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1.
AIDS Behav ; 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642834

RESUMO

In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.

2.
AIDS Behav ; 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648131

RESUMO

Long-acting injectable (LAI) modalities have been developed for ART and PrEP. Women face unique barriers to LAI use yet little research has examined women's perceptions of potential LAI HIV therapy candidates. We conducted 89 in-depth interviews at six Women's Interagency HIV Study (WIHS) sites with women living with HIV (n = 59) and HIV-negative women (n = 30) from 2017 to 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Participants identified specific sub-populations who could most benefit from LAI over daily pills: (1) young people; (2) women with childcare responsibilities; (3) people with adherence-related psychological distress; (4) individuals with multiple sex partners; and (5) people facing structural insecurities such as homelessness. Women are underserved by current HIV care options and their perspectives are imperative to ensure a successful scale-up of LAI PrEP and LAI ART that prioritizes equitable access and benefit for all individuals.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34590235

RESUMO

CHOICES was an open-label, randomized, comparative effectiveness trial of office-based extended-release naltrexone versus treatment as usual in people with untreated opioid use disorder and HIV. This study explored facilitators to recruitment in Miami, a successful recruiting site in the national trial. The mixed-methods study included quantitative surveys of randomized participants, medical record abstraction, and qualitative interviews with study staff. Miami recruited 47 (40.5%) of 116 randomized participants in the six-site national trial. In-depth interviews of study staff (n = 6) revealed that Miami had a recruitment approach consisting of street level outreach and a close relationship with the local syringe services program (SSP). Partnership with a local SSP provided access to people living with HIV who inject drugs in Miami. SSPs' fundamental trust within the community of people who inject drugs can be leveraged in studies aiming to improve health outcomes in this underserved and high-priority population.

4.
BMJ Open ; 11(9): e054903, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489299

RESUMO

OBJECTIVES: People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA. DESIGN: Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015. SETTING: Nine participating sites across the USA. PARTICIPANTS: 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women. OUTCOMES: Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity. RESULTS: The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity. CONCLUSIONS: Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.


Assuntos
Insegurança Alimentar , Infecções por HIV , Estudos de Coortes , Estudos Transversais , Feminino , Abastecimento de Alimentos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fumar/epidemiologia , Estados Unidos/epidemiologia
5.
Open Forum Infect Dis ; 8(8): ofab334, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34377726

RESUMO

Background: Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods: In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018.Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results: Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions: The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration: NCT02641158.

6.
Epidemiology ; 32(6): 877-885, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34347686

RESUMO

BACKGROUND: Prior studies suggest neighborhood poverty and deprivation are associated with adverse health outcomes including death, but evidence is limited among persons with HIV, particularly women. We estimated changes in mortality risk from improvement in three measures of area-level socioeconomic context among participants of the Women's Interagency HIV Study. METHODS: Starting in October 2013, we linked geocoded residential census block groups to the 2015 Area Deprivation Index (ADI) and two 2012-2016 American Community Survey poverty variables, categorized into national tertiles. We used parametric g-computation to estimate, through March 2018, impacts on mortality of improving each income or poverty measure by one and two tertiles maximum versus no improvement. RESULTS: Of 1596 women with HIV (median age 49), 91 (5.7%) were lost to follow-up and 83 (5.2%) died. Most women (62%) lived in a block group in the tertile with the highest proportions of individuals with income:poverty <1; 13% lived in areas in the tertile with the lowest proportions. Mortality risk differences comparing a one-tertile improvement (for those in the two highest poverty tertiles) in income:poverty <1 versus no improvement increased over time; the risk difference was -2.2% (95% confidence interval [CI] = -3.7, -0.64) at 4 years. Estimates from family income below poverty level (-1.0%; 95% CI = -2.7, 0.62) and ADI (-1.5%; 95% CI = -2.8, -0.21) exposures were similar. CONCLUSIONS: Consistent results from three distinct measures of area-level socioeconomic environment support the hypothesis that interventions to ameliorate neighborhood poverty or deprivation reduce mortality risk for US women with HIV. See video abstract at, http://links.lww.com/EDE/B863.

7.
AIDS ; 35(13): 2169-2179, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34148987

RESUMO

OBJECTIVE: Combination strategies generate health benefits through improved health outcomes among people living with HIV (PLHIV) and prevention of new infections. We aimed to determine health benefits attributable to improved health among PLHIV versus HIV prevention for a set of combination strategies in six US cities. DESIGN: A dynamic HIV transmission model. METHODS: Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City (NYC) and Seattle, we assessed the health benefits of city-specific optimal combinations of evidence-based interventions implemented at publicly documented levels and at ideal (90% coverage) scale-up (2020-2030 implementation, 20-year study period). We calculated the proportion of health benefit gains (measured as quality-adjusted life-years) resulting from averted and delayed HIV infections; improved health outcomes among PLHIV; and improved health outcomes due to medication for opioid use disorder (MOUD). RESULTS: The HIV-specific proportion of total benefits ranged from 68.3% (95% credible interval: 55.3-80.0) in Seattle to 98.5% (97.5-99.3) in Miami, with the rest attributable to MOUD. The majority of HIV-specific health benefits in five of six cities were attributable HIV prevention, and ranged from 33.1% (26.1-41.1) in NYC to 83.1% (79.6-86.6) in Atlanta. Scaling up to ideal service levels resulted in three to seven-fold increases in additional health benefits, mostly from MOUD, with HIV-specific health gains primarily driven by HIV prevention. CONCLUSION: Optimal combination strategies generated a larger proportion of health benefits attributable to HIV prevention in five of six cities, underlining the substantial benefits of antiretroviral therapy engagement for the prevention of HIV transmission through viral suppression. Understanding to whom benefits accrue may be important in assessing the equity and impact of HIV investments.


Assuntos
Infecções por HIV , Cidades , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Humanos , Cidade de Nova Iorque/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Anos de Vida Ajustados por Qualidade de Vida
8.
JAMA Netw Open ; 4(4): e215226, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835175

RESUMO

Importance: Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs. Objective: To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-American Women on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition. Design, Setting, and Participants: This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach. Intervention: E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information. Main Outcomes and Measures: Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12-month period. Results: A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P = .01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P = .04). Conclusions and Relevance: The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women. Trial Registration: ClinicalTrials.gov Identifier: NCT02391233.


Assuntos
Assistência à Saúde Culturalmente Competente , Infecções por HIV/prevenção & controle , Prisioneiros/educação , Adulto , Afro-Americanos , Infecções por Chlamydia/prevenção & controle , Serviços de Saúde Comunitária/organização & administração , Feminino , Gonorreia/prevenção & controle , Infecções por HIV/diagnóstico , Humanos , Cidade de Nova Iorque , Vaginite por Trichomonas/prevenção & controle , Sexo sem Proteção/estatística & dados numéricos
9.
Subst Abuse Treat Prev Policy ; 16(1): 32, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832483

RESUMO

BACKGROUND: Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines. METHODS: We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data. RESULTS: We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period. CONCLUSIONS: We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness.

11.
AIDS Behav ; 25(8): 2644-2656, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33743114

RESUMO

Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents' health and wellbeing.


Assuntos
Infecções por HIV , Pessoas em Situação de Rua , Assistência Ambulatorial , Ocupação de Leitos , Infecções por HIV/prevenção & controle , Habitação , Humanos
12.
Drug Alcohol Depend ; 221: 108567, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33610093

RESUMO

BACKGROUND: People living with HIV who report substance use (PLWH-SU) face many barriers to care, resulting in an increased risk for poor health outcomes and the potential for ongoing disease transmission. This study evaluates the mechanisms by which Patient Navigation (PN) and Contingency Management (CM) interventions may work to address barriers to care and improve HIV outcomes in this population. METHODS: Mediation analysis was conducted using data from a randomized, multi-site trial testing PN interventions to improve HIV care outcomes among 801 hospitalized PLHW-SU. Direct and indirect effects of PN and PN + CM were evaluated through five potential mediators-psychosocial conditions, healthcare avoidance, financial hardship, system barriers, and self-efficacy for HIV treatment adherence-on engagement in HIV care and viral suppression. RESULTS: The PN + CM intervention had an indirect effect on improving engagement in HIV care at 6 months by increasing self-efficacy for HIV treatment adherence (ß = 0.042, 95% CI = 0.008, 0.086). PN + CM also led to increases in viral suppression at 6 months (ß = 0.090, 95% CI = 0.023, 0.168) and 12 months (ß = 0.069, 95% CI = 0.009, 0.129) via increases in self-efficacy, although the direct effects were not significant. No mediating effects were observed for PN alone. CONCLUSION: PN + CM interventions for PLWH-SU can increase an individual's self-efficacy for HIV treatment adherence, which in turn improves engagement in care at 6 months and may contribute to viral suppression over 12 months. Building self-efficacy may be a key factor in the success of such interventions and should be considered as a primary goal of PN + CM in practice.


Assuntos
Infecções por HIV/epidemiologia , Navegação de Pacientes/métodos , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Terapia Comportamental , Atenção à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Navegação de Pacientes/organização & administração
13.
AIDS Patient Care STDS ; 35(1): 23-30, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400587

RESUMO

Medications for antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) are currently daily pill regimens, which pose barriers to long-term adherence. Long-acting injectable (LAI) modalities have been developed for ART and PrEP, but minimal LAI-focused research has occurred among women. Thus, little is known about how women's history of injection for medical or nonmedical purposes may influence their interest in LAI. We conducted 89 in-depth interviews at 6 sites (New York, NY; Chicago, IL; San Francisco, CA; Atlanta, GA; Chapel Hill, NC; Washington, DC) of the Women's Interagency HIV study. Interviews occurred with women living with HIV (n = 59) and HIV-negative women (n = 30) from November 2017 to October 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Women's prior experiences with injections occurred primarily through substance use, physical comorbidities, birth control, or flu vaccines. Four primary categories of women emerged; those who (1) received episodic injections and had few LAI-related concerns; (2) required frequent injections and would refuse additional injections; (3) had a history of injection drug use, of whom some feared LAI might trigger a recurrence, while others had few LAI-related concerns; and (4) were currently injecting drugs and had few LAI-related concerns. Most women with a history of injectable medication would prefer LAI, but those with other frequent injections and history of injection drug use might not. Future research needs to address injection-related concerns, and develop patient-centered approaches to help providers best identify which women could benefit from LAI use.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/métodos , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Criança , Cidades , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Injeções , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Estados Unidos
14.
J Community Health ; 46(3): 557-564, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32761292

RESUMO

People living with HIV (PLWH) who use drugs experience worse health outcomes than their non-using counterparts. Little is known about how often they seek dental care and the factors that influence their utilization. PLWH with substance use disorders who were inpatients at 11 urban hospitals (n = 801) participated in a National Institute on Drug Abuse Clinical Trials Network study to improve engagement in HIV outcomes. Dental care utilization at each time point during the study period (baseline, 6 months and/or 12 months) was assessed (n = 657). Univariate analysis and logistic regression were used to examine factors associated with dental care utilization. Over half (59.4%) reported not having received any dental care at any timepoint. Participants with less than high school education had lower odds of reporting dental care utilization than those with more than education (aOR = 0.60 [95% CI 0.37-0.99], p = 0.0382). Participants without health insurance also had lower odds of reporting dental care utilization than those with insurance (aOR = 0.50 [95% CI 0.331-0.76], p = 0.0012). Higher food insecurity was associated with having recent dental care utilization (OR = 1.03 [95% CI 1.00, 1.05], p = 0.0359). Additionally, those from Southern states were less likely to report dental care utilization (aOR = 0.55 [95% CI 0.38, 0.79], p = 0.0013). Having health insurance and education are key factors associated with use of dental care for PLWH with substance use disorders. The association between food insecurity and dental care utilization among this population suggests the need for further exploration.

15.
AIDS Behav ; 25(3): 667-678, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32910351

RESUMO

Long-acting injectable (LAI) pre-exposure prophylaxis (PrEP) has the potential to facilitate adherence and transform HIV prevention. However, little LAI PrEP research has occurred among women, who face unique barriers. We conducted 30 in-depth interviews with HIV-negative women from 2017-2018 across six sites (New York; Chicago; San Francisco; Atlanta; Washington, DC; Chapel Hill) of the Women's Interagency HIV Study. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Few women expressed interest in PrEP and when prompted to choose a regimen, 55% would prefer LAI, 10% daily pills, and 33% said they would not take PrEP regardless of formulation. Perceived barriers included: (1) the fear of new-and perceived untested-injectable products and (2) potential side effects (e.g., injection-site pain, nausea). Facilitators included: (1) believing shots were more effective than pills; (2) ease and convenience; and (3) confidentiality. Future studies should incorporate women's LAI PrEP-related experiences to facilitate uptake.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Adulto , Idoso , Cidades , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Pesquisa Qualitativa , Estados Unidos
16.
Arch Sex Behav ; 50(1): 311-322, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32458301

RESUMO

Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors-sex with a primary/non-primary partner; partner's HIV status; vaginal/anal sex; condom use; and substance use before or during sex act-can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91-2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33-2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.


Assuntos
Assunção de Riscos , Sexo Seguro/psicologia , Comportamento Sexual/psicologia , Sexo sem Proteção/prevenção & controle , Feminino , Humanos , Masculino
17.
Int J Epidemiol ; 49(6): 2021-2029, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-33141177

RESUMO

BACKGROUND: Parametric g-computation is an analytic technique that can be used to estimate the effects of exposures, treatments and interventions; it relies on a different set of assumptions than more commonly used inverse probability weighted estimators. Whereas prior work has demonstrated implementations for binary exposures and continuous outcomes, use of parametric g-computation has been limited due to difficulty in implementation in more typical complex scenarios. METHODS: We provide an easy-to-implement algorithm for parametric g-computation in the setting of a dynamic baseline intervention of a baseline exposure and a time-to-event outcome. To demonstrate the use of our algorithm, we apply it to estimate the effects of interventions to reduce area deprivation on the cumulative incidence of sexually transmitted infections (STIs: gonorrhea, chlamydia or trichomoniasis) among women living with HIV in the Women's Interagency HIV Study. RESULTS: We found that reducing area deprivation by a maximum of 1 tertile for all women would lead to a 2.7% [95% confidence interval (CI): 0.1%, 4.3%] reduction in 4-year STI incidence, and reducing deprivation by a maximum of 2 tertiles would lead to a 4.3% (95% CI: 1.9%, 6.4%) reduction. CONCLUSIONS: As analytic methods such as parametric g-computation become more accessible, epidemiologists will be able to estimate policy-relevant effects of interventions to better inform clinical and public health practice and policy.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções por HIV , Doenças Sexualmente Transmissíveis , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Políticas
18.
Int J Drug Policy ; 87: 102950, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33099160

RESUMO

BACKGROUND: Incarceration increases HIV risk behaviors and strains intimate partnerships of couples of people who inject drugs (PWID) in Kazakhstan. Studies are yet to examine dyadic relationships between criminal justice involvement and injection drug and sexual HIV risk behaviors of couples who inject drugs in Kazakhstan. This study examined associations between individual and partner level criminal justice involvement and injection drug and sexual HIV risk behaviors among 216 intimate dyads (n = 432) of PWID in Almaty, Kazakhstan. METHODS: The Actor Partner Interdependence Model (APIM) using structural equation modeling examined individual (actor), partner and dyadic patterns (actor-partner) of associations between arrest, incarceration and drug crime conviction of dyads of male and female intimate partners of PWID using baseline data from Project Renaissance, a couples-focused HIV prevention intervention for PWID and their intimate partners. RESULTS: Results from the APIM identified significant associations between lifetime (ß=0.10, CI95%=0.01.20, p=.021) and recent (ß=0.12, CI95%=0.01.26, p=.045) arrest and increased risk of injection drug use with any partner for female partners. Partner-only effects were identified in which male PWID's recent arrest was associated with an increase in their study partners' injection drug risk behaviors (ß=0.10 CI95%=0.02, 0.20, p=.044). For female partners, prior incarceration was associated with increased engagement in injection drug risk behaviors (ß=0.10 CI95% =0.02, 0.20, p=.035) with any partner. For male partners' prior incarceration was associated with injection drug risk behaviors with their study partners (ß=0.10 CI95%= 0.02, 0.20. p<.05). Female partners prior drug crime conviction was associated with their own (ß=0.14 CI95%=0.01, 0.28, p=.048) and their intimate partners' (ß=0.18, CI95%=0.03, 0.33, p=.024) engagement in injection drug risk behaviors with any injecting partner. Recent drug crime conviction (ß=0.12, CI95%=0.01, 0.24, p=.038) and arrest (ß=0.13, CI95%, p=.022) was associated with increased engagement in sexual risk behaviors among female partners. CONCLUSION: Findings from this study identified differences in how criminal justice involvement impacts sexual and injection drug and sexual risk behaviors between male and female partners of PWID. Future research must investigate how structural interventions at the dyadic level could address the negative impact of criminal justice involvement on sexual and injection drug HIV risks within the contexts of couples who are PWID.

19.
AIDS Behav ; 25(4): 1047-1062, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33057892

RESUMO

People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.


Assuntos
Infecções por HIV , Preparações Farmacêuticas , Doenças Sexualmente Transmissíveis , Direito Penal , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Políticas , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Estados Unidos
20.
J Public Health Dent ; 81(1): 65-76, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33049081

RESUMO

OBJECTIVES: Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS: We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS: Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION: Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.


Assuntos
Revelação , Infecções por HIV , Confidencialidade , Estudos Transversais , Odontólogos , Feminino , Humanos , Autorrevelação
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