Guardianship Planning Among Grandparents Raising Grandchildren Orphaned by HIV/AIDS in Northern Vietnam

Increasingly, grandparents are raising grandchildren because of the absence of the parental generation due to HIV/AIDS in Vietnam. However, few studies have explored the strategies and plans of grandparents for the future care of their grandchildren in case they can no longer provide care. In-depth qualitative interviews were conducted with a purposive sample of 21 grandparent caregivers and seven key informants in both urban and rural communities in Hanoi and Hai Phong, Vietnam. Five grandparents were selected from the sample to complete participant observations. ATLAS.ti was used as a qualitative data analysis tool. Transcriptions from interviews and field notes were analyzed through constructivist grounded theory coding techniques. The analysis lead a category of “anticipatory coping of guardianship planning.” Within this category, four properties illustrated grandparents’ stance on guardianship planning for their grandchildren. These four properties included: (1) making plans with extended family, (2) investing in education, (3) not having options for guardianship care, and (4) seeing the orphan village as a final option. Whether and how grandparents planned and dreamed for the future was affected by key contextual factors such as the HIV status of their grandchild(ren), their financial situation, their family network, their personal health status, and the extent of community resources. Practice recommendations made in partnership with local nongovernmental organizations are discussed, which include incorporating conversations about guardianship planning into existing casework and incorporating the extended family network into these conversations. Recommendations for policy makers and community leaders include extending government grants to provide adequate benefits including financial, health, and social services to low-income grandparents and extended family members who are fostering grandchildren due to HIV/AIDS

Exploring Household Food Insecurity and Inter-generational Self-help Club Involvement Among Grandparents Raising Grandchildren Due to HIV/AIDS in Vietnam

Intergenerational Self-help Clubs (ISHCs), also known as “Empathy Clubs” in Vietnam may aid in improving quality of life and well-being for grandparent-headed households impacted by HIV/AIDS. However, less is known about how club membership impacts household food security. This cross-sectional, mixed methods study examines the differences in household food security and coping responses to food insecurity among 30 grandparents who are raising grandchildren due to HIV/AIDS, 15 who were involved in ISHC groups and 15 who were not involved in ISHC groups, in Hai Phong, Vietnam. In addition to qualitative interviews, all grandparents completed the Household Food Security Insecurity Access Scale (HFIAS) to assess the prevalence of food insecurity. Chi-square and t-tests were employed to detect differences between ISHC members and nonmembers. The food security domain of anxiety and uncertainty related to having enough food was statistically significant (t [28] = 2.27, p \u3c 0.03), with ISHC participants reporting less anxiety and uncertainty. Close to half (46%) of ISHC members reported mild food insecurity. By comparison, about the same percentage (47%) of nonmembers reported moderate food insecurity. Qualitative interviews revealed that food insecurity arose from barriers to accessing food, which led to three primary coping responses: 1) reconfiguring understandings of age-related nutritional needs, 2) erosive coping, and 3) engaging networks for nutritional support. Differences between members of the ISHCs and those without club involvement suggest that a strong community connection, perhaps bonding social capital, may play a role in reducing anxiety related to having enough food. Findings suggest that ISHCs may build social capital, provide psychosocial support, and increase food security among grandparent-headed households who face vulnerability

Barriers to Implementation of a Technology-Based Mental Health Intervention in a Rural Setting

This study utilized qualitative focus groups with rural health providers and patients to explore barriers to implementation of a technology-based mental health intervention for the treatment of depression in a primary care setting. A randomized controlled trial (RCT) was implemented in both urban and rural primary care practices to test the feasibility and effectiveness of computerized cognitive behavioral therapy (CCBT) for depression. Early implementation identified lower rates of willingness to participate in the intervention by rural patients. Subsequently, focus groups were conducted with rural providers and patients to explore barriers to participation and strategies to overcome these barriers in future implementation efforts. Two focus groups of five to seven participants each were conducted to understand patient experiences. Groups lasted approximately one hour and were recorded and transcribed for coding purposes. Key themes identified about barriers to use of CCBT by rural patients emerged included: 1) technical barriers, 2) stigma, 3) distrust of outsiders, 4) effort/motivational barriers, and 5) staff resistance/frustration. Conversely, several positive themes related to supports for CCBT also emerged, including: 1) readiness to change/symptom severity, 2) program supports and incentives, 3) clinician support, 4) components of the intervention, and 5) individual patient characteristics

Usual care in a multi-centre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation

Objectives: Financial incentives are recommended by the UK's National Institute for Health and Care Excellence (NICE) to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact on their effectiveness. Variations in smoking cessation support (usual care) for pregnant women who smoke were examined qualitatively as part of a prospective process evaluation of the Cessation in Pregnancy Incentives Trial (CPIT III). Design: Longitudinal case studies of five CPIT III trial sites informed by realist evaluation. Setting: A stop smoking service (SSS) serving a maternity hospital constituted each case study, located in three UK countries. Participants: Data collection included semi-structured interviews with trial participants (n=22), maternity (n=12) and SSS staff (n=17); and site observations and perspectives recorded in fieldnotes (n=85). Results: Cessation support (usual care) for pregnant women varied in amount, location, staff capacity, flexibility and content across sites. SSS staff capacity was important to avoid gaps in support. Colocation and good working relationships between maternity and SSS professionals enabled prioritisation and reinforced the importance of smoking cessation. Sites with limited use of carbon monoxide (CO) monitoring reduced opportunities to identify smokers while inconsistency around automatic referral processes prevented the offer of cessation support. SSS professionals colocated within antenatal clinics were available to women they could not otherwise reach. Flexibility around location, timing and tailoring of approaches for support, facilitated initial and sustained engagement and reduced the burden on women. Conclusions: Trial sites faced varied barriers and facilitators to delivering cessation support, reflecting heterogeneity in usual care. If financial incentives are more effective with concurrent smoking cessation support, sites with fewer barriers and more facilitators regarding this support would be expected to have more promising trial outcomes. Future reporting of trial outcomes will assist in understanding incentives’ generalisability across a wide range of usual care settings

Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy : qualitative findings from a mixed-methods process evaluation

OBJECTIVES: Financial incentives are recommended by the UK's National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact on their effectiveness. Variations in smoking cessation support (usual care) for pregnant women who smoke were examined qualitatively as part of a prospective process evaluation of the Cessation in Pregnancy Incentives Trial (CPIT III). DESIGN: Longitudinal case studies of five CPIT III trial sites informed by realist evaluation. SETTING: A stop smoking service (SSS) serving a maternity hospital constituted each case study, located in three UK countries. PARTICIPANTS: Data collection included semistructured interviews with trial participants (n=22), maternity (n=12) and SSS staff (n=17); and site observations and perspectives recorded in fieldnotes (n=85). RESULTS: Cessation support (usual care) for pregnant women varied in amount, location, staff capacity, flexibility and content across sites. SSS staff capacity was important to avoid gaps in support. Colocation and good working relationships between maternity and SSS professionals enabled prioritisation and reinforced the importance of smoking cessation. Sites with limited use of carbon monoxide (CO) monitoring reduced opportunities to identify smokers while inconsistency around automatic referral processes prevented the offer of cessation support. SSS professionals colocated within antenatal clinics were available to women they could not otherwise reach. Flexibility around location, timing and tailoring of approaches for support, facilitated initial and sustained engagement and reduced the burden on women. CONCLUSIONS: Trial sites faced varied barriers and facilitators to delivering cessation support, reflecting heterogeneity in usual care. If financial incentives are more effective with concurrent smoking cessation support, sites with fewer barriers and more facilitators regarding this support would be expected to have more promising trial outcomes. Future reporting of trial outcomes will assist in understanding incentives' generalisability across a wide range of usual care settings. TRIAL REGISTRATION NUMBER: ISRCTN15236311

The Role of Innate APOBEC3G and Adaptive AID Immune Responses in HLA-HIV/SIV Immunized SHIV Infected Macaques

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Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire–9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master’s level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder–7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire–8. Results The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, −2.5; 95% CI, −4.5 to −0.8; P = .005) and 3 month (mean difference, −2.3; 95% CI, −4.5 to −0.8; P = .006) and 6 month (mean difference, −3.2; 95% CI, −4.5 to −0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome