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1.
Public Health Nutr ; : 1-30, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33769239

RESUMEN

OBJECTIVE: Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80% of households are moderately or severely food insecure.(1) For people with HIV (PWH), food insecurity is associated with poor ART adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge. DESIGN: This study examines the factor structure of the 9-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model. SETTING: Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA. PARTICIPANTS: Participants (N=440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorized as severely (n=250, 56.82%) or moderately (n=107, 24.32%) food insecure in the past 30 days. RESULTS: Revised parallel analysis suggested a 3-factor structure, which was inadmissible. A 2-factor structure was examined but did not adequately fit the data. A 2-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (CFI=0.995, SRMR=0.019). The two specific factors identified were: anxiety/insufficient quality, and no food intake. Reliability was adequate (ω=.82). CONCLUSIONS: Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilized in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.

2.
J Subst Abuse Treat ; 122: 108248, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33509420

RESUMEN

Recovery coaches, trained peers with a history of substance use disorder (SUD) who are formally embedded in the health care team, may be a cost-effective approach to support outpatient management of SUD treatment. Although recovery coach programs are scaling nationwide, limited data exist to support their impact on costs or clinical outcomes. This study aimed to evaluate the integration of peer recovery coaches in general medical settings. Staff hired and trained nine recovery coaches as a part of a health system-wide effort to redesign SUD care. We examined reductions in acute care utilization and increases in outpatient treatment utilization among patients connected to a recovery coach. Additionally, we examined buprenorphine treatment engagement and opioid abstinence among a subset of patients who initiated buprenorphine prior to or within 30 days of their first recovery coach contact. We hypothesized recovery coach contact would strengthen outpatient SUD treatment and be associated with reductions in SUD severity and preventable acute care utilization. We included patients with an initial recovery coach contact between January 2015 and September 2017 in the main analyses (N = 1171). We assessed utilization outcomes via medical records over one year, comparing the six months before and after first recovery coach contact. We used chart review to extract toxicology results and buprenorphine treatment engagement for the subset of patients initiated on buprenorphine (n = 135). In the six months following recovery coach contact, there was a 44% decrease in patients hospitalized and a 9% decrease in patients with an ED visit. There was a 66% increase in outpatient utilization across primary care, community health center visits, mental health, and laboratory visits. Among patients who initiated buprenorphine, current recovery coach contact was associated with significantly increased odds of buprenorphine treatment engagement (OR = 1.89; 95% CI: 1.49-2.39; p < 0.001) and opioid abstinence (OR = 1.32; 95% CI: 1.02-1.70; p < 0.001). Recovery coaches may be an impactful and potentially cost-effective addition to an SUD care team, but future research is needed that uses a matched comparison condition.

3.
Subst Abus ; : 1-15, 2020 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-33270540

RESUMEN

Background: Low-income, racial/ethnic minority individuals face significant barriers in access to substance use (SU) treatment. Peer recovery coaches (PRCs), individuals with lived experience with substance use disorder (SUD), may be uniquely well suited to assist those encountering barriers to treatment. PRCs can also help reach those not engaged in treatment to promote harm reduction and support linkage-to-care when embedded in community rather than clinical settings. This study evaluated a community-based program in which a PRC facilitated linkage to and supported retention in SU treatment. Methods: Guided by the RE-AIM framework, we evaluated implementation of the intervention in a community resource center (CRC) serving homeless and low-income residents of Baltimore City. We examined the reach, effectiveness, adoption, and implementation of this PRC model. Results: Of 199 clients approached by or referred to the PRC, 39 were interested in addressing their SU. Of those interested in addressing SU, the PRC linked 64.1% (n = 25) to treatment and was able to follow up with 59.0% (n = 23) at prespecified time points after linkage (24-48 hours, 2 weeks, and 1 month). Fifty-two percent (n = 13) of clients linked to SU treatment remained in treatment at 30 days post-linkage. Of clients who did not remain in treatment, 77% (n = 10) continued contact with the PRC. Conclusions: Results indicate the utility of the CRC's approach in linking people to treatment for SU and addressing barriers to care through work with a PRC. Findings also highlight important barriers and facilitators to implementation of this model, including the need for adaptation based on individual goals and fluctuations in readiness for treatment.

4.
J Subst Abuse Treat ; : 108182, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33160763

RESUMEN

The COVID-19 pandemic and ongoing opioid epidemic are causing notable morbidity and mortality among low-income and minority populations. Peer recovery coaches (PRCs), people with lived experience of substance use and recovery, are uniquely positioned to support underserved, minority individuals who face the greatest barriers to care. This commentary combines research and clinical perspectives to describe the potential role of PRCs in reaching and supporting particularly vulnerable populations in the setting of substantial changes in the opioid use disorder (OUD) recovery landscape during COVID-19. During this time, PRCs can provide guidance from their own experience navigating changes to routines and social support systems, reduce social isolation, build trust and buy-in, and support engagement in care. Specific barriers include access to technology and underlying distrust of public and medical authorities. This article highlights the importance of expanding the reach of the PRC workforce as well as supporting their specific needs at this time to combat the intersecting devastation of two epidemics.

5.
Drug Alcohol Depend ; 216: 108322, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33010712

RESUMEN

BACKGROUND: South Africa has the largest number of people living with HIV in the world. Concurrently, problematic alcohol and other drug use (AOD) is prevalent in the country and associated with poor HIV treatment outcomes. Further, the high rates of stigma surrounding HIV and AOD contribute to poor HIV outcomes. Yet, how HIV stigma and AOD stigma together may affect HIV care has not been extensively studied in this context. Thus, we explored HIV and AOD providers' and patients' experiences of HIV and AOD stigma. METHODS: We conducted 30 semi-structured interviews with patients living with HIV who were struggling with HIV medication adherence and problematic AOD use (n = 19), and providers involved in HIV or AOD treatment (n = 11) in Cape Town, South Africa to assess how HIV and AOD stigmas manifest and relate to HIV care. FINDINGS: Two main themes around the intersection of HIV and AOD and their related stigmas were identified: (1) how patients use AOD to cope with HIV stigma; and (2) enacted/ anticipated AOD stigma from HIV care providers, which acts as a barrier to HIV care. CONCLUSIONS: Intersecting HIV and AOD stigmas exist at multiple levels and increase barriers to HIV care in this setting. Accordingly, it is important that future interventions address both these stigmas at multiple levels.

7.
Soc Sci Med ; 266: 113424, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33065498

RESUMEN

RATIONALE: "Thinking too much" is a cultural idiom of distress identified across sub-Saharan Africa, including among people living with HIV (PLWH), which is associated with depression, substance use, and HIV medication nonadherence. Despite the relevance of mindfulness training to address thinking too much, improve HIV-related outcomes, and reduce substance use, efforts to adapt mindfulness training for this context and underserved populations more broadly have been limited. OBJECTIVE: We explored in this context: (a) the experience of thinking too much among PLWH struggling with adherence and substance use; (b) the appropriateness of mindfulness training to address thinking too much; and (c) potential barriers and facilitators to implementing mindfulness training. METHOD: We conducted semi-structured interviews with patients (n = 19) and providers (n = 11) at two clinics in a peri-urban area of Cape Town. Guided by the ADAPT-ITT model, we included an experiential mindfulness practice and participants shared their observations and descriptions of the intervention in the local language (isiXhosa). RESULTS: Participants found mindfulness relevant, culturally salient, and appropriate for refocusing the mind. Findings provide unique language offered by participants to tailor mindfulness training in the future (e.g., "hearing your veins," "cooling of the mind"). Participants identified potential implementation barriers, including lack of privacy, and facilitators to guide future adaptations. CONCLUSIONS: More research is needed to adapt and increase access to mindfulness training in resource-limited settings globally, while also maintaining treatment integrity and fidelity.

8.
J Neurovirol ; 26(5): 779-784, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32728896

RESUMEN

Few studies have examined neuroimmune pathways that could contribute to impulsivity in people living with HIV who use substances. Eighty-four methamphetamine-using, sexual minority men with an undetectable HIV viral load were administered the Balloon Analogue Risk Task (BART), a behavioral measure of risk-taking propensity. We examined the associations between kynurenine/tryptophan ratio and phenylalanine/tyrosine ratio with BART scores using multiple linear regression. A higher kynurenine/tryptophan ratio was independently associated with greater BART scores (beta = 0.25; 95% CI = 0.05-1.23; p = 0.034). The phenylalanine/tyrosine ratio was not significantly associated with BART scores. Findings support the need for further research to elucidate the neuroimmune mechanisms linking tryptophan degradation with impulsivity to catalyze the development novel pharmacologic treatments for people living with HIV who use methamphetamine.

9.
Artículo en Inglés | MEDLINE | ID: mdl-32607502

RESUMEN

Background: Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population. Methods: Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patient-level effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome. Discussion: Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally. Trial registration: ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

10.
Int J Ment Health Syst ; 14: 40, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32514304

RESUMEN

Due to severe shortages of specialist mental health personnel in low- and middle-income countries (LMICs), psychological therapies are increasingly being delivered by non-specialist health workers (NSHWs). Previous reviews have investigated the effectiveness of NSHW-delivered psychological therapies, including cognitive behavioural therapy (CBT), in LMIC settings. This systematic review aims to synthesise findings on the implementation outcomes of NSHW-delivered CBT interventions addressing common mental disorders and substance-use disorders in LMICs. Four databases were searched, yielding 3211 records, 18 of which met all inclusion criteria. We extracted and synthesised qualitative and quantitative data across eight implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration and sustainability. Findings suggest that delivery of CBT-based interventions by NSHWs can be acceptable, appropriate and feasible in LMIC settings. However, more research is needed to better evaluate these and other under-reported implementation outcomes.

11.
Cogn Behav Pract ; 27(1): 84-92, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32153343

RESUMEN

HIV is prevalent in Sub-Saharan Africa, and depression frequently co-occurs. Depression is one of the most important predictors of poor adherence to antiretroviral therapy (ART). Little has been done to develop integrated interventions that are feasible and appropriate for task-shifting to nonspecialists that seek to address both depression and barriers to ART adherence in Sub-Saharan Africa. This case series describes an integrated intervention for depression and ART adherence delivered by a lay adherence counselor and supervised by a local psychologist. The 6-session intervention was based on problem-solving therapy for depression and for barriers to adherence (PST-AD), with stepped care for those whose depression did not recover with PST-AD. Primary outcomes were acceptability and depression. Acceptability was measured by participant attendance to the 6 sessions. Three case studies illustrate the structured intervention, solutions identified to adherence barriers and to problems underlying low mood, and changes seen in the clients' psychological symptoms. Acceptability of the intervention was high and common mental disorder symptoms scores measured using the SRQ-8 decreased overall. An integrated intervention for depression and adherence to ART appeared feasible in this low-income setting. An RCT of the intervention versus an appropriate comparison condition is needed to evaluate clinical and cost-effectiveness.

12.
AIDS Behav ; 24(9): 2680-2690, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32162093

RESUMEN

South Africa (SA) has the most people living with HIV/AIDS (PLWH) globally and prevalent alcohol use. Beliefs that mixing alcohol and antiretroviral therapy (ART) can lead to adverse reactions may promote ART nonadherence. Healthcare providers (n = 11) and patients (n = 19) recruited from primary HIV and substance use care in SA described their messages, beliefs, and behaviors around simultaneous use of alcohol and ART. Transcripts were analyzed using thematic analysis: (1) most providers indicated a message shift to reflect harm reduction principles: PLWH should manage alcohol use but not let it interfere with taking ART; however, (2) patients recalled conflicting messages from their providers and some displayed interactive toxicity beliefs and behaviors. Despite progress demonstrated by 2016 national adherence guidelines and shifted provider messaging, interactive toxicity beliefs remain a barrier to ART adherence. Results have implications for the adaptation of adherence counseling to minimize the impact of alcohol use on HIV treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Personal de Salud/psicología , Cumplimiento de la Medicación/psicología , Adulto , Interacciones Farmacológicas , Femenino , Adhesión a Directriz , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Reducción del Daño , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica , Encuestas y Cuestionarios
13.
PLoS One ; 15(1): e0228084, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32004328

RESUMEN

Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.


Asunto(s)
Terapia Conductista/métodos , Medicina Comunitaria/métodos , Área sin Atención Médica , Trastornos Relacionados con Sustancias/prevención & control , Adulto , Baltimore , Manejo de Caso , Grupos Étnicos/psicología , Personas sin Hogar , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios/psicología , Grupo Paritario , Pobreza
14.
Adm Policy Ment Health ; 47(4): 497-500, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31823100

RESUMEN

Use of lay health workers for the treatment of common mental disorders is an expanding, yet still underutilized, opportunity for closing the behavioral health treatment gap globally. In this commentary, we describe how "mutual capacity building," an equal exchange of ideas between low and middle-income countries (LMICs) and high-income countries (HICs) to promote shared learning, could promote the development and scale-up of therapies using lay health workers. We propose ways that task sharing models for behavioral health can inform and be supported by bidirectional learning across HICs and LMICs.

15.
Psychotherapy (Chic) ; 57(1): 107-118, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31670529

RESUMEN

South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

16.
J Acquir Immune Defic Syndr ; 82(5): 443-451, 2019 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-31567551

RESUMEN

BACKGROUND: Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. METHODS: Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). RESULTS: Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). CONCLUSIONS: Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/sangre , Consumo de Bebidas Alcohólicas/epidemiología , Depresión/epidemiología , Glicerofosfolípidos/sangre , Infecciones por VIH/epidemiología , Mujeres Embarazadas , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Infecciones por VIH/psicología , Humanos , Embarazo , Mujeres Embarazadas/psicología , Prevalencia , Autoinforme , Estigma Social , Sudáfrica/epidemiología , Uganda/epidemiología , Adulto Joven
17.
J Consult Clin Psychol ; 87(10): 962-966, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556672

RESUMEN

The current opioid crisis in the United States has been considered an "epidemic of poor access to care." Similar to the shortage of trained providers to prescribe medications to treat opioid use disorder (OUD), there is a severe shortage of trained providers to meet the mental health needs of patients with OUD. These workforce shortages are evident nationwide, yet are particularly salient in rural areas. In this commentary in response to the article "Integrating Addiction Medicine into Rural Primary Care: Strategies and Initial Outcomes (Logan et al., 2019)," we propose that we can apply lessons learned from working in resource-constrained settings globally to improve access to mental health care for patients with OUD in rural areas in the United States. We expand upon Logan et al. (2019) by discussing how non-specialist health workers, including community health workers and peer providers, under the supervision of psychologists and other specialists, can expand access to evidence-based mental health care for patients with OUD, particularly those receiving medications for opioid use disorder (MOUD). We draw from established models in global mental health that rely on "task sharing" mental health care to discuss ways in which lessons learned from scaling up evidence-based interventions with lay health workers in low and middle-income countries can directly inform efforts to increase access to mental health care to address the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Servicios de Salud Mental , Salud Mental , Epidemia de Opioides , Trastornos Relacionados con Opioides/terapia , Atención Primaria de Salud , Personal de Salud , Humanos , Estados Unidos
18.
AIDS ; 33 Suppl 1: S71-S79, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-31397725

RESUMEN

OBJECTIVE: Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90-90-90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention. DESIGN: Prospective cohort study. METHODS: From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors. RESULTS: Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89-0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00-1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65-0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02-1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00-1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77-0.92), compared with those who initiated ART but did not achieve plasma RNA suppression. CONCLUSION: Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.


Asunto(s)
Adaptación Psicológica , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Resiliencia Psicológica , Adulto , Antirretrovirales/uso terapéutico , Consejo , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/virología , VIH-1 , Humanos , Modelos Logísticos , Masculino , Estudios Prospectivos , ARN Viral/sangre , Estigma Social , Apoyo Social , Sudáfrica , Adulto Joven
19.
Int J Drug Policy ; 70: 61-69, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31082664

RESUMEN

South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Grupo Paritario , Trastornos Relacionados con Sustancias/psicología , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Comorbilidad , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica/epidemiología , Trastornos Relacionados con Sustancias/terapia , Adulto Joven
20.
Drug Alcohol Depend ; 198: 192-198, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-30953938

RESUMEN

BACKGROUND: South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally. METHODS: Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use). RESULTS: Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02). CONCLUSIONS: Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression.


Asunto(s)
Antirretrovirales/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH/efectos de los fármacos , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Trastornos Relacionados con Sustancias/virología , Adolescente , Adulto , Consejo , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/virología , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Estudios Prospectivos , Sudáfrica , Carga Viral
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