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Partnership status and retention in care among cisgender heterosexual newly diagnosed people with HIV: a cohort study.

ABSTRACT: This study examined the role of partnership status (married, unmarried-partnered, and unpartnered) on retention in care among newly diagnosed (2013-2017), cisgender heterosexual people with HIV in Birmingham, Alabama (n = 152). This study evaluated all scheduled HIV primary care provider visits for two years following diagnosis date. A kept-visit measure was calculated such that, if an individual attended ≥1 visit in each of the four 6-month intervals, they were considered to have high visit constancy. A missed-visit measure was categorized as ≥1 no-show vs. 0 no-show for first and second year after diagnosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models. Models were adjusted for confounding sociodemographic and clinical characteristics. The study population was 76% Black, 57% male, median age of 37 years. Overall, 65% had high visit consistency and 34.5% had ≥1 no-show in both years. Compared to unpartnered, married individuals had higher visit constancy [AOR (95% CI): 2.88 (1.02, 8.16)]; no differences were observed among unmarried-partnered individuals. No differences in having ≥1 no-show among partnership status groups were observed for either year. These findings suggest potential success of interventions involving a social confidant in optimizing retention in care among newly diagnosed, heterosexual PWH.

SUBMITTER: Sohail M

PROVIDER: S-EPMC9519801 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Partnership status and retention in care among cisgender heterosexual newly diagnosed people with HIV: a cohort study.

Sohail Maira M Long Dustin M DM Mugavero Michael J MJ Batey D Scott DS Ojesina Akinyemi I AI Levitan Emily B EB

AIDS care 20220329 9

This study examined the role of partnership status (married, unmarried-partnered, and unpartnered) on retention in care among newly diagnosed (2013-2017), cisgender heterosexual people with HIV in Birmingham, Alabama (n = 152). This study evaluated all scheduled HIV primary care provider visits for two years following diagnosis date. A kept-visit measure was calculated such that, if an individual attended ≥1 visit in each of the four 6-month intervals, they were considered to have high visit con ...[more]

PMID: 35348413

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Project description:BACKGROUND:Psychosocial problems are common among people living with HIV (PLWH) and have been cross-sectionally associated with health-related quality of life (HRQoL). We evaluated the longitudinal relationship between psychosocial status and HRQoL among PLWH during the first year after diagnosis. METHOD:A consecutive sample of newly diagnosed PLWH was recruited from Changsha Center for Disease Control and Prevention in Hunan Province, China. Assessments were conducted at baseline and 1 year later. The measures used in this study included the Medical Outcomes Study HIV Survey (MOS-HIV), the 9-item Patient Health Questionnaire (PHQ-9), the HIV/AIDS Stress Scale (SS-HIV) and the Social Support Rating Scale (SSRS). The trajectories of depression from baseline to 1-year follow-up were categorized into four groups: never (PHQ-9 < 10 at two time points), new-onset (PHQ-9 < 10 at baseline & PHQ-9 ≥ 10 at follow-up), recovered (PHQ-9 ≥ 10 at baseline & PHQ-9 < 10 at follow-up) and persistent depression (PHQ-9 ≥ 10 at two time points). In addition, the trajectories of stress and social support were classified by calculating the proportions of participants whose stress and social support scores changed between baseline and 1-year follow-up by more than 0.5 effect size in either direction. Generalized linear models were used to examine the potential role of baseline and changes in psychosocial status in predicting the HRQoL at 1 year, after adjusting for socio-demographic and clinical characteristics. RESULTS:A total of 410 participants completed both the baseline and 1-year follow-up surveys. Higher stress levels at baseline predicted a lower HRQoL at 1 year, while baseline depression status and social support did not predict 1-year HRQoL scores. Compared to those who were never depressed at both baseline and follow-up, participants who experienced new-onset or persistent depression had lower HRQoL at 1 year. Additionally, the 1-year HRQoL score of participants who recovered from depression by follow-up was comparable to that of participants who were never depressed. Moreover, participants who experienced increases in stress levels by follow-up had lower HRQoL scores at 1 year than those with decreases in stress levels. Changes in social support did not predict 1-year HRQoL scores in this study. CONCLUSIONS:Assessing psychosocial status regularly and implementing effective interventions targeted at psychosocial problems may be particularly important for PLWH to improve their HRQoL. Among PLWH, special attention should be given to those with new-onset or persistent depression and those with high stress levels at the time of diagnosis and increased stress levels 1 year after the new HIV diagnosis.

Project description:BackgroundA better understanding of HIV transmission dynamics is needed to further reduce the number of new HIV diagnoses in Belgium. As environmental and social context play an important role in explaining HIV acquisition despite the availability of effective HIV prevention, this study investigated how social and sexual networks may have influenced HIV prevention and risk behavior among a group of people newly diagnosed with HIV, including their perceptions of how they acquired HIV and their ability to disclose their HIV status.MethodsWe used an ego-centric social network approach, generating sociograms of social and sexual networks through in-depth interviews with 20 participants newly diagnosed with HIV.ResultsMany participants reported a considerable overlap between their social and sexual networks. Friends, family members, regular sex partners and HIV physicians were placed closest to the ego on the sociogram. Self-identified gay men did not consider their casual sex partners as emotionally close enough to be included in the sociogram, despite these partners often being participants' primary source of information about sexual health. Self-identified heterosexual and bisexual men who have sex with men (MSM) had more diverse and separated networks, and often had not considered themselves at risk for HIV. They were less aware of PrEP compared to self-identified gay MSM, partly attributed to target-group specific community-based prevention efforts. Most participants disclosed HIV only to those closest to them, and the anticipated and perceived lack of social support influenced acceptance. Feelings of internalized HIV stigma and homophobia prevented HIV disclosure, especially among heterosexuals and heterosexual and bisexual MSM.ConclusionThis study revealed important differences in the networks of gay-identified MSM, heterosexuals and hetero- and bisexual identified MSM influencing sexual risk taking and prevention behavior. Future prevention initiatives should be inclusive and mainstreamed to ensure to address those who do not identify as belonging established key populations. Awareness of HIV and biomedical prevention should be raised in the general population, providing a base on which tailored prevention can be built. Involving family physicians and socially empowering people living with HIV may help to decrease anticipated and internalized HIV stigma.

Project description:BackgroundPredicting long-term care trajectories at the time of HIV diagnosis may allow targeted interventions. Our objective was to uncover distinct CD4-based trajectories and determine baseline demographic, clinical, and contextual factors associated with trajectory membership.MethodsWe used data from the Sizanani trial (NCT01188941), in which adults were enrolled prior to HIV testing in Durban, South Africa from August 2010-January 2013. We ascertained CD4 counts from the National Health Laboratory Service over 5y follow-up. We used group-based statistical modeling to identify groups with similar CD4 count trajectories and Bayesian information criteria to determine distinct CD4 trajectories. We evaluated baseline factors that predict membership in specific trajectories using multinomial logistic regression. We examined calendar year of participant enrollment, age, gender, cohabitation, TB positivity, self-identified barriers to care, and ART initiation within 3 months of diagnosis.Results688 participants had longitudinal data available. Group-based trajectory modeling identified four distinct trajectories: one with consistently low CD4 counts (21%), one with low CD4 counts that increased over time (22%), one with moderate CD4 counts that remained stable (41%), and one with high CD4 counts that increased over time (16%). Those with higher CD4 counts at diagnosis were younger, less likely to have TB, and less likely to identify barriers to care. Those in the least favorable trajectory (consistently low CD4 count) were least likely to start ART within 3 months.ConclusionsOne-fifth of people newly-diagnosed with HIV presented with low CD4 counts that failed to rise over time. Less than 40% were in a trajectory characterized by increasing CD4 counts. Patients in more favorable trajectories were younger, less likely to have TB, and less likely to report barriers to healthcare. Better understanding barriers to early care engagement and ART initiation will be necessary to improve long-term clinical outcomes.

Dataset Information

Partnership status and retention in care among cisgender heterosexual newly diagnosed people with HIV: a cohort study.

Publications

Partnership status and retention in care among cisgender heterosexual newly diagnosed people with HIV: a cohort study.

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