Popular Opinion Leader intervention for HIV stigma reduction in health care settings.

This study used the Popular Opinion Leader (POL) model to reduce stigma among service providers. The authors focused on the dissemination of intervention messages from trained POL providers to their peer providers and the change of intervention outcome over time. The sample included 880 service providers from 20 intervention hospitals. The levels of message diffusion, prejudicial attitude toward people living with HIV (PLH), and avoidance intent to serve PLH were self-reported at baseline, 6 months, and 12 months. At 6 months, POL providers showed a significantly higher level of message diffusion and lower levels of prejudicial attitude and avoidance intent than non-POL providers. However, such discrepancies diminished at 12 months. The results support the utility of the POL model in stigma reduction interventions. The observed changes were documented not only in POLs but also in non-POLs after a certain period of time. This finding informed the design and implementation of future stigma reduction efforts and POL intervention programs

Gender Differences in Depressive Symptoms Among HIV-Positive Concordant and Discordant Heterosexual Couples in China.

HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIV+ male/HIV- female couples, 98 HIV- male/HIV+ female couples, and 38 HIV-positive concordant couples, were included in the analyses. We collected data using the computer-assisted personal interview method. We used a linear mixed-effects regression model to assess whether gender differences in depressive symptoms varied across couple types. HIV-positive women reported a significantly higher level of depressive symptoms than their partners/spouses. HIV-positive women with HIV-positive partners had higher depressive symptoms than those with HIV-negative partners, whereas HIV-positive men reported similar levels of depressive symptoms regardless of their partners' serostatus. Among the concordant couples, those with the highest annual family income showed the greatest gender differences in depressive symptoms. We suggest that family interventions should be gender- and couple-type specific and that mental health counseling is warranted not only for HIV-positive women but also for HIV-negative women in an HIV-affected relationship

Antiretroviral Therapy Initiation Following Policy Changes: Observations From China.

China's HIV/AIDS treatment policies have been evolving over the preceding decade. This study describes patterns of antiretroviral therapy (ART) initiation for a sample of people living with HIV/AIDS (PLHIV) in rural Anhui, China, where most PLHIV were infected via paid plasma donation during the 1990s. A total of 481 PLHIV who were receiving ART were included in our analyses. Times between HIV diagnosis and the initiation of ART were examined relative to the time points when major ART-related policies changed in China. More than half (53%) of PLHIV who had been diagnosed by 2003 received ART within 6 months, whereas 93% of PLHIV who had been diagnosed in 2010 or later received ART within 6 months. The study results provide additional support that the "Four Frees and One Care" policy in 2003 and the relaxation of ART eligibility in 2010 have facilitated the initiation of treatment for PLHIV in China

Correlated outcomes of a pilot intervention for people injecting drugs and their family members in Vietnam.

BackgroundThe interrelationship between the well-being of injecting drug users (IDUs) and their family environment has been widely documented. However, few intervention programs have addressed the needs of both IDUs and their family members.MethodsThis study describes a randomized intervention pilot targeting 83 IDUs and 83 of their family members from four communes in Phú Thọ province, Vietnam. The IDUs and family members in the intervention condition received multiple group sessions, with the intent to improve psychological well-being and family relationships. The intervention outcomes (depressive symptoms and family relations) were evaluated at baseline, 3-month and 6-month follow-up assessments.ResultsDepressive symptoms and family relations reported by IDUs were found to be correlated to those reported by their family members. Overall, significant intervention effects on depressive symptoms and family relations were observed for both IDUs and family members. A similar improvement pattern in family relations emerged for both the IDU and family member samples, although the intervention effect of reducing depressive symptoms was more sustainable for family members at the 6-month assessment when compared to the IDU sample.ConclusionThe intervention pilot addressed challenges faced by IDUs and their family members and revealed correlated outcomes for the two groups. Findings suggest a vital need to include family members in future drug prevention and harm reduction intervention efforts

An intervention to improve provider-patient interaction at methadone maintenance treatment in China.

BackgroundThis study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China.MethodsSixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions.ResultsThe intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01).ConclusionStudy findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction

An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs

Trends in Memory Problems and Race/Ethnicity in the National Health and Examination Survey, 1999-2014.

BackgroundLittle data exist to describe serial population-level trends in cognitive impairment- especially among minority communities. Because memory problems are among the first warning signs of cognitive impairment, they provide a potential method for monitoring changes in cognitive health at the population level. This exploratory study aimed to: 1) estimate prevalence of memory problems among US residents by race/ethnicity, age category; and 2) examine whether racial/ethnic differences in subjective cognitive concerns (memory problems) varied across recent time periods.Design and settingSerial cross-sectional analysis of self-reported data from the National Health and Examination Survey (NHANES), 1999-2014.Participants20,585 participants aged ≥45 years during 1999-2014, who reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Latino/Hispanic.MeasurementsThe outcome of interest was subjective cognitive concerns, identified as self-reported memory problems. The frequencies of memory problems were examined for each 4-year period, across racial/ethnic groups.ResultsIn adjusted analyses, compared with older (aged ≥ 65 years) NHWs, disparities in subjective cognitive concerns were observed for older Latinos for most periods (range of AOR: 1.43 - 2.01, P<.05). Additionally, Latinos without a high school education had significantly higher odds of reporting memory problems than NHW in multiple periods (range of AOR: 1.95 - 2.17, P<.005), while Latino high school graduates did not. There were no significant changes in racial/ethnic differences in subjective cognitive concerns over time.ConclusionsThe prevalence of subjective cognitive concerns across time periods points to a need to engage patients - particularly older and less-educated Latinos - about warning signs for cognitive impairment. The impact of education on subjective cognitive concerns in older Latinos may be related to acculturation and warrant further investigation

Changes over time in POLST use and content by race and ethnicity among California nursing home residents.

BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. METHODS: California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content-orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. RESULTS: POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two-thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. CONCLUSIONS: Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative