28 results on '"Cornman DH"'
Search Results
2. Facilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial.
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Muvvala SB, Gan G, Morford KL, Dziura J, Esserman D, Porter E, Chan PA, Cornman DH, Reynolds J, Yager JE, Fiellin DA, and Edelman EJ
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- Humans, New England, Alcoholism, Behavior, Addictive, Opioid-Related Disorders, HIV Infections
- Abstract
Background: Integrated addiction treatment in HIV clinics is associated with improved outcomes, yet it is offered inconsistently and with variable models of care. We sought to evaluate the impact of Implementation Facilitation ("Facilitation") on clinician and staff preference for provision of addiction treatment in HIV clinics with on-site resources (all trained or designated on-site specialist) versus outside resources (outside specialist or refer out)., Methods: From July 2017 to July 2020, surveys assessed clinician and staff preferences for addiction treatment models during control (ie, baseline), intervention, evaluation, and maintenance phases in 4 HIV clinics in the Northeast United States., Results: During the control phase, among 76 respondents (response rate, 58%), the proportions who preferred treatment with on-site resources for opioid use disorder (OUD), alcohol use disorder (AUD), and tobacco use disorder (TUD) were 63%, 55%, and 63%, respectively. Compared with control, there were no significant differences in preferred model during the intervention and evaluation phases except for AUD where there was an increased preference for treatment with on-site resources in the intervention versus control phase. Compared with control, during the maintenance phase, a higher proportion of clinicians and staff preferred providing addiction treatment with on-site resources versus outside resources: OUD, 75% (odds ratio [OR; 95% confidence interval {CI}], 1.79 [1.06-3.03]); AUD, 73% (OR [95% CI], 2.23 [1.36-3.65]), and TUD, 76% (OR [95% CI], 1.88 [1.11-3.18])., Conclusions: The findings from this study lend support for "Facilitation" as a strategy to enhance clinician and staff preference for integrated addiction treatment in HIV clinics with on-site resources., Competing Interests: Dr Muvvala reported receiving personal fees from Alkermes for participating in an advisory board meeting in 2020 outside the submitted work. Dr Chan is also on staff at the Rhode Island Department of Health and the Rhode Island Public Health Institute; to the best of the authors' knowledge, there are no existing additional conflicts of interest, financial or otherwise., (Copyright © 2023 American Society of Addiction Medicine.)
- Published
- 2023
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3. Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics: A Randomized Clinical Trial.
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Edelman EJ, Gan G, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Helfrich CD, Reynolds J, Yager JE, Morford KL, Muvvala SB, and Fiellin DA
- Subjects
- Adult, Analgesics, Opioid, Female, Humans, Male, Middle Aged, Alcoholism, HIV Infections drug therapy, Opioid-Related Disorders drug therapy, Tobacco Use Disorder
- Abstract
Importance: Medications for addiction treatment (MAT) are inconsistently offered in HIV clinics., Objective: To evaluate the impact of implementation facilitation (hereafter referred to as "facilitation"), a multicomponent implementation strategy, on increasing provision of MAT for opioid use disorder (MOUD), alcohol use disorder (MAUD), and tobacco use disorder (MTUD)., Design, Setting, and Participants: Conducted from July 26, 2016, through July 25, 2020, the Working with HIV Clinics to adopt Addiction Treatment using Implementation Facilitation (WHAT-IF?) study used an unblinded, stepped wedge design to sequentially assign each of 4 HIV clinics in the northeastern US to cross over from control (ie, baseline practices) to facilitation (ie, intervention) and then evaluation and maintenance periods every 6 months. Participants were adult patients with opioid, alcohol, or tobacco use disorder. Data analysis was performed from August 2020 to September 2022., Interventions: Multicomponent facilitation., Main Outcomes and Measures: Outcomes, assessed using electronic health record data, were provision of MAT among patients with opioid, alcohol, or tobacco use disorder during the evaluation (primary outcome) and maintenance periods compared with the control period., Results: Among 3647 patients, the mean (SD) age was 49 (12) years, 1814 (50%) were Black, 781 (22%) were Hispanic, and 1407 (39%) were female; 121 (3%) had opioid use disorder, 126 (3%) had alcohol use disorder, and 420 (12%) had tobacco use disorder. Compared with the control period, there was no increase in provision of MOUD with facilitation during the evaluation period (243 patients [27%; 95% CI, 22%-32%] vs 135 patients [28%; 95% CI, 22%-35%]; P = .59) or maintenance period (198 patients [29%; 95% CI, 22%-36%]; P = .48). The change in provision of MAUD from the control period to the evaluation period was not statistically significant (251 patients [8%; 95% CI, 5%-12%] vs 112 patients [13%; 95% CI, 8%-21%]; P = .11); however, the difference increased and became significant during the maintenance period (180 patients [17%; 95% CI, 12%-24%]; P = .009). There were significant increases in provision of MTUD with facilitation during both the evaluation (810 patients [33%; 95% CI, 30%-36%] vs 471 patients [40%; 95% CI, 36%-45%]; P = .005) and maintenance (643 patients [38%; 95% CI, 34%-41%]; P = .047) periods., Conclusions and Relevance: In this randomized clinical trial, facilitation led to increased provision of MTUD, delayed improvements in MAUD, and no improvements in MOUD in HIV clinics. Enhanced strategies, potentially including clinic and patient incentives, especially for MOUD, may be needed to further increase provision of MAT in HIV clinics., Trial Registration: ClinicalTrials.gov Identifier: NCT02907944.
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- 2022
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4. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study.
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Morford KL, Muvvala SB, Chan PA, Cornman DH, Doernberg M, Porter E, Virata M, Yager JE, Fiellin DA, and Edelman EJ
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- Analgesics, Opioid therapeutic use, Humans, Mass Screening, Qualitative Research, HIV Infections drug therapy, Substance-Related Disorders drug therapy
- Abstract
Background: While substance use disorders (SUD) disproportionately impact people with HIV (PWH), HIV clinics inconsistently provide evidence-based medications for addiction treatment (MAT). Patient receptivity to MAT is critical to enhance addiction treatment in these settings. However, we know little from patients about how to best integrate MAT into HIV clinics., Methods: This qualitative study used four focus groups informed by the Promoting Action on Research Implementation in Health Services framework to identify barriers and facilitators to receiving opioid, alcohol, and tobacco use disorder care in HIV clinics. The study population included 28 patients with HIV and SUD receiving care at one of four HIV clinics in the northeastern United States. Focus groups were recorded and transcribed for content analysis. The study also performed a brief survey assessing demographics and behaviors., Results: Focus groups revealed several major themes related to MAT in HIV clinics. Barriers included stigma around MAT, knowledge deficits about available MAT options and the impact of substance use on PWH, concerns about medication side effects, substance use screening without adequate clinician follow-up, and peers who discouraged MAT. Facilitators included recognition of substance use as a threat to overall health, integrated care from HIV clinicians, and support for addiction treatment from peers with lived experience., Conclusions: Efforts to enhance MAT in HIV clinics should include patient education to help them recognize addiction as a chronic disease with available medication treatment options; clinician and staff training to promote integrated, multidisciplinary screening and treatment; and thoughtful inclusion of peers with lived experience., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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5. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation.
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Edelman EJ, Gan G, Dziura J, Esserman D, Morford KL, Porter E, Chan PA, Cornman DH, Oldfield BJ, Yager JE, Muvvala SB, and Fiellin DA
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- Alcoholism, HIV Infections therapy, Health Services Accessibility, Humans, Tobacco Use Cessation, HIV Infections complications, HIV-1, Opioid-Related Disorders drug therapy, Substance-Related Disorders drug therapy
- Abstract
Background: We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics., Setting: Four HIV clinics in the northeastern United States., Methods: Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups., Results: Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork., Conclusions: Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models., Competing Interests: S. B. Muvvala consulted for Alkermes in the past year. The remaining authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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6. Working with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study.
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Edelman EJ, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Rebick G, Yager J, Morford K, Muvvala SB, and Fiellin DA
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- Ambulatory Care Facilities, Counseling, Humans, HIV Infections therapy, Opioid-Related Disorders
- Abstract
Background: Tobacco, alcohol and opioid misuse are associated with substantial morbidity and mortality among people with HIV (PWH). Despite existence of evidence-based counseling and medications for addiction, these treatments are infrequently offered in HIV clinics. The Working with HIV clinics to adopt Addiction Treatment using Implementation Facilitation (WHAT-IF?) study was conducted to address this implementation challenge. The study's goals were to conduct a formative evaluation of barriers to and facilitators of implementing addiction treatment for PWH followed by an evaluation of the impact of Implementation Facilitation (IF) on promoting adoption of addiction treatments and clinical outcomes., Methods: The study was conducted at four HIV clinics in the northeast United States, using a hybrid type 3 effectiveness-implementation stepped wedge design and guided by the Promoting Action on Research Implementation in Health Services Research (PARiHS) framework. A mixed-methods approach was used to identify evidence, context, and facilitation-related barriers to and facilitators of integration of addiction treatments into HIV clinics and to help tailor IF for each clinic. An evaluation was then conducted of the impact of IF on implementation outcomes, including provision of addiction treatment (primary outcome), organizational and clinician and staff readiness to adopt addiction treatment, and changes in organizational models of care used to deliver addiction treatment. The evaluation also included IF's impact on effectiveness outcomes, specifically HIV-related outcomes among patients eligible for addiction treatment., Conclusions: Results will generate important information regarding the impact of IF as a reproducible strategy to promote addiction treatment in HIV clinics., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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7. One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner.
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Shuper PA, Pillay S, MacDonald S, Christie S, Cornman DH, Fisher WA, and Fisher JD
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- Adult, Cross-Sectional Studies, Female, Humans, Male, Rural Population, Sample Size, South Africa epidemiology, Young Adult, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Sexual Partners, Unsafe Sex
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- 2016
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8. HIV prevention counseling intervention delivered during routine clinical care reduces HIV risk behavior in HIV-infected South Africans receiving antiretroviral therapy: the Izindlela Zokuphila/Options for Health randomized trial.
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Fisher JD, Cornman DH, Shuper PA, Christie S, Pillay S, Macdonald S, Ngcobo N, Amico KR, Lalloo U, Friedland G, and Fisher WA
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- Adolescent, Adult, Aged, Female, HIV Infections drug therapy, Humans, Male, Middle Aged, South Africa, Young Adult, Anti-Retroviral Agents therapeutic use, Counseling methods, HIV Infections prevention & control, HIV Infections transmission, Risk-Taking, Sexual Behavior
- Abstract
Context: Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression., Objective: To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART., Design: Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care., Setting: Publicly funded HIV clinical care sites., Patients: One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924)., Intervention: Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care., Main Outcome Measures: Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months., Results: Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared with standard-of-care participants. Differences in sexually transmitted infection incidence between arms were not observed., Conclusions: Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic., Trial Registration: Not applicable.
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- 2014
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9. HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.
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Shuper PA, Kiene SM, Mahlase G, MacDonald S, Christie S, Cornman DH, Fisher WA, Greener R, Lalloo UG, Pillay S, van Loggerenberg F, and Fisher JD
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- Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cross-Sectional Studies, Directive Counseling, Female, HIV Infections drug therapy, HIV Infections psychology, HIV Infections transmission, Health Education, Health Knowledge, Attitudes, Practice, Humans, Information Dissemination, Male, Motivation, Physician-Patient Relations, Risk Factors, Risk-Taking, South Africa epidemiology, Condoms statistics & numerical data, HIV Infections prevention & control, Sexual Behavior psychology, Social Stigma, Social Support
- Abstract
The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.
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- 2014
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10. Impact of an adherence intervention on the effectiveness of tenofovir gel in the CAPRISA 004 trial.
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Mansoor LE, Karim QA, Werner L, Madlala B, Ngcobo N, Cornman DH, Amico KR, Fisher J, Fisher WA, Macqueen KM, and Karim SS
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- Adenine administration & dosage, Adult, Anti-HIV Agents therapeutic use, Anti-Infective Agents, Local therapeutic use, Double-Blind Method, Female, Gels, HIV Infections epidemiology, Humans, Incidence, Medication Adherence statistics & numerical data, Models, Psychological, Motivational Interviewing, Socioeconomic Factors, South Africa epidemiology, Tenofovir, Treatment Outcome, Adenine analogs & derivatives, Anti-HIV Agents administration & dosage, Anti-Infective Agents, Local administration & dosage, HIV Infections prevention & control, Health Behavior, Medication Adherence psychology, Organophosphonates administration & dosage
- Abstract
High adherence is important in microbicide trials, but no adherence interventions to date have demonstrated empiric improvements in microbicide adherence or effectiveness. Approximately midway during the CAPRISA 004 trial, we implemented a novel adherence intervention (Adherence Support Program-ASP), based on an Information-Motivation-Behavioral Skills model and incorporating a Motivational Interviewing approach. We assessed the impact of the ASP on adherence and tenofovir gel effectiveness using a before-and-after comparison. Of the 889 women in the trial, 774 contributed 486.1 women-years of follow-up pre-ASP and 828 contributed 845.7 women-years of follow-up post-ASP. Median adherence rose from 53.6 % pre-ASP to 66.5 % post-ASP. Detectable tenofovir levels increased from 40.6 % pre-ASP to 62.5 % post-ASP in 64 women who had paired tenofovir drug samples. Gel effectiveness improved post-ASP; HIV incidence in the tenofovir gel arm was 24 % lower pre-ASP compared to 47 % lower post-ASP. Following implementation of the ASP, microbicide adherence improved with a concomitant increase in the effectiveness of tenofovir gel.
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- 2014
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11. HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms.
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Earnshaw VA, Smith LR, Shuper PA, Fisher WA, Cornman DH, and Fisher JD
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- Adult, Depression prevention & control, Female, HIV Infections prevention & control, HIV Infections psychology, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Longitudinal Studies, Male, Poverty, Prevalence, Risk Factors, Sexual Partners, South Africa epidemiology, Surveys and Questionnaires, Condoms statistics & numerical data, Depression epidemiology, HIV Infections epidemiology, Research Design, Social Stigma, Social Support, Unsafe Sex statistics & numerical data
- Abstract
Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among people living with HIV (PLWH) in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18-month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal.
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- 2014
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12. Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information--motivation--behavioral skills model analysis.
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Kiene SM, Fisher WA, Shuper PA, Cornman DH, Christie S, Macdonald S, Pillay S, Mahlase G, and Fisher JD
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- Adolescent, Adult, Aged, Antiretroviral Therapy, Highly Active, Female, HIV Infections drug therapy, HIV Infections prevention & control, HIV Infections transmission, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Motivation, Risk Factors, Sex Factors, Sexual Behavior statistics & numerical data, South Africa, Young Adult, HIV Infections psychology, Models, Psychological, Risk-Taking, Sexual Behavior psychology
- Abstract
Objective: The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (HIV) transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa's generalized HIV epidemic., Methods: HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa., Results: Findings confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, whereas for women, the effect of HIV prevention motivation works through HIV prevention behavioral skills to affect HIV preventive behavior., Conclusion: These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa's generalized HIV epidemic., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)
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- 2013
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13. Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa.
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Smith LR, Amico KR, Shuper PA, Christie S, Fisher WA, Cornman DH, Doshi M, MacDonald S, Pillay S, and Fisher JD
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- Adolescent, Adult, CD4 Lymphocyte Count, Counseling, Education, Female, HIV Seropositivity drug therapy, Humans, Information Dissemination, Male, Physician-Patient Relations, Social Stigma, Social Support, South Africa, Young Adult, Antiretroviral Therapy, Highly Active psychology, HIV Infections drug therapy, HIV Infections psychology, Health Knowledge, Attitudes, Practice, Motivation
- Abstract
Little is known regarding factors implicated in early engagement and retention in HIV care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients' pre-ART HIV care-related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients, initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients, who were aged 18 years or older, newly entering care (diagnosed within the last six-months), and ineligible for ART (CD4 count > 200 cells/mm(3)) in one of four primary care clinical sites. Self-reported information, motivation, and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e.,≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, eight information, eight motivation, and eight behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV care-related information, motivation, and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions with clinic staff and decreasing community-level stigma and to decrease structural and resource-depleting demands of HIV care may be particularly valuable to facilitate retention in pre-ART HIV care.
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- 2013
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14. Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal, South Africa.
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Cornman DH, Christie S, Shepherd LM, MacDonald S, Amico KR, Smith LR, Shuper PA, Adelaja A, Mahlase G, Fröhlich JA, Pillay S, Lalloo UG, Fisher WA, and Fisher JD
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- Adult, Aged, Condoms statistics & numerical data, Feasibility Studies, Female, Focus Groups, Humans, Male, Middle Aged, Pilot Projects, South Africa, Young Adult, Counseling, HIV Infections, Risk Reduction Behavior, Safe Sex
- Abstract
This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.
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- 2011
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15. Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project.
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Fisher JD, Amico KR, Fisher WA, Cornman DH, Shuper PA, Trayling C, Redding C, Barta W, Lemieux AF, Altice FL, Dieckhaus K, and Friedland G
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- Adult, Antiretroviral Therapy, Highly Active, Computers, Connecticut, Female, HIV Infections psychology, Humans, Male, Middle Aged, Patient Education as Topic, Software, Viral Load, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Medication Adherence, User-Computer Interface
- Abstract
We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.
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- 2011
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16. Prevalence of and barriers to dual-contraceptive methods use among married men and women living with HIV in India.
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Chakrapani V, Kershaw T, Shunmugam M, Newman PA, Cornman DH, and Dubrow R
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- Adolescent, Adult, Condoms statistics & numerical data, Family Planning Services standards, Female, Focus Groups, Health Services Accessibility, Humans, India, Male, Young Adult, Contraception Behavior, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice
- Abstract
Objective: To describe the prevalence and correlates of dual-contraceptive methods use (condoms and an effective pregnancy prevention method) and barriers to their use among married persons living with HIV (PLHIV) in India., Methods: We conducted a quantitative survey (93 men, 97 women), 25 in-depth interviews, seven focus groups, and five key informant interviews., Results: Prevalence of dual-contraceptive method use increased from 5% before HIV diagnosis to 23% after diagnosis (P < 0.001). Condoms were the most common contraceptive method, with prevalence increasing from 13% before diagnosis to 92% after diagnosis (P < 0.001). Barriers to using noncondom contraceptives were lack of discussion about noncondom contraceptives by health care providers, lack of acceptability of noncondom contraceptives among PLHIV, and lack of involvement of husbands in family planning counseling., Conclusion: There is a need for interventions, including training of health care providers, to increase dual-contraceptive methods use among married PLHIV.
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- 2011
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17. Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care.
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Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornman DH, Trayling CA, Redding C, and Fisher JD
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- Adult, Analysis of Variance, Attitude to Health, Female, HIV Infections psychology, HIV Seropositivity drug therapy, HIV Seropositivity psychology, Humans, Male, Medication Adherence statistics & numerical data, Middle Aged, Models, Theoretical, Motivation, Patient Education as Topic, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Medication Adherence psychology
- Abstract
Since the arrival of antiretroviral (ARV) therapy, HIV has become better characterized as a chronic disease rather than a terminal illness, depending in part on one's ability to maintain relatively high levels of adherence. Despite research concerning barriers and facilitators of ARV adherence behavior, relatively little is known about specific challenges faced by HIV-positive persons who report "taking a break" from their ARV medications. The present study employed the Information-Motivation-Behavioral Skills Model of ARV adherence as a framework for understanding adherence-related barriers that may differentiate between non-adherent patients who report "taking a break" versus those who do not report "taking a break" from their ARV medications. A sample of 327 HIV-positive patients who reported less than 100% adherence at study baseline provided data for this research. Participants who reported "taking a break" from their HIV medications without first talking to their healthcare provider were classified as intentionally non-adherent, while those who did not report "taking a break" without first talking with their healthcare provider were classified as unintentionally non-adherent. Analyses examined differences between intentionally versus unintentionally non-adherent patients with respect to demographic characteristics and responses to the adherence-related information, motivation, and behavioral skills questionnaire items. Few differences were observed among the groups on demographics, adherence-related information, or adherence-related motivation; however, significant differences were observed on about half of the adherence-related behavioral skills items. Implications for future research, as well as the design of specific intervention components to reduce intentionally non-adherent behavior, are discussed.
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- 2010
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18. An agenda for advancing the science of implementation of evidence-based HIV prevention interventions.
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Norton WE, Amico KR, Cornman DH, Fisher WA, and Fisher JD
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- HIV Infections prevention & control, Health Plan Implementation, Health Promotion standards, Humans, Preventive Health Services standards, Evidence-Based Medicine, Health Promotion organization & administration, Information Dissemination, Preventive Health Services organization & administration, Program Development methods
- Abstract
In the past 25 years, a tremendous amount of time and resources have been committed to developing evidence-based HIV prevention interventions. More recently, there have been noteworthy efforts to develop an infrastructure and related policies to promote the dissemination (i.e., "the targeted distribution of information and intervention materials to a specific public health or clinical practice audience") of evidence-based interventions. Despite these advances, however, we have had comparatively little success in the effective implementation (i.e., "the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings") of such interventions in everyday practice or community settings. The objective of the current paper is to highlight select and initial areas of research that are critically needed to advance the state-of-the-science of implementation of HIV prevention interventions in our broader efforts to curb the epidemic worldwide.
- Published
- 2009
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19. Accuracy of the stages of change algorithm: sexual risk reported in the maintenance stage of change.
- Author
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Ferrer RA, Amico KR, Bryan A, Fisher WA, Cornman DH, Kiene SM, and Fisher JD
- Subjects
- Adolescent, Condoms statistics & numerical data, Connecticut, Humans, Models, Theoretical, Safe Sex statistics & numerical data, Surveys and Questionnaires, Young Adult, Algorithms, HIV Infections prevention & control, Risk Reduction Behavior
- Abstract
The Transtheoretical Model (TTM), which asserts that health behavior change progresses in stages, is often used to explore health risk behaviors and to target and evaluate health promotion interventions. A four-question staging algorithm is often used to measure an individual's health behavior stage of change (SOC), but its accuracy or appropriateness for tailoring interventions or evaluating outcomes has not been established. The current study utilized data from three studies on HIV sexual risk behavior to compare SOC to reports of sexual risk on more detailed risk assessments, measured concurrently. Within each data set, detailed behavioral risk assessments were compared with SOC, with specific emphasis on maintenance staging, to evaluate the correspondence between SOC and reported behavior. Those classified in the maintenance SOC for condom use should, by definition, report no sexual risk events over the matched time period. Across all three studies, 18% of those classified in the maintenance SOC for condom use reported one or more sexual risk behaviors during the matched time period. Because the SOC algorithm is frequently used in intervention design, targeting, and evaluation, the potential for mis-categorization in the most advanced stage of maintenance raises concerns. Results suggest that intervention inclusion or evaluation strategies that use the maintenance stage as a primary outcome should be further qualified by behavioral data.
- Published
- 2009
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- View/download PDF
20. Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: results of a pilot study.
- Author
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Cornman DH, Kiene SM, Christie S, Fisher WA, Shuper PA, Pillay S, Friedland GH, Thomas CM, Lodge L, and Fisher JD
- Subjects
- Adult, CD4 Lymphocyte Count, Female, HIV Infections transmission, Health Knowledge, Attitudes, Practice, Humans, Male, Pilot Projects, Sexual Behavior, South Africa, Surveys and Questionnaires, HIV Infections prevention & control, Health Education, Risk Reduction Behavior, Unsafe Sex prevention & control
- Abstract
Objective: To evaluate the feasibility, fidelity, and effectiveness of a human immunodeficiency virus (HIV) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal, South Africa., Methods: A total of 152 HIV-infected patients, aged 18 years and older, receiving clinical care at an urban hospital in South Africa, were randomly assigned to intervention or standard-of-care control counselors. Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior. Self-report questionnaires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months., Results: Intervention was delivered in 99% of routine patient visits and included a modal 8 of 8 intervention steps. Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline, patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events. There was a marginally significant increase in these events among patients in the standard-of-care control condition., Conclusions: A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior.
- Published
- 2008
- Full Text
- View/download PDF
21. Attitudes toward needle-sharing and HIV transmission risk behavior among HIV+ injection drug users in clinical care.
- Author
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Norton WE, Amico KR, Fisher WA, Copenhaver MM, Kozal MJ, Cornman DH, Friedland G, and Fisher JD
- Subjects
- Adult, Female, Humans, Logistic Models, Male, Middle Aged, Risk-Taking, HIV Infections psychology, HIV Infections transmission, Health Knowledge, Attitudes, Practice, Needle Sharing psychology, Substance Abuse, Intravenous psychology
- Abstract
Risky behavior related to injection drug use accounts for a considerable proportion of incident HIV infection in the United States. Large numbers of injection drug users (IDUs) currently receive antiretroviral therapy in clinical settings and are accessible for risk-reduction interventions to reduce transmission of drug-resistant HIV and spread of HIV to uninfected others. The current study examined attitudes toward needle- or equipment-sharing among 123 HIV-positive IDUs in clinical care in an effort to understand the dynamics of such behavior and to create a basis for clinic-based risk-reduction interventions. Results indicate that at baseline, participants who reported extremely negative attitudes toward needle-sharing were less likely to have shared during the past month than those with less-extreme negative attitudes. Demographic, behavioral, and attitudinal variables were entered into a logistic regression model to examine needle-sharing group membership among HIV-positive IDUs. Being female and having less-extreme negative attitudes toward sharing were independent and significant correlates of sharing behavior. Interventions targeting needle-sharing attitudes deployed within the clinical care setting may be well-positioned to reduce HIV transmission among HIV-positive IDUs.
- Published
- 2008
- Full Text
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22. Reasons for ART non-adherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi.
- Author
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Amico KR, Konkle-Parker DJ, Cornman DH, Barta WD, Ferrer R, Norton WE, Trayling C, Shuper P, Fisher JD, and Fisher WA
- Subjects
- Attitude to Health, Female, HIV Infections psychology, Humans, Male, Mississippi, Socioeconomic Factors, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Treatment Refusal psychology
- Abstract
HIV prevalence in the American Deep South has reached crisis proportions and greater numbers of patients are enrolling in clinical care and beginning antiretroviral therapy (ART). In order to gain maximum benefit from ART, patients must sustain high levels of adherence to demanding regimens over extended periods of time. Many patients are unable to maintain high rates of adherence and may need assistance to do so, which may be based upon an understanding of barriers to adherence for a given population. The current study sought to gain understanding of barriers to adherence for a mixed urban/rural HIV-positive patient population in Mississippi and to determine whether barriers to adherence may be specific to gender, employment, depressive symptoms or educational attainment status. Seventy-two patients who missed a dose of ART medication over the last three days endorsed the top five reasons for missing a dose as: (1) not having the medication with them, (2) sleeping through the dose time, (3) running out of the medication, (4) being busy with other things and (5) other. Reported barriers were fairly consistent across different groups, although women and those classified as having moderate to severe depressive symptoms reported different patterns of adherence barriers. Results suggest that adherence interventions implemented in the Deep South must take into account specific barriers faced by individuals within this region, where stigma, gender disparities and limited resources are prevalent.
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- 2007
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23. An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India.
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Cornman DH, Schmiege SJ, Bryan A, Benziger TJ, and Fisher JD
- Subjects
- Adult, Aged, Condoms statistics & numerical data, Contraception Behavior psychology, Health Knowledge, Attitudes, Practice, Humans, India, Male, Middle Aged, Models, Psychological, Sexual Behavior psychology, Acquired Immunodeficiency Syndrome prevention & control, Automobile Driving psychology, Health Behavior, Health Education methods, Motivation, Motor Vehicles
- Abstract
The incidence of HIV/AIDS in India is increasing drastically, and truck drivers are seen as critical sources of HIV transmission due to their high rates of unprotected sex with multiple partners. An intervention based on the Information-Motivation-Behavioral Skills (IMB) model was compared to an information-only control condition in a randomized trial. IMB constructs were assessed among 250 male truck drivers immediately prior to and following implementation of the intervention, and sexual and condom use behaviors were assessed approximately 10 months later. The intervention consisted of a single-session group workshop with 5 interactive activities designed to address HIV prevention-related IMB constructs and to motivate condom use. Findings showed mixed support for the effectiveness of the intervention. There was an effect of the IMB intervention on attitudes, norms, behavioral skills, and intentions specific to condom use with marital partners, but no effects on constructs related to non-marital partners. There was some evidence of greater condom use with marital and non-marital partners at behavioral follow-up for participants in the IMB condition, and effects on condom use with marital partners were mediated by changes in IMB constructs. These findings provide initial evidence for the effectiveness of theoretically-based approaches to HIV prevention in India.
- Published
- 2007
- Full Text
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24. Involving behavioral scientists, health care providers, and HIV-infected patients as collaborators in theory-based HIV prevention and antiretroviral adherence interventions.
- Author
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Fisher JD, Cornman DH, Norton WE, and Fisher WA
- Subjects
- Consensus, Health Knowledge, Attitudes, Practice, Humans, Anti-HIV Agents administration & dosage, Anti-HIV Agents therapeutic use, Behavioral Sciences, HIV Infections drug therapy, Health Personnel, Patient Compliance
- Abstract
Health care providers are often hesitant to attempt health behavior change interventions with patients, although such interventions are frequently needed. When provider-initiated health behavior change interventions are attempted, they are often based on intuition or consist solely of delivering information and are insufficient to change behavior, rather than being based on well-validated and effective behavior change models. We argue that provider-initiated health behavior change interventions are effective and efficient if they are based on appropriate empirically validated theoretical models and developed in collaboration with behavioral scientists and patients. We present a new model for developing such collaborative interventions and initial evidence for its success.
- Published
- 2006
- Full Text
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25. Sexual risk behaviour among HIV-positive individuals in clinical care in urban KwaZulu-Natal, South Africa.
- Author
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Kiene SM, Christie S, Cornman DH, Fisher WA, Shuper PA, Pillay S, Friedland GH, and Fisher JD
- Subjects
- Adolescent, Adult, Female, HIV Seropositivity epidemiology, Humans, Incidence, Male, Middle Aged, Sexual Partners, South Africa epidemiology, Unsafe Sex statistics & numerical data, Urban Health, HIV Seropositivity psychology, Unsafe Sex psychology
- Abstract
We assessed the incidence and predictors of unprotected sex among 152 HIV-positive patients in clinical care in KwaZulu-Natal, South Africa. Nearly 50% were sexually active; 30% of those reported unprotected sex. Alcohol use during sex, reporting forced sex, sex with a perceived HIV-positive partner, and sex with a casual partner predicted more unprotected sex, whereas HIV status disclosure was related to less unprotected sex. These findings highlight the need for linking HIV prevention and care in Africa.
- Published
- 2006
- Full Text
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26. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers.
- Author
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Amico KR, Fisher WA, Cornman DH, Shuper PA, Redding CG, Konkle-Parker DJ, Barta W, and Fisher JD
- Subjects
- Humans, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Pain Measurement, Patient Compliance
- Abstract
Background: Brief self-reports of antiretroviral therapy adherence that place minimal burden on patients and clinic staff are promising alternatives to more elaborate adherence assessments currently in use. This research assessed the association between self-reported adherence on visual analog scale (VASs) and an existing, more complex self-reported measure of adherence, the AACTG, and the degree to which each method distinguished optimally and suboptimally adherent patients in terms of reported barriers to adherence., Methods: HIV-infected patients (N = 147) at a southeastern US clinic completed a computerized assessment including an antiretroviral therapy adherence VAS, a modified version of the AACTG, and a measure of adherence., Results: Adherence rates were comparable across the AACTG (81%) and VAS (87%); they significantly correlated (r = 0.585) and produced identical classification of optimal (>90%) or suboptimal (<90%) adherence for 66% of patients. In general, VAS scores tended to be higher than AACTG scores. Suboptimally adherent patients reported more adherence barriers than those classified as optimally adherent, and those so classified by the VAS reported considerably more barriers to adherence than those so classified by the AACTG., Conclusions: Results generally support the construct validity of the VAS and its use as an easily administered assessment tool that can identify patients with barriers to adherence who might benefit from adherence support interventions.
- Published
- 2006
- Full Text
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27. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients.
- Author
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Fisher JD, Fisher WA, Cornman DH, Amico RK, Bryan A, and Friedland GH
- Subjects
- Adult, Aged, Female, HIV Infections transmission, Heterosexuality, Homosexuality, Humans, Male, Middle Aged, Sexual Behavior, HIV Infections rehabilitation, Patient Education as Topic, Unsafe Sex prevention & control
- Abstract
Objective: To evaluate the effectiveness of a clinician-delivered intervention, implemented during routine clinical care, in reducing unprotected sexual behavior of HIV-infected patients., Design: A prospective clinical trial comparing the impact of a clinician-delivered intervention arm vs. a standard-of-care control arm on unprotected sexual behavior of HIV-infected patients., Setting: The 2 largest HIV clinics in Connecticut., Participants: A total of 497 HIV-infected patients, aged > or =18 years, receiving HIV clinical care., Intervention: HIV clinical care providers conducted brief client-centered interventions at each clinical encounter that were designed to help HIV-infected patients reduce unprotected sexual behavior., Main Outcome Measures: Unprotected insertive and receptive vaginal and anal intercourse and unprotected insertive oral sex; unprotected insertive and receptive vaginal and anal intercourse only., Results: HIV-infected patients who received the clinician-delivered intervention showed significantly reduced unprotected insertive and receptive vaginal and anal intercourse and insertive oral sex over a follow-up interval of 18 months (P < 0.05). These behaviors increased across the study interval for patients in the standard-of-care control arm (P < 0.01). For the measure of unprotected insertive and receptive vaginal and anal sex only, there was a trend toward a reduction in unprotected sex among intervention arm participants over time (P < 0.09), and a significant increase in unprotected sex in the standard-of-care control arm (P < 0.01)., Conclusions: A clinician-delivered HIV prevention intervention targeting HIV-infected patients resulted in reductions in unprotected sex. Interventions of this kind should be integrated into routine HIV clinical care.
- Published
- 2006
- Full Text
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28. Clinician-initiated HIV risk reduction intervention for HIV-positive persons: Formative Research, Acceptability, and Fidelity of the Options Project.
- Author
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Fisher JD, Cornman DH, Osborn CY, Amico KR, Fisher WA, and Friedland GA
- Subjects
- Connecticut, HIV Infections psychology, HIV Infections transmission, Humans, Motivation, Patient Compliance, Patient Education as Topic, Poverty, Substance-Related Disorders epidemiology, HIV Infections prevention & control, HIV Seropositivity transmission, Risk Reduction Behavior
- Abstract
Objective: To conduct research on levels and dynamics of HIV risk behavior among HIV-positive patients in clinical care, use this research to design a clinician-initiated HIV prevention intervention for HIV-positive patients, and evaluate the acceptability of the intervention to clinicians and patients and the fidelity with which it can be delivered by clinicians., Methods: Study 1 (elicitation research) involved focus groups with HIV-positive patients and HIV care clinicians to understand the dynamics of HIV risk behavior among HIV-positive patients and how to integrate HIV prevention into routine clinical care. Study 2 (acceptability and intervention fidelity) involved the evaluation of 1455 medical visits by experimental intervention patients (N = 231) for acceptability and fidelity of the clinician-initiated HIV prevention intervention., Results: Elicitation research with patients and clinicians identified critical HIV prevention information, motivation, and behavioral skills deficits in HIV-positive patients as well as risky sexual behavior. These findings were integrated into a theory-based HIV prevention intervention initiated by clinicians that proved acceptable to clinicians and patients and that clinicians were able to implement with adequate fidelity., Conclusion: HIV prevention interventions by clinicians treating HIV-positive patients can and should be integrated into routine clinical care.
- Published
- 2004
- Full Text
- View/download PDF
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