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1.
Sex Transm Dis ; 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38597652

RESUMO

BACKGROUND: Black adolescent girls and young women (AGYW) in the U.S. Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low PrEP uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including PrEP. METHODS: In-depth interviews (IDIs) were conducted with Black AGYW ages 14-24 and healthcare providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. IDIs were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings. RESULTS: Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21, representing nine Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included: 1) Improve sexual health education for providers and adolescents; 2) Normalize conversations in clinical settings; 3) Engage communities to continue these conversations outside of clinical settings. CONCLUSIONS: Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.

2.
BMC Res Notes ; 17(1): 97, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561785

RESUMO

BACKGROUND: Newer antiretrivirals (ART) have shifted the metabolic experiences of people with HIV (PWH) from those of wasting syndrome to increases in body mass index (BMI). This study sought to examine the relationship between BMI and ART use among youth with HIV (YWH). METHODS: Charts from YWH ages 10-24 with at least two documented BMIs at least 6 months apart between 2017 and 2020 were included (N = 44). Statistical analyses were conducted in SAS 9.4. RESULTS: Clients were predominately African American (66%) males (73%) aged 19-24 years (64%), with men having sex with men (48%) being the most common mode of transmission. YWH on non-integrase inhibitor (INSTI) regimens had greater absolute increases in BMI compared to those on INSTI regimens (p = 0.03). Fourteen percent of clients using INSTI experienced an increase in BMI class from normal to overweight or overweight to obese; no non-INSTI users changed BMI class. Time since diagnosis and BMI change due to weight gain were positively associated (p = 0.03) among behaviorally-acquired YWH. CONCLUSIONS: Increasing BMI and changing BMI classes may be more likely among YWH using INSTI. More longitudinal studies inclusive of diet and exercise profiles are needed to understand the relationship between INSTI and YWH BMI.


Assuntos
Infecções por HIV , Inibidores de Integrase de HIV , Masculino , Humanos , Adolescente , Feminino , Sobrepeso/epidemiologia , Índice de Massa Corporal , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Obesidade/epidemiologia , Obesidade/tratamento farmacológico , Aumento de Peso , Inibidores de Integrase de HIV/uso terapêutico
4.
Open Forum Infect Dis ; 11(3): ofae086, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38440303

RESUMO

Gaps in knowledge remain related to understanding missed human immunodeficiency virus (HIV) visits and youth with HIV (YWH). This study examined data from an Alabama academic HIV clinic with clients aged 16 to 24 years old and found that non virally suppressed and older YWH were associated with missed visits among YWH.

5.
J Addict Med ; 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38446860

RESUMO

OBJECTIVES: Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population. METHODS: This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries. RESULTS: The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use. CONCLUSIONS: There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.

6.
BMC Health Serv Res ; 24(1): 101, 2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38238697

RESUMO

BACKGROUND: Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a disproportionate burden of rural infections. To reverse growing infection rates, the state must increase its focus on prevention efforts, including novel strategies. One such approach is to utilize dashboards that visualize real-time data on the pre-exposure prophylaxis (PrEP) care continuum to assist in prioritizing evidence-based preventative care for those most vulnerable for HIV infection. METHODS: We conducted a mixed methods evaluation to ascertain stakeholders' perceptions on the acceptability, feasibility, appropriateness, and usability of a PrEP care continuum dashboard, as well as gain insight on ways to improve the activities necessary to sustain it. Clinicians, administrators, and data personnel from participating sites in Alabama completed surveys (n = 9) and participated in key informant interviews (n = 10) to better understand their experiences with the prototype data dashboard and to share feedback on how it can be modified to best fit their needs. RESULTS: Surveys and interviews revealed that all participants find the pilot data dashboard to be an acceptable, feasible, and appropriate intervention for clinic use. Overall, stakeholders find the pilot dashboard to be usable and helpful in administrative efforts, such as report and grant writing; however, additional refining is needed in order to reduce burden and optimize usefulness. Participants voiced concerns about their site's abilities to sustain the dashboard, including the lack of systematized PrEP protocols and limited funds and staff time dedicated to PrEP data collection, cleaning, and upload. CONCLUSION: Study participants from clinics providing HIV prevention services, including PrEP, in Alabama voiced interest in sustaining and refining a data dashboard that tracks clients across the PrEP care continuum. Despite viewing the platform itself as an acceptable, feasible, and appropriate intervention, participants agreed that efforts need to be focused on standardizing PrEP data collection protocols in order to ensure consistent, accurate data capture and that limited funds and staff time are barriers to the sustained implementation of the dashboard in practice.


Assuntos
Síndrome da Imunodeficiência Adquirida , Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Estudos de Viabilidade , Fármacos Anti-HIV/uso terapêutico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Sudeste dos Estados Unidos , Profilaxia Pré-Exposição/métodos
7.
J Int Assoc Provid AIDS Care ; 22: 23259582231163125, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37009663

RESUMO

Background: Youth with HIV (YWH) aged 18-24 are overburdened by tobacco, with half also using cannabis recreationally. Increasing tobacco cessation necessitates exploring providers' approaches to cessation. Methods: Grounded in social cognitive theory, we explored cognitive, socioenvironmental, and behavioral factors impacting providers' approaches to tobacco use among recreational cannabis users. Virtual interviews were conducted among healthcare providers caring for YWH in Washington (legalized cannabis), Massachusetts (legalized cannabis), and Alabama (cannabis not legal). Interviews were transcribed and analyzed via deductive and exploratory, thematic approaches using NVivo 12 Plus. Results: Twelve providers participated; 80% were subspecialist physicians. All providers (N = 12) reported discussing tobacco use; none reported discussing tobacco use in conjunction with cannabis use. Identified themes included competing demands including cannabis co-use, prioritization of social determinants of health, and need for youth-tailored tools. Conclusions: YWH disproportionately use tobacco and recreational cannabis. Optimizing clinical visits to identify opportunities to address tobacco is crucial.


Assuntos
Cannabis , Infecções por HIV , Abandono do Hábito de Fumar , Adolescente , Humanos , Adulto Jovem , Adulto , Abandono do Hábito de Fumar/psicologia , Fumar/epidemiologia , Fumar/psicologia
8.
Pediatrics ; 151(Suppl 1)2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-37010397

RESUMO

Racism is woven within the fabric of the United States culture, structures, and systems, including its healthcare system. There is extensive research on adults demonstrating racial discrimination's physical and mental health impacts, and the evidence showing similar disproportionate effects for adolescents of color continues to grow. Furthermore, the devastation of the coronavirus pandemic has paralleled the resurgence of white nationalism movements and adverse outcomes associated with the over-policing of Black and Brown communities. Scientific evidence continues to illustrate how sociopolitical determinants of health and experiencing vicarious racism amplify overt racism and implicit bias actions individually and within health care structures. Therefore, evidence-based strategic interventions are desperately needed to ensure the health and well-being of adolescents and young adults.


Assuntos
Saúde do Adolescente , Equidade em Saúde , Racismo , Adolescente , Humanos , Adulto Jovem , Atenção à Saúde , Racismo/psicologia , Estados Unidos/epidemiologia
9.
JMIR Res Protoc ; 12: e44908, 2023 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-36943364

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. OBJECTIVE: This paper describes the "PrEP-Pro" intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. METHODS: The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. RESULTS: Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. CONCLUSIONS: As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44908.

10.
J Adolesc Health ; 72(5): 746-753, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36781324

RESUMO

PURPOSE: Adolescents are disproportionately burdened with HIV. Numerous barriers limit adolescent pre-exposure prophylaxis (PrEP) use for HIV prevention. We explored adolescent-caregiver perspectives on discussing sexual health and PrEP to inform future caregiver interventions as a possible strategy to promote PrEP use. METHODS: We conducted separate in-depth interviews with adolescents aged 14-18 living in Alabama and their parent/guardian (caregiver). Interviews explored attitudes about sex, knowledge and attitudes about HIV prevention and PrEP, and attitudes about PrEP communication within adolescent-caregiver groups. Thematic analysis of adolescent and caregiver interviews was conducted independently and then triangulated to compare shared themes. RESULTS: Nine adolescents and seven caregivers contributed to five dyads and two triads. Adolescents had a median age of 16 years (range 14-18); five were girls (55%), and five were non-Hispanic Black (55%). Most caregivers were mothers (5, 71%), non-Hispanic Black (5, 71%), with a median age of 41 (36-56) years. All adolescents expressed willingness to involve their caregiver around PrEP use. Major themes included as follows: 1) caregiver efforts to overcome cultural taboos about sex and sexuality foster adolescents' willingness to talk with caregivers about sex; 2) evolving societal norms and reflections on their own upbringings motivate caregivers to discuss and support adolescents with sexual health; and 3) caregivers desire to engage in sexual health discussions with providers and support their teens with PrEP. DISCUSSION: As socio-cultural norms around sex evolve, adolescent-caregiver discussions about sexual health and PrEP may be an opportunity to increase PrEP use and reduce HIV infections among select adolescent sub-populations.


Assuntos
Fármacos Anti-HIV , Cuidadores , Infecções por HIV , Comportamentos Relacionados com a Saúde , Profilaxia Pré-Exposição , Comportamento Sexual , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , População Negra , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Mães , Profilaxia Pré-Exposição/métodos , Alabama , Relações Mãe-Filho
11.
BMC Res Notes ; 15(1): 347, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348439

RESUMO

OBJECTIVE: Gaps in sexually transmitted infection (STI) testing can lead to poor health outcomes due to untreated illness among youth living with HIV (YLHIV). Thus, the objective of this study is to examine STI testing behavior and outcomes among a sample of YLHIV in the southern United States. Clinical records of 139 YLHIV who received HIV care in Alabama (2017-2020) were evaluated for receipt of STI testing (gonorrhea, chlamydia, syphilis), prevalence of positive test results, and factors associated with testing outcomes (933 clinical visits). RESULTS: Nearly 80% of our sample identified as African American, most were 20-24 years, and about 60% reported detectable viral load at first visit during the study period. Just under 60% of cisgender male and transgender female clients reported receipt of at least one STI test, compared to less than 40% of cisgender females. Identifying as a cisgender male and having been diagnosed with HIV related to sex with men were associated with greater likelihood receiving STI testing. Cisgender males reported higher rates of positive syphilis test results than cisgender females; the highest rates of positive STI tests were among transgender females. Results underscore need for providers to promote routine STI testing to YLHIV.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Sífilis , Masculino , Adolescente , Feminino , Humanos , Estados Unidos , Sífilis/diagnóstico , Sífilis/epidemiologia , Alabama/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Gonorreia/diagnóstico , Programas de Rastreamento , Homossexualidade Masculina
12.
J Int Assoc Provid AIDS Care ; 21: 23259582221127936, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36147031

RESUMO

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the United States. HIV pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescription rates remain low. We conducted a survey of medical providers caring for Black AGYW in Alabama to explore PrEP prescription practices. While over half of the N = 36 providers reported minimal HIV testing of AGYW in clinic, most (N = 29, 81%) reported feeling confident discussing HIV prevention. Most reported willingness to prescribe PrEP to Black AGYW (58%-72%), but only 11 (31%) had prescribed PrEP to any female client. Low familiarity with CDC guidelines (N = 20, 56%) and PrEP options (N = 19, 53%) were barriers to prescription. Prescribing PrEP to AGYW was associated with provider training, with internal medicine providers being least likely to prescribe. These findings support the need to develop training tools to directly address unique training needs of providers who care for this population.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Alabama , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Pessoal de Saúde , Humanos , Prescrições , Estados Unidos
13.
AIDS Care ; 34(11): 1473-1480, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35914114

RESUMO

HIV disproportionately impacts many groups, including Black adolescent girls and young women (AGYW) aged 13-24 living in the Deep South. Current prevention efforts have the potential to further exacerbate disparities within this population as HIV pre-exposure prophylaxis (PrEP) remains underutilized by Black AGYW in the South. We conducted in-depth interviews (IDIs) grounded in Andersen's Model of Healthcare Utilization exploring providers' PrEP prescribing practices to Black AGYW in Alabama. Eleven providers completed IDIs exploring providers' PrEP prescription knowledge and experiences. Cross-cutting themes included: (1) Community and provider-level stigmas (including those propagated by legislation) relating to HIV and sexuality limit sexual health discussions with Black AGYW clients; (2) Low PrEP knowledge and comfort with guidelines limits PrEP conversations and reinforces low uptake and prescriptions; (3) Healthcare systems and structural barriers impede PrEP access for youth. Multi-level (structural, community, and provider) barriers to PrEP prescription demands high activation energy for providers to prescribe PrEP. We present recommendations in training in sexual health assessment, updates to PrEP guidelines to accommodate risk assessment appropriate for AGYW, and increased implementation science focused on PrEP prescription for Black AGYW in order to reduce HIV incidence for this population.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Feminino , Humanos , Alabama , Fármacos Anti-HIV/uso terapêutico , Negro ou Afro-Americano , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Prescrições , Adulto Jovem
14.
Med Educ Online ; 27(1): 2093692, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35773953

RESUMO

The USA has become increasingly diverse resulting in greater strides to improve workforce diversity and inclusivity. The objective of this study is to compare the experiences of trainees in Graduate Medical Education who identify as Lesbian, Gay, Bisexual, Transgender or Questioning (LGBTQ) to the experiences of non-LGBTQ trainees within the medical workplace. We conducted a cross-sectional, exploratory survey from 1 December 2020 to 14 January 2021 at a single, large teaching institution. We collected data anonymously and stored it in a REDCap database. We excluded surveys in which trainees did not respond to sexual orientation. We used contingency tables and Fisher's exact test to identify outcomes associated with sexual orientation and gender identity particularly with regard to professionalism, well-being, and satisfaction with training. We distributed the survey to 840 trainees. 730 trainees were included (23 (3.2%) LGBTQ and 707 (96%) Straight). LGBTQ trainees were more likely to experience offensive remarks based on race/ethnicity (p = 0.03) and sexual orientation (p = 0.01). Secondary analysis based on race found that Blacks and Other were more likely to report differences based on professionalism and satisfaction with their training program. There was no difference seen among LGBTQ trainees based on race. We found trainees who identified as LGBTQ were more likely to experience discrimination/microaggressions. Also, racial and ethnic groups that are underrepresented in medicine were more likely to encounter discrimination and dissatisfaction with their training. More efforts are needed in academics to promote safe and supportive LGBTQ and minority training experiences.


Assuntos
Minorias Sexuais e de Gênero , Pessoas Transgênero , Estudos Transversais , Feminino , Identidade de Gênero , Humanos , Masculino , Comportamento Sexual
15.
J Int Assoc Provid AIDS Care ; 21: 23259582221107327, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35699978

RESUMO

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in Alabama to explore opportunities for and barriers to sexual health care including PrEP prescription. Twelve AGYW participated in IDIs with median age 20 (range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3 months, and 6 reported prior STI. Themes included: 1) Stigma related to sex contributes to inadequate discussions with educators, healthcare providers, and parents about sexual health; 2) Intersecting stigmas around race and gender impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but don't perceive it as an option for them. Multifaceted interventions utilizing the perspectives, voices, and experiences of Black cisgender AGYW are needed to curb the HIV epidemic in Alabama and the U.S. South.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Saúde Sexual , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , População Negra , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Comportamento Sexual , Parceiros Sexuais , Adulto Jovem
16.
Nicotine Tob Res ; 24(4): 444-452, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34375426

RESUMO

INTRODUCTION: ransgender and gender diverse (TGD) people have a higher prevalence of tobacco and nicotine use compared to their cisgender peers. AIMS AND METHODS: Using the minority stress model as a guide, we conducted a systematic review of correlates of tobacco and nicotine use among TGD people. We reviewed the literature from Pubmed, PsycINFO, and CINAHL between April 1, 1995 and April 20, 2021. Article inclusion criteria were the following: written in English, reported empirical data, sampled exclusively or reported separate outcomes for transgender/gender diverse people, and reported correlates of tobacco or nicotine use, broadly defined. The first and second authors reviewed the articles retrieved from the search and from gray literature (relevant listserv solicitations) for inclusion. They then reviewed references of any included articles for additional candidate articles.Results: This resulted in 35 articles for review, which were synthesized in a qualitative fashion. The overall quality of the articles was fair, with the articles ranging from poor to fair quality and using primarily cross-sectional design and survey methods. CONCLUSIONS: Overall, the literature demonstrated external minority stressors were mostly researched (and supported) correlates of tobacco and nicotine use among TGD people. There is a critical need for higher quality research, such as longitudinal or experimental designs, to improve our understanding and prevention of tobacco and nicotine use in this population. IMPLICATIONS: This systematic review used the minority stress model as a guide to understand correlates of tobacco and nicotine use among transgender and gender diverse people. Literature of fair quality demonstrated that external minority stressors were the most researched and supported correlates of tobacco and nicotine use within the framework of the minority stress model. This review demonstrated a critical need for higher quality research, such as longitudinal or experimental designs, to improve our understanding and prevention of tobacco and nicotine use in this population. Preliminary findings from the limited literature highlight factors that may be relevant to target with this population, including general/environmental stressors and external minority stressors such as discrimination.


Assuntos
Nicotina , Pessoas Transgênero , Estudos Transversais , Identidade de Gênero , Humanos , Nicotiana
17.
Contemp Clin Trials ; 110: 106551, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34481070

RESUMO

BACKGROUND: While addressing smoking cessation in the context of HIV primary care may increase the acceptability of smoking cessation treatment for patients, HIV care providers have not been trained in offering these treatments. Tools that aid providers in treatment selection, such as computer-generated algorithms, may address barriers to providing effective and efficient treatment options to their patients. OBJECTIVE: To test the effectiveness of a computer-generated smoking cessation pharmacotherapy recommendation algorithm fully integrated into HIV primary care against an enhanced usual care condition. METHODS: Six hundred adult smokers living with HIV will be recruited from 3 medical clinics that provide HIV care in Birmingham, AL, Seattle, WA, and Boston, MA. Participants will be asked to complete a baseline visit and 4 follow-up visits, which will include self-report assessments and carbon monoxide monitoring. Additionally, participants have the option to respond to weekly text-message based surveys sent over an 11-week period between baseline and end of treatment. Participants randomized to the AT condition will have a tailored, algorithm-generated smoking cessation pharmacotherapy recommendation delivered to their HIV care provider via EHR, with the potential to receive up to 12 weeks of smoking cessation pharmacotherapy. CONCLUSIONS: A smoking cessation pharmacotherapy recommendation algorithm integrated into HIV primary care may increase treatment utilization and smoking abstinence among smokers living with HIV. If successful, the intervention would be ready for use across the entire CFAR Network of Integrated Clinical Systems network and, more broadly, in HIV clinics that utilize an EHR system.


Assuntos
Infecções por HIV , Abandono do Hábito de Fumar , Adulto , Algoritmos , Infecções por HIV/tratamento farmacológico , Humanos , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Dispositivos para o Abandono do Uso de Tabaco
18.
Nurs Clin North Am ; 56(2): 189-202, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023115

RESUMO

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.


Assuntos
Infecções por HIV/complicações , Terapia de Relaxamento/tendências , Transtornos do Sono-Vigília/terapia , Alabama , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Humanos , Malaui , Terapia de Relaxamento/métodos , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia
20.
PLoS One ; 16(3): e0248858, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33740005

RESUMO

PURPOSE: Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults' (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. METHODS: We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. RESULTS: 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. CONCLUSIONS: Primary support persons are willing to support AYAs using PrEP.


Assuntos
Infecções por HIV/tratamento farmacológico , Profilaxia Pré-Exposição , Apoio Social , Adolescente , Adulto , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autoeficácia , Rede Social , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
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