Browsing by Author "Jones, Deborah"

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    Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina
    (2021-06) Sued, Omar; Cecchini, Diego; Abbamonte, John M; Rodriguez, Violeta J; Mandell, Lissa; Cristofari, Nicholas; Figueroa, Maria Inés; Cassetti, Isabel; Cahn, Pedro; Weiss, Stephen; Alcaide, Maria; Cahn, Florencia; Calanni, Liliana; Crinejo, Ana; David, Daniel; Lupo, Sergio; Pérez, Carolina; Pérez, Rufina; Rodriguez, Claudia; Rolón, María José; Sisto, Alicia; Trapé, Liliana; Jones, Deborah
    Background: Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. Method: Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. Results: Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). Conclusion: This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.
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    Measurement invariance of the Childhood Trauma Questionnaire by genderpoverty leveland HIV status.
    (2017) Rodríguez, Violeta J.; Radusky, Pablo; Kumar, Mahendra; Nemeroff, Charles B.; Jones, Deborah
    ackground Assessing traumatic childhood events has important implications for treatment, due to increased high-risk behaviors, treatment nonadherence, and all-cause mortality. As such, it is important to ensure that screening tools used to measure traumatic childhood events are invariant across groups. The focus of this study was to examine measurement invariance across gender, poverty level, and HIV status in a commonly used childhood trauma screening tool, the Childhood Trauma Questionnaire – Short Form (CTQ-SF). Method Participants were N = 473 HIV-infected and uninfected men and women who completed a demographic questionnaire, the CTQ-SF, and underwent HIV testing. Results Participant age was an average of 36 years (SD = 9.40); 51% of participants were male, and 49% were female. Forty-three percent of participants were below the poverty level, and 36% were HIV-infected. Configural invariance was supported by gender, poverty level, and HIV status; scalar and strict invariance were not supported by gender, poverty level, and HIV status. Neither full nor partial metric invariance could be established by gender and income; however, the scale was invariant at the metric level by HIV status. Discussion Given the measurement bias identified in gender, poverty level, and HIV, practitioners and researchers must use caution when drawing conclusions regarding childhood trauma when using the CTQ-SF. Findings also suggest that statistical inferences and implications for practice based on comparisons of observed means will be distorted and may be misleading, and as such, established cutoffs may not apply similarly for these groups, suggesting an avenue for further research.
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    Obstáculos a la adherencia y retención en los sistemas de salud público y privado según pacientes y personal de salud
    (2014) Aristegui, Ines; Dorigo, Analía; Bofill, Lina; Bordatto, Alejandra; Lucas, Mar; Fernández Cabanillas, Graciela; Jones, Deborah; Sued, Omar; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen
    Introducción: el Programa Nacional de Sida garantiza el acceso universal a los antirretrovirales, aun así las personas que reciben medicamentos a través del sistema público no logran obtener una carga viral indetectable en la misma proporción que los pacientes del sistema privado. Este estudio cualitativo tiene como objeto identificar los factores asociados a la adherencia y retención en la cascada de atención de VIH de los sistemas de salud público y privado de Buenos Aires, según las percepciones de pacientes y del personal de salud. Métodos: se registraron datos cualitativos de 12 entrevistas semi-estructuradas a informantes clave y 4 grupos focales de pacientes y personal de salud tanto del sistema público como privado. Se codificaron y analizaron temas predeterminados sobre adherencia, utilizando el software QRS Nvivo9® de análisis de datos cualitativos. Resultados: pacientes y personal de salud de ambos sistemas coinciden en la importancia del estigma asociado al VIH, la relación médicopaciente, la comunicación entre ambos y la división de responsabilidades en relación al tratamiento como aspectos fundamentales para la adherencia y retención en la cascada de atención. Se observan diferencias entre los sistemas en la forma en que algunos de estos aspectos actúan. Las barreras estructurales se presentan como principales obstáculos del sistema público. Discusión: se resalta la necesidad de intervenciones focalizadas en la díada médico-paciente que considere las particularidades de cada sistema de atención para facilitar el compromiso del paciente en la adherencia.
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    Patient-provider perceptions on engagement in HIV care in Argentina.
    (2014) Bofill, Lina; Lopez, Dorigo; Bordato, Alejandra; Lucas, Mar; Fernandez Cabanillas, Graciela ; Sued, Omar; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen; Jones, Deborah
    Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.