The effectiveness evaluation of a multimedia hepatitis C prevention program for Hispanic HIV-infected individuals

Introduction—With the introduction of highly active antiretroviral therapy the Hepatitis C virus (HCV) infection has became a primary health problem among individuals suffering from HIV/ AIDS in Puerto Rico, principally those who are injecting drug users (IDUs). A multimedia educational intervention, based on the Health Beliefs Model and Social Cognitive Theory was developed and implemented to reduce HCV associated risk behaviors among IDUs. Methods—A pre- and post- intervention study evaluated the knowledge and behavioral changes in a group of HIV-infected persons recruited from February 2006 through December 2008. Results—A total of 110 participants were recruited; all were IDUs; 82% were men; 86.3% were HIV/HCV co-infected and 24.5% had active injected drugs in the last month (prior to recruitment). The group mean age was 42.2 ± 9.2 years and mean educational level was 10th grade. Knowledge of HCV risk behaviors, perception of HCV susceptibility, and perception of disease severity increased after the intervention. Knowledge of HCV clinical manifestations and HIV co-infection complications and treatment also improved. In addition, HCV risk behaviors and injecting drug practice decrease significantly among IDUs. Conclusions—This new multimedia intervention captured and maintained the participants' attention and interest, in that way facilitating their educational process. Thus, a greater of attention and interest leads to greater knowledge and prevention improvement

Hepatitis-C Multimedia Prevention Program in Poor Hispanic HIV-Infected Injecting drug users: Six Months after Intervention

In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injecting drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

Background. There are few recent data on the rates of AIDS-defining opportunistic infections (OIs) among human immunodeficiency virus (HIV)–infected patients in care in the United States and Canada

End-Stage Renal Disease Among HIV-Infected Adults in North America

Background. Human immunodeficiency virus (HIV)-infected adults, particularly those of black race, are at high-risk for end-stage renal disease (ESRD), but contributing factors are evolving. We hypothesized that improvements in HIV treatment have led to declines in risk of ESRD, particularly among HIV-infected blacks

Barriers for Compliance to Breast, Colorectal, and Cervical Screening Cancer Tests among Hispanic Patients

Hispanics are less likely to undergo screening tests for colorectal cancer and cervical cancer than non-Hispanic whites. Compliance with mammography, fecal occult blood testing (FOBT), colonoscopy, and cervical smears (PAP) and barriers for compliance were studied. A descriptive study was performed with 194 ambulatory patients while they attended routine medical visits. Women are more likely than men to undergo a colonoscopy. Conversely, FOBT was most likely reported by men. Reasons for compliance with FOBT differed by gender. Men were most likely to avoid FOBT due to lack of knowledge whereas women reported that physicians do not recommend the procedure. Both men and women reported that lack of physician’s recommendation was their primary reason for not undergoing a colonoscopy. Men tend to report lack of knowledge about colonoscopy procedure. A higher mammogram utilization rate was reported by women older than 40 years. PAP smears were reported by 74% of women older than 21 years. The major reasons for avoiding mammography and PAP tests were having a busy schedule, fear, and feeling uncomfortable during the procedure. In a multivariate regression analysis, occupational status was found to be a predictor for compliance with FOBT and colonoscopy

Persistent HIV Viremia: Description of a Cohort of HIV Infected Individuals with ART Failure in Puerto Rico

The introduction of antiretroviral therapy (ART) has allowed human immunodeficiency virus (HIV) suppression in patients. We present data of a cohort of Puerto Rican patients with HIV who were under treatment with a steady regime of ART across a time horizon of eleven years. The time periods were categorized into four year stratums: 2000 to 2002; 2003 to 2005; 2006 to 2008 and 2009 to 2011. Socio-demographic profile, HIV risk factors, co-morbid conditions were included as study variables. One year mortality was defined. The p value was set at ≤0.05. The cohort consisted of 882 patients with 661 subjects presenting with persistent HIV viral load after a self-reported 12 month history of ART use. In this sub-cohort a higher viral load was seen across time (p < 0.05). Illicit drug use, IV drug use, alcohol use, loss of work were associated to having higher viral load means (p < 0.05). HIV viral load mean was lower as BMI increased (p < 0.001). It is imperative to readdress antiretroviral adherence protocols and further study ART tolerance and compliance

Profile of HIV-Infected Hispanics with Pancytopenia

Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 μL, white cell count <4000 μL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student’s t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders

Hepatitis-C Multimedia Prevention Program in Poor Hispanic HIV-Infected Injecting drug users: Six Months after Intervention

BACKGROUND: In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injecting drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS: A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 poor Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS: A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices and HIV/HCV co-infection synergisms was observed in the group six months post intervention. CONCLUSION: Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Therefore, preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations

Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART Cambios en la situación epidemiológica del sida en Puerto Rico tras la reforma sanitaria y la introducción de la TARGA

OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island’s public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island’s 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico’s fight against AIDS will depend on the island’s ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.<br>OBJETIVOS: Comparar la frecuencia de casos de sida, así como las características sociodemográficas y clínicas de los pacientes de sida en Puerto Rico, antes y después de la introducción de la terapia antirretrovírica de gran actividad (TARGA) y la privatización del sistema de salud de la isla. MÉTODOS: Comparamos los nuevos casos de sida durante dos períodos de tres años, 1992-1994 y 1998-2000, en cuatro poblaciones: 1) todos los Estados Unidos, 2) Puerto Rico, 3) la Región de Salud de Bayamón (que se sitúa en la parte norte del centro de Puerto Rico y contiene 11 de las 78 municipalidades de la isla) y una cohorte de pacientes infectados por el VIH y atendidos en la Escuela de Medicina de la Universidad Central del Caribe (UCC). La UCC está en Bayamón, Puerto Rico, dentro de un complejo médico universitario donde se encuentran el hospital escuela (Hospital Universitario Ramón Ruíz Arnaú), las clínicas ambulatorias (Clínicas de Inmunología) para pacientes infectados por el VIH y los edificios administrativos. Todo ello en conjunto representa la principal infraestructura de atención sanitaria de carácter público en la Región de Salud de Bayamón. RESULTADOS: La frecuencia de nuevos casos de sida se redujo notablemente entre los dos períodos en cada una de las cuatro poblaciones estudiadas. La reducción de 48,1% observada en Puerto Rico superó a la de 40,9% observada en los Estados Unidos en general. La reducción en Puerto Rico obedeció probablemente a la mayor disponibilidad y aplicación de la TARGA y a la provisión de atención sanitaria de manera integrada a pacientes de sida o con infección por el VIH en cada clínica ambulatoria regional. A pesar de estas mejoras, sin embargo, el número absoluto de pacientes de sida en la isla sigue siendo elevado. Hacen falta cuantiosos recursos para proporcionar tratamiento y aplicar medidas de prevención. La proporción de casos de sida nuevos fue menor entre las mujeres, las personas de 40 años de edad o mayores, las personas con menos escolaridad y las que vivían solas. El uso de drogas inyectadas sigue siendo la principal vía de transmisión en Puerto Rico. CONCLUSIONES: En Puerto Rico, cualquier adelanto futuro en la lucha contra el sida dependerá de la capacidad de la isla para reducir la transmisión ocasionada por el uso de drogas inyectadas; de la administración de la TARGA a un gran número de pacientes vulnerables, especialmente a usuarios de drogas intravenosas; de intervenciones educativas para mejorar la observancia del tratamiento en ciertos grupos en riesgo; y de medidas orientadas a reducir la frecuencia del uso de drogas inyectadas