scholarly journals Feasibility of Four Interventions to Improve Treatment Adherence in Migrants Living with HIV in The Netherlands

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 980
Author(s):  
Sabrina K. Been ◽  
David A.M.C. van de Vijver ◽  
Jannigje Smit ◽  
Nadine Bassant ◽  
Katalin Pogány ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Treatment Adherence ◽  
Peer Support ◽  
Intervention Group ◽  
Hiv Treatment ◽  
Hiv Rna ◽  
Related Stigma ◽  
Living With Hiv ◽  
Group Medical Appointments

We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. At baseline and after the interventions, socio-demographic characteristics, psychosocial variables, and data on HIV treatment adherence were collected. The two questionnaires were completed by 234/301 (78%) MLWH included at baseline. Detectable HIV RNA decreased (from 10.3 to 6.8%) as did internalized HIV-related stigma (from 15 to 14 points), and self-reported adherence increased (between 5.5 and 8.3%). DAART and GMA were not feasible interventions. Screening of psychological distress was feasible; however, follow-up diagnostic screening and linkage to psychiatric services were not. Peer support for and by MLWH was feasible. Within this small intervention group, results on HIV RNA < 400 copies/mL (decrease of 23.6%) and outpatient clinic attendance (up to 20.4% kept more appointments) were promising.

scholarly journals A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya

2021 ◽  
Author(s):  
Ashley Chory ◽  
Grant Callen ◽  
Winstone Nyandiko ◽  
Tabitha Njoroge ◽  
Celestine Ashimosi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Behavioral Health ◽  
Treatment Adherence ◽  
Peer Support ◽  
Mobile Technologies ◽  
Hiv Care ◽  
Individual Counseling ◽  
Middle Income ◽  
Western Kenya ◽  
Living With Hiv

AbstractMobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.

scholarly journals The role of unintended pregnancy in internalized stigma among women living with HIV in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Chace Dwyer ◽  
Aparna Jain ◽  
Wilson Liambila ◽  
Charlotte E. Warren
Keyword(s):  
Unintended Pregnancy ◽  
Hiv Treatment ◽  
Outcome Variable ◽  
Internalized Stigma ◽  
Health Seeking ◽  
Logistic Regression Models ◽  
Stigma And Discrimination ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv

Abstract Background Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV. Methods Baseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored. Results About 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2–2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents’ characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3–2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination. Conclusions Results suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.

scholarly journals Effectiveness of one-to-one peer support for patients with severe mental illness – a randomised controlled trial

2017 ◽  
Vol 42 ◽  
pp. 103-110 ◽  
Author(s):  
C.I. Mahlke ◽  
S. Priebe ◽  
K. Heumann ◽  
A. Daubmann ◽  
K. Wegscheider ◽  
...  
Keyword(s):  
Mental Illness ◽  
Peer Support ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Treatment As Usual ◽  
Secondary Outcomes ◽  
One To One ◽  
Randomised Controlled

AbstractBackgroundOne-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments.MethodsThis is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years’ duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations.ResultsPatients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses.ConclusionsThe findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.

scholarly journals Characteristics, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: A methodological replication and elaboration (Preprint)

2020 ◽  
Author(s):  
Eyal Karin ◽  
Monique Francis Crane ◽  
Blake Farran Dear ◽  
Olav Nielssen ◽  
Gillian Ziona Heller ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Treatment Adherence ◽  
Statistical Models ◽  
Post Treatment ◽  
Symptom Change ◽  
Web Based ◽  
Reduction Effect

BACKGROUND Missing cases present a challenge to our ability to evaluate the effects of web-based psychotherapy trials. As missing cases are often lost to follow up, less is known about their characteristics, their likely clinical outcomes, or the likely effect of the treatment being trialled. OBJECTIVE To explore the characteristics of missing cases, their likely treatment outcomes, and the ability of different statistical models to approximate missing post-treatment data. METHODS A sample of internet-delivered cognitive behavioural therapy participants, in routine care (n = 6701 with 36% missing cases at post-treatment), was used to identify predictors of dropping out of treatment and predictors that moderated clinical outcomes, such as psychological distress, anxiety and depressive symptoms. These variables were then incorporated into a range of statistical models that approximated replacement outcomes for missing cases, with the results compared using sensitivity and cross-validation analyses. RESULTS Treatment adherence, as measured by the rate of an individual’s progress through the treatment modules, and higher symptom scores at pre-treatment, were identified as the dominant predictors of missing cases probability (Nagelkerke R2 = 60.8%), as well as the rate of symptom change. Low treatment adherence, in particular, was associated with increased odds for presenting as missing cases during post-treatment assessment (eg, OR = 161.1:1) and at the same time, attenuate the rate of symptom change across anxiety (up to 28% of the total symptom 48% reduction effect), depression (up to 41% of the total 48% symptom reduction effect) and psychological distress symptom outcomes (up to 52% of the total 37% symptom reduction effect) at the end of an eight week window. Reflecting this pattern of results, statistical replacement methods that overlooked the features of treatment adherence, and baseline severity, underestimated missing case symptom outcomes by as much as 40% at post-treatment. CONCLUSIONS The treatment outcomes of the cases that were missing at follow up were distinct from the remaining observed sample. Thus, overlooking the features of missing cases is likely to result in an inaccurate estimate of the effect of treatment. CLINICALTRIAL

Psychosocial interventions to improve HIV treatment adherence: A systematic review

2021 ◽  
Author(s):  
Stefanella Costa-Cordella ◽  
Alejandra Rossi ◽  
Aitana Grasso-Cladera ◽  
Javiera Duarte ◽  
Claudia P. Cortes
Keyword(s):  
Systematic Review ◽  
Treatment Adherence ◽  
Peer Support ◽  
Psychosocial Interventions ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Individual Counselling ◽  
Suboptimal Adherence ◽  
Study Designs

Introduction: The problem of suboptimal adherence to antiretroviral treatment (ART) can be overcome through multidisciplinary management that includes evidence-based psychosocial interventions. Existing reviews focus only on randomized controlled trials, overlooking valuable interventions whose evidence comes from different study designs. This review aimed to synthesize the current state of the art in psychological interventions for ART adherence, integrating studies with a variety of research designs.Methods: We conducted a systematic review following PRISMA guidelines. We searched five databases for articles reporting a psychosocial intervention to improve treatment adherence for people living with HIV. The quality of each study was analyzed, and the data summarized using a narrative synthesis method.Results and discussion: Twenty-six articles were identified for inclusion. Individual counselling was the most common intervention, followed by peer-support based interventions delivered virtually or in person. Most interventions mixed different strategies, combining technology with individual counselling and peer support. It is important to note that the quality of evidence was not dependent on the study design.Conclusion: While the evidence requires further advancement, the review provides insight into which psychosocial interventions are helpful in improving ART treatment adherence.

Effect of psychoeducation website named “Imacoco-care” on improving psychological distress among workers under COVID-19 pandemic: a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Kotaro Imamura ◽  
Natsu Sasaki ◽  
Yuki Sekiya ◽  
Kazuhiro Watanabe ◽  
Asuka Sakuraya ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Effect ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Intervention Group ◽  
Psychoeducational Intervention ◽  
Favorable Effect ◽  
Randomized Controlled ◽  
Small Effect Size

BACKGROUND The prolonged coronavirus disease 2019 (COVID-19) pandemic affected mental health among workers. Psychoeducational intervention via an Internet website could be effective for primary prevention of mental health among workers in the current COVID-19 pandemic. OBJECTIVE The aim of this randomized controlled trial (RCT) was to examine the effect of a newly developed online psychoeducational website named "Imacoco-care" on reducing psychological distress and fear about COVID-19 infection among workers. METHODS Participants in the present study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to intervention or control groups. Participants in the intervention group were invited to access the Imacoco-care within a month after the baseline survey. Kessler’s Psychological Distress Scale (K6) and The Fear of COVID-19 Scale (FCV-19S) were obtained at baseline, 1-, and 3-month follow-ups. RESULTS A total of 1200 workers were randomly allocated to an intervention or control group (n = 600 for each). In the intention-to-treat (ITT) analyses, the Imacoco-care showed significant favorable effect on K6 (p = 0.03) with small effect size (d = -0.14), and adverse effect on FCV-19S (p = 0.01) with small effect size (d = 0.16) in the intervention group at 3-month follow-up. In the per-protocol analyses (only included participants who have read the Imacoco-care at least one time), the Imacoco-care also showed significant favorable effect on reducing K6 (p = 0.03), while adverse effect on FCV-19S was not significant (p = 0.06) in the intervention group at 3-month follow-up. CONCLUSIONS A web-based psychoeducation approach may be effective on improving psychological distress in a general working population, while it may be important not only distributing information but also encouraging to access and see the contents to prevent the adverse effect of psychoeducational intervention. CLINICALTRIAL The University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR). The registration number is UMIN000042556 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548).

scholarly journals 1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S479-S479
Author(s):  
Jamie Campbell ◽  
Christopher Polk ◽  
Danya Roshdy ◽  
Michael Leonard
Keyword(s):  
Hospice Care ◽  
Intervention Group ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Short Term ◽  
Patient Admissions ◽  
Short Term Mortality ◽  
Living With Hiv ◽  
The Impact

Abstract Background Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes. Methods We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care. Results We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1. Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge. Conclusion Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up. Disclosures All authors: No reported disclosures.

scholarly journals 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

10.2196/27897 ◽  
2021 ◽  
Vol 23 (11) ◽  
pp. e27897
Author(s):  
Yiran Li ◽  
Yan Guo ◽  
Y Alicia Hong ◽  
Chengbo Zeng ◽  
Yu Zeng ◽  
...  
Keyword(s):  
Social Media ◽  
Depressive Symptoms ◽  
Intervention Group ◽  
Control Group ◽  
People Living With Hiv ◽  
Mediating Effects ◽  
Long Term Effects ◽  
Related Stigma ◽  
Living With Hiv

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

Sign in / Sign up

Export Citation Format

Share Document