8 results on '"Nance, R. M."'
Search Results
2. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era.
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Ma, J., Luu, B., Ruderman, S. A., Whitney, B. M., Merrill, J. O., Mixson, L. S., Nance, R. M., Drumright, L. N., Hahn, A. W., Fredericksen, R. J., Chander, G., Lau, B., McCaul, M. E., Safren, S., O'Cleirigh, C., Cropsey, K., Mayer, K. H., Mathews, W. C., Moore, R. D., and Napravnik, S.
- Subjects
CLINICAL drug trials ,HIV infection transmission ,SUBSTANCE abuse ,PATIENT compliance ,SELF-evaluation ,STATISTICAL models ,ANTIRETROVIRAL agents ,METHAMPHETAMINE ,ACADEMIC medical centers ,VIRAL load ,RESEARCH funding ,MULTIPLE regression analysis ,QUESTIONNAIRES ,VISUAL analog scale ,CD4 lymphocyte count ,SEVERITY of illness index ,HIV infections ,MULTIVARIATE analysis ,DESCRIPTIVE statistics ,RELATIVE medical risk ,PSYCHOLOGY of HIV-positive persons ,HEROIN ,MEN who have sex with men ,RESEARCH ,CANNABIS (Genus) ,ALCOHOLISM ,INDIVIDUALIZED medicine ,HEALTH outcome assessment ,COMPARATIVE studies ,DISEASE susceptibility ,INFECTIOUS disease transmission ,CONFIDENCE intervals ,DRUGS of abuse ,CRACK cocaine ,REGRESSION analysis ,EVALUATION ,DISEASE risk factors ,ADULTS - Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort
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Fredericksen, R. J., Whitney, B. M., Trejo, E., Nance, R. M., Fitzsimmons, E., Altice, F. L., Carrico, A. W., Cleland, C. M., Del Rio, C., Duerr, A., El-Sadr, W. M., Kahana, S., Kuo, I., Mayer, K., Mehta, S., Ouellet, L. J., Quan, V. M., Rich, J., Seal, D. W., Springer, S., Taxman, F., Wechsberg, W., Crane, H. M., and Delaney, J. A. C.
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- 2021
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4. Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care
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Fredericksen, R. J., Nance, R. M., Whitney, B. M., Harding, B. N., Fitzsimmons, E., Del Rio, C., Eron, J., Feaster, D. J., Kalokhe, A. S., Mathews, W. C., Mayer, K. H., Metsch, L. R., Mugavero, M. J., Potter, J., O’Cleirigh, C., Napravnik, S., Rodriguez, B., Ruderman, S., JAC, Delaney, and Crane, H. M.
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- 2021
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5. Vaporized nicotine use among patients in HIV care who smoke tobacco: perceived health effects and effectiveness as a smoking cessation tool.
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Fredericksen, R. J., Fitzsimmons, E., Drumright, L. N., Loo, S., Dougherty, S., Brown, S., Pearce, J., Nance, R. M., Whitney, B. M., Ruderman, S., O'Cleirigh, C., Cropsey, K., Mayer, K. H., Mugavero, M. J., Delaney, J. A. C., Crane, H. M., and Hahn, A.
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ELECTRONIC cigarettes ,GROUNDED theory ,RESEARCH methodology ,NICOTINE ,INTERVIEWING ,PATIENTS' attitudes ,COMPARATIVE studies ,HEALTH attitudes ,DESCRIPTIVE statistics ,RESEARCH funding ,SMOKING ,TOBACCO products ,DATA analysis software ,THEMATIC analysis ,SMOKING cessation products ,PSYCHOLOGY of HIV-positive persons ,MEDICAL coding - Abstract
Evidence suggests adverse health effects from vaporized nicotine (VN) use, such as electronic "e" cigarettes, and limited efficacy to aid tobacco cessation. People with HIV (PWH) smoke tobacco at higher rates than the general population, with greater morbidity, highlighting the necessity of effective tobacco cessation tools. PWH may be more vulnerable to adverse effects of VN. Using semi-structured 1:1 interviews, we examined health beliefs regarding VN, patterns of use, and perceived effectiveness for tobacco cessation among PWH in HIV care at three geographically diverse U.S. sites. PWH (n = 24) had limited understanding of VN product content or health effects, presuming VN less harmful than tobacco cigarettes (TC). VN failed to adequately replicate the psychoactive effects or desired ritual of smoking TC. Concurrent TC use, and continuous VN use throughout the day, was common. Satiety using VN was elusive, and consumption quantity was difficult to track. VN had limited desirability and durability as a TC cessation tool among the interviewed PWH. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Impact and correlates of sub-optimal social support among patients in HIV care.
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Fredericksen, R. J., Gibbons, L. E., Fitzsimmons, E., Nance, R. M., Schafer, K. R., Batey, D. S., Loo, S., Dougherty, S., Mathews, W. C., Christopoulos, K., Mayer, K. H., Mugavero, M. J., Kitahata, M. M., Crane, P. K., and Crane, H. M.
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HIV infections ,STATISTICS ,EVALUATION of medical care ,SOCIAL support ,CONFIDENCE intervals ,MULTIVARIATE analysis ,HEALTH outcome assessment ,MEDICAL care ,PATIENTS ,ANTIRETROVIRAL agents ,DRUGS ,DESCRIPTIVE statistics ,QUALITY of life ,RESEARCH funding ,PATIENT compliance - Abstract
Social support (SS) predicts health outcomes among patients living with HIV. We administered a brief, validated measure of SS, the Multifactoral Assessment of Perceived Social Support, within a patient-reported outcomes assessment of health domains in HIV care at 4 U.S. clinics in English and Spanish (n = 708). In univariate analysis, low SS was associated with poorer engagement in care, antiretroviral adherence, and health-related quality of life; current methamphetamine/crystal use, depression, anxiety, and HIV stigma (all p < 0.001); any use of either methamphetamines/crystal, illicit opioids, or cocaine/crack (p = 0.001), current marijuana use (p = 0.012), nicotine use (p = 0.005), and concern for sexually transmitted infection exposure (p = 0.001). High SS was associated with undetectable viral load (p = 0.031). Multivariate analyses found low SS independently associated with depression (risk ratio (RR) 3.72, 95% CI 2.93–4.72), lower adherence (RR 0.76, 95% CI 0.64–0.89), poor engagement in care (RR 2.05, 95% CI 1.44–2.96), and having more symptoms (RR 2.29, 95% CI 1.92–2.75). Medium SS was independently associated with depression (RR 2.59, 95% CI 2.00–3.36), poor engagement in care (RR 1.62, 95% CI 1.15–2.29) and having more symptoms (RR 1.75, 95% CI 1.44–2.13). SS assessment may help identify patients at risk for these outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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7. Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes.
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Fredericksen, R. J., Harding, B. N., Ruderman, S. A., McReynolds, J., Barnes, G., Lober, W. B., Fitzsimmons, E., Nance, R. M., Whitney, B. M., Delaney, J. A. C., Mathews, W. C., Willig, J., Crane, P. K., and Crane, H. M.
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MENTAL depression risk factors ,HIV infections ,RISK-taking behavior ,NARCOTICS ,CONFIDENCE intervals ,HAPPINESS ,MULTIVARIATE analysis ,ANALGESICS ,HEALTH outcome assessment ,REGRESSION analysis ,PATIENT satisfaction ,RACE ,PATIENTS' attitudes ,HEALTH behavior ,DESCRIPTIVE statistics ,QUALITY of life ,ETHNIC groups ,PATIENT compliance ,SEXUAL partners ,PORTABLE computers - Abstract
We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91% male; 49% white; 17% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95%CI:0.3-2.3); +1.6 points/Latino patients (95%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95%CI:0.2-0.5)) and adherence (0.4 points (95%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use. [ABSTRACT FROM AUTHOR]
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- 2021
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8. Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US.
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Bender Ignacio RA, Shapiro AE, Nance RM, Whitney BM, Delaney J, Bamford L, Wooten D, Karris M, Mathews WC, Kim HN, Van Rompaey SE, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Jacobson J, Saag MS, Moore RD, Eron JJ, Willig AL, Christopoulos KA, Martin J, Hunt PW, Crane HM, Kitahata MM, and Cachay E
- Abstract
Objectives: To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19., Design: Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020., Methods: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores., Results: Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity., Conclusions: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.
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- 2021
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