Trajectories of viral suppression in people living with HIV receiving coordinated care: Differences by comorbidities

Mon, 23 Mar 2020 00:00:00 GMT-05:00 - Li, Michael J.; Su, Erica; Garland, Wendy H.; Oksuzyan, Sona; Lee, Sung-Jae; Kao, Uyen H.; Weiss, Robert E.; Shoptaw, Steven J.
Εισαγωγή: In March of 2013, the Los Angeles County (LAC) Division of HIV and STD Programs (DHSP) implemented a clinic-based Medical Care Coordination (MCC) Program to increase viral suppression (VS) (<200 c/mL) among people living with HIV (PLWH) at high risk for poor health outcomes.
Θέμα: This study aimed to estimate trajectories of VS and to assess whether these trajectories differed by stimulant use, housing instability, and depressive symptom severity as reported by PLWH participating in MCC.
Μέθοδοι: Data represent 6,408 PLWH in LAC receiving services from the MCC Program, and were obtained from LAC HIV surveillance data matched to behavioral assessments obtained across 35 Ryan White Program clinics participating in MCC. Piecewise mixed effects logistic regression with a random intercept estimated probabilities of VS from 12 months prior to MCC enrollment through 36 months post-enrollment, accounting for time by covariate interactions for three comorbid conditions: housing instability, stimulant use, and depressive symptoms.
Αποτελέσματα: The overall probability of VS increased from 0.35 to 0.77 within the first six months in the MCC Program, and this probability was maintained up to 36 months post-enrollment. Those who reported housing instability, stimulant use, or multiple comorbid conditions did not achieve the same probability of VS by 36 months as those with none of those comorbidities.
Συμπεράσματα: Findings suggest that MCC improved the probability of VS for all patient groups regardless of the presence of comorbidities. However, those with comorbid conditions will still require increased support from patient-centered programs to address disparities in VS. Corresponding author: Michael J. Li, Ph.D., M.P.H. Department of Family Medicine 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA 90024 mjli@mednet.ucla.edu 310-825-2557 Conflicts of interest and Source of Funding: The authors report no conflicts of interest. Author contributions: MJ Li – study conceptualization, writing, and analysis. E Su – data analysis, reporting, and visualization, writing methods section. WH Garland – study implementation, conceptualization, and supervision, writing, revision. S Oksuzyan – data collection and management, study conceptualization, writing, revision S-J Lee – study conceptualization, writing, revision. UH Kao – study conceptualization, study coordination, writing, revision. RE Weiss – senior statistician, study conceptualization, writing, revision. SJ Shoptaw – study conceptualization and supervision, writing, revision This work was supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) NIMH grant P30MH58107, the California HIV/AIDS Research Grants Program Office of the University of California grant MH10-LAC-610, the University of California, Los Angeles Postdoctoral Fellowship Training Program in Global HIV Prevention Research NIMH grant 5T32MH080634-13. - Β© 2020

The impact of loneliness on brain health and quality of life among adults living with HIV in Canada

Mon, 23 Mar 2020 00:00:00 GMT-05:00 - Harris, Marianne; Brouillette, Marie-JosΓ©e; Scott, Susan C.; Smaill, Fiona; Smith, Graham; Thomas, RΓ©jean; Fellows, Lesley K.; Mayo, Nancy E.
Εισαγωγή: People aging with HIV are at risk for loneliness, with stigmatization and economic marginalization added to the health challenges arising from chronic infection. This study provides evidence for the extent, contributors, and consequences of loneliness in people living with HIV, focusing on brain health and quality of life. Setting: Cross-sectional data from 856 middle-aged and older adults living with HIV recruited from five urban specialty clinics in Canada were drawn from the inaugural visit of the Positive Brain Health Now cohort study.
Μέθοδοι: Participants completed an extensive assessment of biopsychosocial variables. The prevalence, severity and quality of life impact of self-reported loneliness were described. Clinical and environmental factors hypothesized as contributing to loneliness and the consequences of loneliness on health and function were identified using logistic, ordinal, and linear regression.
Αποτελέσματα: Eighteen percent reported being β€�quite oftenβ€� and 46% β€�sometimesβ€� lonely. Those with more loneliness were younger, less mobile, suffered more financial hardship, and were more likely to use opioids. HIV symptoms, pain, fatigue, low motivation, stigma, and unemployment were related to loneliness. Loneliness increased the odds of cognitive impairment, low mood, stress, and poor physical health. Those who were β€�quite oftenβ€� lonely were over four times more likely to report poor or very poor quality of life than those who were β€�almost neverβ€� lonely.
Συμπέρασμα: Loneliness is common in older people living with HIV in Canada. Many of the associated factors are modifiable, offering novel targets for improving brain health, general health and quality of life in HIV. Corresponding author: Lesley Fellows, MD CM, DPhil, room 276, Montreal Neurological Institute, rue UniversitΓ©, MontrΓ©al, QC H3A 2B4 Canada 514-398-8481 lesley.fellows@mcgill.ca. The authors report no conflicts of interest related to this work. * equal contribution Funding: The project was supported by a Team Grant from the Canadian Institutes of Health Research (CIHR) (TCO-125272) and by the CIHR HIV Clinical Trials Network (CTN 273). The funding agency had no role in the design, data collection, analysis, or interpretation of the study, nor in the writing of the report or the decision to submit the paper for publication. Author contributions: MH: study conception, data acquisition, interpreted results, drafted manuscript. MJB: study conception, data acquisition, interpretation, revised manuscript. SC: data analysis, interpretation, drafted manuscript. FS: study conception, data acquisition, revised manuscript. GM: study conception, data acquisition, revised manuscript. RT: study conception, data acquisition, revised manuscript. LKF: study conception, data acquisition, interpretation, drafted manuscript. NB: study conception, data acquisition, data analysis, interpretation, drafted manuscript All authors approved the final manuscript. - Β© 2020