Psychological intervention to improve the response capacity and mental health of paid blood donors with HIV/AIDS infected adults in countryside has a
Sweat, Michael; Kerrigan, Deanna; Moreno, Luis; Rosario, Santo; Gomez, Bayardo; Jerez, Hector; Weiss, Ellen; Barrington, Clare
Behavior change communication often focuses on individual-level variables such as knowledge, perceived risk, self-efficacy, and behavior. A growing body of evidence suggests, however, that structural interventions to change the policy environment and environmental interventions designed to modify the physical and social environment further bolster impact. Little is known about the cost-effectiveness of such comprehensive intervention programs. In this study we use standard cost analysis methods to examine the incremental cost-effectiveness of two such interventions conducted in the Dominican Republic in sex establishments. In Santo Domingo the intervention was environmental; in Puerto Plata it was both environmental and structural (levying financial sanctions on sex establishment owners who failed to follow the intervention). The interventions in both sites included elements found in more conventional behavior change communication (BCC) programs (e.g., community mobilization, peer education, educational materials, promotional stickers). One key aim was to examine whether the addition of policy regulation was cost-effective. Data for the analysis were gleaned from structured behavioral questionnaires administered to female sex workers and their male regular paying partners in 41 sex establishments conducted pre- and post-intervention (1 year follow-up); data from HIV sentinel surveillance, STI screening results conducted for the intervention; and detailed cost data we collected. We estimated the number of HIV infections averted from each of the two intervention models and converted these estimates to the number of disability life years saved as compared with no intervention. One-way, two-way, three-way, and multivariate sensitivity analysis were conducted on model parameters. We examine a discount rate of 0%, 3% (base case), and 6% for future costs and benefits. The intervention conducted in Santo Domingo (community mobilization, promotional media, and interpersonal
Lim, Raymond B T; Cheung, Olive N Y; Tai, Bee Choo; Chen, Mark I-C; Chan, Roy K W; Wong, Mee Lian
We assessed the efficacy of a multicomponent culturally tailored HIV/STI prevention intervention programme on consistent condom use and STI incidence among foreign Thai and Vietnamese female entertainment workers (FEWs) in Singapore. We conducted a quasi-experimental pretest and post-test intervention trial with a comparison group. We recruited 220 participants (115 Vietnamese and 105 Thai) for the comparison group, followed by the intervention group (same number) from the same sites which were purposively selected after a 3-month interval period. Both groups completed a self-administered anonymous questionnaire and STI testing for cervical gonorrhoea and Chlamydia, as well as pharyngeal gonorrhoea at baseline and 6-week follow-up. The peer-led intervention consisted of behavioural (HIV/STI education and condom negotiation skills), biomedical (STI screening and treatment services) and structural components (access to free condoms). We used the mixed effects Poisson regression model accounting for clustering by establishment venue to compute the adjusted risk ratio (aRR) of the outcomes at follow-up. At follow-up, the intervention group was more likely than the comparison group to report consistent condom use for vaginal sex with paid (aRR 1.77; 95% CI 1.71 to 1.83) and casual (aRR 1.81; 95% CI 1.71 to 1.91) partners. For consistent condom use for oral sex, this was aRR 1.50; 95% CI 1.23 to 1.82 with paid and aRR 1.54; 95% CI 1.22 to 1.95 with casual partners. STI incidence at follow-up was significantly lower in the intervention (6.8 per 100 FEWs) than the comparison (14.8 per 100 FEWs) group (aRR 0.42; 95% CI 0.32 to 0.55). This trial was effective in promoting consistent condom use for vaginal and oral sex as well as reducing STI incidence among the foreign Thai and Vietnamese FEWs in Singapore. The feasibility of scaling up the interventions to all entertainment establishments in Singapore should be assessed. © Article author(s) (or their employer
O'Brien, Kelly K; Bayoumi, Ahmed M; Solomon, Patricia; Tang, Ada; Murzin, Kate; Chan Carusone, Soo; Zobeiry, Mehdi; Nayar, Ayesha; Davis, Aileen M
Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0-8 months), participants will be monitored bimonthly. In the intervention phase (8-14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14-22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of
Gurnani, Vandana; Beattie, Tara S; Bhattacharjee, Parinita; Mohan, H L; Maddur, Srinath; Washington, Reynold; Isac, Shajy; Ramesh, B M; Moses, Stephen; Blanchard, James F
Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Stigma, discrimination, violence, harassment and social equity issues are
Full Text Available Abstract Background Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media and primary stakeholders (FSWs themselves. The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Methods Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. Results The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Conclusions Stigma
Hill, William Allen; McNeely, Clea
This manuscript examines the HIV/AIDS health disparity among African-American (AA) men who have sex with men (MSM) as compared to non-Hispanic White (NHW) MSM, and proposes faith-based intervention strategies as a means of reducing the disparity. Effective faith-based HIV/AIDS intervention programs to encompass AA MSM must include community-based participatory research; engage the faith community through data sharing; specifically target and equip church leaders in addition to laity; involve effective collaboration and compromise between public health practitioners and faith leaders; emphasize spirituality and compassion; utilize popular opinion leaders; and be intergenerational.
Dukers-Muijrers Nicole HTM
Full Text Available Abstract Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre services were integrated to provide sexual health counselling and sexually transmitted infections (STIs testing and treatment (sexual health care to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254, and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals. Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.
Mi, Guodong; Wu, Zunyou; Wang, Xiaodong; Shi, Cynthia X; Yu, Fei; Li, Tian; Zhang, Linglin; McGoogan, Jennifer M; Pang, Lin; Xu, Jie; Rou, Keming
The men who have sex with men (MSM) population in China has experienced a recent increase in HIV incidence. Due to the dual stigma and discrimination towards homosexuality and HIV infection, most MSM living with HIV/AIDS are hard to reach by offline intervention initiatives. We recruited HIV-positive MSM participants in Chengdu, China and assessed whether they disclosed their HIV status to partners, motivated a partner to receive testing, used condoms consistently, or initiated antiretroviral therapy. Participants were quasi-randomized to either the intervention or control arm. The intervention group was given instructions for an online program with four modules: an information exchange website, a bulletin board system, individualized online counseling with trained peer educators, and an animation game. All participants were re-assessed at 6 months. The study enrolled 202 HIV-positive MSM. The intervention group had significant increases in disclosing their HIV status to their partners (76.0% vs 61.2%, P=0.0388) and motivating partners to accept HIV testing (42.3% vs 25.5%, P=0.0156) compared with the control group, but there were no between-group differences in receiving early treatment or using condoms consistently. We found that a web-based intervention targeting HIV-positive MSM was an effective tool in increasing the uptake of HIV testing within this high-risk population.
Ciara E O'Reilly
Full Text Available In 2009, basic care packages (BCP containing health products were distributed to HIV-infected persons in Ethiopia who were clients of antiretroviral therapy clinics. To measure health impact, we enrolled clients from an intervention hospital and comparison hospital, and then conducted a baseline survey, and 7 bi-weekly home visits. We enrolled 405 intervention group clients and 344 comparison clients. Intervention clients were more likely than comparison clients to have detectable chlorine in stored water (40% vs. 1%, p<0.001, soap (51% vs. 36%, p<0.001, and a BCP water container (65% vs. 0%, p<0.001 at every home visit. Intervention clients were less likely than comparison clients to report illness (44% vs. 67%, p<0.001 or health facility visits for illness (74% vs. 95%, p<0.001, and had lower median illness scores (1.0 vs. 3.0, p<0.05. Participation in the BCP program appeared to improve reported health outcomes.
Mugweni, Esther; Omar, Mayeh; Pearson, Stephen
Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify…
Martin, C. Andrew
This paper presents the findings of a qualitative study designed to describe the experience of HIV medication adherence using a mobile phone application. For the purpose of this qualitative study, nine semi-structured focus group discussions were conducted over a three-month period at an AIDS service organization in Central Texas. The data were…
Kelcey, Ben; Shen, Zuchao
A key consideration in planning studies of community-based HIV education programs is identifying a sample size large enough to ensure a reasonable probability of detecting program effects if they exist. Sufficient sample sizes for community- or group-based designs are proportional to the correlation or similarity of individuals within communities.…
Eloff, Irma; Finestone, Michelle; Forsyth, Brian
A secondary study was conducted within a broader National Institutes of Health (NIH)-funded longitudinal study on resilience in South African mothers and children affected by HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome). The aim of this study was to evaluate the effect of a 24-week support group intervention…
Full Text Available Introduction. Early infant diagnosis (EID of human immunodeficiency virus (HIV ensures prompt treatment and infant survival. In Kaabong Hospital, 20% of HIV exposed infants (HEIs had access to HIV diagnosis by eight weeks. We aimed to improve EID of HIV by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR testing by eight weeks from 20 to 100% between June 2014 and November 2015. Method. In this quality improvement (QI project, EID data was reviewed, gaps prioritized using theme matrix selection, root causes analyzed using fishbone tool, and improvement changes were selected using counter measures matrix but implemented using Plan-Do-Study-Act cycle. Root causes of low first DNA-PCR testing included maternal EID ignorance, absent lost mother-baby pairs (LMBP tracking system, and no EID performance reviews. Health education, Continuous Medical Education (CMEs, and integration of laboratory and EID services were initial improvement changes used. Results. DNA-PCR testing increased from 20 to 100% between June 2014 and July 2015 and was sustained at 100% until February 2016. Two declines, 67% in September 2014 and 75% in June 2015, due to LMBP were addressed using expert clients and peer mothers, respectively. Conclusion. Formation of WIT, laboratory service integration at MBCP, and task shifting along EID cascade improved EID outcomes at 6 weeks.
Health extension workers, school teachers, youth AIDS club members and the radio were found to be key sources of HIV information. Yet, these sources .... chosen using a lottery method. With an application of population ..... that they are not as mobile as men who migrate with livestock in search of water and pasture and ...
Wang, Jichuan; Siegal, Harvey A.; Falck, Russel S.; Carlson, Robert G.; Rahman, Ahmmed
Demonstrates how the latent growth model can be applied to the evaluation of programs targeting HIV risk behavior among drug users. Multigroup piecewise latent growth models were fit to longitudinal data with three repeated response measures. Participants were 430 drug users and their sex partners. (SLD)
This study was conducted to examine the effect of the Betegna radio (diary-show) programme in mitigating the tide of HIV related stigma and discrimination which are considered a prominent factor that worsens the impact of the epidemic in Ethiopia. The study employed qualitative Individual In-depth Interviews and Focus ...
sharp and skin piercing objects as modes of transmission. Adjusted logistic regression of association revealed that knowledge on modes of HIV transmission is significantly limited among women (AOR=2.0; 95% CI=1.1-3.3) those who reside in Arero and Teltele Districts. (AOR=5.3; 95% CI=2.8-10.0) and those who do not.
Wijk, J.P.H. van
The focus of this thesis is on two aspects of metabolic dysregulation, type 2 diabetes mellitus and HIV-lipodystrophy, and the effects of insulin-sensitizing agents. Thiazolidinediones (TZDs) have received increasing attenttion for the treatment of hyperglycemia in type 2 diabetes. Currently,
Rhodes, Scott D; Leichliter, Jami S; Sun, Christina J; Bloom, Fred R
Hispanics/Latinos in the United States are affected disproportionately by human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), and other sexually transmitted diseases (STDs); however, few effective evidence-based prevention interventions for this population exist. This report describes the Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) (HoMBReS) intervention, which was developed by a community-based, participatory research partnership in North Carolina and initially implemented during 2005-2009. HoMBReS is an example of an effective intervention that uses lay health advisors (known as Navegantes [navigators]) in the context of existing social networks (i.e., recreational soccer teams) to promote consistent condom use and HIV and STD testing among Hispanic/Latino men. In 2012, HoMBReS was classified as a best-evidence community-level HIV prevention intervention (CDC. Compendium of evidence-based behavioral interventions and best practices for HIV prevention. Atlanta, GA: US Department of Health and Human Services, CDC; 2015). The intervention has been implemented elsewhere, enhanced, and further evaluated in longitudinal intervention and implementation studies. HoMBReS has been adapted for other populations, including men who have sex with men and transgender persons. Additional evaluation has found that Navegantes continue in their roles as health advisors, opinion leaders, and community advocates after study support ends. Hispanic/Latino men's social networks can be leveraged to promote sexual health within the community by decreasing HIV risk behaviors among Hispanics/Latinos in the United States.
Rao, Deepa; Desmond, Michelle; Andrasik, Michele; Rasberry, Tonya; Lambert, Nina; Cohn, Susan E; Simoni, Jane
Observational studies have examined the prevalence and impact of internalized stigma among African American women living with HIV, but there are no intervention studies investigating stigma reduction strategies in this population. Based on qualitative data previously collected, we adapted the International Center for Research on Women's HIV Stigma Toolkit for a domestic population of African American women to be consistent with Corrigan's principles of strategic stigma change. We implemented the intervention, led by an African American woman living with HIV, as a workshop across two afternoons. The participants discussed issues "triggered" by videos produced specifically for this purpose, learned coping mechanisms from each other, and practiced them in role plays with each other. We pilot tested the intervention with two groups of women (total N=24), measuring change in internalized stigma with the Stigma Scale for Chronic Illness before and after workshop participation. Sixty-two percent of the participants self-reported acquiring HIV through heterosexual sexual contact, 17% through intravenous drug use, 4% in utero, and 13% did not know the route of transmission. The intervention was feasible, enthusiastically accepted by the women, and led to decreased stigma from the start of the workshop to the end (p=0.05) and 1 week after (p=0.07) the last session of workshop. Findings suggest the intervention warrants further investigation.
Bhatta, Dharma Nand; Liabsuetrakul, Tippawan; McNeil, Edward B
Improvement in quality of life is crucial for HIV infected people. Social and behavioral interventions have been implemented in different contexts to improve the quality of life among HIV infected people. This review appraises the evidence for available interventions that focused on quality of life of HIV infected people receiving antiretroviral therapy (ART). We searched electronic databases for randomized controlled trials of interventions to improve the quality of life of HIV infected people receiving ART. We searched PUBMED and the Cochrane Centre Register of Controlled Trials (CENTRAL) with the terms "social", "behavioral", "educational", "quality of life", "HIV", and "RCT". Searches were conducted for articles published from 1980 to December 16, 2015. Standardized data abstraction methods and searching steps were applied. Twenty-eight studies reported the impact of social or behavioral interventions in quality of life among HIV infected people, of which 15 were conducted in United States of America. A total of 4136 participants were enrolled. Of the 28 studies, four studies included females, two studies included males and remaining studies excluded both males and females. The overall reported methodological quality of the studies was subject to a high risk of bias and the study criteria were unclear in most studies. Twenty-one studies reported a significant intervention effect on at least one quality of life domain. Meta-analyses showed significant improvement in general health, mental health, physical function and environment domains of quality of life among intervention groups. However, the expected impact of the intervention was low to moderate because the rigorousness of the studies was low, information was limited, the sample sizes were small and other the quality of the study designs were poor. Although the available evidence suggests that existing social and behavioral interventions can improve some quality of life domains, the quality of evidence was
Meade, Christina S; Drabkin, Anya S; Hansen, Nathan B; Wilson, Patrick A; Kochman, Arlene; Sikkema, Kathleen J
Few interventions exist to reduce alcohol and non-injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV-positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use. Participants were assigned randomly to the experimental coping group or a time-matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90-minute sessions. A diverse sample of 247 HIV-positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City. Substance use was assessed pre- and post-intervention and every 4 months during a 12-month follow-up period. Using an intent-to-treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations. At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ²(₄)=10.77, P = 0.029) and any cocaine use (Wald χ²(₄) = 9.81, P = 0.044) overtime. Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12-month follow-up. Integrating mental health treatment into HIV prevention may improve outcomes. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
Amirkhanian, Yuri A.; Kelly, Jeffrey A.; Takacs, Judit; McAuliffe, Timothy L.; Kuznetsova, Anna V.; Toth, Tamas P.; Mocsonaki, Laszlo; DiFranceisco, Wayne J.; Meylakhs, Anastasia
Objective To test a novel social network HIV risk reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections. Design A 2-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling. Setting St. Petersburg, Russia and Budapest, Hungary. Participants 18 “seeds” from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen 3-ring sociocentric networks (mean size=35 members, n=626) were recruited. Intervention Empirically-identified network leaders were trained and guided to convey HIV prevention advice to other network members. Main Outcome and Measures Changes in sexual behavior from baseline to 3- and 12-month followup, with composite HIV/STD incidence measured at 12-months to corroborate behavior changes. Results There were significant reductions between baseline, first followup, and second followup in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (P=.04); UAI with a nonmain partner (P=.04); and UAI with multiple partners (P=.002). The mean percentage of unprotected AI acts significantly declined (P=.001), as well as the mean number of UAI acts among men who initially had multiple partners (P=.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks. Conclusions Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks. PMID:25565495
Full Text Available Background: The study site started its roll-out of the human immunodeficiency virus (HIV prevention of mother-to-child transmission in 2006. All patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medicines were collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and acquired immune deficiency syndrome (AIDS. Thus a dedicated antiretroviral pharmacy managed by a pharmacist was established to support the counsellors. Objectives: The objective of the study was to assess the impact of a pharmacist intervention on the knowledge gained by HIV and AIDS patients with regard to the disease, antiretroviral drug use (i.e. how the medication is taken, its storage and the management of side effects as well as adherence to treatment.Method: This study was undertaken at a public sector hospital using anonymous structured questionnaires and was divided into three phases: pre-intervention, intervention and postintervention phases. After obtaining patient consent the questionnaires were administered during the first phase. A month later all patients who visited the pharmacy were counselled intensely on various aspects of HIV and antiretroviral medication. Thereafter patients who participated in Phase 1 were asked to participate in the second phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre-intervention and post-intervention stages by using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar’s Chi-square test (Binary or McNemar-Bowker test for ordinal variables.Results: Overall the mean knowledge score on the disease itself had increased significantly (s.d. 6.6%, (p < 0.01, after the pharmacists’ intervention (pre-intervention was 82.1% and post-intervention
Ranebennur, Virupax; Gaikwad, Sanjeevsingh; Ramesh, Sowmya; Bhende, Amrita
Background It is important for targeted interventions to consider vulnerabilities of female sex workers (FSWs) such as poverty, work-related mobility, and literacy, for effective human immunodeficiency virus (HIV) prevention. This paper describes and examines the association of the Aastha HIV/sexually transmitted infection (STI) prevention project in Mumbai and Thane, India, on the relationship between vulnerability and behavioral outcomes. Materials and methods Data were drawn from the Behavioural Tracking Survey, a cross-sectional behavioral study conducted in 2010 with 2,431 FSWs recruited in Mumbai and Thane. The key independent measures used were program exposure and “vulnerability index”, a composite index of literacy, factors of dependence (alternative livelihood options, current debt, and children), and aspects of sex work (mobility and duration in sex work). Dependent measures included service uptake, self-confidence, self-identity, and individual agency. Logistic regression analysis was used to examine the study objectives. Results Of the analytical sample of 2,431 FSWs, 1,295 (53.3%) were categorized as highly vulnerable. Highly vulnerable FSWs who were associated with the Aastha program for more than a year were more likely to have accessed crisis-response services in the past 6 months (adjusted odds ratio [AOR] 2.2, 95% confidence interval [CI] 1.4–3.6; P<0.001), to have visited a clinic to get a checkup for STI symptoms (AOR 2.4, 95% CI 1.2–4.8; P<0.015), not to be ashamed to disclose identity as an FSW to health workers (AOR 2.1, 95% CI 1.2–3.5; P<0.008), and to be confident in supporting a fellow FSW in crisis (AOR 1.7, 95% CI 1.0–2.8, P<0.033) compared to those less vulnerable with similar exposure to the Aastha program. Conclusion It is critical for HIV/STI interventions to consider vulnerabilities of FSWs at project inception and address them with focused strategies, including a segmented service-delivery model and community
Kerrigan, Deanna; Moreno, Luis; Rosario, Santo; Gomez, Bayardo; Jerez, Hector; Barrington, Clare; Weiss, Ellen; Sweat, Michael
Objectives. We assessed the effectiveness of 2 environmental–structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic. Methods. Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention–postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings. Results. Significant increases in condom use with new clients (75.3%–93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%–28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%–16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers’ verbal rejections of unsafe sex (50.0%–79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments’ ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22). Conclusions. Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers. PMID:16317215
Jongbloed, Kate; Friedman, Anton J; Pearce, Margo E; Van Der Kop, Mia L; Thomas, Vicky; Demerais, Lou; Pooyak, Sherri; Schechter, Martin T; Lester, Richard T; Spittal, Patricia M
Despite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers. The Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat. Culturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way m
Cordova, David; Alers-Rojas, Francheska; Lua, Frania Mendoza; Bauermeister, Jose; Nurenberg, Rachel; Ovadje, Lauretta; Fessler, Kathryn; Delva, Jorge; Salas-Wright, Christopher P; Council