Are neighborhood conditions associated with <scp>HIV</scp> management?

Shacham, Enbal; Lian, Min; Önen, Nur F.; Donovan, Michael; Overton, Edgar Turner

doi:10.1111/hiv.12067

Cited by 54 publications

(51 citation statements)

References 47 publications

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“…However, our findings are validated by other adherence studies that have documented similar rates and have highlighted known socioeconomic disparities in adherence. 40,41 Further research should seek to generalize the effectiveness of the PCL among a more diverse study sample from an array of ambulatory care and pharmacy practices, not limited solely to settings serving those that are socioeconomically disadvantaged.…”

Section: Limitationsmentioning

confidence: 99%

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

et al. 2016

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BACKGROUND: Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. OBJECTIVE: To test the effectiveness of a patientcentered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. DESIGN: Two-arm, multi-site patient-randomized pragmatic trial. PARTICIPANTS: English-and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. INTERVENTION: A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which uses standard intervals for expressing when to take medicine (morning, noon, evening, bedtime). MAIN MEASURES: Demonstrated proper use of a multidrug regimen; medication adherence measured by selfreport and pill count at 3 and 9 months. KEY RESULTS: A total of 845 patients participated in the study (85.6 % cooperation rate). Patients receiving the PCL demonstrated slightly better proper use of their drug regimens at first exposure (76.9 % vs. 70.1 %, p = 0.06) and at 9 months (85.9 % vs. 77.4 %, p = 0.03). The effect of the PCL was significant for English-speaking patients (OR 2.21, 95 % CI 1.13-4.31) but not for Spanish speakers (OR 1.19, 95 % CI 0.63-2.24). Overall, the intervention did not improve medication adherence. However, significant benefits from the PCL were found among patients with limited literacy (OR 5.08,) and for those with medications to be taken ≥2 times a day (OR 2.77, 95 % CI 1.17-6.53). CONCLUSIONS:A simple modification to pharmacygenerated labeling, with minimal investment required, can offer modest improvements to regimen use and adherence, mostly among patients with limited literacy and more complex regimens. Trial Registration (ClinicalTrials.gov): NCT00973180, NCT01200849

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Section: Limitationsmentioning

confidence: 99%

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

et al. 2016

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“…Neighborhood factors have been associated with increased engagement in risky behaviors, as well as reduced access to HIV-related medical treatment and elevated AIDS-related mortality (7-9). In fact, one recent study demonstrated that neighborhoods with higher rates of poverty and unemployment, and those with higher racial segregation, were associated with poorer overall HIV disease management, manifested as lower CD4 counts (8). …”

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confidence: 99%

Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder

et al. 2015

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Objectives Neighborhood factors have been associated with increased HIV risk behaviors and elevated AIDS-related mortality, yet prior research has not examined the impact of neighborhood disorder on behavioral disease management among HIV-positive individuals. We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures leading to reduced antiretroviral (ARV) medication adherence. Methods Using targeted sampling, the study enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida. Participants completed a one-time standardized interview, which took approximately one hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related non-adherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. Results The total indirect effect in the model was statistically significant (p=.001), and the proportion of the total effect mediated was 53 percent. The model indicated substantial influence of neighborhood disorder on non-adherence to ARVs, operating through recent homelessness and diverter network size. Conclusions Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARVs, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.

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“…Geographical clustering of new HIV infections is a common phenomenon, particularly in urban areas (Shacham et al, 2013). The high AIDS incidence, which was observed in the metropolitan region of the State of Rio de Janeiro, can also be seen in other metropolitan areas, such as in some populated urban regions of South Africa (Manda et al, 2012), the metropolitan area of Atlanta (Hixson, 2011) and another 11 large urban areas in the United States of America (Hall et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…The Metropolitan Rio de Janeiro area has hundreds of low-income communities and some studies indicate that higher AIDS incidence tend to occur in poorer neighbourhoods (Greco and Simão, 2007;Hixson et al, 2011;Shacham et al, 2013;da Silva Pires Araujo et al, 2014). It has been suggested that poverty may increase the vulnerability to HIV infection since it hinders access to information, preventive measures and healthcare.…”

Section: Discussionmentioning

confidence: 99%

The acquired immunodeficiency syndrome in the State of Rio de Janeiro, Brazil: a spatio-temporal analysis of cases reported in the period 2001-2010

Alves

Nobre

2014

Geospat Health

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Abstract. Despite increased funding for research on the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS), neither vaccine nor cure is yet in sight. Surveillance and prevention are essential for disease intervention, and it is recognised that spatio-temporal analysis of AIDS cases can assist the decision-making process for control of the disease. This study investigated the dynamic, spatial distribution of notified AIDS cases in the State of Rio de Janeiro, Brazil, between 2001 and 2010, based on the annual incidence in each municipality. Sequential choropleth maps were developed and used to analyse the incidence distribution and Moran's I spatial autocorrelation statistics was applied for characterisation of the spatio-temporal distribution pattern. A significant, positive spatial autocorrelation of AIDS incidence was observed indicating that municipalities with high incidence are likely to be close to other municipalities with similarly high incidence and, conversely, municipalities with low incidence are likely to be surrounded by municipalities with low incidence. Two clusters were identified; one hotspot related to the State Capital and the other with low to intermediate AIDS incidence comprising municipalities in the north-eastern region of the State of Rio de Janeiro.

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Are neighborhood conditions associated with HIV management?

Cited by 54 publications

References 47 publications

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder

The acquired immunodeficiency syndrome in the State of Rio de Janeiro, Brazil: a spatio-temporal analysis of cases reported in the period 2001-2010

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