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Biomedical subjects

Jane M Simoni

Publications and source records attributed to Jane M Simoni.

At least 19 recordsLinked to original sources
PubMed2007

Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues.

We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R (2) = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1-3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.

Adult↗
PubMed2006

Modified directly observed therapy to facilitate highly active antiretroviral therapy adherence in Beira, Mozambique. Development and implementation.

As resource-limited countries expand access to highly active antiretroviral therapy (HAART) treatment, innovative programs are needed to support adherence in the context of significant health system barriers. Modified directly observed therapy (mDOT) is one such strategy, but little is known about the process of designing and implementing mDOT programs for HAART in resource-limited settings. In this descriptive study, we used a mixed-methods approach to describe the process of implementing mDOT for an ongoing randomized control trial (RCT) in Beira, Mozambique. Interviews with clinic staff, mDOT peers, and participants provided information on design elements, problems with implementation, satisfaction, and benefits. Acceptability and feasibility measures were obtained from the RCT. Most (81%, N = 350) eligible persons agreed to participate, and of those randomized to mDOT (n = 174), 95% reported that their time with peers was beneficial. On average, participants kept 93% of the 30 required daily mDOT visits. Key components of the intervention's success included using peers who were well accepted by clinic staff, adequate training and retention of peers, adapting daily visit requirements to participants' work schedules and physical conditions, and reimbursing costs of transportation. This study identified aspects of mDOT that are effective and can be adopted by other clinics treating HIV patients.

Adult↗
PubMed2006

How qualitative methods contribute to understanding combination antiretroviral therapy adherence.

Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance.

Anti-HIV Agents↗
PubMed2006

Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials.

Adherence to highly active antiretroviral therapy (HAART) is generally suboptimal, limiting the effectiveness of HAART. This meta-analytic review examined whether behavioral interventions addressing HAART adherence are successful in increasing the likelihood of a patient attaining 95% adherence or an undetectable HIV-1 RNA viral load (VL). We searched electronic databases from January 1996 to September 2005, consulted with experts in the field, and hand searched reference sections from relevant articles. Nineteen studies (with a total of 1839 participants) met the selection criteria of describing a randomized controlled trial among adults evaluating a behavioral intervention with HAART adherence or VL as an outcome. Random-effects models indicated that across studies, participants in the intervention arm were more likely than those in the control arm to achieve 95% adherence (odds ratio [OR] = 1.50, 95% confidence interval [CI]: 1.16 to 1.94); the effect was nearly significant for undetectable VL (OR = 1.25; 95% CI: 0.99 to 1.59). The intervention effect for 95% adherence was significantly stronger in studies that used recall periods of 2 weeks or 1 month (vs. </=7 days). No other stratification variables (ie, study, sample, measurement, methodologic quality, intervention characteristics) moderated the intervention effect, but some potentially important factors were observed. In sum, various HAART adherence intervention strategies were shown to be successful, but more research is needed to identify the most efficacious intervention components and the best methods for implementing them in real-world settings with limited resources.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian Men in New York City.

OBJECTIVES: secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population. METHODS: A survey was mailed to all members of an American Indian community organization in New York City. RESULTS: The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men). CONCLUSIONS: Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.

Adult↗
PubMed2006

Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.

A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode = 7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.

Acquired Immunodeficiency Syndrome↗
PubMed2006

A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.

Anti-Retroviral Agents↗
PubMed2006

"My spirit in my heart": identity experiences and challenges among American Indian two-spirit women.

Many Native women embrace the term two-spirit to capture their sexuality and gender expression. By analyzing the narratives of five two-spirit women who are Native activists, we explored contemporary understandings of the concept and what it means for Native communities. The incorporation of the identity within indigenous worldviews, its manifestation in terms of (be)coming out, and the triple stressors of heterosexism, racism, and sexism emerged as key themes.

Adult↗
PubMed2005

Suicidal ideation and attempted suicide among women living with HIV/AIDS.

The prevalence, timing, and predictors of suicidal ideation and attempted suicide were evaluated in a sample of 207 HIV-positive women in New York City. Twenty-six percent of the women reported attempting suicide since their HIV diagnosis. Of those who made an attempt, 42% acted within the first month after diagnosis and 27% acted within the first week. AIDS diagnosis, psychiatric symptoms, and physical or sexual abuse were significant positive predictors of both suicidal ideation and attempts. Contrary to expectations, having children and being employed were also significant positive predictors. Spirituality was significantly negatively associated with suicidal ideation only. These results suggest that suicide prevention measures should be implemented for HIV-positive women immediately after diagnosis. Specifically, interventions should target those with an AIDS diagnosis, psychiatric symptoms, an abuse history, children, or employment. The encouragement of spiritual connection seems to be a deterrent to suicidal thoughts and is a possible avenue for intervention.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Social support and depressive symptomatology among HIV-positive women: the mediating role of self-esteem and mastery.

Women constitute an increasing proportion of individuals contracting HIV in the United States and, once diagnosed, are living longer lives since the advent of combination antiretroviral therapies. HIV-positive women, who are disproportionately ethnic minority, face unique challenges to their psychosocial adaptation. Findings from a survey of 373 mainly indigent African-American and Puerto Rican women living with HIV/AIDS in the New York City area indicated high levels of depressive symptomatology, which were inversely related to HIV-related social support from friends, relatives, partner, and groups/ organizations. In line with the Cognitive Adaptation Model, structural equation modeling indicated that psychological resourcefulness (i.e., self-esteem and mastery) mediated the effects of social support on depressive symptomatology. Findings suggest the need to assess HIV-positive women for social isolation and depression and to provide them with interventions such as support groups that capitalize on their existing strengths, including their psychological resourcefulness.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The health belief model, sexual behaviors, and HIV risk among Taiwanese immigrants.

In this first investigation of Taiwanese sexual behaviors in the United States, 144 Taiwanese students completed an online anonymous survey. Demographics, health belief model (HBM) constructs, and acculturation were examined as predictors of sexual behaviors over the last year. Analyses indicated that participants who reported a higher number of sexual partners and more frequent sexual intercourse tended to be more educated and more likely to be nonheterosexual. The HBM constructs, as a set, reliably predicted participants' sexual behaviors. Self-efficacy was the strongest predictor within the HBM. Furthermore, acculturation moderated the predictive power of the HBM with respect to intercourse frequency. The main limitation of the study is that the measure of HBM, which was not designed to target Asian immigrants, was psychometrically poor. The results suggest self-efficacy is a target for behavioral change, acculturation may need to be incorporated into the HBM, and more culturally sensitive measures need to be developed.

Acculturation↗
PubMed2004

Triangle of risk: urban American Indian women's sexual trauma, injection drug use, and HIV sexual risk behaviors.

A community-based mail survey of 155 urban American Indian women revealed 91% engaged in at least one lifetime HIV sexual or drug risk behavior, including 19% who had sex with an injection drug user and 7% who had traded sex. Sixty-eight percent of the respondents were sexually active in the last year, with more than half never using condoms. Six percent had ever injected nonprescription drugs; 62% drank alcohol in the last year, with 28% reporting at least one occasion of consuming six or more drinks containing alcohol. Respondents reported high rates of lifetime physical (37%) and sexual (39%) assault, which was generally associated with lifetime but not more recent indicators of sexual and drug risk behavior. Injection drug use mediated the relationship between nonpartner sexual (but not physical) trauma and high-risk sexual behaviors. Findings underscore the need for the integrated assessment and treatment of abuse and substance use as well as more research on the risk behaviors of this understudied and underserved population.

Adolescent↗
PubMed2004

Culture, trauma, and wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit native americans.

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance use. Compared with their heterosexual counterparts, two-spirit participants reported higher rates of childhood physical abuse and more historical trauma in their families, higher levels of psychological symptoms, and more mental health service utilization. Two-spirit participants reported differences in patterns of alcohol use and were more likely to have used illicit drugs other than marijuana. Discussion and recommendations for health promotion interventions and future research are presented in consideration of an "indigenist" health model and the multiple minority status of two-spirit people.

Adolescent↗
PubMed2003

Mediational models of spirituality and depressive symptomatology among HIV-positive Puerto Rican women.

A survey of 142 Puerto Rican women living with HIV/AIDS in New York City revealed high Centers for Epidemiological Studies Depression (CES-D) scores, with 66% of the sample scoring above the conventional threshold of possible clinical depression. Most respondents (71%) were Catholic, 29% considered themselves members of a church or other place of worship, and 30% reported attending religious services 1-3 times a month. As predicted, spirituality was high and negatively associated with CES-D scores. A series of simultaneous multiple regression analyses controlling for all potentially confounding medical and sociodemographic variables demonstrated that both mastery and self-esteem scores mediated this relationship. Implications for future research and the provision of services to HIV-positive Puerto Rican women are discussed.

Acculturation↗
PubMed2002

Mediators of social support and antiretroviral adherence among an indigent population in New York City.

Survey interviews were conducted with a random sample of 50 primarily indigent, African American and Puerto Rican men and women at an outpatient human immunodeficiency virus (HIV) clinic in the Bronx, New York. Analyses revealed a generally high rate of adherence according to self-report data (i.e., on average, participants reported taking 85% of their medications over the last 3 days). However, adherence to the correct number of pills, dosing schedules, and special instructions was more problematic. No sociodemographic or substance use indicators were associated with adherence. Compared to men, women reported higher scores on the Crowne-Marlowe Social Desirability Scale, which were positively correlated with self-reported adherence. "Forgot" (50%) and "felt worse" (46%) were the most common reasons for missed doses. Mediation analyses provided partial support for our proposed model of social support and adherence. Specifically, regression analyses controlling for social desirability indicated that need for social support was positively correlated with acknowledged nonadherence and that this relationship was mediated by self-efficacy and depressive symptomatology.

Adult↗
PubMed2002

Reconceptualizing native women's health: an "indigenist" stress-coping model.

This commentary presents an "indigenist" model of Native women's health, a stress-coping paradigm that situates Native women's health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the "soul wound" of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices. Current epidemiological data on Native women's general health and mental health are reconsidered within the framework of this model.

Acculturation↗