Motivational Interviewing Training for HIV Care Physicians in Argentina: Uptake and Sustainability of an Effective Behavior Change Intervention.

Motivational interviewing (MI) utilizes a patient-centered approach to address patient ambivalence about treatment and has been found to improve treatment ART adherence among patients living with HIV disengaged from care. This study examined MI training for clinicians, uptake, and sustainability over time. Clinics (n = 7) with N = 38 physicians were randomized to condition (MI, Enhanced Standard of Care). Physicians completed video- recorded patient consultations at baseline and 6, 12, and 18-month follow-up. MI condition physicians had greater relational and technical scores over time and were more likely to adhere to and sustain MI over time. Overall, physicians found the MI training highly acceptable and were able to sustain their skills. Results illustrate the feasibility of MI training, implementation, and sustainment over 18 months. Findings support previous research in Argentina in which trained physicians found MI useful with challenging patients. Broader implementation of MI among HIV care physicians in Argentina is merited.

RESUMEN: La entrevista motivacional (EM) es una intervención con enfoque en el paciente que sirve para abordar la ambivalencia del paciente sobre el tratamiento. Se ha descubierto que EM mejora la adherencia al tratamiento antirretroviral en pacientes con VIH y que no están recibiendo tratamiento. En este estudio se examinó la capacitación de EM entre médicos, como también la aceptación y la sostenibilidad de EM a lo largo del tiempo. Las clínicas (n = 7) con N = 38 médicos se asignaron al azar a la condición (EM o estándar de atención mejorada). Los médicos hicieron consultas de pacientes, las cuales fueron grabadas en video al inicio del estudio y a los 6, 12 y 18 meses de seguimiento. Los médicos de la condición de EM obtuvieron puntuaciones relacionales y técnicas más altas a lo largo del tiempo y fueron más propensos ha adherirse y usar la EM con el tiempo. En general, los médicos consideraron que la formación en EM era muy aceptable y pudieron mantener sus habilidades. Los resultados ilustran la viabilidad de la capacitación, implementación y mantenimiento de la EM durante 18 meses. Los descubrimientos sustentan investigaciones anteriores en Argentina en las que médicos capacitados encontraron que la EM era útil para pacientes desafiantes. Una implementación más amplia de la EM entre los médicos de atención del VIH en Argentina es necesaria para mejorar el tratamiento de personas con VIH.

National Estimates of Prevalence, Time-Trend, and Correlates of Smoking in US People Living with HIV (NHANES 1999-2016).

OBJECTIVE: Approximately one in four deaths among people living with HIV (PLWH) in the United States can be attributed to cigarette smoking. Using a nationally representative sample of PLWH, this study examines the prevalence, time-trends, and correlates of current cigarette smoking among PLWH compared to people without HIV. DESIGN: Secondary analysis of population-based cross-sectional biobehavioral survey. METHODS: Data were pooled from the 1999-2016 National Health and Nutrition Examination Survey (NHANES). All adults (20-59 years) who self-reported their smoking status and were tested for HIV (HIV+ = 152; HIV- = 26 305) were included in the analysis. Prevalence with 95% confidence interval (95% CI), trend analysis by year and group (HIV+/HIV-), and multivariable logistic regression analyses were performed with the complex survey design adjustments. RESULTS: Overall, 47.0% of PLWH were current smokers compared to 25.5% of those without HIV. From 1999 to 2016, the decline in smoking in PLWH was comparable to those without HIV (10.7% vs. 8.0%). PLWH smokers were more likely than PLWH nonsmokers to be substance users (adjusted odds ratio [aOR] = 17.52; 95% CI = 2.04 to 27.8). Compared to smokers without HIV, PLWH smokers were more likely to be older (1.10; 1.06 to 1.14), males (7.96; 2.50 to 25.40), non-Hispanic Black (10.45; 4.13 to 26.45), with depression (Patient Health Questionnaire-9 sum score ≥5) (3.79; 1.22 to 11.79), and less likely to be gay (0.02; 0.00 to 0.07). CONCLUSION: Cigarette smoking among PLWH is a major public health problem in the United States. Targeted and tailored smoking cessation interventions that incorporate assessment and treatment of depression and co-occurring substance use are critical for PLWH, especially among those who are disproportionately affected by smoking and HIV (sexual minority). IMPLICATIONS: This study offers important research implications in four areas:1. The decline in smoking among PLWH over 18 years has been modest, and half of PLWH are still smokers.2. More resources and efforts should be allocated to reduce cigarette smoking among PLWH.3. There is a critical need to develop and test culturally tailored smoking cessation interventions for minority subgroups who are most impacted by HIV infection and smoking (non-Hispanic Blacks and men who have sex with men)4. Smoking cessation interventions designed for PLWH should incorporate assessment and treatment of depression and substance use.

HIV and carotid atherosclerosis: a mediational model.

Cardiovascular disease (CVD) is the leading cause of death in the US and is a significant contributor to morbidity and mortality for people living with HIV (PLWH). This study examined the association between HIV infection, cocaine usage, and inflammatory markers, and their combined association with carotid atherosclerosis among young and middle-aged adults with HIV. Participants (N = 494) were enrolled based on HIV status and cocaine use. Blood pressure, body mass index (BMI), and cocaine use were assessed. Cytokines and growth factors, IL-1a, IL-6, TNFα and VEGF, and immune activation markers, sCD14 and sCD163 were measured. Participant age was 36.2 years (SD = 9.5); 50% were male, 49% female and 1% transgender; 39% were HIV-positive, 50% were current or past smokers, and 39% endorsed cocaine use. A path analysis showed an indirect effect of HIV serostatus on the presence of carotid atherosclerotic plaques (Indirect Effect = 0.048, SE = 0.024, p = .043), when controlling age, BMI, smoking, and cocaine use. This effect was mediated by inflammatory markers and changes in blood pressure. Findings point to putative underlying mechanisms leading to atherosclerosis among PLWH.

A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa.

BACKGROUND: We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. METHODS: In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n  = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n  = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. RESULTS: In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no differences in maternal adherence at 32 weeks, reported infant adherence at 6 weeks, or PMTCT and HIV knowledge by study condition over time. CONCLUSION: The enhanced intervention administered by trained lay health workers did not have any salutary impact on HIV infant status, ART adherence, HIV and PMTCT knowledge. Trial registration clinicaltrials.gov: number NCT02085356.

High Rates of STIs in HIV-Infected Patients Attending an STI Clinic.

OBJECTIVES: To evaluate the rates and types of sexually transmitted infections (STIs) in patients infected with the human immunodeficiency virus (HIV) attending a public STI clinic in Miami, Florida as compared with HIV-uninfected patients attending the same clinic. METHODS: This was a retrospective review of medical records of individuals attending the Miami-Dade County Health Department STI clinic from March 2012 to May 2012. Demographic and clinical information was abstracted and transferred to an electronic database. Consecutive age-matched HIV-infected and HIV-uninfected patients were identified during the study period. Demographics, risk factors, and history and rates of STIs for HIV-infected and HIV-uninfected patients and for those with newly diagnosed and previously diagnosed HIV infection were compared. RESULTS: A total of 175 medical records were reviewed (89 HIV-infected patients and 86 HIV-uninfected patients). The median age was 37 years. A history of STIs, including syphilis, was more common in HIV-infected than in HIV-uninfected patients. Individuals with a prior diagnosis of HIV were more likely to be older (older than 37 years of age, χ(2) = 15.3, P < 0.01), male (χ(2) = 4.74, P = 0.05), to have a new STI (χ(2) = 5.83, P = 0.01), to have a new diagnosis of syphilis (χ(2) = 5.15, P = 0.01), and to be under medical care (χ(2) = 31.19, P < 0.001) than those newly diagnosed as having HIV. CONCLUSIONS: HIV-infected individuals who attended this urban STI clinic had high rates of new and past STIs, suggesting the persistence of high-risk sexual behaviors. STI clinics could be a premier site to identify individuals with HIV and high-risk sexual behaviors who could benefit from additional targeted interventions.

Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women's HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. METHODS: From April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18-45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher's exact test, studentized t-test, and multivariate logistic regression (MLR). RESULTS: A total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators. CONCLUSION: Findings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake.

Sociodemographics and health-literacy as predictors of cervical cancer screening practices among Haitian women: A secondary data analysis of 2016-17 DHS surveys.

Cervical cancer screening rates in Haiti are concerningly low. Access to health-related information and health literacy may be important determinants of engagement in cervical cancer screening. This study explored the relationship between sociodemographics,literacy, and sources of information on cervical cancer screening among Haitian women. A secondary data analysis was conducted using USAID Demographics and Health Survey Haiti household data from 2016-2017. Univariate logistic regressions identified significant predictor covariates measuring sociodemographics and sources of information in cervical cancer screening uptake.Two multivariate logistic regression models with adjusted odds ratios were developed using the significant predictor variables from the univariate analysis. N = 610 women responded to questions pertaining to cervical cancer screening. The first multivariate model evaluating sociodemographics demonstrated an economic background of poorer (aOR = 4.06, 95% CI [1.16,14.27]) and richest (aOR = 19.10 , 95% CI[2.58,141.57]), higher education levels (aOR 7.58 , 95% CI [1.64,34.97]), and having insurance (aOR = 16.40, [95% CI 2.65, 101.42]) were significant predictors of cervical cancer screening. The second model evaluating literacy and sources of information indicated that access to a television (aOR = 4.28, 95% CI [1.21,9.34]), mobile phone ownership (aOR = 4.44, 95% CI [1.00,5.59]), and reading the newspaper (aOR = 3.57, [95% CI 1.10,11.59]) were significant predictors of cervical cancer screening. Diverse health communication initiatives that are adapted for literacy level and that incorporate multimedia components may effective in raising women's cervical cancer knowledge and awareness , and increasing intention and uptake of cervical cancer screening in Haiti.

HIV patients' perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention.

OBJECTIVES: Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), "Craving-to-Quit." Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app's content and design to PLWH's unique psychosocial profile and needs. METHODS: We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants' perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. RESULTS: Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. CONCLUSIONS: Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.

A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care.

Background: Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods: Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient-provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings: Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, P = 0·027), and self-efficacy (B = 0·063, P = 0·001), suggesting the intervention was associated with improved patient-provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation: These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted. Funding: National Institutes of Health.

Syndemic burden and systemic inflammation, HIV health status, and blood pressure among women with unsuppressed HIV viral loads among women living with HIV.

INTRODUCTION: Smoking, low education, obesity, and depressive symptoms are all associated with HIV health status, increased blood pressure, and inflammation, and constitute a syndemic burden that may contribute to poor health outcomes. The current study examined syndemic burden and health outcomes among women living with HIV. METHODS: Women were participants enrolled in the Women's Interagency HIV Study. Outcomes included blood pressure, HIV health status (HIV-1 RNA viral load and CD4 T-cell counts), and IL-6. Syndemic burden was defined as a count variable of low education, obesity, cigarette use, and depressive symptoms. RESULTS: Women (N = 131) were an average of 60.54 years of age (SD = 8.86), and 49% were non-Hispanic Black. In multivariable analyses, syndemic burden was not significantly associated with SBP (P = 0.342) or DBP (P = 0.763), IL-6 (P = 0.168), or CD4 cell count (P = 0.846). However, syndemic burden was associated with increased viral load (age adjusted ß = 0.35, P < 0.001). Comparing women with high versus low syndemic burden, also controlling for women's age, women with high syndemic burden had higher DBP and HIV viral load. DISCUSSION: Syndemic burden appeared to play an important role in HIV health status and could potentially increase the risk of HIV transmission. High syndemic burden, defined as at least two syndemic conditions, had the greatest effects of HIV viral load and DBP. Targeted interventions to address syndemic burden may help improve health outcomes in women living with HIV as well as reduce the risk of hypertension and HIV transmission.

Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care.

This study evaluated the reasons for not taking antiretroviral treatment (ART) among women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups and physician visits), with the goal of identifying strategies for reengagement in HIV care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who completed sociodemographic, medical history, reasons why they were not taking ART, mental health, motivation, and self-efficacy assessments. Latent class analysis was used for analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher depression (U = 608.5, z = -2.7, P = .007), lower motivation (U = 601, z = -2.8, P = .006), and lower self-efficacy (U = 644.5, z = -2.4, P = .017) than those not using this maladaptive strategy. As women living with HIV experience a disproportionate burden of poor health outcomes, interventions focused on the management of depression may improve HIV outcomes and prevent HIV transmission.

Impacto de la pandemia de COVID-19 y la cuarentena en hombres que tienen sexo con hombres viviendo con VIH en Argentina / mpact of COVID-19 pandemic and lockdown among Men who have sex with Men living with HIV in Argentina

Introducción: Las personas que viven con VIH (PVV) tienen mayor riesgo de complicaciones de salud mental. Para mitigar la propagación del COVID-19 en nuestro país se estableció una cuarentena temprana. Estudiamos el impacto del estrés relacionado con COVID-19 y la cuarentena en hombres que tienen sexo con hombres que viven con VIH (HSHV) en Argentina.Materiales y métodos: Realizamos una encuesta anónima en abril-mayo de 2020. Se incluyeron PVV en seguimiento en una institución privada en Argentina. Se evaluaron la adherencia a medidas preventivas de COVID-19 y al tratamiento antirretroviral, el acceso a recursos, factores psicosociales y el consumo de sustancias durante la cuarentena. Este análisis se centró en los resultados de HSHV.Resultados: Entre 1336 participantes incluidos, 596 se autoreportaron HSHV (mediana de edad de 44 años, RIC 35-52). La adherencia a la cuarentena fue del 96,8%; la pérdida de empleo en el hogar 55,4%. Se observó interrupción en la obtención de medicamentos antirretrovirales en el 4,9% y el 29,9% reportó adherencia subóptima. Los problemas de salud mental fueron frecuentes: depresión (14,1%), soledad (15,6%) y ansiedad (20,2%).Conclusiones: Nuestro estudio evidenció alta adherencia a las medidas preventivas al inicio de la cuarentena y dificultades en el acceso a los servicios de salud. La pandemia de COVID-19 ha comprometido la economía del país; este estudio muestra su impacto en el acceso de los HSHV a recursos básicos. Dado que la salud mental de los HSHV ha sido afectada, la pandemia resalta la necesidad de una visión integral de la salud de nuestros pacientes

Background: People living with HIV (PLWH) are at increased risk of mental health complications. In order to mitigate the spread of COVID-19 in our country, an early quarantine was established. We studied the impact of COVID-19-related stress and quarantine in men who have sex with men living with HIV(MSMLH) in Argentina.Materials and methods: An anonymous survey was conducted between April and May 2020. PLWH in follow-up at a private institution in Argentina were included. We assessed adherence to preventive measures of COVID-19 and antiretroviral treatment, access to resources, psychosocial factors and substance use during quarantine. This analysis focused on MSMLH results.Results: Among 1336 participants included, 596 self-reported as MSMLH (median age 44, IQR 35-52). Quarantine adherence was 96.8%; household job loss 55.4%. Interruption to access to antiretroviral medication was observed in 4.9% and 29.9% reported suboptimal adherence. Mental health problems were common: depression (14.1%), loneliness (15.6%) anxiety (20.2%).Conclusions: Our study showed high adherence to preventive measures during the beginning of lockdown and difficulties to access health services. The COVID-19 pandemic has compromised the country's economy; this study shows its impact on MSMLH access to basic resources. Since MSMLH mental health has been affected, the pandemic highlights the need of a comprehensive approach to our patients' health

Cavitary pneumonia secondary to Tsukamurella in an AIDS patient. First case and a review of the literature.

Tsukamurella is a Gram-positive, variable rod-shaped, weakly acid-alcohol-fast, non motile, aerobic bacterium that belongs to the genus Rhodococcus. Tsukamurella has been reported as a cause of infections in humans with immunosuppression and indwelling foreign bodies. It has also been isolated in one patient with AIDS (Acquired Immunodeficiency Syndrome) as a saprophytic organism. Optimal management of infections secondary to this micro-organism is still uncertain due to the paucity of cases. The combination of a beta-lactam and an aminoglycoside, along with removal of medical devices, appear to be the treatment of choice. We report the case of an AIDS patient who presented with multiple lung cavitary lesions secondary to Tsukamurella. This is the first case reported of Tsukamurella as a pathogenic agent in an AIDS patient. We also propose a successful oral antibiotic regimen with fluoroquinolone and rifampin to treat infections secondary to this uncommon micro-organism.