Assessing the Effectiveness of Multilevel Intervention Sequences on "Tension" Among Men Living with HIV: A Randomized-Control Trial.

BACKGROUND: Tension (often times called "Tenshun" in Hindi) is a cultural expression used to convey feelings of distress and common mental disorders in India and among South Asia communities. This study compared the effectiveness of different intervention sequences in reducing tension among alcohol-consuming men living with HIV in India. METHOD: This secondary data analysis paper utilized data from a randomized trial study titled "Alcohol and Antiretroviral Therapy (ART) Adherence: Assessment, Intervention, and Modeling in India." The multilevel interventions, including individual counseling (IC), group intervention (GI), and collective advocacy (CA), were conducted sequentially over three cycles at three ART centers. Additionally, another ART center, serving as a pilot site, received all three interventions simultaneously in the final cycle. Participants completed surveys assessing demographic characteristics, tension, and other variables including HIV stigma, a 4-day ART adherence, HIV symptoms, and depressive symptoms at four time points: baseline, 9 months, 18 months, and 24 months. General linear mixed models were employed to assess the intervention effects on tension. RESULTS: Out of 940 participants, 666 reported experiencing tension, including 54% reporting high tension. At site 1, the GI-CA-IC sequence resulted in a slope of -0.06, indicating that this sequence reduced tension from T1 to T4 compared to the control group (p < 0.01). Additionally, the pilot site where the intervention package was conducted simultaneously had a slope of -0.06, indicating that the intervention package also reduced tension compared to the control group (p < 0.01). Conversely, the CA-IC-GI sequence resulted in a slope of 0.07, indicating that this sequence resulted in significantly higher tension levels than the control group (p = 0.008) contrary to the expectation that the sequence would reduce tension. CONCLUSION: This study contributes valuable insights on the issue of tension among alcohol-consuming men living with HIV. The significant reduction in tension observed at the site using the GI-CA-IC sequence, which began with a group intervention, underscores the importance of intervention order and the importance of group intervention within multilevel intervention programs for tension reduction. Further research is needed to validate these observations and broaden our understanding of effective tension management strategies among people living with HIV in diverse settings. TRIAL REGISTRATION: URL: clinicaltrials.gov. REGISTRATION NUMBER: NCT03746457.

Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal.

Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy that remarkably reduces HIV transmission risk. Although PrEP has been available in Nepal since 2019, very little is known about PrEP use among MSM in Nepal. This study aimed to examine PrEP awareness and its use among Nepali MSM and the factors influencing its adoption. A cross-sectional survey was conducted among MSM in Nepal between October and December 2022 (N = 250). Bivariate analysis and logistic regression were performed to determine factors associated with awareness and use of PrEP. In the study population, 59.6% of participants were aware of PrEP, however, only 30.4% of them had utilized it. The odds of PrEP awareness were higher among participants who had completed high school or above (aOR = 4.1; 95% CI = 1.8-9.6), those with health insurance coverage (aOR = 6.9; 95% CI = 2.1-22.3) and had tested for HIV (aOR = 21.2; 95% CI = 8.3-53.9). Similarly, participants who identified as gay (aOR = 3.4; 95% CI = 1.4-8.4), had visited a doctor within the past 6 months (aOR = 2.9; 95% CI = 1.2-6.5), had previously tested for HIV (aOR = 12.3; 95% CI = 3.4-44.7), and had been diagnosed with sexually transmitted infections (aOR = 7.0; 95% CI = 2.5-19.5) were more likely to have used PrEP. Our results highlight the critical importance of healthcare providers engaging in providing care for MSM, including facilitating as well as discussions about PrEP. In addition, there is a pressing need for innovative strategies (e.g., peer educators, social media, online facilitating technologies) to disseminate PrEP knowledge and reduce stigma surrounding PrEP.

Alcohol Use, HIV Stigma and Quality of Life Among Alcohol Consuming Men Living with HIV in India: A Mediation Analysis.

This study examined the hypothesis that HIV-related stigma mediates the effect of alcohol use on health-related quality of life (HRQoL) among alcohol consuming Indian men living with HIV (PLWH). The study used baseline data from a randomized controlled clinical trial entitled 'Alcohol and ART adherence: Assessment, Intervention, and Modeling in India. Participants completed surveys assessing demographic characteristics, alcohol use, HIV-related stigma, HRQoL. Mediation analysis was conducted to establish the mediation effect of HIV-related stigma on the relationship between alcohol use and HRQoL. The final mediation model showed that the effect of alcohol use on HRQoL were partially mediated by overall HIV-related stigma. Specially, 27.1% of the effects of alcohol use on HRQoL was mediated through overall HIV stigma. In the HIV stigma subdomain analyses, negative self-image mediated 14% and concerns with public attitudes (anticipated stigma) mediated 17.3% of the effect of alcohol use on HRQoL respectively. The findings suggest that efforts to reduce the negative impact of alcohol use on HRQoL and improve HRQoL among PLWH should include interventions addressing both alcohol use and specific forms of HIV-related stigma.

RESUMEN: Este estudio examinó la hipótesis de que el estigma relacionado con el VIH mediaría el efecto del consumo de alcohol en la calidad de vida relacionada con la salud entre hombres indios que consumen alcohol y viven con VIH. El estudio utilizó datos de línea base de un ensayo clínico aleatorizado controlado titulado "Consumo de alcohol y adherencia al TAR: evaluación, intervención y modelización en India". Los participantes completaron encuestas que evaluaron características demográficas, consumo de alcohol, estigma relacionado con el VIH y calidad de vida relacionada con la salud (CVRS). Se realizó un análisis de mediación para establecer el efecto de la mediación del estigma relacionado con el VIH en la relación entre el consumo de alcohol y la CVRS. El modelo final de mediación mostró que el efecto del consumo de alcohol en la CVRS fue parcialmente mediado por el estigma general relacionado con el VIH. Específicamente, el 27,1% de los efectos del consumo de alcohol en la CVRS se medió a través del estigma general relacionado con el VIH. En los análisis de subdominios del estigma del VIH, la imagen negativa de sí mismo medió el 14% y las preocupaciones sobre las actitudes públicas (estigma anticipado) mediaron el 17,3% del efecto del consumo de alcohol en la CVRS, respectivamente. Los resultados sugieren que los esfuerzos para reducir el impacto negativo del consumo de alcohol en la CVRS y mejorar la CVRS entre las personas que viven con VIH deberían incluir intervenciones que aborden tanto el consumo de alcohol como formas específicas de estigma relacionado con el VIH.

Living with respiratory viruses: The next saga in human/viral coexistence?

Testing for respiratory viruses and SARS-CoV-2 in clinical and epidemiological settings has contrasting purposes and utility. Symptomatic patients are best tested with respiratory virus panels to establish the pathogen and guide personalized treatment. Asymptomatic patients are tested for a single infectious pathogen to establish carrier status and guide containment.

Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones.

BACKGROUND: Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam. METHODS: A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants. RESULTS: The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations. CONCLUSIONS: Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.

High Interest in Long-acting Injectable Pre-exposure Prophylaxis (LAI-PrEP) for HIV Prevention Among Men Who Have Sex With Men (MSM): Result From A Nationwide Survey in Malaysia.

The recent approval of long-acting injectable cabotegravir (CAB-LA) as PrEP for HIV prevention could be an attractive alternative for MSM, particularly among those who face barriers to adherence using the oral pill. This study reports on the awareness of long-acting injectable PrEP (LAI-PrEP) and factors associated with interest in LAI-PrEP use among a nationwide sample of MSM in Malaysia. An online cross-sectional survey was conducted between August and September 2021 to explore perspectives on PrEP modalities among Malaysian MSM (N = 870). Convenience sampling was used to recruit participants using ads on two platforms hornet and facebook. While only 9.1% of the study participants were aware of LAI-PrEP, the majority had heard of oral PrEP (80.9%). After giving a description of it, a large majority (86.6%) expressed interest in using it if made accessible. Those who had a prior history of HIV testing (aOR = 1.9; 95% CI = 1.2-3.2) were more likely to use LAI-PrEP. Interestingly, despite the concerns related to potential high cost (aOR = 3.4; 95% CI = 2.1-5.5) and long-term side effects (aOR = 1.9; 95% CI = 1.2-3.1), the majority of the participants were interested in using LAI-PrEP. Those who were afraid of (or disliked) syringes were less interested in using it (aOR = 0.2; 95% CI; 0.1-0.4). In the recent context that LAI-PrEP was shown to be safe and effective at preventing HIV, our results indicate its potential relevance as an additional PrEP option that could accelerate the uptake and scale-up of PrEP. However, it is crucial to conduct future research urgently to improve the understanding of strategies that could enhance the accessibility, acceptability, and affordability of LAI-PrEP for MSM in low- and middle-income countries, including Malaysia.

Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India.

Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the efficacy of three multilevel interventions, individual counselling (IC), group intervention (GI) and collective advocacy (CA) for change, among HIV positive males who consume alcohol, treated at five ART Centers in urban Maharashtra, India. While GI shows a significant effect on the largest number of outcome variables, IC through its psychosocial emphasis demonstrated a significant impact over time on stigma and depression, and CA with its emphasis on societal change showed positive impact on stigma and advocacy for self and others. Each of the interventions had variable effects on CD4 count and viral load.Clinical Registration Number: NCT03746457; Clinical Trial.Gov.

RESUMEN: El consumo de alcohol tiene un efecto nocivo en el estado de salud de las personas que viven con VIH, afectando negativamente la adherencia a los antirretrovirales y aumentando el riesgo de transmisión del virus. El consumo de alcohol no es un comportamiento aislado, sino que está íntimamente relacionado con el estigma y el mal estado psicológico, entre otros factores. Este documento utiliza un diseño cruzado para evaluar la eficacia de tres intervenciones: asesoramiento individual, intervención grupal y defensa colectiva para el cambio, entre hombres con VIH que consumen alcohol que reciben tratamiento en cinco centros de terapia antiretroviral en la zona urbana de Maharashtra, India. Si bien la intervención grupal muestra un efecto significativo en el mayor número de variables de interés, el asesoramiento individual a través de su énfasis psicosocial demostró un impacto significativo en el estigma y la depression a largo plazo, y la defensa colectiva con su énfasis en el cambio social mostró un impacto positivo en el estigma y la defensa de sí mismo y otros.

Oral health-related quality of life outcomes in a randomized clinical trial to assess a community-based oral hygiene intervention among adults living in low-income senior housing.

BACKGROUND: Quality of life outcomes have been used frequently in clinical trials of oral health interventions. This study assessed the effects of a randomized trial on oral health related quality of life comparing an individual-based oral hygiene intervention to a community-based intervention. METHODS: Participants were recruited from six low-income senior housing residences. Buildings were randomly assigned to receive the individual-based intervention followed by the community-based intervention or to receive the community-based intervention followed by the individual intervention. Participants' oral hygiene was assessed at baseline (T0), one month after the first intervention (T1) and one month after the second intervention (T2) and six months after the T2 assessment (T3). Oral hygiene was measured by the Gingival Index (GI) and Plaque scores (PS). Surveys collected data on beliefs, attitudes, behaviors and self-reported health status at T0, T1 and T2. Only oral hygiene and quality of life, measured by the General Oral Health Assessment Index (GOHAI), was assessed at all time points. general linear mixed models (GLMM) were used to assess changes in GOHAI over time, the interaction of condition by time and the contribution of psychosocial, behavioral, health status and background variables to changes in GOHAI. RESULTS: 331 people completed T0 assessments; 306 completed T1; 285 completed T2 and 268 completed T3. Scores on GOHAI at T0 ranged from 10 to 48 with a mean of 39.7 (sd = 7.8) and a median of 42. At T1, mean GOHAI was 40.7 (sd = 8.2), at T2 mean GOHAI was 41.1 (sd = 7.8) and at T3, GOHAI was 42.3 (sd = 8.2). GLMM showed that GOHAI improved significantly from T0 to T3 (p = 0.01) but the time by intervention interaction was not significant indicating that both interventions were effective in improving GOHAI but one intervention was not better than the other. Ethnicity, health status, worries, self-efficacy, number of missing teeth and symptoms of dry mouth were related to improvements in GOHAI. Neither GI nor PS were related to GOHAI. CONCLUSIONS: The participants reported relatively good oral health related quality of life which improved significantly over time. Improvement occurred among all participants regardless of condition, suggesting that either intervention would be effective in future studies. TRIAL REGISTRY: Clinicaltrials.gov, Clinical Trials ID #NCT02419144; Title: A Bi-level Intervention to Improve Older Adult Oral Health Status; Registered 04/07/2015 URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005H9X&selectaction=Edit&uid=U0000KBK&ts=2&cx=-rajj5q.

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults.

BACKGROUND: This paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial. METHODS: Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs). Both were based on Fishbein's Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcomes were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics and ten mechanisms of change including oral health beliefs, attitudes, norms and behaviors. GLMM was used to assess the effects of time, intervention arm, participant characteristics, intervention mechanisms and differences between the two interventions over time in relation to outcomes. RESULTS: At baseline, both groups had similar background characteristics. Both groups improved significantly in outcomes. Overall GI scores changed from baseline mean of 0.38 (SD = .032) to .26 (SD = .025) and PS scores changed from baseline mean of 71.4 (SD = 18%) to 59.1% (SD = 21%). T-tests showed that fears of oral disease, oral health intentionality, oral health norms, worries about self-management of oral health, flossing frequency and sugar control improved significantly in both interventions from baseline to post intervention. Oral health self-efficacy, perceived risk of oral health problems, oral health locus of control and brushing frequency improved significantly only in the counseling intervention. GLMM models showed that the significant predictors of GI improvement were intentionality to perform oral hygiene, locus of control, and improvement in frequency of brushing and flossing in association with the counseling intervention. Predictors of PS improvement were worries about oral hygiene self-management and fear of oral diseases, in association with the counseling intervention. In the reduced final models, only oral health locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant in association with the counseling intervention. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI improvement. Fear, an emotional response, drove improvement in PS, reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions. CONCLUSIONS: Though both groups improved in outcomes, GI and PS outcomes improved more in response to the counseling intervention than the campaign. The counseling intervention had an impact on more mechanisms of change than the campaign. Improvements in intervention mechanisms across both interventions however, suggest a closer examination of the campaign intervention impact on outcomes over time. TRIAL REGISTRATION: Clinicaltrials.gov NCT02419144, first posted April 17, 2015.

Remote Peer Learning Between US and Cambodian Lay Health Workers to Improve Outcomes for Cambodians with Type 2 Diabetes: a Pilot Study.

BACKGROUND: This paper reports a single-group, pre-post pilot of a peer-learning intervention between community health workers (CHWs) in the USA and Village Health Support Guides (Guides) in Cambodia to improve outcomes for Cambodians with type 2 diabetes (T2D). METHOD: Two US-based CHWs were trained in a culturally derived cardiometabolic education curriculum called Eat, Walk, Sleep (EWS) and they were also trained in principles of peer learning. They in turn trained five Cambodia-based Guides remotely through videoconference with a phablet in EWS. Finally, Cambodia-based Guides met with 58 patients with diabetes, face-to-face in their villages, monthly for 6 months to deliver EWS. US-based CHWs and Cambodia-based Guides responded to surveys at baseline and post-treatment. Patients responded to surveys and provided blood pressure and blood samples at baseline and post-treatment. RESULTS: For US-based CHWs, scores on all surveys of diabetes knowledge, self-evaluation, job satisfaction, and information technology improved, though no statistical tests were run due to sample size. For Cambodia-based Guides, all scores on these same measures improved except for job satisfaction. For patients, n = 60 consented, 2 withdrew, and 7 were lost to follow-up leaving n = 51 for analysis. In paired t tests, patients showed significantly decreased A1c, decreased systolic and diastolic blood pressures, improved attitudes toward medicines, and a trend for switching from all-white to part-brown rice. No changes were detected in self-reported physical activity, medication adherence, sleep quality, or frequency or amount of rice consumed. CONCLUSION: If proven effective in a controlled trial, cross-country peer learning could eventually help other diaspora communities.

Gingivitis and plaque scores among residents of low-income senior housing.

OBJECTIVES: The purpose of this paper is to present Gingival Index (GI) and Plaque Scores (PS) of older and disabled adults living in low-income senior housing and their association with sociodemographic, health status and oral health behaviours. METHODS: Participants were recruited from six low-income senior housing residences in Connecticut. Primary outcome measures were Gingival Index (GI) and Plaque Scores (PS). Surveys assessed sociodemographic characteristic, beliefs and behaviours. Logistic regression analysis was used to model the binary outcomes of probability of unfavourable GI status (>=0.34) and unfavourable PS (>=74%) against variables including demographic characteristics, oral hygiene behaviours and health status. RESULTS: 331 participants volunteered for the study. Mean baseline GI was 0.38 (SD: 0.3), and mean PS was 71.7% (SD: 18%). Logistic regression showed that males were more likely to have higher GI and plaque scores than females. Those with less formal education were more likely to have worse GI scores and high PS compared to those with college educations. Those with lower incomes and those who rated their oral health poor/fair were more likely to have higher PS. CONCLUSION: Participants had remarkably good gingival health regardless of relatively high PS. Males and less educated individuals should receive special attention when implementing oral hygiene interventions because of their relatively poor oral hygiene status.

Building a new scale to measure worries about oral hygiene self-management in vulnerable older adults.

OBJECTIVE: This paper describes a new scale to measure worries about self-management of oral hygiene in low-income older adults. BACKGROUND: Oral hygiene that prevents oral diseases and worsening of chronic conditions improves with instruction, but other cognitive/emotional factors impede oral hygiene practice especially among older adults. Many scales measure dental anxiety, but none measures oral hygiene self-management worries. MATERIALS AND METHODS: Formative research with diverse older adults 55-95 in low-income housing identified scale items. A 23-item scale was tested in a pilot intervention study (n = 84) and formalised with a new sample (N = 331). RESULTS: In both studies, PCA/factor analysis produced two subscales: (a) worries about cleaning teeth and (b) consequences of cleaning. Chronbach's alpha coefficient evaluated internal consistency, and Pearson's r and Kendall tau/Spearman's rho evaluated scale predictability, convergent and divergent validity. The scale and subscales showed good internal consistency in both studies (over 0.90) and stability T0 0.90; T1: 0.90). In the larger sample, statistically significant correlations between the scale, subscales; plaque score, and similar scales (perceived risk of oral health problems, and fears of oral diseases) demonstrated convergent validity. For divergent validity, the worries scale, not the GOHAI, a similar scale measuring oral health life quality, was associated with Plaque Score. Each scale was associated with different mediators suggesting different constructs. CONCLUSION: The overall scale has good internal consistency, test-retest reliability, predictability and convergent and divergent validity. It captures a psycho-emotional construct useful in oral health research and hygiene education with older adults.

Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India.

Depression, as well as other psychosocial factors, remains largely unaddressed among people living with HIV (PLHIV) in low and middle-income countries. Depression is a common occurrence among PLHIV and is elevated in those who consume alcohol. This paper will document the presence of depressive symptoms in alcohol-consuming male PLHIV receiving antiretroviral treatment (ART) in India. It examines the correlates of depressive symptoms and uses the data from in-depth interviews to explain the nature of the statistical relationships obtained from an NIH-funded a multilevel, multi-centric intervention study. A cross-sectional, baseline survey was administered to 940 alcohol consuming, male PLHIV in five hospital-based ART Centers in urban Maharashtra, India via face to face interviews from October 2015 to April 2016. An additional 55 men were recruited independently to engage in in-depth interviews on alcohol use and other factors related to adherence. The results of the survey showed that approximately 38% of PLHIV reported having moderate to severe depressive symptoms. Depressive symptoms were positively associated with higher levels of family-related concerns (OR 1.18; 95% CI 1.12-1.23), work difficulties (OR 2.04; 95% CI 1.69-2.69) and HIV-related self-stigma (OR 1.05; 95% CI 1.03-1.07) and a lower level of ART service satisfaction (OR 0.58 95% CI 0.44-0.77). The results of in-depth interviews showed that PLHIV's tenshun (a Hindi term most closely corresponding to depressive symptoms) resulted from feelings of guilt and concerns about how family, friends, and neighbors might react to their HIV status and the potential for loss of a job as a result of disclosure of their HIV status at work. The level of depressive symptoms among male PLHIV involved in ART treatment points to the need to strengthen the psychological component of PLHIV treatment in India.

Sexual intimacy and marital relationships in a low-income urban community in India.

Data from a six-year study of married women's sexual health in a low-income community in Mumbai indicated that almost half the sample of 1125 women reported that they had a negative view of sex with their husbands. Qualitative interviews and quantitative survey data identified several factors that contributed to this diminished interest including: a lack of foreplay, forced sex, the difficulty of achieving privacy in crowded dwellings, poor marital relationships and communication, a lack of facilities for post-sex ablution and a strong desire to avoid conception. Women's coping strategies to avoid husband's demands for sex included refusal based on poor health, the presence of family members in the home and non-verbal communication. Factors that contributed to a satisfactory or pleasurable sexual relationship included greater relational equity, willingness on the part of the husband to not have sex if it is not wanted, a more 'loving' (pyaar karna) approach, women able to initiate sex and greater communication about sexual and non-sexual issues. This paper examines the ecological, cultural, couple and individual dynamics of intimacy and sexual satisfaction as a basis for the development of effective interventions for risk reduction among married women.

Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure.

People living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex but the connections among these events are correlational. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provide a fine grained understanding of how multiple behavioral risks coincide in time and space, explores concordance/discordance of measures with survey data and identifies potential recall bias. Data are drawn from a survey of behavior, knowledge and attitudes, and a 30 day TLFB assessment of multiple risk behaviors adapted for the Indian PLHIV context, administered to 940 alcohol-consuming, HIV positive men on ART at the baseline evaluation stage of a multilevel, multi-centric intervention study. On days participants drank they were significantly more likely to be medication non-adherent and to have unprotected sex. In the first day after their alcohol consuming day, the pattern of nonadherence persisted. Binge and regular drinking days were associated with nonadherence but only binge drinking co-occurred with unprotected sex. Asking about specific "drinking days" improved recall for drinking days and number of drinks consumed. Recall declined for both drinking days and nonadherence from the first week to subsequent weeks but varied randomly for sex risk. There was high concordance and low discordance between A-TLFB drinking and nonadherence but these results were reversed for unprotected sex. Moving beyond simple drinking-adherence correlational analysis, the A-TLFB offers improved recall probes and provides researchers and interventionists with the opportunity to identify types of risky days and tailor behavioral modification to reduce alcohol consumption, nonadherence and risky sex on those days.

Longitudinal trajectories of depressive symptoms among alcohol consuming men with HIV in India.

BACKGROUND: Depression and alcohol use are common among people living with HIV (PLWH) and associated with adverse outcomes. However, there is a paucity of studies exploring trajectories of depressive symptom presence over time among alcohol consuming men PLWH. METHODS: Men PLWH were repeatedly assessed for depressive symptoms from baseline through 27 months using the 10-item Center for Epidemiologic Studies-Depression scale. Group-based trajectory modeling was used to identify trajectories of depressive symptoms over time among control (n = 188) and intervention participants (n = 564). Multinomial logistic regression was used to explore the relationship between trajectory subgroups and baseline independent variables. RESULTS: Among intervention participants, the three subgroups were characterized as 'low' (85.8 % of the participants), 'fluctuating' (8.7 %), and 'persistently increasing' symptoms (5.5 %). Similarly, three trajectory subgroups among control participants were labeled as: "low" (54.4 %); "fluctuating" (33.5 %) and "persistently increasing'" (12.1 %). Among intervention participants, longer duration since HIV diagnosis (aOR: 1.05, 95 % CI: 1.01-1.12) and HIV-related stigma (aOR: 1.09, 95 % CI: 1.02-1.18) were associated with persistently increasing depressive symptoms trajectory. Further, alcohol drinking problems (aOR: 1.10, 95 % CI: 1.04-1.17) was associated with fluctuating depressive symptoms trajectory. Among control participants, only lower overall self-rated health status was associated with persistently increasing depressive symptoms trajectory (aOR: 0.96, 95 % CI: 0.93-0.99). LIMITATIONS: Selection bias; Information bias; Lack of causal interference; Generalizability. CONCLUSION: Identifying subgroups of men PLWH with different depressive symptoms trajectories may inform effective and tailored intervention approaches to address mental health treatment and prevention among alcohol consuming men PLWH in India and elsewhere.

Mediating role of food insecurity in the relationship between perceived MSM related stigma and depressive symptoms among men who have sex with men in Nepal.

BACKGROUND: Previous studies have indicated the association between stigma and depressive symptoms among frequently stigmatized groups, such as men who have sex with men (MSM). While this association has been suggested in the literature, there is a dearth of evidence that examines whether food insecurity statistically mediates the relationship between stigma and depressive symptoms. METHODS: This cross-sectional study conducted between October and December 2022 among a sample of 250 MSM in Kathmandu, Nepal, recruited through respondent-driven sampling. An unadjusted model including the exposure (stigma), mediator (food insecurity), and outcome variables (depressive symptoms) and an adjusted model that controlled for sociodemographic, behavioral, and health-related confounders were used. Bootstrapping was utilized to estimate the coefficients of these effects and the corresponding 95% confidence intervals. Via bootstrap approach, we find out the mediating role of food insecurity in the association between stigma and depressive symptoms. RESULTS: Depressive symptoms, stigma, and food insecurity were 19.6%, 24.4%, and 29.2%, respectively, among MSM. Food insecurity was associated with higher age (b = 0.094; 95% CI = 0.039, 0.150) and monthly income (b = -1.806; 95% CI = -2.622, -0.985). Depressive symptoms were associated with condom-less sex in past six months (b = -1.638; 95% CI = -3.041, -0.092). Stigma was associated with higher age (b = 0.196; 95% CI = 0.084, 0.323) and PrEP uptake (b = 2.905; 95% CI = 0.659. 5.248). Food insecurity statistically mediated 20.6% of the indirect effect of stigma in depressive symptoms. CONCLUSION: Our findings show that food insecurity affects the relationship between stigma and depressive symptoms in this population. Reducing food insecurity and addressing the stigma surrounding sexual orientation should be a priority when addressing mental health concerns among MSM in Nepal and other resource-limited countries with similar socio-cultural settings.

A U-shaped association between selenium intake and cancer risk.

While selenium is a cofactor of several antioxidant enzymes against cancer and is essential for human health, its excess intake may also be harmful. Though a safe intake of selenium has recently been recommended, it is not well understood in the Asian population. We aimed to determine the association between dietary intake of selenium and cancer risk in a case-control study of 3758 incident cancer cases (i.e., stomach, colon, rectum, lung cancers, and other sites) and 2929 control subjects in Vietnam. Daily intake of selenium was derived from a semiquantitative food frequency questionnaire. The unconditional logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selenium intake and cancer risk. We observed a U-shaped association between selenium intake and cancer risk. A safe intake ranged from 110.8 to 124.4 µg/day (mean 117.8 µg/day). Compared to individuals with the safe intake of selenium, individuals with the lowest intake (i.e., 27.8-77.2 µg/day) were associated with an increased risk of cancer (OR = 3.78, 95% CI 2.89-4.95) and those with the highest intake (169.1-331.7 µg/day) also had an increased cancer risk (OR = 1.86, 95% CI 1.45-2.39). A U-shaped pattern of association between selenium intake and cancer risk was stronger among participants with body mass index (BMI) < 23 kg/m2 and never smokers than BMI ≥ 23 kg/m2 and ever smokers (P'sheterogeneity = 0.003 and 0.021, respectively) but found in both never and ever-drinkers of alcohol (Pheterogeneity = 0.001). A U-shaped association between selenium intake and cancer risk was seen in cancer sites of the stomach, colon, rectum, and lung cancers. In summary, we found a U-shaped association between selenium intake and cancer risk and a safe selenium intake (mean: 117.8 µg/day) in the Vietnamese population. Further mechanistic investigation is warranted to understand better a U-shaped association between selenium intake and cancer risk.

The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India.

Heavy alcohol use is negatively affecting antiretroviral therapy adherence, mental health and health-related quality of life among people living with HIV (PLWH). This paper aims to test the mediation model examining whether changes in depression symptoms mediate in the relationship between health-related quality of life and alcohol use among male PLWH who consume alcohol in India. The study is guided by the stress-coping model, which posits that individuals facing stress may turn to maladaptive coping mechanisms such as alcohol use to alleviate their distress, which includes depression and a low health-related quality of life due to various physical, psychological, and social factors associated with the HIV infection. This study used the data from a randomized controlled clinical trial entitled 'Alcohol and ART adherence: Assessment, Intervention, and Modeling in India'. Participants completed surveys assessing demographic characteristics, health-related quality of life, depressive symptoms, and alcohol use. Multiple simple mediation models were investigated to examine whether changes in depression symptoms mediated the association between the changes in health-related quality of life and alcohol use after a 9-month follow-up. A total of 940 male PLWH were recruited and interviewed, with 564 participants in the intervention group and 376 participants in the control group. After a 9-month intervention, the mediation results showed that, among intervention participants, a decrease in depressiove symptoms mediated the relationship between improved health-related quality of life and lower alcohol use. However, among control participants, changes in depressive symptoms did not mediate the relationship between changes in health-related quality of life and alcohol use. The study findings have practical and theoretical implications. From a practical perspective, the results suggest that interventions aimed at simultaneously improving HRQoL and depressive symptoms among male PLWH with alcohol use may help reduce alcohol consumption. Therefore, interventions that address depressive symptoms in addition to improving HRQoL may have an even greater impact on reducing alcohol use among this population. Theoretically, the study supports the use of the stress-coping theory in understanding the association between HRQoL, mental health, and alcohol use among male PLWH, contributing to existing literature on a gap in our understanding of the interactions among these factors among PLWH.

Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam.

Background: Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. Methods: iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. Results: There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). Conclusions: The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.