Clinics In Atlanta Research Articles

Early Implementation and Outcomes Among People with HIV Who Accessed Long-Acting Injectable Cabotegravir/Rilpivirine at Two Ryan White Clinics in the U.S. South.

The use of long-acting injectable cabotegravir/rilpivirine (LAI-CAB/RPV) as maintenance therapy for persons with HIV (PWH), which may improve treatment access and outcomes, though real-world data on uptake are limited, was studied at two Ryan White clinics in Atlanta, Georgia. Among PWH referred from 4/1/2021 to 9/15/2022 to switch to LAI-CAB/RPV, characteristics were ascertained at time of referral; and disposition (initiated; ineligible; uninterested; pending) was recorded as of 9/15/2022. Among patients initiated on CAB/RPV, we assessed the drug procurement process and clinical outcomes through 6/1/2023. Among 149 PWH referred, 74/149 (50%) initiated CAB/RPV as of 9/15/2022, of whom, characteristics were median age 47 (Q1-Q3 36-55) years, 16% cisgender female, 72% Black race, median HIV duration 15 (Q1-Q3 9-19) years, and 64% had commercial health insurance. Of the 75 PWH not initiated, 35 were ineligible owing to a clinical concern (n = 16) or insurance issue (n = 19); 15 patients changed their mind about switching; and 25 were pending eligibility review or therapy initiation. Median time from CAB/RPV prescription to initiation was 46 (Q1-Q3 29-78) days. Of 731 total injections administered (median 11 injections/patient), 95% were given within 7 days of the target treatment date. Nearly all patients were virally suppressed upon referral and remained suppressed through follow-up. At two clinics in the U.S. South, half of the patients referred for LAI-CAB/RPV successfully accessed therapy nearly 2 years after U.S. drug approval. We identified barriers to uptake at the patient and structural levels, highlighting key areas to invest resource and personnel support to sustain and scale long-acting antiretroviral therapy programming.

What keeps you coming back? Health care experience and determinants of consistent follow-up among persons experiencing homelessness in Atlanta, GA

ABSTRACT People experiencing homelessness have difficulties accessing primary care and maintaining follow-up. Little is known about what factors contribute to satisfaction with care and subsequent return visits. In this 2019 qualitative study of 20 individuals experiencing homelessness at an urban non-profit clinic in Atlanta, GA, we conducted a hybrid deductive-inductive thematic analysis to identify factors that impacted satisfaction with care and encouraged consistent follow-up. A comprehensive care model – including psychiatry and dental services, access to medication, and housing – supported ongoing utilization of primary care. However, it was also essential to promote dignity and respect, and foster emotional connection with and trust between patients and clinic staff. Many also reported religion or spirituality as an important factor. In their prior experience, when these same factors were absent, participants were less likely to follow-up consistently. These findings will help to encourage consistent follow-up and create opportunities to treat chronic conditions that require consistent medical care.

Incorporating Cardiovascular Risk Assessment into Adolescent Reproductive Health and Primary Care Visits

Study ObjectiveThis study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits. Design, Setting, and ParticipantsWe recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA.Main Outcome Measures: Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants’ perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice. ResultsAdolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants’ median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants’ median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits. ConclusionHerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics.

Clinic-level complexities prevent effective engagement of people living with HIV who are out-of-care.

Approximately half of people living with HIV (PLWH) in the United States are not retained in HIV care. Although numerous studies have identified individual-level barriers to care (i.e., substance abuse, mental health, housing, transportation challenges), less is known about institutional-level barriers. We aimed to identify clinic-level barriers to HIV care and strategies to address them to better engage PLWH who have been out of care (PLWH-OOC). As part of a larger qualitative study in a Ryan White-funded HIV Clinic in Atlanta, which aimed to understand the acceptance and feasibility of community-based HIV care models to better reach PLWH-OOC, we explored barriers and facilitators of HIV care engagement. From October 2022-March 2023, 18 in-depth-interviews were conducted with HIV-care providers, administrators, social workers, and members of a Community Advisory Board (CAB) comprised of PLWH-OOC. Transcripts were coded by trained team members using a consensus approach. Several clinic-level barriers emerged: 1) the large burden placed on patients to provide proof of eligibility to receive Ryan White Program services, 2) inflexibility of provider clinic schedules, 3) inadequate processes to identify patients at risk of disengaging from care, 4) poorly-resourced hospital-to-clinic transitions, 5) inadequate systems to address primary care needs outside of HIV care, and 6) HIV stigma among medical professionals. Strategies to address these barriers included: 1) colocation of HIV and non-HIV services, 2) community-based care options that do not require patients to navigate complex transportation systems, 3) hospital and community-based peer navigation services, 4) dedicated staffing to identify and support PLWH-OOC, and 5) enhanced systems support to help patients collect the high burden of documentation required to receive subsidized HIV care. Several systems-level HIV care barriers exist and intersect with individual and community-level barriers to disproportionately affect HIV care engagement among PLWH-OOC. Findings suggest several strategies that should be considered to reach the remaining 50% of PLWH who remain out-of-care.

A 3-year Retrospective Review of Contraceptive Initiation, Continuation, Switching, and Pregnancy Among Adolescents and Young Adults

PurposeTo understand contraceptive use patterns (initiation, switching, discontinuation) as well as associations with pregnancy in adolescents and young adults attending a teen family planning clinic. MethodsWe performed a chart review of adolescent and young adult patients (ages 12–20) attending a teen family planning clinic in Atlanta, GA between January 1, 2017, and December 31, 2019. Using a standardized abstraction form with quality controls, we collected available data on contraceptive methods used and pregnancy test results during the 3-year period. We analyzed contraceptive use patterns descriptively. We calculated and compared pregnancy incidence according to different contraceptive switch patterns. ResultsOur sample included 2,798 individuals who initiated 2,358 prescribed methods. The most commonly prescribed methods of contraception were the contraceptive injection (28.3%), etonogestrel implant (23.5%) and combined hormonal pill (23.2%). There were 599 discontinuations of prescribed methods; side effects like bleeding and headache were the most cited reasons for discontinuation. Most (75.8%) initiated a moderately or highly effective method after discontinuing a moderately or highly effective method. The incidence rate of pregnancy was highest for those who had discontinued an intrauterine device or implant and started a shorter-acting contraceptive method. DiscussionEmploying patient-centered contraceptive counseling that incorporates contraceptive experiences in addition to facts and allows for exploration and change may be valuable for young people. Successful navigation of contraceptive switches may require additional attention, education, and strategy, which could include hypothetical problem solving, close follow-up, and telehealth or virtual care.

Ambient traffic related air pollution in relation to ovarian reserve and oocyte quality in young, healthy oocyte donors

Studies in mice and older, subfertile women have found that air pollution exposure may compromise female reproduction. Our objective was to evaluate the effects of air pollution on ovarian reserve and outcomes of ovarian stimulation among young, healthy females. We included 472 oocyte donors who underwent 781 ovarian stimulation cycles at a fertility clinic in Atlanta, Georgia, USA (2008–2019). Antral follicle count (AFC) was assessed with transvaginal ultrasonography and total and mature oocyte count was assessed following oocyte retrieval. Ovarian sensitivity index (OSI) was calculated as the total number of oocytes divided by total gonadotrophin dose × 1000. Daily ambient exposure to nitric oxide (NOx), carbon monoxide (CO), and particulate matter ≤ 2.5 (PM2.5) was estimated using a fused regional + line-source model for near-surface releases at a 250 m resolution based on residential address. Generalized estimating equations were used to evaluate the associations of an interquartile range (IQR) increase in pollutant exposure with outcomes adjusted for donor characteristics, census-level poverty, and meteorological factors. The median (IQR) age among oocyte donors was 25.0 (5.0) years, and 31% of the donors were racial/ethnic minorities. The median (IQR) exposure to NOx, CO, and PM2.5 in the 3 months prior to stimulation was 37.7 (32.0) ppb, 612 (317) ppb, and 9.8 (2.9) µg/m3, respectively. Ambient air pollution exposure in the 3 months before AFC was not associated with AFC. An IQR increase in PM2.5 in the 3 months before AFC and during stimulation was associated with −7.5% (95% CI −14.1, −0.4) and −6.4% (95% CI −11.0, −1.6) fewer mature oocytes, and a −1.9 (95% CI −3.2, −0.5) and −1.0 (95% CI −1.8, −0.2) lower OSI, respectively. Our results suggest that lowering the current 24-h PM2.5 standard in the US to 25 µg/m3 may still not adequately protect against the reprotoxic effects of short-term PM2.5 exposure.

P1: Dosing and treatment outcomes of rTMS for treatment-resistant depressed older adults in a naturalistic outpatient clinic population.

Introduction:Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.Methods:This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.Results:Eighty-nine patients were included for analysis: Group 1: >55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: <55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A >50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps < .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a >50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps < .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.Conclusion:With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.

Multisite Mpox Infection and Viral Dynamics Among Persons With HIV in Metro Atlanta.

The 2022 mpox outbreak primarily involved sexual transmission among men who have sex with men and disproportionately affected persons with human immunodeficiency virus (HIV). We examined viral dynamics and clinical features in a cohort evaluated for mpox infection at a comprehensive HIV clinic in Atlanta, Georgia. Viral DNA was found in 8 oropharyngeal and 5 anorectal specimens among 10 mpox cases confirmed by lesion swab polymerase chain reaction. Within-participant anatomic site of lowest cycle threshold (Ct) value varied, and lower Ct values were found in oropharyngeal and anorectal swabs when corresponding symptoms were present. This provides insight into mpox infection across multiple anatomic sites among people with HIV.

1714. Incidence of Sexually Transmitted Infections in Youth with HIV Pre-COVID and COVID Era

Abstract Background Adolescents and young adults (AYAs) living with HIV have high rates of co-sexually transmitted infections (STIs). During the COVID pandemic, STI prevention strategies including access to testing and treatment facilities, availability of public health practitioners and healthcare workers, and condom availability may have decreased. The aim of this study was to determine if differences in STI incidence for first infection and re-infection existed between the pre-COVID and COVID eras in a cohort of AYAs living with HIV in Atlanta, GA. Methods Retrospective chart review was conducted for all patients aged 13-24 at the Grady Ponce and Family Youth Clinic in Atlanta, GA. Two eras were identified: a pre-COVID era from 1/1/2009 – 12/31/2019 and a COVID era from 1/1/2020 – 6/30/2021. Patients could be followed in both eras, where follow-up for first and recurrent STI incidences were reinitiated at the start of the COVID era. STIs recorded included gonorrhea, chlamydia, human papillomavirus, syphilis, trichomonas, herpes simplex virus, lymphogranuloma venereum, hepatitis C, bacterial vaginosis, and chancroid. First and recurrent incidence rates for any STIs were reported. Results Our sample included 766 sexually active AYAs with HIV. The mean age of first observation was 18.91 (±2.86) years. 72.3% of our patients were male and 90.7% were black. 721 patients were included in the pre-COVID era and 583 (80.9%) had at least one STI. 337 patients were included in the COVID era, and 158 had at least one STI (46.9%). The overall first STI incidence rate increased from 42.47 to 58.67 per 100 person-years from the pre-COVID to the COVID era (p< 0.001). Gonorrhea, trichomonas and syphilis had significantly higher rates during the COVID era (Table 1). The recurrent STI incidence rate for any STI also significantly increased from 121.50 to 169.85 per 100 person-years (p< 0.001) (Table 2). Conclusion Our study demonstrated significantly higher incidence rates of first and recurrent STIs in AYAs living with HIV in the COVID era compared to the pre-COVID era. Reallocation of resources during pandemics should emphasize continuation of existing STI prevention programs to avoid secondary clinical and economic adverse effects of increased infections. Disclosures All Authors: No reported disclosures

Painful to Discuss: The Intersection of Chronic Pain, Mental Health, and Analgesic Use among People with HIV

Objective: This retrospective chart review study aims to identify patients in an HIV clinical setting in an area of high HIV prevalence in Atlanta, Georgia, USA who have chronic pain, analgesic prescriptions, and/or mental health diagnoses. Design: People living with HIV (PLWH) are at higher risk for experiencing trauma, mental health conditions, and chronic pain than their HIV-negative counterparts. This study was designed to evaluate the intersection of these factors within an urban HIV clinic. Methods: Retrospective chart review study. Results: Of the adult patients enrolled at an HIV clinic in Atlanta, Georgia USA between 2011-2022 (n=15,970), 93.7% were prescribed analgesics, 40.5% had documented pain diagnoses, and 23.5% had documented mental health diagnoses. Additionally, 14.3% of all enrolled patients had all three factors concurrently. Conclusions: The complexity of HIV, chronic pain, mental health challenges, and analgesic use demand a patient-centered, collaborative approach including a multidisciplinary care team. Seeing persistent pain among PLWH with a trauma-informed approach to care within the lens of co-occurring mental health diagnoses will allow us to better understand, treat, and sustain patients in life-saving HIV care.

EXAMINING THE CUMULATIVE EFFECTS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS WITH HIV

Abstract Social isolation exists when one has limited or lacks social contact with others and is distinct from loneliness, an affective state on the perception of isolation. Social isolation and loneliness are recognized as risks to well-being among older adults. Less in known about the cumulative effects of social isolation and loneliness in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA (N=146), we aimed to 1) describe the overlap between social isolation and loneliness and 2) examine the combined effects of social isolation and loneliness on quality-of-life (QoL), HIV-related stigma, depressive symptoms, and comorbidity burden. Loneliness and social isolation were assessed using the PROMIS-Social Isolation Scale and Social Network Index, respectively. Participants were grouped into four categories into ‘lonely only,’ ‘isolated only,’ ‘both lonely and isolated,’ or ‘neither.’ Bivariate and adjusted associations were conducted. Among participants (mean age=56.53), 26.7% (n=39) were considered ‘lonely’ only, 12.3% (n=18) ‘isolated’ only, 15.1% (n=22) ‘both lonely and isolated,’ and 45.9% (n=67) ‘neither.’ In bivariate analyses, individuals categorized as ‘both lonely and isolated’ were likely to have past homelessness and higher depressive symptoms, stigma, and comorbidity burden, and lower QoL. In adjusted models, ‘both isolated and lonely’ significantly predicted QoL, stigma, and depressive symptoms. Findings highlight the critical emphasis on targeting OPWH who are both isolated and lonely.

EXAMINING THE CUMULATIVE EFFECTS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS WITH HIV

Abstract Social isolation exists when one has limited or lacks social contact with others and is distinct from loneliness, an affective state on the perception of isolation. Social isolation and loneliness are recognized as risks to well-being among older adults. Less in known about the cumulative effects of social isolation and loneliness in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA (N=146), we aimed to 1) describe the overlap between social isolation and loneliness and 2) examine the combined effects of social isolation and loneliness on quality-of-life (QoL), HIV-related stigma, depressive symptoms, and comorbidity burden. Loneliness and social isolation were assessed using the PROMIS-Social Isolation Scale and Social Network Index, respectively. Participants were grouped into four categories into ‘lonely only,’ ‘isolated only,’ ‘both lonely and isolated,’ or ‘neither.’ Bivariate and adjusted associations were conducted. Among participants (mean age=56.53), 26.7% (n=39) were considered ‘lonely’ only, 12.3% (n=18) ‘isolated’ only, 15.1% (n=22) ‘both lonely and isolated,’ and 45.9% (n=67) ‘neither.’ In bivariate analyses, individuals categorized as ‘both lonely and isolated’ were likely to have past homelessness and higher depressive symptoms, stigma, and comorbidity burden, and lower QoL. In adjusted models, ‘both isolated and lonely’ significantly predicted QoL, stigma, and depressive symptoms. Findings highlight the critical emphasis on targeting OPWH who are both isolated and lonely.

Assessing and Promoting Cardiovascular Health for Adolescent Women: User-Centered Design Approach.

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women's Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Only 10.5% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6%) or family history of CVD (8/67, 11.9%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions.

Antipsychotics and Medical Comorbidity: A Retrospective Study in an Urban Outpatient Psychiatry Clinic.

Patients with psychotic disorders have increased rates of medical comorbidities. In this cross-sectional study, we investigated the relationship between antipsychotics and medical comorbidities among patients with psychotic disorders in an urban psychiatry clinic in Atlanta, Georgia (n = 860). Each antipsychotic group was compared to a group of patients from the same sample who were not on any antipsychotic, and logistic regression models were constructed for each comorbidity. Ziprasidone was associated with diabetes (aOR 2.56, 95% CI 1.03-6.38) and obesity (aOR 3.19, 95% CI 1.37-7.41). Aripiprazole was associated with obesity (aOR 2.39, 95% CI 1.27-4.51). Clozapine was associated with GERD (aOR 3.59, 95% CI 1.11-11.61), movement disorders (aOR 4.44, 95% CI 1.02-19.32), and arrythmias (4.89, 95% CI 1.44-16.64). Two antipsychotics that are considered weight neutral, ziprasidone and aripiprazole, were associated with cardiometabolic comorbidities. This study suggests that research is warranted to study the association between antipsychotics, medical comorbidity, and psychotic symptom burden.

Factors Associated With Anal High-Grade Intraepithelial Lesions and Carcinoma Among Young Men Who Have Sex With Men and Transgender Women With HIV in Atlanta.

This study aimed to evaluate factors associated with anal high-grade intraepithelial lesions (HSIL) and anal carcinoma among young men who have sex with men (MSM) and transgender women (TW) with HIV in Atlanta, GA, to better inform screening guidelines and preventative measures. Cross-sectional retrospective chart review was completed for cisgender MSM and TW with HIV aged 13-25 years at the Grady Ponce and Family Youth Clinic in Atlanta, GA, from 2009 to 2020. High-grade anal disease was defined as anal intraepithelial neoplasia (AIN) 2, 3, or anal carcinoma (AIN 2+). Associations between clinical and demographic factors with AIN 2+ were estimated using logistic regression. Adjusted odds ratios (aORs) and associated 90% CIs are reported. One hundred nine MSM and TW with HIV who underwent anoscopy were included. One hundred three participants received anal biopsies, and 62% had AIN 2+. Being incompletely or unvaccinated against human papillomavirus (HPV, 0-2 doses) relative to being fully vaccinated (3 doses; aOR = 5.85; 90% CI = 1.28-26.83; p = .06) and having ever received surgical treatment for anogenital HPV (aOR = 2.89; 90% CI = 1.10-7.65; p = .07) were associated with AIN 2+, controlling for age and CD4 T-cell count at time of biopsy. Our study found a high prevalence of anal HSIL among young MSM and TW with HIV. Those who had ever received surgical treatment for anogenital HPV and those who were incompletely or unvaccinated against HPV were more likely to have HSIL. Our data emphasize the urgent need to improve HPV vaccination efforts and to pursue larger surveillance studies of anal HSIL and carcinoma among young MSM and TW with HIV.

Preferences of Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Regarding Integration of HIV and Mental Health Care Services.

Optimization of mental health service use is critical to HIV care engagement among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM). Clinic-level interventions to integrate HIV and mental health services have been proposed; however, patient perspectives on such care models are often lacking. We conducted a mixed-methods study consisting of surveys (N = 100) and qualitative in-depth interviews (n = 15) with YB-GBMSM recruited from two Ryan White-funded HIV clinics in Atlanta, Georgia. Most participants (70%) agreed that integration of HIV and mental health services was beneficial to them. Thirty-six percent (36%) desired a higher level of integration than what they perceived was currently available in their clinic setting, 51% believed their clinic was already optimally integrated, and 13% preferred less integration. In the qualitative interviews, participants discussed their support for potential integration strategies such as training HIV providers to prescribe antidepressants, closer in-clinic proximity of HIV and mental health providers, and use of patient navigators to help patients access mental health care and remind them of appointments. Perceived benefits of care integration included easier access to mental health services, enhanced overall well-being, and improved HIV care engagement. In summary, YB-GBMSM were supportive of integrating HIV and mental health services, with varying individual preferences regarding the degree and operationalization of this integration. Improving integration of mental health and HIV services, and tailoring modes of service delivery to individual preferences, has the potential to improve both general well-being and HIV care engagement in this high priority population.

The Impact of Churn on HIV Outcomes in a Southern United States Clinical Cohort.

BackgroundPersons with human immunodeficiency virus (PWH) may experience a cycle of engaging and disengaging in care referred to as “churn.” While human immunodeficiency virus (HIV) churn is predicted to be more prevalent in the southern United States (US), it has not been well characterized in this region.MethodsWe conducted a retrospective cohort study involving PWH newly establishing care at a large urban clinic in Atlanta, Georgia, from 2012 to 2017, with follow-up data collected through 2019. The primary exposure was churn, defined as a ≥12-month gap between routine clinic visits or viral load (VL) measurements. We compared HIV metrics before and after churn and assessed the risk of future churn or loss to follow-up.ResultsOf 1303 PWH newly establishing care, 81.7% were male and 84.9% were Black; 200 (15.3%) experienced churn in 3.3 years of median follow-up time. The transmissible viremia (TV) rate increased from 28.6% prechurn to 66.2% postchurn (P < .0001). The 122 PWH having TV on reengagement had delayed time to subsequent viral suppression (adjusted hazard ratio, 0.59 [95% confidence interval {CI}, .48–.73]), and PWH returning to care contributed disproportionately to the community viral load (CVL) (proportion of CVL/proportion of patients, 1.96). Churn was not associated with an increased risk of subsequent churn (adjusted odds ratio [aOR], 1.53 [95% CI, .79–2.97]) or loss to follow-up (aOR, 1.04 [95% CI, .60–1.79]).ConclusionsThe rate of churn in a southern US clinic was high, and those who experienced churn had increased TV at reentry and disproportionately contributed to the CVL and likely contributing to ongoing HIV transmission.

Loneliness Mediates the Effect of HIV-related Stigma on Depressive Symptoms among Older Persons Living with HIV.

Studies have shown associations among stigma, loneliness, and depressive symptoms in older persons living with HIV (PWH) but research assessing the mediating pathway among these variables is sparse. Building on this prior work, the aim of this study was to test the mediating effects of loneliness. A sample of 146 older PWH (≥50 years old) from an outpatient HIV clinic in Atlanta, GA, completed a cross-sectional survey. Mediation analysis, guided by Baron and Kenny's criteria, was conducted using Stata v14.2 to assess the direct and indirect effects of loneliness on the association between stigma and depressive symptoms while controlling for covariates (sex; income; self-rated health; past unstable housing). Loneliness mediated the association between stigma and depressive symptoms. Stigma predicted higher loneliness, which in turn predicted more depressive symptoms. Findings suggest that addressing depressive symptoms in older PWH may require multifaceted interventions targeting psychosocial and interpersonal factors including stigma and loneliness.

Social network size and its relationship to domains of quality-of-life among older persons living with HIV

ABSTRACT Gerontological research suggests that social network characteristics are key elements of successful aging as they are related to a positive quality-of-life (QoL). Less is known about the social networks of persons aging with HIV. To describe social network characteristics and assess the effect of social network size on QoL, a sample of 146 OPWH (age ≥50) was recruited from an outpatient HIV clinic in Atlanta, GA. Social network size was assessed using Cohen’s social network index (SNI). Domains of QoL (physical, emotional, and social) were assessed using the RAND-36. Descriptive analyses were used to determine the frequency of contact within social networks and multivariable regression models were used to assess the relationship between SNI and three domains of QoL controlling for potential covariates. Participants were predominantly male (60%), heterosexual (63%), and African American (86%). Regular contact occurred most frequently with friends (82%) and relatives (77%). Multivariable modeling revealed that SNI explained 58% of the variance in emotional QoL (R 2 = 0.58, F(8, 137) = 25.48, p < .001). Findings provide basis for potential interventions focused on the specific social network to improve emotional QoL of this vulnerable population.

Cognitively Based Compassion Training for HIV Immune Nonresponders-An Attention-Placebo Randomized Controlled Trial.

Chronic inflammation is associated with increased morbidity and mortality for people with HIV (PWH). Psychological stress is an important contributor to this chronic inflammation. We hypothesized that a cognitively based compassion training (CBCT) approach could reduce inflammation and psychological stress in immune nonresponder PWH. An attention-placebo randomized controlled trial design to evaluate the acceptability of CBCT among PWH and its effects on key aspects of stress and immune function compared with an active-attention control group (NCT02395289). This study was conducted at an HIV clinic in Atlanta, Georgia. Eligible individuals determined by (1) adherence to antiretroviral therapy for at least a year, (2) virologic suppression; and (3) stable CD4+ T-cell counts <350 cells/μL were randomized in a 2:1 ratio to either CBCT or control in 2 study periods: April-May, 2016, and September-December, 2016. Psychological measures and inflammatory biomarkers associated with HIV disease progression (IL-1β, TNF-α, sCD14, IL-6, and IL-10) were obtained for all study participants at baseline and at the time of study completion. We found a significant association between CBCT practice time engagement and fold reduction in IL-6 and TNF-α levels. There was no association between CBCT practice time and other biomarkers markers assessed (IL-1β, sCD14, and IL-10). These changes were coincident with significant increases in self-reported psychological well-being and HIV disease acceptance and in benefits for CBCT participants. We also observed fewer instances of virologic failure for those in the CBCT arm compared with controls. CBCT is a novel and feasible nonmedication-based intervention that could reduce inflammation and psychological stress in PWH.