scholarly journals HIV and Aging: Multimorbidity in Older People Living with HIV in One Non-Urban Southeastern Ryan White HIV/AIDS Program Clinic

2020 ◽  
Author(s):  
Elizabeth C Arant ◽  
Ceshae Harding ◽  
Maria Geba ◽  
Paul V Targonski ◽  
Kathleen A McManus
Keyword(s):  
Private Insurance ◽  
Female Gender ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Medical Visit ◽  
Age Related ◽  
Ryan White ◽  
Aids Program ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background Age-related chronic conditions are becoming more concerning for people living with HIV (PLWH). We aimed to identify characteristics associated with multimorbidity and evaluate for association between multimorbidity and HIV outcomes. Methods Cohorts included PLWH aged 45-89 with >1 medical visit at one Ryan White HIV/AIDS Program (RWHAP) Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2). Multimorbidity was defined as >2 chronic diseases. We used multivariable logistic regression to assess for associations between characteristics and multimorbidity and between multimorbidity and HIV outcomes. Results Multimorbidity increased from Cohort 1 (n=149) to Cohort 2 (n=323) (18.8% vs 29.7%, p<0.001). Private insurance was associated with less multimorbidity than Medicare (Cohort 1: adjusted Odds Ratio [aOR] 0.15, 95% Confidence Interval [CI] 0.02-0.63; Cohort 2: aOR 0.53, 95% CI 0.27-1.00). In Cohort 2, multimorbidity was associated with female gender (aOR 2.57, 95% CI 1.22-5.58). In Cohort 1, Black participants were less likely to be engaged in care compared to non-Black participants (aOR 0.72, 95% CI 0.61-0.87) Cohort 2, participants with rural residences were more likely to be engaged in care compared to those with urban residences (aOR 1.23, 95% CI 1.10-1.38). Multimorbidity was not associated with differences in HIV outcomes. Conclusions While PLWH have access to RWHAP HIV care, PLWH with private insurance had lower rates of multimorbidity, which may reflect better access to preventative non-HIV care. In 2016, multimorbidity was higher for women. The RWHAP and RWHAP Part D could invest in addressing these disparities related to insurance and gender.

scholarly journals Medicaid Expansion’s Impact on HIV Outcomes in a Non-urban Southeastern Ryan White HIV/AIDS Program Clinic

2020 ◽  
Author(s):  
Kathleen A McManus ◽  
Karishma Srikanth ◽  
Samuel D Powers ◽  
Rebecca Dillingham ◽  
Elizabeth T Rogawski McQuade
Keyword(s):  
Private Insurance ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Insurance Status ◽  
Engagement In Care ◽  
Poverty Level ◽  
Medicaid Enrollment ◽  
Ryan White ◽  
Aids Program ◽  
Hiv Aids

Abstract Background While the Ryan White HIV/AIDS Program (RWHAP) supports high-quality HIV care, Medicaid enrollment provides access to non-HIV care. People living with HIV (PLWH) with Medicaid historically have low viral suppression (VS) rates. In a state with previously high Qualified Health Plan coverage of PLWH, we examined HIV outcomes by insurance status during the first year of Medicaid expansion (ME). Methods Participants were PLWH ages 18-63 who attended ≥1 HIV medical visit/year in 2018 and 2019. We estimated associations of sociodemographic characteristics with ME enrollment prevalence and associations between insurance status and engagement in care and VS. Results Among 577 patients, 151 (33%) were newly eligible for Medicaid, and 77 (51%) enrolled. Medicaid enrollment was higher for those with incomes <100% Federal Poverty Level (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to others. Controlling for age, income, and 2018 engagement, those with employment-based private insurance (adjusted risk difference [aRD] -8.5%, 95% CI -16.9-0.1) and Medicare (aRD -12.5%, 95% CI -21.2- -3.0) had lower 2019 engagement than others. For those with VS data (n=548), after controlling for age and baseline VS, those with Medicaid (aRD -4.0%, 95% CI -10.3-0.3) and with Medicaid due to ME (aRD -6.2%, 95% CI -14.1- -0.8) were less likely to achieve VS compared with others. Conclusions Given that PLWH who newly enrolled in Medicaid had high engagement in care, the finding of lower VS is notable. The discordance may be due to medication access gaps associated with changes in medication procurement logistics.

scholarly journals Gamification: An Innovative Way to Enhance Health Behaviors for people Living with HIV/AIDs Via Mobile Health Appliacations

2020 ◽  
Author(s):  
Chan Sreypouv
Keyword(s):  
Rhode Island ◽  
Mobile Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Digital Platforms ◽  
Ryan White ◽  
Mobile Health Applications ◽  
Living With Hiv ◽  
Health Applications ◽  
Hiv Aids

Mobile health applications are known as any wireless technology in medical care and have been considered as one of innovative ways to assist and engage patients in care. This project focused on mobile health applications that were designed specifically for HIV medication adherence and to serve People Living with HIV/AIDs (PLWHA) with their HIV care in Rhode Island (RI) Ryan White Part B program, a federal program that provide HIV care to PLWHA (HRSA,2019). RI-Ryan White program partnered with 360 Medlink, Inc. (a software development company) developed and delivered two advanced digital platforms called TAVIE-HIV (an application with no gamification) and TAVIE-RED (an application with gamification) to Ryan White’s clients in RI.

scholarly journals Gamification: An Innovative Way to Enhance Health Behaviors for people Living with HIV/AIDs Via Mobile Health Appliacations

2020 ◽  
Author(s):  
Chan Sreypouv
Keyword(s):  
Rhode Island ◽  
Mobile Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Digital Platforms ◽  
Ryan White ◽  
Mobile Health Applications ◽  
Living With Hiv ◽  
Health Applications ◽  
Hiv Aids

Mobile health applications are known as any wireless technology in medical care and have been considered as one of innovative ways to assist and engage patients in care. This project focused on mobile health applications that were designed specifically for HIV medication adherence and to serve People Living with HIV/AIDs (PLWHA) with their HIV care in Rhode Island (RI) Ryan White Part B program, a federal program that provide HIV care to PLWHA (HRSA,2019). RI-Ryan White program partnered with 360 Medlink, Inc. (a software development company) developed and delivered two advanced digital platforms called TAVIE-HIV (an application with no gamification) and TAVIE-RED (an application with gamification) to Ryan White’s clients in RI.

scholarly journals High Rates of Retention and Viral Suppression in the US HIV Safety Net System: HIV Care Continuum in the Ryan White HIV/AIDS Program, 2011

2014 ◽  
Vol 60 (1) ◽  
pp. 117-125 ◽  
Author(s):  
R. K. Doshi ◽  
J. Milberg ◽  
D. Isenberg ◽  
T. Matthews ◽  
F. Malitz ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Safety Net ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Ryan White ◽  
The Us ◽  
Aids Program ◽  
Hiv Aids

scholarly journals “Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

2021 ◽  
Author(s):  
Linda Sprague Martinez ◽  
Melissa Davoust ◽  
Serena Rajabiun ◽  
Allyson Baughman ◽  
Sara Bachman ◽  
...  
Keyword(s):  
Health Care ◽  
Health Workers ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Hiv Care ◽  
Organizational Policies ◽  
Ryan White ◽  
Aids Program ◽  
Group Interviews ◽  
Hiv Aids

Abstract Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.

Comorbid Medical Problems and Motivational Interviewing

2019 ◽  
pp. 97-104
Author(s):  
Sharon Connor ◽  
Hanna K. Welch
Keyword(s):  
Motivational Interviewing ◽  
Chronic Diseases ◽  
Congestive Heart Failure Patient ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Medical Problems ◽  
Patient Centered ◽  
Age Related ◽  
Social And Cultural Factors ◽  
Living With Hiv

As HIV treatments become more effective and accessible, people living with HIV (PLWH) are achieving longer lifespans; however, this aging population also faces a greater risk of age-related co-morbidities. Many chronic diseases affect people living with HIV disproportionately, including diabetes, ischemic heart disease, and congestive heart failure. Patient-centered healthcare should aim to optimize quality and length of life while also considering the person’s value system. Motivational interviewing (MI) has been effective in helping PLWH to better manage chronic diseases requiring behavioral modification in both high- and low-resource settings. MI is a useful approach in the complex care of PLWH and medical co-morbidities. MI can promote self-management integrating HIV care as well as other co-morbidities in the context of social and cultural factors. This chapter discusses the application of MI to achieve better control of co-morbid medical conditions in PLWH.

The Validity of the Substance Abuse and Mental Illness Symptom Screener (SAMISS) in People Living with HIV/AIDS in Primary HIV Care in Cape Town, South Africa

2014 ◽  
Vol 18 (6) ◽  
pp. 1133-1141 ◽  
Author(s):  
Erica Breuer ◽  
Kevin Stoloff ◽  
Landon Myer ◽  
Soraya Seedat ◽  
Dan J. Stein ◽  
...  
Keyword(s):  
South Africa ◽  
Substance Abuse ◽  
Mental Illness ◽  
Cape Town ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence

2020 ◽  
Vol 26 (1) ◽  
pp. 9-16
Author(s):  
Linlin Lindayani ◽  
Irma Darmawati ◽  
Heni Purnama ◽  
Bhakti Permana
Keyword(s):  
Health Care ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Health Care Professionals ◽  
Hiv Care ◽  
Geriatric Syndrome ◽  
People Living With Hiv ◽  
Age Related ◽  
Care Systems ◽  
Living With Hiv

Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.

scholarly journals Reasons for Disclosure of HIV Status by People Living with HIV/AIDS and in HIV Care in Uganda: An Exploratory Study

2010 ◽  
Vol 24 (10) ◽  
pp. 675-681 ◽  
Author(s):  
Sarah N. Ssali ◽  
Lynn Atuyambe ◽  
Christopher Tumwine ◽  
Eric Segujja ◽  
Nicolate Nekesa ◽  
...  
Keyword(s):  
Exploratory Study ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Living With Hiv ◽  
Hiv Aids
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