Browsing by Author "Jones, Deborah L."

Now showing 1 - 6 of 6
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    A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care
    (2022-06) Sued, Omar; Cecchini, Diego; Rolón, María José; Calanni, Liliana; David, Daniel; Lupo, Sergio; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen M.; Alcaide, Maria Luisa; Rodriguez, Violeta J.; Mantero, Alejandro; Jones, Deborah L.
    Background Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, p = 0·027), and self-efficacy (B = 0·063, p = 0·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted.
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    Detection of antiretrovirals in transgender women with HIV is not altered by hair treatments
    (Wolters Kluwer Health, 2023-11) Rodriguez Violeta J; Alcaide, Maria Luisa; Sued, Omar; Aristegui, Ines; Radusky, Pablo; Kozlova, Sofia; Cardozo, Nadir; Dell’Isola, Emanuel; Gandhi, Monica; Jones, Deborah L.
    This study evaluated the detection of ARVs in hair samples from TW with HIV in Argentina. Results suggest that hair collection is acceptable to TW; that adherence measured by detection of ARVs in hair was high; and that ARVs can be detected in hair even in the context of hair treatments.
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    Differential Item Functioning by HIV Status and Sexual Orientation of the Center for Epidemiological Studies– Depression Scale: An Item Response Theory Analysis
    (2021-1) Radusky, Pablo; Rodriguez, Violeta J.; Kumar, Mahendra; Jones, Deborah L.
    The Center for Epidemiological Studies-Depression Scale (CES-D) is the most widely used instrument to assess depressive symptoms in people living with HIV. However, its differential item functioning (DIF) by HIV status and sexual orientation has yet to be explored. This study examined DIF and measurement invariance of the CES-D using an item response theory (IRT) framework, and a more traditional factor analytic approach. Data from 841 HIV-infected and HIV-uninfected individuals, from Miami, Florida, were analyzed. Uniform DIF by HIV status was detected in Items 4, 12, and 16 from the Positive Affect factor. Nonuniform DIF was detected in Items 13 and 17. Uniform DIF by sexual orientation was detected in Items 2, 15, and 19, two of them from the Interpersonal factor. Nonuniform DIF was detected in Item 2. Using a factor analytic approach, the CES-D was invariant at the configural and metric levels by HIV and sexual orientation. These findings indicate that overall, however, using IRT, the magnitudes of DIF were negligible, the CED-D was somewhat invariant using factor analytic methods; the CES-D may be reliably used to compare by HIV status or sexual orientation.
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    Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina
    (2015-3) Jones, Deborah L.; Cook, Ryan; Cecchini, Diego; Sued, Omar; Bofill, Lina; Weiss, Stephen M.; Waldrop-Valverde, D.; Lopez, María R.; Spence, Andrew.
    Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3–6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings.
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    Implementation and uptake of the Conexiones y Opciones en la Argentina (COPA) intervention: Feasibility and acceptability.
    (2016-4) Jones, Deborah L.; Mar, Lucas; Aristegui, Ines; Bordato, Alejandra; Fernandez Cabanillas, Graciela; Zalazar, Virginia; Sued, Omar; Cecchini, Diego; Cassetti, Isabel; Cahn, Pedro; Bofill, Lina; Weiss, Stephen M.
    Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.
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    The Impact of Gender Identity Stigma and Mental Health on HIV Treatment Among Transgender Women in Argentina
    (Springer Publishing Company, 2022) Radusky, Pablo; Aristegui, Ines; Mandell, Lissa N.; Dell’Isola, Emanuel; Zalazar, Virginia; Cardozo, Nadir; Frola, Claudia; Jones, Deborah L.; Sued, Omar
    In Argentina, HIV prevalence in transgender women (TGW) is high while engagement in HIV treatment is low due to multiple factors: gender identity stigma (GIS), mental health problems (e.g., depressive symptoms) and substance use. This study examined the impact of these factors on HIV treatment uptake among TGW in Argentina. A sample of 79 TGW “on” and “off” treatment completed questionnaires to assess GIS, depressive symptoms (CES-D), alcohol (AUDIT) and drug use (DAST-10), suicidal ideation, HIV-related stigma (HIV Stigma Scale) and support from family. From them, 36.7% met criteria for “off” HIV treatment; 49.4%, for significant depressive symptoms; 53.2%, for hazardous alcohol use; and 29.7%, for problems related to drug use. GIS was positively associated with depressive symptoms and HIV-related stigma, both in TGW “on” and “off” treatment, and with alcohol and drug use, only in the last group. In the multivariable model, only experiences of GIS from the police were negatively associated with being “on” treatment, whereas GIS in workplaces (excluding sex work venues) were associated with increased odds of being “on” treatment. GIS, specifically from the police, has a far-reaching impact on the physical and emotional health of TGW living with HIV in Argentina, as it is associated with negative mental health indicators, substance use and suboptimal HIV care uptake.