A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV.

Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.

Strategies of Managing Repeated Measures: Using Synthetic Random Forest to Predict HIV Viral Suppression Status Among Hospitalized Persons with HIV.

The HIV/AIDS epidemic remains a major public health concern since the 1980s; untreated HIV infection has numerous consequences on quality of life. To optimize patients' health outcomes and to reduce HIV transmission, this study focused on vulnerable populations of people living with HIV (PLWH) and compared different predictive strategies for viral suppression using longitudinal or repeated measures. The four methods of predicting viral suppression are (1) including the repeated measures of each feature as predictors, (2) utilizing only the initial (baseline) value of the feature as predictor, (3) using the last observed value as the predictors and (4) using a growth curve estimated from the features to create individual-specific prediction of growth curves as features. This study suggested the individual-specific prediction of the growth curve performed the best in terms of lowest error rate on an independent set of test data.

Continuous successive cycles of biosorption and desorption of acid red 27 dye using water hyacinth leaves as an effective, economic, and ecofriendly biosorbent.

We investigated the capacity of water hyacinth leaves (LEC) to biosorb 75 mg/L acid red 27 (AR27) in a continuous system comprising 30 successive biosorption/desorption cycles in a packed-bed column at pH 2.0 and 56.5 L/m2·h volumetric flux. Using 0.025 M NaHCO3 eluent at 113 L/m2·h volumetric flux, all the dye was desorbed (100% desorption efficiency) from the loaded LEC biomass within 5-6 h. The same biosorbent was used for 147.5 consecutive days. The AR27 biosorption capacity, breakthrough time, and exhaustion time decreased from 69.4 to 34.5 mg/g, 74.81 to 14.1 h, and 101.1 to 34.1 h, respectively, and the critical bed height increased from 1.04 to 2.35 cm, as the number of biosorption/desorption cycles increased from 1 to 30. LEC life factor based on biosorption capacity predicted that the packed bed would be exhausted after 51.95 cycles. LEC is a promising biosorbent for bioremediation of AR27-laden wastewaters.

Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020.

Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).

Association of positive psychobehavioral factors and structural disadvantage with condomless sex in men who have sex men with childhood sexual abuse histories.

Previous research has highlighted both psychological and structural risk factors as correlates of condomless anal sex, a key pathway to HIV acquisition in men who have sex with men (MSM). Fewer studies have focused on positive psychobehavioral factors, which may be associated with more consistent condom use. This study hypothesized that positive psychobehavioral factors would be associated with more frequent condom use over and above psychological and structural risk factors. MSM with histories of childhood sexual abuse in Boston, MA and Miami, FL (N = 108) completed cross-sectional assessments of psychosocial, structural, and positive psychobehavioral factors. These factors were entered simultaneously in a linear regression model to examine their association with frequency of condomless sex. More recent seroadaptive behavior (B = 0.323, 95% CI = 0.055-0.590, p = .019) and receipt of government benefits to supplement income (B = 0.892, 95% CI = 0.171-1.612, p = .016) were independently associated with higher frequency of condomless sex over and above all other psychosocial, structural, and positive psychobehavioral factors. R2 for the final model was 0.270. Ancillary analyses including participants taking and adherent to biomedical HIV prevention suggested an association between higher distress tolerance and lower frequency of condomless sex. Positive psychobehavioral factors may potentially lower risk for HIV in high-risk MSM; however, left unaddressed, structural disadvantage is a potent influence which may limit potential benefits.

Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder.

BACKGROUND: Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. METHODS: CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. RESULTS: Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001). CONCLUSIONS: Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

Tryptophan depletion predicts lower positive affect in sexual minority men living with HIV who use methamphetamine.

This longitudinal study with 76 sexual minority men living with HIV who use methamphetamine examined whether dysregulation of essential amino acid precursors for neurotransmitters at baseline predicted positive and negative affect at 15 months. After controlling for covariates including baseline positive affect, a higher baseline kynurenine/tryptophan (K/T) ratio independently predicted lower positive affect at 15 months (ß = - 18.31; 95% CI = - 35.35, - 1.27; p = 0.036). Future clinical research should examine whether bio-behavioral interventions targeting tryptophan degradation could optimize treatments for people living with co-occurring HIV and stimulant use disorders.

Understanding Willingness to Participate in HIV Biomedical Research: A Mixed Methods Investigation.

Biomedical research often enrolls people living with HIV (PLWH) receiving effective treatment to complete invasive procedures. This mixed methods study characterized determinants of willingness to undergo specific biomedical procedures among PLWH. In 2017, 61 participants (77% Black) from Miami completed a quantitative assessment examining willingness to participate. A subset of 19 participants completed an in-depth qualitative interview. Across all procedures, there was greater willingness to participate if asked by a primary care provider and if experimental results were shared. However, half of participants reported that they would experience undue influence (i.e., excessive persuasion) to participate from their primary care provider. In thematic analyses, altruism and personal benefit were identified as facilitators while medication changes, confidentiality, and perceived stigma were identified as barriers to participation in HIV biomedical research. Addressing participants' expectations and mitigating potential undue influence from primary care providers could optimize the ethical conduct of HIV biomedical studies.

Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests.

Black women living with HIV (BWLWH) in the U.S. face microaggressions based on race, gender, HIV-status, and sexual orientation. We examined changes in daily microaggressions and related distress among 143 BWLWH in Miami, FL. Microaggression-related distress increased from 52% at baseline/October, peaked at 70% during the holidays (November/December), declined to 55% in March when COVID-19 social distancing began, and peaked to 83% in June/July 2020 during widespread Black Lives Matters protests. Baseline viral suppression was associated with lower microaggressions across the 9-months. Microaggression-related distress may change due to social context and research is needed on microaggressions and viral load overtime.

RESUMEN: Las mujeres de raza negra que viven con el VIH (MNVV) en los EE. UU. enfrentan microagresiones basadas en la raza, el género, el estado serológico del VIH y la orientación sexual. Examinamos los cambios en las microagresiones diarias y el estrés relacionado entre 143 MNVV en Miami, FL. El estrés relacionado con la microagresión aumentó del 52% en la línea de base/octubre, alcanzó un máximo del 70% durante las vacaciones (noviembre/diciembre), disminuyó al 55% en marzo cuando comenzó el distanciamiento social por el COVID-19 y alcanzó un máximo del 83% en junio/julio de 2020 durante las protestas generalizadas de Black Lives Matters. La supresión viral inicial se asoció con menores microagresiones durante los 9 meses. El estrés relacionada con la microagresión puede cambiar debido al contexto social y se necesitan investigaciones sobre las microagresiones y la carga viral con el tiempo.

The effectiveness of a community-based exercise program on depression symptoms among people living with HIV.

HIV is a worldwide public health issue affecting millions of individuals, and people living with HIV (PLWH) are often affected by depression. Nonetheless, exercise can prevent and treat depression among PLWH. The aim of the present study was to investigate the effect of exercise on depression symptoms in PLWH. Using a prospective single-arm trial, a semi-supervised community-based exercise intervention was offered 3 times/week for 12 weeks to PLWH (n = 52; age: 49 ± 6 years; HIV diagnosis: 19 ± 15 years). Participants were divided into compliant (≥1 exercise session/week) and non-compliant (<1 exercise session/week) groups according to their attendance in the intervention. Depression symptoms were assessed using the Beck Depression Inventory (BDI), and the change in BDI from baseline to post-intervention was assessed with an analysis of covariance, adjusted for demographics. The post-intervention BDI score was significantly lower (p = 0.027) for the compliant group compared to the non-compliant group, and the rate of improvement from moderate/severe symptoms of depression to minimal symptoms of depression was four times greater in the compliant group. In conclusion, a community-based exercise program may be effective in reducing depression symptoms among PLWH.