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1.  Using Online Social Media for Recruitment of Human Immunodeficiency Virus-Positive Participants: A Cross-Sectional Survey 
Background
There are many challenges in recruiting and engaging participants when conducting research, especially with HIV-positive individuals. Some of these challenges include geographical barriers, insufficient time and financial resources, and perceived HIV-related stigma.
Objective
This paper describes the methodology of a recruitment approach that capitalized on existing online social media venues and other Internet resources in an attempt to overcome some of these barriers to research recruitment and retention.
Methods
From May through August 2013, a campaign approach using a combination of online social media, non-financial incentives, and Web-based survey software was implemented to advertise, recruit, and retain participants, and collect data for a survey study with a limited budget.
Results
Approximately US $5,000 was spent with a research staff designated at 20% of full-time effort, yielding 2034 survey clicks, 1404 of which met the inclusion criteria and initiated the survey, for an average cost of US $3.56 per survey initiation. A total of 1221 individuals completed the survey, yielding 86.97% retention.
Conclusions
These data indicate that online recruitment is a feasible and efficient tool that can be further enhanced by sophisticated online data collection software and the addition of non-financial incentives.
doi:10.2196/jmir.3229
PMCID: PMC4026571  PMID: 24784982
HIV; AIDS; online social media; Facebook; Twitter; recruitment; Internet research; survey retention; online data collection software; non-financial incentives
2.  Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV infected adults: A mediation model 
AIDS patient care and STDs  2006;20(4):258-268.
Adherence to antiretroviral (ARV) therapy for HIV infection is critical for maximum benefit from treatment and for the prevention of HIV-related complications. There is evidence that many factors determine medication adherence, including adherence self-efficacy (confidence in one's ability to adhere) and relations with health care providers. However, there are no studies that examine how these two factors relate to each other and their subsequent influence on HIV medication adherence. The goal of the current analysis was to explore a model of medication adherence in which the relationship between positive provider interactions and adherence is mediated by adherence self-efficacy. Computerized self administered and interviewer administered self reported measures of medication adherence, demographic and treatment variables, provider interactions, and adherence self-efficacy were administered to 2765 HIV infected adults on ARV. Criteria for mediation were met, supporting a model in which adherence self-efficacy is the mechanism for the relationship between positive provider interactions and adherence. The finding was consistent when the sample was stratified by gender, race, injection drug use history, and whether the participant reported receipt of HIV specialty care. Positive provider interactions may foster greater adherence self-efficacy, which is associated with better adherence to medications. Results suggest implications for improving provider interactions in clinical care, and future directions for clarifying inter-relationships among provider interactions, adherence self-efficacy, and medication adherence are supported.
doi:10.1089/apc.2006.20.258
PMCID: PMC2432422  PMID: 16623624
HIV/AIDS; Provider Relations; Adherence/Compliance
3.  A Qualitative Study of HIV Treatment Adherence Support From Friends and Family among Same Sex Male Couples 
Psychology and education  2011;2(4):318-322.
HIV-positive individuals seek support for medication adherence from a variety of sources—spouses, family and friends. We conducted a qualitative study of twenty same sex male couples where we asked men to give narratives of support received for medication adherence from their partner, family and friends. Men in couple relationships did not routinely seek tangible or practical assistance for adherence from friends and family but almost exclusively from partners. These men did seek and receive informational and emotional support from friends and family. These results have implications for designing interventions for medication support when an individual is in a relationship.
doi:10.4236/psych.2011.24050
PMCID: PMC3632405  PMID: 23616739
social support; gay couples; antiretroviral adherence; HIV/AIDS
4.  Mindfulness-Based Stress Reduction for HIV Treatment Side Effects: A Randomized Wait-List Controlled Trial 
Context
Advances in antiretroviral therapy (ART) for HIV offer life-extending benefit; however, the side effects associated with ART use negatively impact quality of life and medication adherence among people living with HIV.
Objectives
This study tested the efficacy of mindfulness-based stress reduction (MBSR) for reducing ART symptoms and bother/distress related to ART side effects. Secondary aims were to test the impact of MBSR on medication adherence and psychological functioning.
Methods
Seventy-six people living with HIV who were actively taking ART and reported distress from ART-related side effects were randomly assigned to MBSR or a wait-list control standard care condition. We measured side effects, ART adherence, perceived stress, depression, positive and negative affect, and mindfulness at three time points: baseline, three-month follow-up, and six-month follow-up. Side effects and related distress were assessed separately from other symptoms.
Results
Compared to a wait-list control, participants in the MBSR condition experienced a reduction in the frequency of symptoms attributable to antiretroviral therapies at three months post intervention (mean difference = 0.33; 95% confidence interval [CI] = 0.01, 0.66; t(132) = 2.04, P = 0.044) and at six months post intervention (mean difference = 0.38; 95% CI = 0.05, 0.71; t(132) = 2.27, P = 0.025). MBSR participants also experienced a reduction in distress associated with those symptoms at three months post intervention (mean difference = 0.47; 95% CI = 0.003, 0.94; t(132) = 1.99, P = 0.048) compared with the wait-list control condition.
Conclusion
Mindfulness-based stress reduction is a promising approach for reducing HIV treatment-related side effects.
doi:10.1016/j.jpainsymman.2011.04.007
PMCID: PMC3253947  PMID: 21925831
Mindfulness-based stress reduction; HIV; antiretroviral therapy; side effects; symptoms; adherence
5.  Expectancy and Readiness-Based Predictors of Treatment Uptake Among the Urban Poor Living With HIV 
There is growing evidence that early treatment with antiretroviral therapy (ART) confers benefit to HIV-infected persons and may reduce the risk of transmission. Among an urban poor sample living with HIV who meet guidelines for but are not taking ART, we explored treatment beliefs at baseline and subsequent ART uptake over the following 12 months. Most demographic/background characteristics did not differ between ART initiators and non-initiators, but baseline beliefs of expectancies about treatment ease, efficacy, and readiness sensitively predicted ART initiation. Treatment-related stigma/social concerns did not. Results offer direction for interventions to optimize treatment among those most in need.
doi:10.1097/QAI.0b013e3182365671
PMCID: PMC3215899  PMID: 21926630
Treatment uptake; readiness; expectancies; IDU
6.  Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus 
Background
The Model of Health Care Empowerment (HCE) defines HCE as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. We examined the hypothesized antecedents and clinical outcomes of this model using data from ongoing human immunodeficiency virus (HIV)-related research. The purpose of this paper is to explore whether a new measure of HCE offers direction for understanding patient engagement in HIV medical care. Using data from two ongoing trials of social and behavioral aspects of HIV treatment, we examined preliminary support for hypothesized clinical outcomes and antecedents of HCE in the context of HIV treatment.
Methods
This was a cross-sectional analysis of 12-month data from study 1 (a longitudinal cohort study of male couples in which one or both partners are HIV-seropositive and taking HIV medications) and 6-month data from study 2, a randomized controlled trial of HIV-seropositive persons not on antiretroviral therapy at baseline despite meeting guidelines for treatment. From studies 1 and 2, 254 and 148 participants were included, respectively. Hypothesized antecedents included cultural/social/environmental factors (demographics, HIV-related stigma), personal resources (social problem-solving, treatment knowledge and beliefs, treatment decision-making, shared decision-making, decisional balance, assertive communication, trust in providers, personal knowledge by provider, social support), and intrapersonal factors (depressive symptoms, positive/negative affect, and perceived stress). Hypothesized clinical outcomes of HCE included primary care appointment attendance, antiretroviral therapy use, adherence self-efficacy, medication adherence, CD4+ cell count, and HIV viral load.
Results
Although there was no association observed between HCE and HIV viral load and CD4+ cell count, there were significant positive associations of HCE scores with likelihood of reporting a recent primary care visit, greater treatment adherence self-efficacy, and higher adherence to antiretroviral therapy. Hypothesized antecedents of HCE included higher beliefs in the necessity of treatment and positive provider relationships.
doi:10.2147/PPA.S30040
PMCID: PMC3363300  PMID: 22654510
human immunodeficiency virus; acquired immune deficiency syndrome; health care empowerment; adherence; compliance
8.  Association between dog guardianship and HIV clinical outcomes 
Despite numerous potential health outcomes of dog guardianship, their value has not been examined in the HIV-positive population. The study objective was to examine the relationship between dog guardianship and HIV clinical outcomes (antiretroviral adherence [≥95% versus <95%], HIV viral load [≥48copies/mL versus <48copies/mL], and CD4+ cell count) among HIV-positive individuals. We conducted a secondary analysis of baseline data of 370 HIV-positive men on antiretrovirals enrolled in the Duo Project. Generalized estimating equations were used for inferential regression analyses, while controlling for the focal dog guardianship variable and non-focal covariates. Current dog guardianship was reported in 28.7% of participants. Dog guardianship may be associated with higher CD4+ (coefficient=60.6, p=0.052) and adherence ≥95% (OR=1.80, p=0.048); however, having a detectable viral load was not related to dog guardianship (OR=0.94, p=0.85). Further clinical research with detailed dog guardianship data is needed to further examine the association between dog guardianship and HIV clinical outcomes.
PMCID: PMC3995900  PMID: 25436253
dog; canine; HIV/AIDS; adherence; antiretroviral therapy; CD4+ cell count
9.  Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS 
AIDS care  2013;25(12):10.1080/09540121.2013.780119.
The objective of this study was to extend the psychometric evaluation of a brief version of the Self Compassion Scale (SCS). A secondary analysis of data from an international sample of 1,967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with .714 for the total scale and .822 for Factor I and .774 for Factor II. Factor I (lower self compassion) demonstrated strongly positive correlations with measures of anxiety and depression while Factor II (high self compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.
doi:10.1080/09540121.2013.780119
PMCID: PMC3796174  PMID: 23527887
Brief self-compassion inventory; HIV; psychometrics; factor analysis
10.  Male Same Sex Couple Dynamics and Received Social Support for HIV Medication Adherence 
This qualitative study examines received social support by analyzing relationship dynamics concerning antiretroviral therapy (ART) adherence among HIV+ seroconcordant and serodiscordant male couples. Using narrative data from forty participants (20 couples interviewed separately), we describe patterns of relationship dynamics and support preferences. One group viewed adherence as a Personal Responsibility. A second group viewed adherence as a Couple Responsibility and integrated support for medication adherence into the relationship. A third group was in the process of ending their relationships and adherence support was one-sided or withdrawn altogether. Examining support exchanges contexts at cultural, situational, relational, and personal levels illuminated adherence processes. Qualitative methods provided a framework for investigating these complex relationships and their associations with HIV treatment adherence.
doi:10.1177/0265407510364870
PMCID: PMC2907902  PMID: 20651943
Adherence; Antiretroviral Therapy; Gay Couples; HIV Infection; Social Support
11.  Receipt of Prevention Services Among HIV-Infected Men Who Have Sex with Men 
American journal of public health  2008;98(6):1011-1014.
Unprotected sexual intercourse remains a primary mode of HIV transmission in the United States. We found that receipt of services to reduce HIV transmission-risk behaviors was low among 3787 HIV-infected individuals and that men who have sex with men were especially unlikely to receive these services even though they were more likely to report unprotected sexual intercourse with seronegative and unknown serostatus casual partners. Greater efforts should be made to ensure that prevention counseling is delivered to all HIV-infected persons, especially men who have sex with men.
doi:10.2105/AJPH.2007.124933
PMCID: PMC2377307  PMID: 18445790
12.  Predictors of Attrition among High Risk HIV-Infected Participants Enrolled in a Multi-Site Prevention Trial 
AIDS and behavior  2008;12(6):974-977.
Objective
Recruiting and retaining high-risk individuals is critical for HIV prevention trials.
Design
The current analyses addressed predictors of trial dropout among high-risk HIV-infected men and women.
Results
Trial dropouts (n=74) were more likely to be younger, depressed, and not taking antiretroviral therapy than those who continued (n=815). No other background, substance use, or transmission risk differences were found, suggesting no dropout bias on key risk outcomes.
Conclusions
Efforts are warranted for early detection and treatment of depression and for improving retention of younger participants.
doi:10.1007/s10461-007-9356-y
PMCID: PMC2574761  PMID: 18202908
Clinical Trials; Prevention; Retention; Depression
13.  Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: The Healthy Living Project randomized controlled study 
Objective
To examine the effect of a 15-session, individually delivered cognitive behavioral intervention on antiretroviral (ART) medication adherence.
Design
A multisite, two-group, randomized controlled trial.
Participants
204 HIV-infected participants with self-reported ART adherence < 85% out of 3,818 screened were randomized into the trial. Potential participants were recruited for the main trial based on sexual risk criteria in Los Angeles, Milwaukee, New York, and San Francisco.
Intervention
The primary outcome of the intervention was a reduction in HIV transmission risk behaviors. Fifteen 90-minute individually delivered sessions divided into three modules: Stress, Coping, and Adjustment; Safer Behaviors; and Health Behaviors, including an emphasis on ART adherence. Controls received no intervention until trial completion. Both groups completed follow-up assessments at 5, 10, 15, 20, and 25 months after randomization.
Main Outcome Measure
Self-reported ART adherence as measured by 3 day computerized assessment.
Results
A significance difference in rates of reported adherence was observed between intervention and control participants at months 5 and 15, corresponding to the assessments following Stress, Coping and Adjustment module (5 month time point) and after the Health Behaviors module (15 month time point). The relative improvements among the intervention group compared to the control group dissipated at follow up.
Conclusions
Cognitive behavioral intervention programs may effectively improve ART adherence, but the effects of intervention may be short-lived.
PMCID: PMC2442469  PMID: 18193499
Antiretroviral therapy; adherence; compliance; RCT
14.  Neuroticism, Side Effects, and Health Perceptions Among HIV-Infected Individuals on Antiretroviral Medications 
Side effects from antiretroviral therapy (ART) for HIV disease can deter treatment, impact quality of life, and impede medication adherence. Individual differences in neuroticism may account for variations in the experience of side effects and perceptions of health status. Cross-sectional assessments were conducted with 258 HIV-infected participants with confirmed HIV infection and current ART regimen. Structural equation modeling (SEM) was used to evaluate a model of self-reported ART side effect frequency and severity and perceived health status, as related to symptoms of neuroticism. Symptoms of neuroticism were associated with greater reports of ART side effects and poorer perceived health but unrelated to reported CD4 count and viral load. A structural model was supported in which greater symptoms of neuroticism are linked to poorer perceived health through greater side effect frequency and severity. Individual differences in symptoms of neuroticism can explain variations in side effect reporting and consequential impairments in perceived health in the context of HIV treatment. Identification and intervention with individuals high in symptoms of neuroticism may be warranted to alleviate side effect-related concerns and maximize treatment benefit.
doi:10.1007/s10880-007-9056-9
PMCID: PMC2435048  PMID: 18568088
Neuroticism; HIV; AIDS; Adherence; Compliance; Symptom Reporting; Structural Equation Modeling
15.  The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) 
Journal of behavioral medicine  2007;30(5):359-370.
Adherence to HIV treatment, including adherence to antiretroviral (ART) medication regimens, is paramount in the management of HIV. Self-efficacy for treatment adherence has been identified as an important correlate of medication adherence in the treatment of HIV and other medical conditions. This paper describes the validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) with two samples of HIV+ adults on ART. Factor analyses support subscales measuring Adherence Integration (eigenvalue = 6.12) and Adherence Perseverance (eigenvalue = 1.16), accounting for 61% of the variance in scale items. The HIV-ASES demonstrates robust internal consistency (ρs > .90) and 3-month (rs > .70) and 15-month (rs > .40) test-retest reliability. Concurrent validity analyses revealed relationships with psychosocial measures, ART adherence, clinical status, and healthcare utilization. Findings support the use of the HIV-ASES and provide guidance for further investigation of adherence self-efficacy in the context of treatment for HIV and other diseases.
doi:10.1007/s10865-007-9118-3
PMCID: PMC2423379  PMID: 17588200
HIV; AIDS; Adherence; Self-Efficacy
16.  A Pilot Study to Engage and Counsel HIV-Positive African American Youth Via Telehealth Technology 
AIDS Patient Care and STDs  2013;27(9):529-532.
Abstract
Antiretroviral nonadherence is a strong determinant of virologic failure and is negatively correlated with survival. HIV-positive African American youth have lower antiretroviral adherence and treatment engagement than other populations. We assessed the feasibility and acceptability of a telehealth (remote videoconferencing) medication counseling intervention as an innovative approach to address these disparities. HIV-positive African American youth (18–29 years old) on antiretrovirals were enrolled in a telehealth medication counseling session, followed by a semi-structured qualitative interview to explore likes/dislikes of the format, modality, and content; potential impact on adherence; privacy issues; and interaction quality. Fourteen participants with a mean age of 24 years, who were 86% male, and had a mean self-reported adherence in the past month of 89%, were interviewed. Participants stated that they liked telehealth, would use it if offered in clinic/research settings, and indicated that their privacy was maintained. Participants described telehealth as convenient and efficient, with positive impact on their knowledge. Telehealth provided a modality to interact with providers that participants described as less intimidating than in-person visits. Telehealth is feasible and acceptable for delivering medication counseling to HIV-positive African American youth when conducted in a controlled clinical setting and may improve quality of patient-provider dialogue. Use of telehealth may lead to more disclosure of treatment difficulties, increased patient comfort, and improved health education.
doi:10.1089/apc.2013.0185
PMCID: PMC3760070  PMID: 23991691
17.  Suicidal Ideation is Associated with HIV Transmission Risk in Men who Have Sex with Men 
doi:10.1097/QAI.0b013e3181da1270
PMCID: PMC4144977  PMID: 20611031
AIDS; Cocaine; HIV Transmission Risk; Methamphetamine; Suicidal Ideation
18.  Alcohol use and HIV disease management: The impact of individual and partner-level alcohol use among HIV-positive men who have sex with men 
AIDS care  2013;26(6):702-708.
Alcohol use among HIV-positive (HIV+) individuals is associated with decreased adherence to antiretroviral therapy (ART) and consequently poorer HIV treatment outcomes. This study examined the independent association of individual and partner-level alcohol use with HIV disease management among men who have sex with men (MSM) in primary partnerships. In total, 356 HIV+ MSM and their male primary partners completed a baseline visit for a longitudinal study examining the role of couple-level factors in HIV treatment. The Alcohol Use Disorders Identification Test (AUDIT) was administered to assess the individual and the partner-level alcohol use. Primary outcome variables included: self-reported ART adherence, ART adherence self-efficacy and HIV viral load. Results demonstrated that abstainers, compared to hazardous drinkers, had higher self-efficacy to integrate and persevere in HIV-treatment and a lower odds of having a detectable viral load. Participants with a partner-abstainer, versus a partner-hazardous drinker, had less self-efficacy to persevere in HIV-treatment, a lower odds of 100% 3-day adherence and a higher viral load. Together, these findings suggest that assessment and treatment of both the patient’s and the patient’s primary partner’s pattern of alcohol consumption is warranted when attempting to optimize HIV care among MSM.
doi:10.1080/09540121.2013.855302
PMCID: PMC4001861  PMID: 24215238
19.  An omitted level: An examination of relational orientations and viral suppression among HIV serodiscordant male couples 
Couples’ adopting a relational orientation – when partners regard themselves as a collective unit – is associated with optimal health. HIV-positive men and their HIV-negative partners (N = 116 serodiscordant male couples) were surveyed. Logistic regression showed greater relational orientations of HIV-positive (aOR=7.87; 95% CI = 1.63, 38.05) and HIV-negative partners (aOR=6.16; 95% CI: 1.43, 26.59) and HIV-positive partners’ higher income (aOR=2.95; 95% CI = 1.13, 7.70) and lower depression (aOR=0.39; 95% CI = 0.15, 0.97) were associated with viral suppression with no evidence of mediation by adherence. Incorporating relationship dynamics into biomedical strategies is a promising avenue for research and intervention.
doi:10.1097/QAI.0000000000000148
PMCID: PMC4021039  PMID: 24662295
MSM; serodiscordant couples; viral suppression
20.  Relationship Characteristics and HIV Transmission Risk in Same-sex Male Couples in HIV Serodiscordant Relationships 
Archives of sexual behavior  2014;43(1):139-147.
Unprotected anal intercourse (UAI) remains a main risk factor for HIV among men who have sex with men (MSM) and this is of particular concern for partners of HIV serodiscordant status. However, HIV transmission risk has been demonstrated to vary by the sexual position adopted among partners. Guided by interdependence theory, this study examined how relational factors were differentially associated with risk taking (HIV-positive/insertive and HIV-negative/receptive) and strategic positioning (HIV-positive/receptive and HIV-negative/insertive) UAI withinserodiscordant same-sex male couples. HIV-positive men and their HIV-negative partners (ncouples=91; nindividuals=182) simultaneously but independently completed computerized questionnaires and HIV-positive men had blood drawn for viral load.A minority of couples (30%) engaged in risk taking and/or strategicpositioning unprotected anal sex. Results of multinomial logistic regressionindicated that HIV-negative partners’ levels of relationship commitment were positively associated with the odds of engaging in both risk taking and strategic positioning sexual behaviors. For HIV-negative partners, reports of relationship intimacy, autonomy, and sexual satisfaction were negatively associated with odds of reporting risk taking behavior. In contrast, HIV-positive partners’reported sexual satisfaction was positively associated with odds of engaging in risk taking behavior. Findings suggested that aspects of relational quality may be differentially associated with sexual decision making for same-sex male couples in serodiscordant relationships. Study findings lend support for the incorporation ofdiscussions of HIV risk reduction strategies, enhancing communication between partners, and support for general relationship functioning in HIV care.
doi:10.1007/s10508-013-0216-8
PMCID: PMC3996999  PMID: 24243004
HIV; serodiscordant couples; Sexual behavior; Gay men; relationship quality; sexual orientation
21.  A qualitative study examining HIV Antiretroviral Adherence Counseling and Support in Community Pharmacies 
OBJECTIVE
To use qualitative research methods to obtain an in-depth understanding of how antiretroviral therapy (ART) adherence support and counseling is provided in HIV-focused community pharmacies. To determine relevant facilitators and barriers around adherence support from both patient’s and pharmacist’s perspectives.
METHODS
Qualitative research study of patients who patronize and pharmacists employed at HIV-focused pharmacies in the San Francisco Bay Area. Participants were recruited using flyers at HIV clinics, community-based organizations, and using newsletter blurbs. Transcripts were analyzed using grounded theory methods to determine emergent themes in the data.
RESULTS
19 eligible patients with a self-reported diagnosis of HIV, taking their current ART regimen for at least 3 months, and who obtained their ART from a community pharmacy in the San Francisco Bay Area were included. 9 pharmacists employed at 13 different pharmacy locations frequented by participants were interviewed. Emergent themes included descriptions of pharmacy adherence counseling and support, roles and responsibilities regarding medication adherence, barriers to providing adherence support, and feeling connected as a facilitator to adherence support relationships.
CONCLUSION
Pharmacists provide diverse types of ART adherence support and are uniquely positioned to help clients manage their medications. Additional training on developing relationships with patients and advertising regarding their adherence services may further the role of community pharmacists in supporting antiretroviral adherence.
PMCID: PMC3988691  PMID: 23806059
AIDS/HIV; community pharmacy; antiretroviral therapy; adherence
22.  “Taking a Half Day at a Time:” Patient Perspectives and the HIV Engagement in Care Continuum 
AIDS Patient Care and STDs  2013;27(4):223-230.
Abstract
The HIV treatment continuum, or “cascade,” outlines key benchmarks in the successful treatment of HIV-infected individuals. However, the cascade fails to capture important dimensions of the patient experience in that it has been constructed from a provider point of view. In order to understand meaningful steps in the HIV care cascade for individuals diagnosed with HIV through expanded, more routine testing, we conducted in-depth interviews (n=34) with three groups of individuals: those diagnosed with HIV in the emergency department/urgent care clinic who linked to HIV care and exhibited 100% appointment adherence in the first 6 months of HIV care; those diagnosed in the emergency department/urgent care clinic who linked to HIV care and exhibited sporadic appointment adherence in the first 6 months of HIV care, and; hospitalized patients with no outpatient HIV care for at least 6 months. This last group was chosen to supplement data from in-care patients. The engagement in care process was defined by a changing perspective on HIV, one's HIV identity, and the role of health care. The linkage to care experience laid the groundwork for subsequent retention. Interventions to support engagement in care should acknowledge that patient concerns change over time and focus on promoting shifts in perspective.
doi:10.1089/apc.2012.0418
PMCID: PMC3661033  PMID: 23565926
23.  Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV 
The engagement of patients with their health care providers (HCP) improves patients’ quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client’s choices, and management of client concerns. This study compares country-level differences in patients’ engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR −7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = −5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = −3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.
doi:10.4172/2155-6113.1000256
PMCID: PMC3932545  PMID: 24575329
Adherence; Engagement; Healthcare providers; HIV; Self-efficacy; Self-esteem; Quality of life
24.  Uthando Lwethu (‘our love’): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa 
Trials  2014;15:64.
Background
Couples-based HIV counseling and testing (CHCT) is a proven strategy to reduce the risk of HIV transmission between partners, but uptake of CHCT is low. We describe the study design of a randomized controlled trial (RCT) aimed to increase participation in CHCT and reduce sexual risk behavior for HIV among heterosexual couples in rural KwaZulu-Natal, South Africa. We hypothesize that the rate of participation in CHCT will be higher and sexual risk behavior will be lower in the intervention group as compared to the control.
Methods/design
Heterosexual couples (N = 350 couples, 700 individuals) are being recruited to participate in a randomized trial of a couples-based intervention comprising two group sessions (one mixed gender, one single gender) and four couples’ counseling sessions. Couples must have been in a relationship together for at least 6 months. Quantitative assessments are conducted via mobile phones by gender-matched interviewers at baseline, 3, 6, and 9 months post-randomization. Intervention content is aimed to improve relationship dynamics, and includes communication skills and setting goals regarding CHCT.
Discussion
The Uthando Lwethu (‘our love’) intervention is the first couples-based intervention to have CHCT as its outcome. We are also targeting reductions in unprotected sex. CHCT necessitates the testing and mutual disclosure of both partners, conditions that are essential for improving subsequent outcomes such as disclosure of HIV status, sexual risk reduction, and improving treatment outcomes. Thus, improving rates of CHCT has the potential to improve health outcomes for heterosexual couples in a rural area of South Africa that is highly impacted by HIV. The results of our ongoing clinical trial will provide much needed information regarding whether a relationship-focused approach is effective in increasing rates of participation in CHCT. Our intervention represents an attempt to move away from individual-level conceptualizations, to a more integrated approach for HIV prevention.
Trial registration
Study Name: Couples in Context: An RCT of a Couples-based HIV Prevention Intervention
ClinicalTrials.gov identifier: NCT01953133.
South African clinical trial registration number: DOH-27-0212-3937
doi:10.1186/1745-6215-15-64
PMCID: PMC3936910  PMID: 24552199
Couples-based HIV testing; CHCT; Couples-based intervention; HIV prevention; South Africa
25.  Characteristics of Successful and Failed Mentoring Relationships: A Qualitative Study Across Two Academic Health Centers 
Purpose
To explore the mentor–mentee relationship with a focus on determining the characteristics of effective mentors and mentees and understanding the factors influencing successful and failed mentoring relationships.
Method
The authors completed a qualitative study through the Departments of Medicine at the University of Toronto Faculty of Medicine and the University of California, San Francisco, School of Medicine between March 2010 and January 2011. They conducted individual, semistructured interviews with faculty members from different career streams and ranks and analyzed transcripts of the interviews, drawing on grounded theory.
Results
The authors completed interviews with 54 faculty members and identified a number of themes, including the characteristics of effective mentors and mentees, actions of effective mentors, characteristics of successful and failed mentoring relationships, and tactics for successful mentoring relationships. Successful mentoring relationships were characterized by reciprocity, mutual respect, clear expectations, personal connection, and shared values. Failed mentoring relationships were characterized by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest, and the mentor’s lack of experience.
Conclusions
Successful mentorship is vital to career success and satisfaction for both mentors and mentees. Yet challenges continue to inhibit faculty members from receiving effective mentorship. Given the importance of mentorship on faculty members’ careers, future studies must address the association between a failed mentoring relationship and a faculty member’s career success, how to assess different approaches to mediating failed mentoring relationships, and how to evaluate strategies for effective mentorship throughout a faculty member’s career.
doi:10.1097/ACM.0b013e31827647a0
PMCID: PMC3665769  PMID: 23165266

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