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Background Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam.Methods Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n= 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined.Results The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life.Conclusions Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.

Background and Objectives: Psychiatric disorders could limit the success of behavioral counseling strategies. We evaluated the prevalence of psychiatric disorders among sexually transmitted disease (STD) clinic patients and their association with STD risk. Methods: A systematic sample of 201 patients presenting to a public STD clinic in Baltimore, Maryland, participated in the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Results: Overall, 45% of 201 STD clinic patients interviewed had a current axis I disorder and 29% had an axis II personality disorder. Substance use disorders predominated among axis I diagnoses; antisocial personality disorder (ASPD) predominated among axis II diagnoses, with an ASPD prevalence of 29.4% in men. ASPD was associated with a diagnosis of an STD (odds ratio, 3.67; 95% confidence interval, 1.63-8.30; P = 0.002). Substance use was not associated with an STD diagnosis. Conclusions: STD clinic patients have complex psychopathology that could increase HIV risk and compromise prevention interventions. Specialized counseling strategies, particularly targeting personality traits of ASPD, could improve prevention outcomes.

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This study examined whether the Megargee MMPI typology had differential validity for African American and Caucasian forensic psychiatric inpatients. We compared 516 African American and Caucasian patients in our four most common Megargee types across demographic, clinical, and forensic variables. Our findings indicate that the profile descriptions of types Charlie, Delta, How, and Item cannot be applied with equal confidence to African American and Caucasian forensic patients. Although certain demographic factors did not differ across ethnic groups, there were differences in clinical/forensic and hospital assault variables. In addition, the Caucasian sample showed the expected pattern of associations, whereas the African American sample did not.

Objective: The authors' goal was to investigate the relationship between depression and HIV risk behaviors or sexually transmitted disease (STD) diagnosis at an urban STD clinic. Method: Using audio computer-assisted self-interview, 671 STD clinic patients answered questions about HIV risk behaviors and depression in a large-scale, cross-sectional study. A subset of the patients (N=201) was evaluated for current major depressive disorder by interviewers using the nonpatient edition of the Structured Clinical Interview for DSM-IV. Results: Depressed patients were more likely to have sex for money or drugs, to have had sex with an intravenous drug user, to have sex when 'high' on alcohol or drugs, to have a greater number of lifetime sex partners, and to abuse alcohol or drugs than were nondepressed patients. Associations of HIV risk behaviors with depression persisted after adjustment for substance abuse. Conclusions: Depression in STD clinic patients is associated with HIV risk behaviors but not STD diagnosis. Identifying depression and developing strategies to intervene effectively may reduce HIV risk behaviors and improve health outcomes.

Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex‐stratified alcohol consumption trajectories and their predictors. We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV‐infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care. Alcohol consumption trajectories are heterogeneous among People With HIVand range from people with stable use, who tend to have lower levels of other risk behaviors, to those whose consumption patterns vary, and have a higher prevalence of risk behaviors and other comorbidities. With the increased life expectancy of People With HIV, the potential for increased alcohol‐related morbidity and mortality has grown and highlights the need to integrate routine screening and interventions for alcohol misuse into HIVprimary care.

Persons living with HIV and substance use disorders face barriers to sustained engagement in medical care, leading to suboptimal antiretroviral treatment outcomes. Innovative mobile technology tools such as customizable smartphone applications have the potential to enhance existing care coordination programs, but have not been rigorously studied. We developed and implemented a two-component intervention consisting of peer health navigation supported by a smartphone application conducting ecologic momentary assessment (EMA) of barriers to care and medication adherence. Patients with a history of antiretroviral treatment failure and substance use were recruited to participate in the 9-month pilot intervention. Three peer health navigators were trained to provide social and logistical support while participants re-engaged in HIV care. We assessed the acceptability of the intervention components using qualitative analysis of in-depth interviews conducted with study participants and peer navigators. Of 19 patients enrolled in the study, 17 participated for at least 2 months and 15 completed the entire 9-month study protocol. The acceptability of the peer navigation intervention was rated favorably by all participants interviewed, who felt that peer support was instrumental in helping them re-engage in HIV care. Participants also responded favorably to the smartphone application, but described its usefulness mostly as providing reminders to take medications and attend appointments, rather than as a facilitator of patient navigation. Peer health navigation and smartphone-based EMA are acceptable approaches to facilitating engagement in HIV care for drug using populations. Future studies to evaluate the efficacy of this approach for improving long-term retention in care and antiretroviral treatment outcomes are warranted. ClinicalTrials.gov IdentifierNCT01941108; registered on September 4, 2013

•Heavy alcohol use is associated with subsequent lower self-reported health status among women with HIV.•Decrease in self-reported health status score was independent of depressive symptoms.•Men who have sex with men reporting no alcohol use had a subsequently worse self-reported health status compared to moderate alcohol use.

Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol‐related problems have been equivocal. This study examined relationships between scores on self‐report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. Media‐recruited, heavy drinkers with AUD(N= 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper‐and‐pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index‐3 (ASI‐3), and the Perceived Stress Scale (PSS). Eligible subjects (N= 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. In multivariate analyses, higher BAIscores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI‐3 scores were associated with higher drinking frequency. BAIanxiety symptom and ASI‐3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUDsymptom and problem subscale measures. Higher BAIand ASI‐3 scores but not PSSscores were related to greater self‐reported alcohol craving during early alcohol abstinence. Finally, BAIscores were positively related to laboratory stress‐induced cortisol and alcohol craving. In contrast, the PSSshowed no relationship with most measures of alcohol craving or stress reactivity. Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol‐related measures in current heavy drinkers with AUD. Stress and anxiety are widely believed to contribute to drinking; however, prior research findings have been inconsistent. In this study, measures of anxiety and anxiety sensitivity as compared with perceived stress were more strongly associated with frequency and intensity of drinking, alcohol craving during withdrawal, and alcohol craving and cortisol levels following the Trier Social Stress Test. These findings highlight the importance of maintaining distinctions among these terms given unique relationships with drinking, craving, and stress reactivity among heavy drinkers.

Alcohol-exposed pregnancy (AEP) is a significant public health problem in the United States. Sexually transmitted disease (STD) clinics serve female clients with a high prevalence of heavy alcohol consumption coupled with ineffective contraceptive use. Project CHOICES (Changing High-Risk AlcOhol Use and Increasing Contraception Effectiveness) is an evidence-based, brief intervention to lower risk of AEP by targeting alcohol and contraceptive behaviors through motivational interviewing and individualized feedback. We describe our experience integrating and implementing CHOICES in STD clinics. This endeavor aligns with CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's program collaboration and service integration strategic priority to strengthen collaborative work across disease areas and integrate services provided by related programs at the client level.

In place of generalist delivery, externally provided physical activity programmes (EPPAPs) are potentially an effective method for offering primary school students specialist physical education (PE) instruction, as well as providing training for generalist classroom teachers. In the present study, a group of generalist teachers were interviewed regarding the professional benefits of their class's involvement in a 6-month EPPAP. Semi-structured interviews were conducted with five generalist teachers pre- and post-intervention. Wilcoxon signed ranks procedures revealed moderate to large effect sizes for improvements in teachers' beliefs about their ability to provide students with a range of PE-based requirements from pre- to post-intervention (e.g., inclusivity, fun, safety). Content analyses also revealed that generalist teachers reported improvements in their skills, knowledge, and confidence as a result of observing and working alongside PE specialists. This investigation provided preliminary evidence that generalist teachers who observe and participate in an EPPAP report enhanced confidence and skills regarding their ability to effectively instruct PE.

Background Effective models of support for HIV pre-exposure prophylaxis (PrEP) are needed for populations at elevated risk. In a hyperendemic Ugandan fishing community, PrEP counseling was provided through a situated Information, Motivation, and Behavioral Skills (sIMB)-based community health worker (CHW) intervention. We evaluated the intervention using a mixed-methods, implementation science design.Methods We surveyed all community members aged 15-49 through the Rakai Community Cohort Study. We used multivariable logistic regressions with generalized estimating equations to estimate the intervention’s effect on PrEP knowledge and utilization. To understand intervention experiences and mechanisms, we conducted 74 qualitative interviews with 5 informant types (clients, CHWs, program staff, community leaders, health clinic staff) and analyzed data using an iterative, deductive approach. A mobile phone application provided intervention process implementation data.Results Individuals self-reporting receipt of the CHW intervention showed significantly higher PrEP knowledge (N = 1848, PRR: 1.10, 95% CI: 1.06-1.14, p= <.0001), PrEP ever use (N = 1176, PRR: 1.77, 95% CI: 1.33-2.36, p= <.0001), and PrEP current use (N = 1176, PRR: 1.86, 95% CI: 1.22-2.82, p = 0.0039) compared to those who did not. Qualitative findings attributed positive PrEP outcomes to CHW counseling and effective use of motivational interviewing skills by CHWs. Salient themes across the RE-AIM framework included support for the CHW intervention and PrEP across clients, community, and implementers. Mobile application data demonstrated consistent delivery of the PrEP module throughout implementation.Conclusions CHWs improved PrEP knowledge and use among clients in an HIV hyperendemic fishing community. Mixed-methods, implementation science evaluations can inform adaptation of similar PrEP implementation strategies.

Background: Binge drinking is associated with risky sexual behaviors and sexually transmitted diseases (STDs). Few studies have investigated this by gender or in an STD clinic. This cross‐sectional study examined the association between binge drinking and risky sexual behaviors/STDs among patients attending an urban STD clinic.

The study sought to determine the effectiveness of a model pmgram of psychiatric care for human immunodeficiency virus (HIV)-infected patients. This was a cohort study of 126 HIV-positive outpatients referred for psychiatric evaluation and treatment (average follow up of 14 months) in a HIV-dedicated primary-care outpatient clinic in the inner city. A global outcome measure (encompassing symptom relief functioning, and HIV-risk behaviors), and a measure of abstinence from alcohol and illicit substances were used. Fifty percent of patients improved, with 19% “nearly well” at follow-up. Abstinence was achieved 48% of the time. Good compliance with treatment and the absence of injection drug use were the primary predictors of good outcomes. Of the compliant patients, 94% improved, with 45.7% being nearly well. Psychiatric treatment of HIV-infected patients is effective when located in the HIV primary-care setting and administered by a multidisciplinary team under the direction of a psychiatrist, using evidence-based interventions.

ABSTRACTBackgroundHazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care.ObjectiveTo estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam.MethodsWe undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD.ResultsThe total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%).ConclusionsImplementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations.