Social Determinants of Health Needs and Health-related Quality of Life Among Surgical Patients: A Retrospective Analysis of 8512 Patients.

OBJECTIVE: To assess associations between social determinants of health (SDOH) needs and health-related quality of life (HRQOL) among surgical patients. BACKGROUND: Despite the profound impact of SDOH on health outcomes, studies examining the effect of SDOH needs on HRQOL among surgical patients are limited. METHODS: A retrospective study was conducted using responses from the SDOH needs assessment and the Patient-Reported Outcomes Measurement Information Systems Global Health instrument of adults seen in surgical clinics at a single institution. Patient characteristics including socioeconomic status (insurance type, education level, and employment status) were extracted. Stepwise multivariable logistic regression analyses were performed to identify independent predictors of global health scores. RESULTS: A total of 8512 surgical patients (mean age: 55.6±15.8 years) were included. 25.2% of patients reported one or more SDOH needs. The likelihood of reporting at least one SDOH need varied by patient characteristics and socioeconomic status variables. In fully adjusted regression models, food insecurity [odds ratio (OR), 1.53; 95% CI, 1.38-1.70 and OR, 1.49; 95% CI, 1.22-1.81, respectively], housing instability (OR, 1.27; 95% CI, 1.12-1.43 and OR, 1.39; 95% CI, 1.13-1.70, respectively) lack of transportation (OR, 1.46; 95% CI, 1.27-1.68 and OR, 1.25; 95% CI, 1.00-1.57, respectively), and unmet medication needs (OR, 1.31; 95% CI, 1.13-1.52 and OR, 1.61; 95% CI, 1.28-2.03, respectively) were independent predictors of poor physical and mental health. CONCLUSIONS: SDOH needs are independent predictors of poor patient-reported physical and mental health among surgical patients. Assessing and addressing SDOH needs should be prioritized in health care settings and by policymakers to improve HRQOL.

Patterns of Social Needs Predict Quality-of-Life and Healthcare Utilization Outcomes in Patients from a Large Hospital System.

BACKGROUND: Unmet social needs (SNs) often coexist in distinct patterns within specific population subgroups, yet these patterns are understudied. OBJECTIVE: To identify patterns of social needs (PSNs) and characterize their associations with health-related quality-of-life (HRQoL) and healthcare utilization (HCU). DESIGN: Observational study using data on SNs screening, HRQoL (i.e., low mental and physical health), and 90-day HCU (i.e., emergency visits and hospital admission). Among patients with any SNs, latent class analysis was conducted to identify unique PSNs. For all patients and by race and age subgroups, compared with no SNs, we calculated the risks of poor HRQoL and time to first HCU following SNs screening for each PSN. PATIENTS: Adult patients undergoing SNs screening at the Mass General Brigham healthcare system in Massachusetts, United States, between March 2018 and January 2023. MAIN MEASURES: SNs included: education, employment, family care, food, housing, medication, transportation, and ability to pay for household utilities. HRQoL was assessed using the Patient-Reported Outcomes Measurement Information System Global-10. KEY RESULTS: Six unique PSNs were identified: "high number of social needs," "food and utility access," "employment needs," "interested in education," "housing instability," and "transportation barriers." In 14,230 patients with HRQoL data, PSNs increased the risks of poor mental health, with risk ratios ranging from 1.07(95%CI:1.01-1.13) to 1.80(95%CI:1.74-1.86). Analysis of poor physical health yielded similar findings, except that the "interested in education" showed a mild protective effect (0.97[95%CI:0.94-1.00]). In 105,110 patients, PSNs increased the risk of 90-day HCU, with hazard ratios ranging from 1.09(95%CI:0.99-1.21) to 1.70(95%CI:1.52-1.90). Findings were generally consistent in subgroup analyses by race and age. CONCLUSIONS: Certain SNs coexist in distinct patterns and result in poorer HRQoL and more HCU. Understanding PSNs allows policymakers, public health practitioners, and social workers to identify at-risk patients and implement integrated, system-wide, and community-based interventions.

The PROMIS-16 reproduces the PROMIS-29 physical and mental health summary scores accurately in a probability-based internet panel.

PURPOSE: The Patient-Reported Outcomes Measurement Information System® (PROMIS)-16 assesses the same multi-item domains but does not include the pain intensity item in the PROMIS-29. We evaluate how well physical and mental health summary scores estimated from the PROMIS-16 reproduce those estimated using the PROMIS-29. METHODS: An evaluation of data collected from 4130 respondents from the KnowledgePanel. Analyses include confirmatory factor analysis to assess physical and mental health latent variables based on PROMIS-16 scores, reliability estimates for the PROMIS measures, mean differences and correlations of scores estimated by the PROMIS-16 with those estimated by the PROMIS-29, and associations between differences in corresponding PROMIS-16 and PROMIS-29 scores by sociodemographic characteristics. RESULTS: A two-factor (physical and mental health) model adequately fits the PROMIS-16 scores. Reliability estimates for the PROMIS-16 measures were slightly lower than for the PROMIS-29 measures. There were minimal differences between PROMIS physical and mental health summary scores estimated using the PROMIS-16 or the PROMIS-29. PROMIS-16 and PROMIS-29 score differences by sociodemographic characteristics were small. Using the PROMIS pain intensity item when scoring the PROMIS-16 produced similar estimates of physical and mental health summary scores. CONCLUSION: The PROMIS-16 provides similar estimates of the PROMIS-29 physical and mental health summary scores. The high reliability of these scores indicates they are accurate enough for use with individual patients.

Development of an ultra-short measure of eight domains of health-related quality of life for research and clinical care: the patient-reported outcomes measurement information system® PROMIS®-16 profile.

PURPOSE: We describe development of a short health-related quality of life measure, the patient-reported outcomes measurement information system® (PROMIS®)-16 Profile, which generates domain-specific scores for physical function, ability to participate in social roles and activities, anxiety, depression, sleep disturbance, pain interference, cognitive function, and fatigue. METHODS: An empirical evaluation of 50 candidate PROMIS items and item pairs was conducted using data from a sample of 5775 respondents from Amazon's Mechanical Turk (MTurk). Results and item response theory information curves for a subset of item pairs were presented and discussed in a stakeholder meeting to narrow the candidate item sets. A survey of the stakeholders and 124 MTurk adults was conducted to solicit preferences among remaining candidate items and finalize the measure. RESULTS: Empirical evaluation showed minimal differences in basic descriptive statistics (e.g., means, correlations) and associations with the PROMIS-29 + 2 Profile, thus item pairs were further considered primarily based on item properties and content. Stakeholders discussed and identified subsets of candidate item pairs for six domains, and final item pairs were agreed upon for two domains. Final items were selected based on stakeholder and MTurk-respondent preferences. The PROMIS-16 profile generates eight domain scores with strong psychometric properties. CONCLUSION: The PROMIS-16 Profile provides an attractive brief measure of eight distinct domains of health-related quality of life, representing an ideal screening tool for clinical care, which can help clinicians quickly identify distinct areas of concern that may require further assessment and follow-up. Further research is needed to confirm and extend these findings.

Associations between HIV disclosure and HIV care continuum outcomes among men who have sex with men living with HIV: systematic review and meta-analysis.

ABSTRACTThe objective of this study is to synthesize the existing empirical literature and perform a systematic review and meta-analysis on the relationship between HIV disclosure and engagement in the HIV care continuum among men who have sex with men living with HIV. Twenty-three studies were included, with thirteen quantitative studies and ten qualitative studies. Meta-analytic techniques were used to compute and aggregate effect sizes (odds ratio [OR] and their confidence intervals [95%CI]) for the quantitative studies and a thematic analysis was employed for qualitative studies. Given the small number of eligible studies, meta-analysis was only conducted for the linkage to care outcome, where a positive association was observed from the pooled estimation (OR = 1.51, 95%CI [1.15, 1.99]). Regarding ART initiation, retention in care, and viral suppression outcomes, most of the individual studies revealed a positive association between HIV disclosure and these outcomes. Thematic analysis from qualitative studies complemented the quantitative findings by incorporating the approaching and avoidance motivations underlying the relationship between non-HIV disclosure and the participation in HIV care continuum. The small number of available studies limits the definitive conclusions, and more research is needed to ascertain the magnitude of effect sizes.

Revealing geographic transmission pattern of COVID-19 using neighborhood-level simulation with human mobility data and SEIR model: A case study of South Carolina.

Direct human physical contact accelerates COVID-19 transmission. Smartphone mobility data has emerged as a valuable data source for revealing fine-grained human mobility, which can be used to estimate the intensity of physical contact surrounding different locations. Our study applied smartphone mobility data to simulate the second wave spreading of COVID-19 in January 2021 in three major metropolitan statistical areas (Columbia, Greenville, and Charleston) in South Carolina, United States. Based on the simulation, the number of historical county-level COVID-19 cases was allocated to neighborhoods (Census block groups) and points of interest (POIs), and the transmission rate of each allocated place was estimated. The result reveals that the COVID-19 infections during the study period mainly occurred in neighborhoods (86%), and the number is approximately proportional to the neighborhood's population. Restaurants and elementary and secondary schools contributed more COVID-19 infections than other POI categories. The simulation results for the coastal tourism Charleston area show high transmission rates in POIs related to travel and leisure activities. The results suggest that neighborhood-level infectious controlling measures are critical in reducing COVID-19 infections. We also found that households of lower socioeconomic status may be an umbrella against infection due to fewer visits to places such as malls and restaurants associated with their low financial status. Control measures should be tailored to different geographic locations since transmission rates and infection counts of POI categories vary among metropolitan areas.

Population Mobility and Aging Accelerate the Transmission of Coronavirus Disease 2019 in the Deep South: A County-Level Longitudinal Analysis.

Population mobility and aging at local areas contributed to the geospatial disparities in the coronavirus disease 2019 (COVID-19) transmission among 418 counties in the Deep South. In predicting the incidence of COVID-19, a significant interaction was found between mobility and the proportion of older adults. Effective disease control measures should be tailored to vulnerable communities.

HIV Service Interruptions During the COVID-19 Pandemic in China: The Role of COVID-19 Challenges and Institutional Response from Healthcare Professional's Perspective.

During the COVID-19 pandemic, HIV-related services have been unavoidably disrupted and impacted. However, the nature and scope of HIV service disruptions due to COVID-19 has rarely been characterized in China. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service disruption levels, then hierarchical multilevel logistic regression was conducted to analyze the relationships of COVID-19 challenges, institutional responses, and HIV service disruption levels adjusting for the clustering effect of institutional ownership levels. Four classes of HIV service disruption were identified, with 22.0% complete disruption, 15.4% moderate disruption, 21.9% minor disruption, and 40.7% almost no disruption. COVID-19 challenges were positively associated with the probabilities of service disruption levels. Institutional responses were negatively associated with the probabilities of being classified as "minor disruption" and moderated the association of COVID-19 challenges with complete and moderate disruptions compared with no disruption group. To maintain continuity of core HIV services in face of a pandemic, building a resilient health care system with adequate preparedness is necessary.

Racial disparities in the association between resilience and ART adherence among people living with HIV: the mediating role of depression.

Research examining the mediating role of depressive symptoms in the association between resilience and antiretroviral therapy (ART) adherence is lacking. Therefore, this study aims to examine the mediating role of depression between resilience and ART adherence, as well as to explore whether this relationship varies across racial background. A total of 327 people living with HIV and on ART in South Carolina were surveyed about their ART adherence and mental health, including resilience and depressive symptoms. Path analyses were conducted to determine the direct and indirect effects between resilience, depressive symptoms, and ART adherence. After adjusting for age, gender, income, education, employment and time since diagnosis, among Black individuals, resilience was negatively associated with depressive symptoms (ß = --0.248, p < 0.001); depressive symptoms were negatively associated with ART adherence (ß = -0.166, p = 0.020); however, resilience was not significantly associated with ART adherence. Among White individuals, there was no statistically significant association. The indirect effect between resilience and ART adherence through depressive symptoms was statistically significant (ß = 0.041, p = 0.040) for Black individuals, while not statistically significant for White individuals (ß = 0.024, p = 0.578). Interventions aimed at improving ART adherence, which attenuate depressive symptoms through accentuating resilience may be especially beneficial for Black populations living with HIV.

Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love.

BACKGROUND: The effectiveness of psychosocial interventions on quality of life (QOL) among people living with HIV has been validated, including mobile health (mHealth) interventions. However, it is unclear which components of such interventions account for these effects. OBJECTIVE: This study aims to examine positive coping as a potential mediator of the effects of an mHealth intervention on QOL among people living with HIV. METHODS: For this secondary analysis, we used data from an mHealth-based randomized controlled trial, Run4Love, which was conducted to improve QOL and mental health outcomes of people living with HIV. A total of 300 participants were randomly assigned to the intervention group to receive the adapted cognitive-behavioral stress management courses and regular physical activity promotion or the waitlist control group in a 1:1 ratio. Our analysis focused on positive coping and QOL, which were repeatedly measured at baseline and at 3-, 6-, and 9-month follow-ups. Latent growth curve models were constructed to explore the mediating role of positive coping in the effects of the mHealth intervention on QOL. RESULTS: Positive coping served as a mediator in the effect of the mHealth intervention on QOL for up to 9 months. The mHealth intervention had a significant and positive indirect effect on the slope of QOL via the slope of positive coping (b=2.592×1.620=4.198, 95% CI 1.189-7.207, P=.006). The direct effect of the intervention was not significant (b=0.552, 95% CI -2.154 to 3.258, P=.69) when controlling for the mediator. CONCLUSIONS: The longitudinal findings suggest that positive coping could be a crucial mediator of the mHealth intervention in enhancing QOL among people living with HIV. These findings underscore the importance of improving positive coping skills in mHealth interventions to improve QOL among people living with HIV.

Perioperative Risk Factors Associated With Unplanned Reoperation Following Vascularized Free Flaps Reconstruction of the Oral Squamous Cell Carcinoma.

OBJECTIVES: To find out the occurrence rate and risk factors of unplanned reoperation (any unscheduled surgery within 30 d after the initial surgery) in patients who have received oral squamous cell carcinoma (OSCC) surgery and vascularized free flap reconstruction. PATIENTS AND METHODS: We organized a retrospective study of 1058 patients who underwent OSCC resection and reconstruction with vascularized free flaps from 2011 to 2019. Clinical characteristics, reasons for unplanned reoperation, flap types, and previous treatment were compared between the unplanned reoperation group and the control group. Univariate and multivariate analyses were performed to identify perioperative risk factors for unplanned reoperation. The related perioperative factors that may influence perioperative infusion were included in propensity score matching to investigate the independent contribution of intraoperative colloid infusion on unplanned reoperation. RESULTS: The overall rate of unplanned reoperation in OSCC patients was 11% (n=115). Flap necrosis and bleeding were the most common causes. Higher American Society of Anesthesiologists (ASA) grade [odds ratio (OR)=1.709, P=0.009], postoperative anemia (OR=0.983, P=0.011) and excessive intraoperative colloid input (OR=1.55, P=0.037) were identified as risk factors for unplanned reoperation. Propensity score matching was applied, and the difference of unplanned reoperation incidence between the matched groups was statistically significant (14.59% versus 8.54%; P=0.025). The multivariate analyses after propensity score matching confirmed that the intraoperative rate of colloid infusion of more than 2.3 mL/kg/h (OR=1.756, P=0.042) and prior radiotherapy (OR=2.78, P=0.001) are independent risk factors for unplanned reoperation. CONCLUSION: High intraoperative colloid infusion rate and prior radiotherapy may increase the risk of unplanned reoperation in patients who underwent OSCC surgery and vascularized free flap reconstruction.

Stress coping strategies and their perceived effectiveness among HIV/AIDS healthcare providers in China: a qualitative study.

Previous studies have suggested that many HIV/AIDS healthcare providers (HCPs), especially those in resource-poor settings, suffer from various work-related stress because of the complexity of HIV/AIDS patients' medical conditions, occupational exposure, HIV-related stigma, and challenges with patients' physical, mental, and social conditions. However, data are limited regarding how HIV/AIDS HCPs cope with the stress and their perceived effectiveness of these coping strategies. This qualitative study was designed to explore HCPs' coping strategies and their perceptions of effectiveness of these strategies. We conducted in-depth face-to-face interviews with 46 HIV/AIDS HCPs in Guangxi, China. The interviews were audio-recorded, transcribed and imported into NVivo V.11. Data were analyzed using a thematic approach. The analysis of the data revealed six general coping strategies: seeking social support, applying problem-solving strategies, adopting healthy lifestyle, developing self-compassion, using mindfulness-based stress reduction methods, and avoidance and escaping. It is imperative to increase institutional support and develop training programs to improve problem-solving skills, healthy lifestyle, and self-compassion among HIV/AIDS HCPs in China.

Violence Victimization and Condomless Anal Intercourse Among Transgender Women in China: Mediating Role of Depression.

Transgender women (TGW) worldwide report disproportionate violence victimization, depression and condomless anal intercourse (CAI), but the mechanism of the coexistence remains unclear. Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China between April 2017 and July 2017, and conducted confidential questionnaire survey among them. Positive HIV status was reported by 49 (24.7%) participants. 117 (59.1%) reported at least one type of lifetime violence victimization, with transactional sexual partners being the main violence perpetrators. 108 (54.5%) reported mild to severe depression. 105 (53.0%) reported having CAI with their sexual partners during the last 6 months. Path analysis showed that the association between participants' violence victimization and CAI was fully mediated by their depression (indirect effect: 0.083, p = 0.014; direct effect: 0.137, p = 0.121). We suggest to incorporate violence screening and prevention and mental health services into intervention strategies to prevent CAI among Chinese TGW.

Differential relationships of stress and HIV disclosure by gender: a person centered longitudinal study.

BACKGROUND: Existing literature mostly consider HIV disclosure as a static event and investigate its relationship with stress using a cross-sectional design. It is unclear about the dynamic changes of HIV disclosure levels (defined as the number of disclosure targets) and how stress may influence these changes. This study explored different disclosure levels using a person-centered longitudinal approach, examined whether stress could predict these disclosure levels, and investigated if this relationship differed by gender among people living with HIV (PLWH). METHODS: Data were derived from a prospective cohort study conducted from November 2016 to January 2018 in Guangxi, China. Four hundred forty-four PLWH were included. Participants were assessed on perceived stress, sociodemographic characteristics, and number of HIV disclosure targets at baseline, 6-month, and 12-month follow-ups. Growth mixture modeling was used to characterize disclosure levels based on the changes of disclosure target number. Multinomial logistic regression was used to predict disclosure levels with baseline stress after adjusting for covariates. The interaction effect of stress by gender was examined. Adjusted odds ratio (AOR) with its 95% confidence interval were reported to show the strength of association.  RESULTS: Three levels of disclosure were characterized as "Low levels of disclosure" (Level One), "Increased levels of disclosure" (Level Two), and "High levels of disclosure" (Level Three). Accordingly, 355 (81.2%), 28 (6.4%), and 64 (12.4%) of PLWH were categorized respectively under low, increased, and high levels of disclosure. The interaction of baseline stress by gender was significant in differentiating Level One from Three (AOR = 0.85 [0.74 ~ 0.99]) while it was not significant between Level One and Two (AOR = 0.96 [0.81 ~ 1.15]). Compared to female, male PLWH with higher baseline stress had lower probability to have consistent high disclosure levels over time. PLWH who were married/cohabited had lower probability of being classified into consistent high levels of disclosure than low level (AOR = 0.43 [0.19 ~ 0.94]). CONCLUSIONS: There was gender difference in the relationship between stress and levels of HIV disclosure. To promote HIV disclosure, gender tailored interventions should be employed to help PLWH cope with stress.

Spatial-Temporal Relationship Between Population Mobility and COVID-19 Outbreaks in South Carolina: Time Series Forecasting Analysis.

BACKGROUND: Population mobility is closely associated with COVID-19 transmission, and it could be used as a proximal indicator to predict future outbreaks, which could inform proactive nonpharmaceutical interventions for disease control. South Carolina is one of the US states that reopened early, following which it experienced a sharp increase in COVID-19 cases. OBJECTIVE: The aims of this study are to examine the spatial-temporal relationship between population mobility and COVID-19 outbreaks and use population mobility data to predict daily new cases at both the state and county level in South Carolina. METHODS: This longitudinal study used disease surveillance data and Twitter-based population mobility data from March 6 to November 11, 2020, in South Carolina and its five counties with the largest number of cumulative confirmed COVID-19 cases. Population mobility was assessed based on the number of Twitter users with a travel distance greater than 0.5 miles. A Poisson count time series model was employed for COVID-19 forecasting. RESULTS: Population mobility was positively associated with state-level daily COVID-19 incidence as well as incidence in the top five counties (ie, Charleston, Greenville, Horry, Spartanburg, and Richland). At the state level, the final model with a time window within the last 7 days had the smallest prediction error, and the prediction accuracy was as high as 98.7%, 90.9%, and 81.6% for the next 3, 7, and 14 days, respectively. Among Charleston, Greenville, Horry, Spartanburg, and Richland counties, the best predictive models were established based on their observations in the last 9, 14, 28, 20, and 9 days, respectively. The 14-day prediction accuracy ranged from 60.3%-74.5%. CONCLUSIONS: Using Twitter-based population mobility data could provide acceptable predictions of COVID-19 daily new cases at both the state and county level in South Carolina. Population mobility measured via social media data could inform proactive measures and resource relocations to curb disease outbreaks and their negative influences.

Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. OBJECTIVE: This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. METHODS: We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL. RESULTS: About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. CONCLUSIONS: These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.

Anticipated stigma and medication adherence among people living with HIV: the mechanistic roles of medication support and ART self-efficacy.

This study aimed to examine the relationship between anticipated stigma and medication adherence as well as the mechanistic roles of medication support and ART self-efficacy. Data were derived from the baseline assessment of a prospective cohort study in Guangxi, China. A total of 1198 PLWH were recruited and assessed on their sociodemographic characteristics, medication adherence, anticipated stigma, medication support, and ART self-efficacy. Path analysis was used to examine the direct effect from anticipated stigma to medication adherence and indirect effects through medication support and ART self-efficacy. Path model revealed that the indirect effect from anticipated stigma to medication adherence was statistically significant while the direct effect was not significant. Anticipated stigma could influence medication adherence through ART self-efficacy but not through medication support. The serial mediating effect of medication support and ART self-efficacy on the relationship between anticipated stigma and medication adherence was significant. Anticipated stigma affects medication adherence among PLWH through its adverse impact on medication support and ART self-efficacy. Tailored interventions promoting medication support and ART self-efficacy may alleviate the negative influence of anticipated stigma on medication adherence among PLWH. Additionally, policy efforts aiming to reduce stigma against PLWH and increasing medication support are warranted to improve medication adherence among PLWH.

HIV-related stigma and quality of life in people living with HIV and depressive symptoms: indirect effects of positive coping and perceived stress.

Despite a strong evidence on the negative association between HIV-related stigma and quality of life (QoL), few studies have examined the indirect effects of this relationship. This study aimed to examine the association between HIV-related stigma and QoL and the indirect effects of positive coping and perceived stress in people living with HIV and depressive symptoms (PLWHD). This study used baseline date from a randomized controlled trial. Structural equation model was used to examine the association between HIV-related stigma and QoL as well as the indirect effects of positive coping and perceived stress. Perceived and internalized stigma had negative direct (ß = -0.14, p < 0.05) effect on QoL. Moreover, perceived and internalized stigma had indirect effects on QoL through decreased positive coping and increased perceived stress (ß = -0.23, p < 0.001). Multilevel interventions to reduce perceived and internalized stigma and perceived stress as well as programs to enhance positive coping may improve QoL of PLWHD. Integrated interventions that both enhance positive coping and reduce perceived stress and stigma are potentially more effective in improving QoL than programs that focus on only one aspect of stigma reduction among PLWHD.

Gender differences in the relationship of sexual partnership characteristics and inconsistent condom use among people living with HIV in China.

Few studies have examined the relationship between inconsistent condom use and sexual partnership characteristics among people living with HIV (PLWH). The current study focused on such association and its gender differences. The study was conducted in a large hospital in South China in 2013. A total of 320 dyads (PLWH indexes and their sexual partners) were recruited from an outpatient clinic using convenience sampling. The proportion of inconsistent condom use in the last six months among female indexes was higher than that among male indexes (52.4% vs. 43.6%). Of sexual partnership characteristics, HIV seropositive status was a risk factor for inconsistent condom use for both male and female indexes (aOR = 2.32, 95%CI = 1.15∼4.66, aOR = 3.09, 95%CI = 1.10∼8.67, respectively). For male indexes, lower educational level was also a risk factor (aOR = 2.39, 95%CI = 1.23∼4.67); while having had emotionally intimate relationships was a protective factor (aOR = 0.40, 95%CI = 0.21∼0.77). For female indexes, receiving material support was a risk factor (aOR = 10.17, 95%CI = 2.13∼48.61) and receiving health-related advice was a protective factor (aOR = 0.11, 95%CI = 0.02∼0.55). Future HIV interventions for PLWH need to be gender-sensitive and include their sexual partners.

Effect of a WeChat-Based Intervention (Run4Love) on Depressive Symptoms Among People Living With HIV in China: A Randomized Controlled Trial.

BACKGROUND: People living with HIV (PLWH) have high rates of depressive symptoms. However, only a few effective mental health interventions exist for this vulnerable population. OBJECTIVE: The aim of this study was to assess the efficacy of a WeChat-based intervention, Run4Love, with a randomized controlled trial among 300 people living with HIV and depression (PLWHD) in China. METHODS: We recruited PLWH from the HIV outpatient clinic in South China. Participants were screened based on the Center for Epidemiologic Studies-Depression (CES-D) scale. Those who scored 16 or higher were eligible to participate. A total of 300 eligible patients were enrolled. After obtaining informed consent from the participants, completion of a baseline survey, and collection of participants' hair samples for measuring cortisol, the participants were randomly assigned to an intervention or a control group in a 1:1 ratio. The intervention group received the Run4Love program, delivered via the popular social media app WeChat. Cognitive behavioral stress management courses and weekly reminders of exercise were delivered in a multimedia format. Participants' progress was monitored with timely and tailored feedback. The control group received usual care and a brochure on nutrition for PLWH. Data were collected at 3, 6, and 9 months. The primary outcome was depression, which was measured by a validated instrument. RESULTS: Participants in the intervention and control groups were comparable at baseline; about 91.3% (139/150), 88.3% (132/150), and 86.7% (130/150) participants completed the 3-, 6-, and 9-month follow-ups, respectively. At the 3-month follow-up, a significant reduction in CES-D score was observed in the intervention group (from 23.9 to 17.7 vs from 24.3 to 23.8; mean difference=-5.77, 95% CI -7.82 to -3.71; P<.001; standard effect size d=0.66). The mean changes in CES-D score from baseline to the 6- and 9-month follow-ups between the two groups remained statistically significant. No adverse events were reported. CONCLUSIONS: The WeChat-based mobile health (mHealth) intervention Run4Love significantly reduced depressive symptoms among PLWHD, and the effect was sustained. An app-based mHealth intervention could provide a feasible therapeutic option for many PLWHD in resource-limited settings. Further research is needed to assess generalizability and cost-effectiveness of this intervention. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showproj.aspx?proj=21019 (Archived by WebCite at https://www.webcitation.org/78Bw2vouF).