Search tips
Search criteria

Results 1-8 (8)

Clipboard (0)

Select a Filter Below

Year of Publication
author:("Rana, nadia")
1.  Multiple Gaps in Care Common Among Newly Diagnosed HIV Patients 
AIDS care  2015;27(6):679-687.
The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI of 581 newly diagnosed HIV-patients >18 entering into care from 2004-2010 and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for > 6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had ≥ 2 gaps, 84 (14.5%) had ≥ 3 gaps, and 21 (3.6%) died;77% of gaps were followed by a re-linkage with care The KM curves estimate that one quarter of patients (95%CI=22-29%) would experience ≥ 1 gap in care by year one; nearly one-half (CI=45-54%) by year two; and 90% (CI=93-96%) by year eight;. A prior gap was a strong predictor (HR=2.36; CI=2.16-2.58) of subsequent gaps; other predictors included age <25 (HR=1.29; CI=1.04-1.60), and no prescription of ART in first year of care (HR=1.23; CI=1.01-1.50). The results of this study suggest that a significant proportion of newly diagnosed HIV-infected patients will experience multiple gaps in care and yet re-engagement is possible. Interventions should focus on both prevention of gaps as well as re-engaging those lost to follow-up.
PMCID: PMC4366312  PMID: 25634492
HIV; retention in care; treatment adherence; gaps
2.  Pregnancy Intentions among Women Living with HIV in the United States 
The number of HIV-infected women giving birth in the U.S. is increasing. Research on pregnancy planning in HIV-infected women is limited.
Between January 1 and December 30, 2012, pregnant women with a known HIV diagnosis prior to conception at 12 U.S. urban medical centers completed a survey including the London Measure of Unplanned Pregnancy (LMUP) scale. We assessed predictors of LMUP category (unplanned/ambivalent versus planned pregnancy) using bivariate and multivariable analyses.
Overall, 172 women met inclusion criteria and completed a survey. Based on self-report using the LMUP scale, 23% of women had an unplanned pregnancy, 58% were ambivalent and 19% reported a planned pregnancy. Women were at lower risk for an unplanned or ambivalent pregnancy if they had previously given birth since their HIV diagnosis (adjusted Relative Risk = 0.67, 95% CI 0.47-0.94, p=0.02), had seen a medical provider in the year before the index pregnancy (aRR 0.60, 95% CI 0.46-0.77, p<0.01), or had a patient-initiated discussion of pregnancy intentions in the year prior to the index pregnancy (aRR = 0.63, 95% CI 0.46-0.77, p<0.01). Unplanned or ambivalent pregnancy was not associated with age, race/ethnicity, or educational level.
In this multi-site U.S. cohort, patient-initiated pregnancy counseling as well as being engaged in medical care prior to pregnancy were associated with a decreased probability of unplanned or ambivalent pregnancy. Interventions that promote health-care engagement among HIV-infected women and integrate contraception and preconception counseling into routine HIV care may decrease the risk of unplanned pregnancy among HIV-infected women in the U.S.
PMCID: PMC3927156  PMID: 24525467
Pregnancy intention; HIV; pregnancy; serodiscordant; serodifferent
3.  Psychosocial Predictors of Non-Adherence and Treatment Failure in a Large Scale Multi-National Trial of Antiretroviral Therapy for HIV: Data from the ACTG A5175/PEARLS Trial 
PLoS ONE  2014;9(8):e104178.
PEARLS, a large scale trial of antiretroviral therapy (ART) for HIV (n = 1,571, 9 countries, 4 continents), found that a once-daily protease inhibitor (PI) based regimen (ATV+DDI+FTC), but not a once-daily non-nucleoside reverse transcriptase inhibitor/nucleoside reverse transcriptase inhibitor (NNRTI/NRTI) regimen (EFV+FTC/TDF), had inferior efficacy compared to a standard of care twice-daily NNRTI/NRTI regimen (EFV+3TC/ZDV). The present study examined non-adherence in PEARLS.
Outcomes: non-adherence assessed by pill count and by self-report, and time to treatment failure. Longitudinal predictors: regimen, quality of life (general health perceptions  =  QOL-health, mental health  =  QOL-mental health), social support, substance use, binge drinking, and sexual behaviors. “Life-Steps” adherence counseling was provided.
In both pill-count and self-report multivariable models, both once-a-day regimens had lower levels of non-adherence than the twice-a-day standard of care regimen; although these associations attenuated with time in the self-report model. In both multivariable models, hard-drug use was associated with non-adherence, living in Africa and better QOL-health were associated with less non-adherence. According to pill-count, unprotected sex was associated with non-adherence. According to self-report, soft-drug use was associated with non-adherence and living in Asia was associated with less non-adherence. Both pill-count (HR = 1.55, 95% CI: 1.15, 2.09, p<.01) and self-report (HR = 1.13, 95% CI: 1.08, 1.13, p<.01) non-adherence were significant predictors of treatment failure over 72 weeks. In multivariable models (including pill-count or self-report nonadherence), worse QOL-health, age group (younger), and region were also significant predictors of treatment failure.
In the context of a large, multi-national, multi-continent, clinical trial there were variations in adherence over time, with more simplified regimens generally being associated with better adherence. Additionally, variables such as QOL-health, regimen, drug-use, and region play a role. Self-report and pill-count adherence, as well as additional psychosocial variables, such QOL-health, age, and region, were, in turn, associated with treatment failure.
PMCID: PMC4143224  PMID: 25153084
4.  Cognitive and Field Testing of a New Set of Medication Adherence Self-Report Items for HIV Care 
AIDS and Behavior  2013;18(12):2349-2358.
We conducted four rounds of cognitive testing of self-report items that included 66 sociodemographically diverse participants, then field tested the three best items from the cognitive testing in a clinic waiting room (N = 351) and in an online social networking site for men who have sex with men (N = 6,485). As part of the online survey we conducted a randomized assessment of two versions of the adherence questionnaire—one which asked about adherence to a specific antiretroviral medication, and a second which asked about adherence to their “HIV medicines” as a group. Participants were better able to respond using adjectival and adverbial scales than visual analogue or percent items. The internal consistency reliability of the three item adherence scale was 0.89. Mean scores for the two different versions of the online survey were similar (91.0 vs. 90.2, p < 0.05), suggesting that it is not necessary, in general, to ask about individual medications in an antiretroviral therapy regimen when attempting to describe overall adherence.
PMCID: PMC4000749  PMID: 24077970
HIV; Medication adherence; Self-report; Questionnaires; Survey methodology
5.  Addressing Mississippi’s HIV/AIDS crisis 
Lancet  2011;378(9798):1217.
PMCID: PMC3760153  PMID: 21962554
6.  HIV testing practices among New England college health centers 
The prevalence of human immunodeficiency virus (HIV) continues to increase among certain populations including young men who have sex with men (MSM). College campuses represent a potential setting to engage young adults and institute prevention interventions including HIV testing. The purpose of this study was to evaluate testing practices for HIV and other sexually transmitted infections (STIs) on college campuses.
Medical directors at four-year residential baccalaureate college health centers in New England were surveyed from June, 2011 to September, 2011. Thirty-one interviews were completed regarding experiences with HIV testing, acute HIV infection, other STI testing, and outreach efforts targeting specific at-risk groups such as MSM.
Among schools that responded to the survey, less than five percent of students were tested for HIV at their local college health center in the past academic year (2010–2011). Significant barriers to HIV testing included cost and availability of rapid antibody testing. One-third of college health medical directors reported that their practitioners may not feel comfortable recognizing acute HIV infection.
Improved HIV testing practices are needed on college campuses. Programs should focus on outreach efforts targeting MSM and other at-risk populations.
PMCID: PMC3606211  PMID: 23496891
HIV; College; STI; Prevention
7.  The Changing Face of HIV in Pregnancy in Rhode Island 2004–2009 
Meeting the needs of HIV-infected pregnant women requires understanding their backgrounds and potential barriers to care and safe pregnancy. Foreign-born women are more likely to have language, educational, and economic barriers to care, but may be even more likely to choose to keep a pregnancy. Data from HIV-infected pregnant women and their children in Rhode Island were analyzed to identify trends in demographics, viral control, terminations, miscarriages, timing of diagnosis, and adherence to followup. Between January 2004 and December 2009, 76 HIV-infected women became pregnant, with a total of 95 pregnancies. Seventy-nine percent of the women knew their HIV status prior to becoming pregnant. Fifty-four percent of the women were foreign-born and 38 percent of the 16 women who chose to terminate their pregnancies were foreign-born. While the number of HIV-infected women becoming pregnant has increased only slightly, the proportion that are foreign-born has been rising, from 41 percent between 2004 and 2005 to 57.5 percent between 2006 and 2009. A growing number of women are having multiple pregnancies after their HIV diagnosis, due to the strength of their desire for childbearing and the perception that HIV is a controllable illness that does not preclude the creation of a family.
PMCID: PMC3385607  PMID: 22778535
8.  Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi 
Journal of Women's Health  2010;19(10):1863-1867.
Data from the Centers for Disease Control and Prevention (CDC) indicate that reproductive-age black women in the Southeast are disproportionately affected by the HIV epidemic. There are few data describing HIV infection, pregnancies, and follow-up care in this population.
A retrospective chart review was performed at the Perinatal HIV Service at the University of Mississippi Medical Center in Jackson, Mississippi, to identify HIV-infected women ≥18 years of age with deliveries from 1999 to 2006. Optimal follow-up was defined as at least two follow-up visits with an HIV provider within 1 year of delivery. Univariate and multivariate logistic regression analyses were used to identify factors associated with optimal adherence.
We identified 274 women with 297 total deliveries. Median age was 25, and 89% were black. Only 37% of women had two or more visits with an HIV provider in the postpartum year. On univariate analysis, presentation before the third trimester was associated with optimal follow-up (p = 0.04). On multivariate analyses, presentation before the third trimester was the only variable associated with optimal follow-up (odds ratio [OR] 2.1, p = 0.02).
The poor follow-up rates in this growing population highlight the critical need for research and development of targeted interventions to improve rates of retention in care, particularly in women with late trimester presentation.
PMCID: PMC2965694  PMID: 20831428

Results 1-8 (8)