Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25
Filtrar
Más filtros

Bases de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
AIDS Res Ther ; 20(1): 86, 2023 12 09.
Artículo en Inglés | MEDLINE | ID: mdl-38071351

RESUMEN

BACKGROUND: In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. METHODS: We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. RESULTS: Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. CONCLUSION: Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.


Asunto(s)
Infecciones por VIH , Investigación en Rehabilitación , Humanos , Envejecimiento , Encuestas y Cuestionarios , Canadá
2.
AIDS Care ; 34(6): 753-761, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-33739198

RESUMEN

"U = U" is the principle that HIV is untransmittable from people living with an undetectable HIV viral-load. Wide-spread knowledge about U = U is believed to produce public health benefit by reducing HIV-related stigma - promoting wellbeing for people living with HIV. Therefore, we examined the diffusion of U = U with respect to the social position of sexual and gender minority men (SGMM). Participants were SGMM recruited from 16 LGBTQ2S+ pride festivals across Canada. Social position was measured using an index assessing whether participants were (a) trans, (b) a person of colour, (c) Indigenous, (d) born abroad, (e) bisexual or straight, (f) not out, (g) struggling with money, (h) not college educated, (i) and not participating in LGBTQ2S+ Organizations, Queer Pop-ups, or HIV advocacy organizations. Multivariable logistic regression tested whether Index Scores were associated with knowledge about U = U. Among 2681 participants, 72.6% knew about U = U. For HIV-negative/unknown status SGMM, each 1-point increase in Social Positionality Index Scores was associated with a 21% reduction in the odds that they knew about U = U (aOR: 0.79 [0.73, 0.85], per 1-point increase). Results indicate that social marginalization harms the diffusion of HIV-related biomedical knowledge, independent of risk-taking behaviour and other factors.


Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Minorías Sexuales y de Género , Estatus Social , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Masculino , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Estigma Social , Carga Viral
3.
Harm Reduct J ; 19(1): 124, 2022 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-36384634

RESUMEN

BACKGROUND: Hospital-based harm reduction services are needed to reduce drug-related harms, facilitate retention in care, and increase medical treatment adherence for people who use drugs. Philanthropic donor support plays a key role in delivering such innovative services which might fall outside current funding streams. However, little is known about how the principles, implementation, and practice of harm reduction services, which are often highly stigmatized, may impact donor behaviours. We explored this issue within Casey House, a speciality hospital in Toronto, Canada. METHODS: Our mixed methods study utilized an explanatory sequential design. A convenience sample of n = 106 philanthropic individual donors, recruited via email, completed an anonymous web-based survey, between July and October 2020, which assessed their knowledge of harm reduction services and the potential impact of implementing new hospital-based harm reduction services on donors' future support. Following this, we conducted semi-structured qualitative interviews with n = 12 of the donors who completed a survey and volunteered to be interviewed. Interviews examined donors' perspectives about harm reduction and their hopes/concerns for such programming at Casey House. Data were analysed using descriptive statistics and participatory-based thematic analysis. RESULTS: Survey data show a high level of support for hospital-based harm reduction services, with participants reporting that they "strongly agree/agree" with providing harm reduction equipment (85%), supervised consumption services (82%), and prescription opioid treatment (76%) at Casey House. A majority of participants (66%) claimed that implementing new harm reduction services at the hospital would not impact their future donation, while 6% said they would be less inclined to donate. Interview participants were supportive of harm reduction services at Casey House, recognizing the benefits of providing such services for hospital clients and the wider community. However, some spoke of the potential impact that implementing hospital-based harm reduction services may have on "other" donors who might be opposed. Although some believed harm reduction services should be fully funded by the government, most saw a role for donors in supporting such services. CONCLUSIONS: Our findings show support of hospital-based harm reduction services among philanthropic donors and provide insight into how donor support may be affected when such services are introduced.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Obtención de Fondos , Humanos , Reducción del Daño , Hospitales , Encuestas y Cuestionarios
4.
BMC Public Health ; 21(1): 1595, 2021 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-34496825

RESUMEN

BACKGROUND: Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. METHODS: We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. RESULTS: In the multiple regression analysis, internalized stigma (coefficient = -0.20, p < 0.01) and depression (coefficient = -0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = -0.08, se = 0.03, 95% CI (-0.14, -0.02)] and depression [coefficient = -0.16, se = 0.03, 95% CI (-0.22, -0.11)]. CONCLUSIONS: We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one's HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.


Asunto(s)
Depresión , Infecciones por VIH , Depresión/epidemiología , Humanos , Ontario/epidemiología , Prejuicio , Estigma Social
5.
AIDS Res Ther ; 17(1): 21, 2020 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-32429973

RESUMEN

BACKGROUND: People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. METHODS: We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. RESULTS: Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. CONCLUSIONS: These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.


Asunto(s)
Envejecimiento , Infecciones por VIH/epidemiología , Investigación en Rehabilitación/organización & administración , Canadá/epidemiología , Enfermedad Crónica , Congresos como Asunto , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Humanos , Internacionalidad , Investigación en Rehabilitación/normas , Investigación
6.
BMC Infect Dis ; 19(1): 594, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31286891

RESUMEN

BACKGROUND: People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. METHODS: We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. RESULTS: Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). CONCLUSIONS: Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.


Asunto(s)
Infecciones por VIH , Encuestas Epidemiológicas , Canadá , Evaluación de la Discapacidad , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Infecciones por VIH/rehabilitación , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/normas , Humanos , Internet , Encuestas y Cuestionarios
7.
Harm Reduct J ; 16(1): 55, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481067

RESUMEN

Community-based research in HIV in Canada is a complex undertaking. Including peer researchers living with HIV meaningfully is intricate and costly. However, this inclusion guarantees results that translate to community action, policy-making, and public awareness. Including HIV+ peer researchers expedites the path from research to intervention. However, we must constantly review our support in light of three implicit tasks performed by peer researchers: constant disclosure, emotional labor, and advocating for meaningful participation. Our team offers four pillars of support to reduce harm and strengthen the self-determination, confidence, advocacy, and impact for HIV+ peer researchers. The provision of emotional, instrumental, educational, and cultural/spiritual support might seldom be standardized within a study, but to successfully engage in community-based research, study teams must articulate what support can be offered in each area.


Asunto(s)
Investigación Participativa Basada en la Comunidad/organización & administración , Infecciones por VIH/terapia , Reducción del Daño , Grupo Paritario , Apoyo Social , Canadá , Comunicación , Evaluación Ecológica Momentánea , Humanos , Grupo de Atención al Paciente , Guías de Práctica Clínica como Asunto
8.
Qual Health Res ; 28(6): 859-872, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29676675

RESUMEN

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.


Asunto(s)
Infecciones por VIH/complicaciones , Trastornos Neurocognitivos/etiología , Trastornos Neurocognitivos/psicología , Automanejo/psicología , Adulto , Anciano , Investigación Participativa Basada en la Comunidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/patología , Pruebas Neuropsicológicas , Investigación Cualitativa , Factores de Riesgo
9.
BMC Infect Dis ; 14: 724, 2014 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-25551619

RESUMEN

BACKGROUND: HIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed 'disability'. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation. METHODS: We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques. RESULTS: Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy. CONCLUSIONS: These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada.


Asunto(s)
Investigación Biomédica/tendencias , Personas con Discapacidad/rehabilitación , Infecciones por VIH/rehabilitación , Calidad de Vida/psicología , Envejecimiento/psicología , Canadá , Personas con Discapacidad/psicología , Infecciones por VIH/psicología , Humanos , Irlanda , Reino Unido , Estados Unidos
10.
J Med Internet Res ; 16(3): e81, 2014 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-24642066

RESUMEN

BACKGROUND: Web or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear. OBJECTIVE: The aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach. METHODS: We piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis. RESULTS: Of 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful. CONCLUSIONS: Strengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one's own time at one's own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Infecciones por VIH , Encuestas Epidemiológicas/métodos , Internet , Adulto , Canadá , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Centros de Rehabilitación/estadística & datos numéricos , Autoinforme , Programas Informáticos , Encuestas y Cuestionarios
11.
J Int Assoc Provid AIDS Care ; 23: 23259582241242703, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38545687

RESUMEN

Cognitive health is a significant concern for people aging with HIV/AIDS. Psychosocial group therapies may help people aging with HIV who experience cognitive challenges cope with their symptoms. The COVID-19 pandemic revealed in-person group therapies need adaptation for technology-mediated delivery. Peer-led focus groups discussed adapting cognitive remediation group therapy (CRGT) as an online intervention. CRGT combines mindfulness-based stress reduction and brain training activities. Purposive sampling recruited people aging with HIV (40+) who self-identified cognitive concerns and resided in one of two Canadian provinces. Thematic content analysis was employed on transcripts by seven independent coders. Ten, 2-hour focus groups were conducted between August and November 2022. Participants (n=45) responded favorably to CRGT's modalities. Alongside support for its continued implementation in-person, participants requested online synchronous and online asynchronous formats. Preferred intervention facilitators were peers and mental health professionals. We also discuss how to adapt psychosocial HIV therapies for technology-mediated delivery.


Changing an in-person support group about cognitive health to an online support group via focus group consultations with middle-aged and older adults living with HIV/AIDSCognitive health concerns are common for people living with HIV as they grow older. Support groups may help individuals make connections with each other and develop ways to manage symptoms of cognitive impairment. In-person support groups need to have online adaptations for many reasons, including access for rural and remote communities. We conducted ten focus groups, led by people living with HIV, to discuss how to change an in-person support group to be online. The support group uses mindfulness and brain training activities. Forty-five people over age 40+ who are living with HIV in Ontario and Saskatchewan, Canada, and concerned about cognitive health participated in these focus groups. Seven researchers analysed the focus group transcripts. Participants liked the idea of the support group, both in-person and online. They specifically requested two forms of an online support group: synchronous, where everyone attends together at the same time, and asynchronous, where people attend at different times. This paper discusses how to change other in-person counselling and support group options for HIV to online formats.


Asunto(s)
Remediación Cognitiva , Infecciones por VIH , Psicoterapia de Grupo , Humanos , Grupos Focales , Pandemias , Infecciones por VIH/terapia , Infecciones por VIH/psicología , Canadá , Envejecimiento
12.
Work ; 78(2): 489-503, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38427522

RESUMEN

BACKGROUND: As a large number of people live with HIV, it is worthwhile to examine the integration of this group in the workplace. OBJECTIVE: To investigate how the operationalization of GIPA/MEPA supports workplace policies and practices for PLHIV. The study aims to explore what is being offered to support PLHIV in community-based agencies and what can be done to enhance the offerings. METHODS: For this community-based research, 2 bilingual online surveys were sent to 150 Canadian organizations that work closely with PLHIV or offer support to them. One of the surveys was for Executive Directors of these organizations while the other was sent to peers; i.e. PLHIV whose job is to offer services to PLHIV. Questions in the surveys varied between open-ended, binary, and Likert. RESULTS: GIPA/MEPA are implemented in most organizations and Executive Directors affirmed that PLHIV and their impacts on the workplace are valued. There is a consensus among Executive Directors that formal support is provided but most respondents argued that this support is not specific for PLHIV. More than half of respondents were either unaware or uncertain about the existence of informal support. Peer-employees claimed that one of the challenges of disclosing HIV to receive peer support is that they may face stigma. CONCLUSION: The application of GIPA/MEPA results in positive outcomes in the workplace. The study emphasizes the need to facilitate access to informal support.


Asunto(s)
Infecciones por VIH , Lugar de Trabajo , Humanos , Lugar de Trabajo/psicología , Lugar de Trabajo/normas , Encuestas y Cuestionarios , Canadá , Estigma Social , Política Organizacional , Grupo Paritario , Masculino , Femenino , Apoyo Social , Adulto
13.
Front Rehabil Sci ; 4: 1154692, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37869573

RESUMEN

Background: This paper describes the design, implementation, and evaluation of a community of practice (CoP), HIV in MOTION (HIM), to advance physical activity rehabilitation interventions with adults living with HIV, clinicians, researchers, and representatives from community-based organizations. We attracted a diverse audience of geographically dispersed people living with HIV, clinicians, exercise personnel, and trainees to eight HIM community of practice events that featured the clinical, research, and lived experience of people living with HIV. HIV in MOTION had (a) a domain related to physical rehabilitation, exercise, and social participation for people living with HIV; (b) a community of diverse individuals; and (c) a practice, that is, a series of sustained interactions online and offline, synchronous, and asynchronous. Our team included six diverse people living with HIV, two coordinators, and three academic researchers who planned, prepared, implemented, and evaluated each online session. To evaluate the HIV in MOTION CoP, we employed an evaluation framework composed of five criteria: Goals and Scope, Context and Structure, Process and Activities, Outcomes, and Impact. We collected quantitative and qualitative evaluative data using online evaluation, audiovisual archiving, and participant observations during the debriefing with all members of our team. Results: We widened the Goals and Scope of the HIV in MOTION CoP to include the HIV narrative of lived experiences, including autopathography, and participant storytelling. In matters of Context and Structure, we received explicit satisfaction with our governance and leadership. Also, being flexible to fit online formats was a productive strategy that made the HIV in MOTION CoP sessions agile and amenable to audiovisual archiving. Our indicators of success in Process, Activities, and Outcomes included participant retention online, elicited verbal interventions and comments in the chat room, and a rate of three repeat visits online. The indicators of success of Impact were the presence of voluntary and unscripted autopathography, the patient storytelling and how it reportedly caused changes in the participants, and the "legitimate peripheral participation" of emerging research and clinical students. In conclusion, we recommend our form of CoP for mixing the knowledge of diverse persons in this area. However, we recommend considering budget and burnout as serious challenges to sustainability.

14.
BMJ Open ; 13(3): e067703, 2023 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-36997255

RESUMEN

INTRODUCTION: Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS: We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION: Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05006391.


Asunto(s)
Infecciones por VIH , Ciencia de la Implementación , Humanos , Adulto , Estudios Prospectivos , Ejercicio Físico , Terapia por Ejercicio , Calidad de Vida
15.
BMJ Open ; 12(4): e059294, 2022 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-35428647

RESUMEN

OBJECTIVES: To describe the need for, and utility of, online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV. DESIGN: Qualitative descriptive study using web-based semistructured interviews. PARTICIPANTS: We recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: (1) adults living with HIV, (2) rehabilitation professionals, (3) fitness personnel, (4) educators with eLearning experience and (5) representatives from HIV community-based organisations (CBOs). DATA COLLECTION: We asked participants to describe their experiences with online CBE, need and utility for online CBE and factors in developing and implementing online CBE interventions. We analysed data using a group-based thematic analytical approach. RESULTS: Among the 11 participants, most had experience working with adults living with HIV (73%) or with telehealth/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants (eight women; two men; one non-binary; median age: 49 years), identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: (1) person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), (2) accessibility of programme (physical space to exercise, reliable internet, access to devices, digital literacy), (3) programme delivery and technology (live vs prerecorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), (4) attributes of programme personnel (working with CBOs, relatable instructors, diverse staff), (5) programme content and design (tailored exercise classes, educational sessions) and (6) building community (shared experiences, peer support, social opportunities). CONCLUSIONS: There is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.


Asunto(s)
Infecciones por VIH , Adulto , Ejercicio Físico , Terapia por Ejercicio , Femenino , Infecciones por VIH/terapia , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estigma Social
16.
J Int Assoc Provid AIDS Care ; 21: 23259582221079148, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35175151

RESUMEN

Our aim was to examine the utility of the HIV Disability Questionnaire (HDQ), a patient-reported outcome measure for use in clinical practice from the perspectives of people living with HIV (PLWH) and healthcare providers. We conducted a qualitative descriptive study. Fifteen PLWH and five healthcare providers participated in an interview, of which ten PLWH participated in a follow-up focus group discussion. The HDQ has value in clinical practice, including its role in assessing disability, facilitating communication, tailoring treatments, and guiding referrals. Strengths of the HDQ included its comprehensiveness, relevance of domains, and importance of specific items. Concerns related to length of the HDQ, the potential for some items to trigger emotional response, and negative connotations with the term 'disability.' Recommendations for HDQ implementation included the importance of score interpretability, shortening the questionnaire, and tailoring administration to the individual. Results suggest the HDQ possesses clinical utility with PLWH and healthcare providers.


Asunto(s)
Personas con Discapacidad , Infecciones por VIH , Evaluación de la Discapacidad , Personas con Discapacidad/psicología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Personal de Salud , Humanos , Encuestas y Cuestionarios
17.
Artículo en Inglés | MEDLINE | ID: mdl-34444297

RESUMEN

Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS based on the insights and lived experiences of racially and ethnically diverse, older gbMSM. Applying a community-based participatory research approach that included the meaningful involvement of older gbMSM living with HIV/AIDS in different roles (i.e., advisory committee member, collaborator, peer researcher, and participant), the study recruited and included forty-one older gbMSM living with HIV/AIDS from Ontario, Canada, in confidential, semi-structured interviews. Utilizing thematic analysis, we identified three major themes from the participant interviews as factors that fostered the resilience of older gbMSM to HIV/AIDS and helped to address HIV/AIDS health disparities: (1) established protective factors, (2) behavioral protective factors, and (3) controversial protective factors. This paper argues for the importance of valuing and capitalizing on these protective factors in the conceptualization and development of interventions, services, and programs that are dedicated to fostering resilience to HIV/AIDS.


Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Bisexualidad , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , Ontario/epidemiología , Factores Protectores
18.
J Int Assoc Provid AIDS Care ; 20: 23259582211005628, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33779374

RESUMEN

The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Infecciones por VIH/rehabilitación , Accesibilidad a los Servicios de Salud , Modalidades de Fisioterapia , Calidad de Vida , Femenino , Infecciones por VIH/psicología , Personal de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Ontario , Investigación Cualitativa
19.
Artículo en Inglés | MEDLINE | ID: mdl-32549263

RESUMEN

(1) Background: Although HIV has not diminished in importance in Canada, the field of HIV research remains small, and the graduate students who decide to pursue careers within it feel isolated and uncertain about their professional skills and opportunities. Universities Without Walls (UWW) was created in 2009 to help redress these shortcomings. This paper presents a case study of UWW, a non-credit training program for emerging HIV researchers in Canada. In particular, we focus on the possibilities of experiential learning via online and blended delivery. UWW uses both online and in-person teaching modalities to teach engaged scholarship, interdisciplinarity, community-based research (CBR), intervention research, and ethics. (2) Methods: Using a case study, we elucidated the research question: "What are the factors that make Universities Without Walls a viable training environment in the contemporary HIV/AIDS field?" Focus groups were conducted with 13 UWW key stakeholders in 2012 during a program mid-point evaluation; in 2014, telephone or in-person interviews with the three directors were conducted by a UWW fellow (the 4th author of this paper), and in 2019 the authors analyzed the information and anecdotal evidence, which had been incorporated as thick description. In addition, fellows' self-assessments via portfolio and results from formal learning assessments were included. We also thematically analyzed 65 student self-reports (2009-2015). (3) Results and Discussion: Each UWW cohort lasted 9 months to one year and was comprised of: a) sustained mentorship from the co-directors (e.g., phone conversations, assistance with grant writing, letters of reference, etc.); b) fortnightly online webinars that aim to develop fellows' knowledge of community-based research (CBR), research ethics, intervention research, and interdisciplinary research; c) community service learning in the form of a "field mentoring placement"; d) face-to-face engagement with fellows and mentors, most notably at the week-long culminating learning institute; e) a stipend for fellows to carry out their training activities. The UWW pedagogical framework features experiential learning, critical pedagogy, and heutagogy made manifest in the field mentoring placements (community service learning), mentorship mediated by technologies, and in-person learning institutes. Our analysis showed that experiential learning was imparted by UWW's a) transparency about its "implicit curriculum", the attitudes, values, character, and professional identity imparted in the program as well as the overarching programmatic elements, such as commitment to diversity, the inclusion of those with lived experience, the flexible admissions policies and procedures, interdisciplinary faculty, flexible team, administrative structure, and valuing of technology in conducting research, learning, and teaching; b) curriculum co-designing and co-teaching, and c) sustaining a community of practice. The main results reported in our case study included significant "soft outcomes" for UWW fellows, such as developing a "social presence" as a precursor to lasting professional connections; learning to experience community-based research, intersectionality, and interdisciplinarity by interacting online with persons living with HIV, leaders in the field, and a variety of stakeholders (including nonprofit staff and policymakers). (4) Limitations: While fellows' self-evaluation data were collected by an independent assessor and anonymized to the extent this was possible, the co-authors inevitably bring their preconceptions and positive biases to UWW's assessment. As UWW was developed to function outside of traditional academic structures, it is unlikely that the UWW program could be transferred to a post-secondary environment in its entirety. UWW was also built for the socio-political environment of HIV health research. (5) Conclusions: The experiences of those involved with UWW demonstrate that explicit curricular components-such as interdisciplinarity, community-based research, intervention research, and applied ethics-can be learned through a blended delivery when combined with opportunities to apply the knowledge in ways, such as a field mentoring placement and a learning institute. Related to this outcome, our case study describes that implicit curricular components in the formation of a professional-the sense of self in the field as a researcher, student, and community member-can also be delivered through a blended model. However, the tools and activities need to be tailored to each student for their context, while pushing their disciplinarian and professional boundaries.


Asunto(s)
Infecciones por VIH , Universidades , Canadá , Curriculum , Humanos , Investigadores
20.
J Int Assoc Provid AIDS Care ; 18: 2325958218822336, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30672357

RESUMEN

BACKGROUND: HIV-associated neurocognitive disorders and other causes of neurocognitive challenges experienced by people living with HIV (PLWH) persist as public health concerns in developed countries. Consequently, PLWH who experience neurocognitive challenges increasingly require social support and mental health services from community-based providers in the HIV sector. METHODS: Thirty-three providers from 22 AIDS service organizations across Ontario, Canada, were interviewed to determine the strategies they used to support PLWH experiencing neurocognitive difficulties. Thematic analysis was conducted to determine key themes from the interview data. RESULTS: Three types of strategies were identified: (a) intrapersonal, (b) interpersonal, and (c) organizational. Intrapersonal strategies involved learning and staying informed about causes of neurocognitive challenges. Interpersonal strategies included providing practical assistance, information, counseling, and/or referrals to PLWH. Organizational strategies included creating dedicated support groups for PLWH experiencing neurocognitive challenges, partnering with other organizations with services not available within their own organization, and advocating for greater access to services with expertise and experience working with PLWH. CONCLUSION: Through concerted efforts in the future, it is likely that empirically investigating, developing, and customizing these strategies specifically to address HIV-associated neurocognitive challenges will yield improved social support and mental health outcomes for PLWH.


Asunto(s)
Agentes Comunitarios de Salud , Infecciones por VIH/complicaciones , Servicios de Salud Mental , Trastornos Neurocognitivos/prevención & control , Adulto , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/psicología , Trastornos Neurocognitivos/virología , Ontario , Investigación Cualitativa , Apoyo Social
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA