Browsing by Subject "HIV/AIDS"

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Advancing Pharmacy Practice Through Social Theory
(University of Minnesota, College of Pharmacy, 2011) Rovers, John
Although there is a substantial role for social theory in explaining patients’ health behaviors, it does not appear that pharmacists commonly use such theories to provide patient care. This paper attempts to demonstrate an explicit link between social theory and pharmacy practice. The theory of structure and agency and the practice problem of poor medication adherence (MA) in patients with HIV/AIDS are used as exemplars to illustrate such a link. Factors influencing MA were identified from qualitative studies of adherence in patients with HIV/AIDS. All factors identified were stratified into one of four categories: agency related factors that facilitate MA; agency related factors that are barriers to MA; structural factors that facilitate MA; structural factors that are barriers to MA. Stratifying MA in this manner allows pharmacists to identify clinical interventions that are targeted towards the specific cause of MA problems.
Cost-Effectiveness and the Role of Socioeconomic Support Services in Ending the HIV/AIDS Epidemic in the United States
(2022-08) Wheatley, Margo
There is still no cure for human immunodeficiency virus (HIV), meaning infected individuals must remain on lifelong treatment. While the United States has made substantial progress on HIV prevention, there are still more than 1.2 million people living with HIV (PLWH) in the U.S. and prevalence continues to increase. Treatment not only extends life expectancy and improves quality of life for PLWH, it also reduces the risk of HIV transmission by suppressing HIV viral loads to undetectable levels. However, only 58% of diagnosed PLWH in the U.S. were retained in care and only 66% were virally suppressed in 2019, which is well-below the National HIV/AIDS Strategy goal of reaching 95% viral suppression and ending the HIV epidemic by 2030. This dissertation summarizes existing evidence on the cost-effectiveness of improving retention in HIV care. It then presents new findings on the potential costs, benefits, and cost-effectiveness of socioeconomic support services funded by the U.S. Ryan White HIV/AIDS Program (RWHAP), the largest federally funded program focused on HIV care for low-income populations. Specific aims are to: 1) Systematically review evidence on the cost-effectiveness of HIV retention and re-engagement interventions. A systematic review of literature published in the past 10 years on retention interventions in high-income settings was conducted. Findings on methods, cost-effectiveness, quality, and overall strength of evidence were summarized. 2) Estimate the impact of support services on sustained viral suppression among low-income PLWH. Five years (2015-2019) of RWHAP data from the Minneapolis-St. Paul region was analyzed. Logistic and linear regressions using generalized estimating equations and propensity scores to adjust for the probability of service use were used to estimate the causal effect of support service use on sustained viral suppression. 3) Investigate the barriers, opportunities, and potential costs of expanding HIV socioeconomic support services. Semi-structured interviews were conducted with service providers in Minneapolis-St. Paul to explore current barriers, potential opportunities, estimated costs, and anticipated outcomes of program expansion for food, financial, transportation, and housing support services for low-income people living with HIV. 4) Evaluate the potential cost-effectiveness of expanding food aid vouchers to fill unmet need. An individual-based microsimulation model of post-diagnosis HIV care was developed and parameterized to reflect the RWHAP client population in the Minneapolis-St. Paul region. Using results from Aims 2 and 3, the model was used to estimate the potential cost-effectiveness of expanding food aid vouchers. Preliminary results from the base case and relevant sensitivity and scenario analyses are reported. Outcomes from this project provide support for continued funding of programs that address socioeconomic challenges for PLWH and can be used to inform local resource allocation decisions for HIV care. Socioeconomic support programs such as food aid, financial assistance, housing, and transportation could be integrated into multifaceted strategies aimed at improving HIV outcomes and achieving national HIV treatment goals.
Exploring the relationship between HIV and alcohol use in a remote Namibian mining community
(African Journal of AIDS Research, 2009-09) Lightfoot, Elizabeth; Maree, Maretha; Ananias, Janet
In southern Africa, the use of alcohol is increasingly seen as creating a context of risk for HIV transmission. This qualitative study investigates the links between alcohol use and higher-risk sexual behaviours in a remote southern Namibian mining-town community. Using data from six focus groups and 16 in-depth interviews conducted in 2008, the researchers investigated knowledge of the link between alcohol consumption and HIV risk, focusing on the specific mechanisms related to drinking and higher-risk sexual behaviours. Although knowledge regarding HIV and alcohol was high among the mineworkers and other community members, the social structure of a remote mining town appears to lead to high levels of alcohol use and higher-risk sexual behaviours. The heavy use of alcohol acts as an accelerant to these behaviours, including as a source of fortitude for those with an intention to engage in casual sexual partnerships or multiple concurrent partnerships, and as a cause for those behaviours for people who may otherwise intend to avoid them. The findings suggest a need for HIV-prevention programmes that focus more holistically on HIV and AIDS and alcohol use, as well as the need for structural changes to mining-town communities in order to reduce the likelihood of both heavy alcohol use as well as a high prevalence of higher-risk sexual behaviours.
Exploring the Relationships Between Supports and Depression Among Elderly Caregivers Raising Children Orphaned by AIDS in Rural Namibia
(2015-05) Kalomo, Eveline
Using the ecological systems theory, the present study examined the levels of depression in elderly caregivers of AIDS orphaned children in relations to those caregivers' financial stability, social support, informational support, and personal characteristics. Cross-sectional data were collected through face-to face interviews using the Center for Epidemiological Studies Depression Scale (CES-D) of depression and the Multidimensional Scale of Perceived Social Support (MSPSS). Measures for financial stability and informational supports were specifically developed for this study. Multiple regression analysis found elevated levels of depressive symptoms, with all caregivers in this study scoring above the threshold criteria for depression (≥16 points). The mean score of CES-D for the entire sample was 48. Findings also revealed a significant negative association between financial stability and depression. In addition, results showed a negative association between caring for an HIV-infected child and depression after controlling for caregiver age and caring for an HIV-infected child. Findings suggest the need for greater economic security and mental health interventions for elderly caregivers.
Human Immunodeficiency Virus and Soil Transmitted Helminths: Measuring the Systemic Effects of Co-Infection in a Low-Resource Context
(2017-04) Morawski, Bozena
The impacts of helminth infection and anthelmintic therapy among HIV-infected people in co-endemic areas remains unknown. Health effects are likely species-dependent, and each species may exert countervailing effects on its host. Furthermore, there is a dearth of high-quality research conducted in the era of widely available ART. Data from two studies conducted in Mbale, Uganda were used to: 1) estimate clinical correlates of helminth infection among HIV-infected Ugandans; 2) characterize fecal microbiome composition in these participants, and correlate clinical characteristics with microbiome composition; and 3) evaluate the impact of anthelmintic therapy on markers of systemic inflammation in HIV-infected Ugandans via a randomized control trial. Aim I uses molecular methods to describe the prevalence and burden of 5 soil-transmitted helminth species among patients in outpatient HIV care, and quantifies the relationship between baseline helminth infection and immune status. We observed a clinically significant inverse relationship between hookworm infection and CD4+ T cells/mcL. Aim II analyses the fecal microbiome of HIV-infected Ugandans to identify differences in community structure across clinical characteristics, and determine if gut community structure and/or taxa are associated with change in immune status over time. Our results indicate lower bacterial community richness among participants with <100 CD4+ T cells/mcL, and identify two taxa that may be linked to CD4+ T cell recovery. Aim III quantifies changes in soluble CD14, C-reactive protein, and 10 pro-inflammatory cytokines in ART-initiated Ugandans randomized to either immediate or delayed albendazole therapy. Our findings indicate low helminth infection prevalence (10%) and an increase in soluble CD14 after 1-month of follow-up among participants receiving immediate albendazole. These aims contribute to knowledge of clinical and sub-clinical correlates of helminth infection in the ART era. Results may support integration of anthelmintic therapy into adult HIV care, which is often overlooked when setting anthelmintic program priorities.
Improving HIV/AIDS Treatment and Adherence through Telemedicine
(HHH, 2015) Ly, Sabrina, M.
In the Life: Accounting and Triage for Black LGBTQIA Communities in HIV Prevention
(2020-07) Mallory, Aaron
The HIV/AIDS epidemic continues to persist into its fourth decade with black LGBTQIA communities at the center of its continuation. This dissertation examines black LGBTQIA communities’ relationship to the HIV/AIDS epidemic through HIV prevention strategies in Atlanta, GA. I provide a Black Geographies study of HIV prevention with attention given to the theoretical relationship between biological citizenship, Black Feminist Thought, and Queer of Color Critique. I explore these relationships through an analysis of racial formations in HIV interventions and the ways in which community-based organization in Atlanta, GA navigate limited HIV prevention resources. My analysis uses the phrase the “hidden epidemic” as a conceptual tool understand the ways black LGBTQIA communities’ access HIV/AIDS resources and HIV prevention strategies. My dissertation contributes to current geographical scholarship on health care, antiblackness, citizenship, and queer worldmaking.
Interview with Paul Quie
(University of Minnesota, 2011-03-21) Tobbell, Dominique A.; Quie, Paul
Paul Quie begins by discussing his background, including his childhood, why he went into medicine, his education, and being drafted into the Navy. He discusses his experiences as a student at Yale Medical School, as an intern at the Minneapolis General Hospital, as a pediatrician in the Navy, and doing research at the Rockefeller Institute in New York in the early 1960s. He describes medical developments in the 1950s; the environment in the UMN Medical School in the 1950s; the American Legion professorship; his research; collaboration between Pediatrics, Medicine, and Surgery in the 1960s; the UMN Pediatrics Department; the College of Medical Sciences deans; the faculty practice issue and Robert Howard; leadership at the UMN health sciences; the strict full-time model in Pediatrics in the 1960s; the relationship between the UMN and private practitioners in Minneapolis and St. Paul; the effort to establish a second medical school in the Twin Cities; and the establishment of the Department of Family Practice at UMN. He also discusses medical specialization in the US; the establishment of the Children’s Hospital; the medical school curriculum revisions in the 1960s; the reorganization of the health sciences in the 1960s; the Korea Project; the Program in Human Sexuality; the pediatric infectious diseases program at Red Lake at the Indian Reservation; the transsexuality program in the late 1960s and early 1970s; the appointment of Konald Prem as chair of the Department of Obstetrics and Genecology in 1976; retrenchments in the early 1980s; the NIH; the early history of HIV/AIDS; the Center for Bioethics; and the Rural Physician Associate Program. He talks about Lewis Thomas; Irvine McQuarrie; John Anderson; Harold Diehl; Robert Howard; Neal Gault; Lyle French; John Westerman; Richard Chilgren; his brother, Al Quie; and Jack Verby.
Marital risk factors and HIV infection among women: a comparison between Ghana and Kenya.
(2009-08) Rombo, Dorothy Owino
The purpose of this study is to establish and compare marital risk factors associated with HIV infection among women in Ghana and Kenya, regions representing low and high HIV prevalence, respectively. The study controls for individual demographics, sexual behavior, and socio-cultural contexts. Samples of 2,057 in Ghana and 1,657 in Kenya are drawn from Demographic Health Surveys of 2003. Of married/ cohabiting women, about 3% and 8% are infected with HIV in Ghana and Kenya respectively. These mirror the general population prevalence in both countries. Results of logistic regression analyses indicate that when individual demographics including SES, degree of autonomy to make self-healthcare decisions, religious affiliation, sexual behavior, and socio-cultural factors are controlled for, marital characteristics significantly account for HIV infection. For Ghana, the model accounts for 7% of variance and remarriage is the only significant marital risk, increasing the odds of infection 1.9 times over those who are not remarried. For Kenya, marital factors explain one-half (6%) of the 12% total variability accounted for by the model. Remarriage, polygyny, and traditional marriage are the positive risk factors, with estimated increased risk likelihood of 2.8, 2.4, and 2.2 respectively. Negative predictors include delayed sexual debut and marriage and longer duration of marriage. The latter is a significant predictor in Kenya. Implications for educators are including content stating the life course risk factors, beginning with early sexual debut, delayed marriage, and ending up in a marriage that is likely to be characterized by multiple occurrences of consensual unprotected sex. Such unions include traditional/ cohabitation, polygyny, and/or remarriage. Additionally, public health and social policies that delay sexual debut, marriage, and reduce the risk of infection both before and after marriage should be put in place. Risk-reduction policy is a public health approach that provides options for safe sex for young people who might be engaging in sex. Social policies include laws that govern social life, such as marriage. Both countries need to outlaw early marriage and enforce laws against it. The challenges of multiple partner marriages like polygyny and remarriage, which are protected by human rights laws, can be addressed through continued dialogue in communities to adopt riskreduction strategies in such unions. Other factors that support such practices, like poverty, require long-term plans. These should be relentlessly pursued. Further research with valid measurements for empowerment and socio-cultural factors that are relevant to HIV infection is needed. Similarly, research on long-term marriages that have weathered the HIV era could provide insights for strengthening marriages through education.
Medication Experiences of Hispanic People Living with HIV/AIDS
(University of Minnesota, College of Pharmacy, 2010) Sánchez, Luz Dalia
Objective: The objective of this study was to describe the medication experiences of Hispanic people living with HIV/AIDS. Specific aims were to describe their current medication experiences and to describe how they viewed their medication history in order to determine essential themes for improving culturally-appropriate medication therapy management services. Methods: A qualitative, phenomenological research methodology was employed. Ten adults living with HIV/AIDS were audiotaped during semi-structured, in-depth interviews conducted in Spanish. In addition to audiotaping, field notes were taken. Thematic analysis of text was done to obtain themes consistent with the research objectives. Analysis was accomplished in two phases. The first phase applied Van Manen’s lifeworld existentials of lived body, lived time, lived relation and lived space as the organizing framework for identifying themes. The second phase identified “essential themes” using holistic, selective, and detailed approaches that were applied to the themes identified in the first phase. Results: The results showed that lifeworld existentials were relevant medication experiences for Hispanic patients living with HIV/AIDS and their medication-taking behavior during their lives. Ten themes were identified. From these, we identified an overall “essential theme” comprised of: (1) Duality of Living with HIV/AIDS and (2) Primacy of Medications for Hispanic HIV/AIDS patients. Conclusions: The findings revealed that the medication taking experiences for Hispanic people living with HIV/AIDS can be described in terms of the duality of living with HIV/AIDS as “living dead” patients and in terms of the centrality that medications take in their lives, even to the point of a spiritual level.
A narrative inquiry of socio-cultural influences on Antiretroviral treatment and medication experiences of African-born persons living with HIV in Minnesota
(2019-05) Cernasev, Alina
Background: The number of new cases of HIV among African-born persons living in Minnesota continues to be disproportionate compared to other racial/ethnic groups. Consequent to the development of effective antiretroviral (ARV) medications, HIV is now a chronic and manageable disease. By implication, persons with HIV live much longer but also engage with healthcare continuously and need to be on medications. However, there is limited knowledge regarding HIV treatment and the medication experience of African-born persons living with HIV. Study Aims: The aims of this study were to - - Capture the lived experiences of African-born HIV positive patients’ who are taking ARV treatment (Aim 1); - Reveal the cultural and personal beliefs as well as socio-economic factors about medications of African-born HIV positive patients (Aim 2); - Understand the influence of these beliefs and impact of economic factors on their decisions to follow ARV treatment (Aim 3); and - Explore patients’ perception of clinical pharmacists’ roles in fostering adherence to ARV therapy (Aim 4). Methods: A qualitative approach was used for this study. African-born persons living with HIV (PLWH) in Minnesota were recruited from pharmacies and HIV treatment centers. Narrative Interviews with 14 participants lasting up to two hours were conducted over five months. All the interviews were audio-recorded and transcribed verbatim. Conventional Content Analysis was used to analyze the data. Dedoose, a qualitative software program was used to code the data. Results: Eight participants were female, and six were male. The participants were originally from seven different African countries. Analysis of interview data resulted in ten distinct themes that relate to the study aims. These included: Theme 1: Lack of awareness of symptoms of HIV Theme 2: Cruel News:” HIV-Oooooo! I wish I was dead” Theme 3: “This is my secret!” Theme 4: The impact of stigma: “Stigma and HIV are brother and sister” Theme 5: The power of spirituality and prayers Theme 6: The significance of taking ARV medications: “To exist I have to take the medicine” Theme 7: Barriers and Facilitators in taking ARV medications Theme 8: Accessing the U.S. healthcare system Theme 9: Role of Herbal Remedies in Their Treatment Theme 10: Interaction with pharmacists Conclusion: Findings from this study showed that lived medication experiences of African-born PLWH focused on “staying alive” and learning how to navigate an unfamiliar U.S. healthcare system. Cultural beliefs from their country of origin persisted and resulted in stigma at individual, familial, and societal levels. The most significant personal belief to help each participant was a strong belief in God. The participants highlighted their perspectives on the importance of adhering to the prescribed medications. This study also showed that participants were generally unaware of the potential roles that pharmacists could play in their ARV medication management. When interacting with African-born PLWH, pharmacists need to take into consideration the social and cultural factors that may significantly influence adherence to their ARV medications. Pharmacists also need to be aware of differences in healthcare policies and processes in the home countries of these patients and how these may shape their perceptions of HIV care, especially regarding confidentiality.
The preventive and survival benefits of antiretroviral use in a rural South African community
(2014-11) Vandormael, Alain Marc
In this dissertation, I undertake three empirical analyses using data from the Africa Centre for Health and Population Studies, which is located in the Hlabisa subdistrict of northern KwaZulu-Natal, South Africa. In the first analysis I assess if antiretroviral therapy(ART) usage in the household is associated with a reduction in individual HIV acquisition risk. To my knowledge, this analysis is the first attempt to quantify the preventive impact of a public sector treatment program based in a rural community with poor knowledge and disclosure of HIV status, frequent migration, late marriage, and multiple partnerships. I argue in the second analysis that efforts to optimize the preventive efficacy of ART in South Africa and elsewhere will be critically dependent on the ability of the public health sector to initiate and then keep HIV-infected patients on treatment. Here, I examine the socio-demographic and structural factors that are associated with poor or imperfect adherence to antiretroviral medications, which can be obtained for free at multiple health-care centers within the study area. The third analysis continues this work by examining the diagnostic performance and cost-effectiveness of two monitoring strategies---CD4 and HIV-1 viral load count testing---to detect poor patient response to ART. My approach is based on the idea that the cost-effectiveness of a treatment monitoring strategy is a function of its predictive performance.
Red Ribbon Re-Route Report
(Hubert H. Humphrey Institute of Public Affairs, 2009-04-30) Pearson, Shawn
With the Ride being in its seventh year, past participant feedback indicates the Ride’s route is becoming stale. For individuals who frequently participate in the annual event, the sights have gone generally unchanged. Though some individuals may find comfort in a well-established routine, consistent feedback indicates that change is needed. Having a static route does not go far towards accomplishing the mission of MN-FAB of educating the public about HIV/AIDS. The towns on the current route have seen and heard the Ride’s message since the first Ride. A reroute would provide a mechanism for outreach into greater Minnesota. Being an organization that relies exclusively on volunteers, human resources necessary to reroute the Ride are scarce. The time and effort needed to perform such a re-route is outside the current capabilities of the Ride. The purpose of this report is to bridge this gap. The intent is to lay the foundation for the eventual complete re-route of the Ride. This is a first step in that process. This document outlines the re-route of the first two legs of the Ride while leaving the last two legs generally intact. Re-routing only half the ride helps reduce the burden associated with a route change. Changing the route is complex and goes beyond merely picking a different road. New vendors for water and ice need sourcing. Schools and pit locations needs identification, new contracts need to be signed as well as understanding municipality needs for permits associated with such an event. In this context, this document may help provide the beginnings of a model for establishing yearly route changes to support of the Ride’s mission of expanding awareness of HIV/AIDS.
Systemic Change in a Community-Based HIV/AIDS Organization: A Case Study Examining the Response to Affordable Care Act Reforms
(2015-07) Lee, Michael
Background: The United States' HIV medical and social service systems remain "a fragile edifice with disparate parts" (Sherer, 2013, p. 133). While the Affordable Care Act (ACA) offers several opportunities, considerable uncertainty remains concerning its influence on HIV-affected populations, who face persistent socioeconomic service barriers. Since the early AIDS crisis, nonprofit HIV/AIDS service organizations ("ASOs") � have provided a critical link between healthcare providers and consumers. This qualitative case study examined the systemic change experiences of a nonprofit ASO, with specific attention to technological considerations, members' identification with HIV-affected consumers, and perceptions of the organization's ' history and service values. Methodology: This study aimed to examine an HIV/AIDS service organization's systemic change experiences via the perspectives of its members. Four central questions guided the investigation: 1) How do members of an HIV/AIDS service organization (i.e., Board, leadership, and staff) experience systemic change in the current policy environment? 2) What technological changes do members of the organization consider (i.e., interventions selected to carry out its mission) as they develop a strategic response to Affordable Care Act legislation? 3) To what extent does ASO members' knowledge of and/or identification with HIV-affected constituencies (e.g., gay/bisexual men, injection drug users, communities of color) influence the organization's systemic change process? 4) To what extent does ASO members' understanding of the organization's history and service values influence the organization's systemic change process? Data collection coincided with strategic plan implementation in 2013-2014 and included analysis of 40 documents, observation of 10 implementation meetings, and semi-structured interviews with 20 Board and staff members. This study was determined to be exempt by the university's Institutional Review Board. Results: Findings revealed ten unique themes. Members recognized an opportunity to reckon with external factors, including uncertain policy shifts and changing public perceptions. The rationale for change included both survival and positioning the organization as a sector leader and service destination. Technological considerations included defining measurable outcomes, identifying expansion opportunities, and addressing barriers to growth. Members described personal, longstanding familiarity with consumers, especially concerning stigma and marginalization. Consumers' needs were characterized as both medically and psychosocially complex. Defining organizational characteristics included nonjudgmental services tailored to consumers' needs and identities and longevity of operations. Perspectives on workplace culture were less settled concerning staff and leadership relationships, professionalism, and accountabilities. Appraisals of how to proceed included competing desires for quick, decisive action and cautious, collaborative deliberation. While most members expressed enthusiasm for the changes, some indicated waning confidence in leaders' decisions and communication, and staff departures sharply increased as the study concluded. Significance: This study is timely and relevant for understanding how changes in the U.S. health and human service system influence services targeting historically marginalized populations. Research and practice implications include the influence of shared historical trauma in organizational development and conceptually reframing community-level HIV suppression efforts around contributing social service factors. Social workers in this study demonstrated a continuing role for the profession in HIV services, including organizational leadership, policy advocacy, program supervision, and direct services to consumers.

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