Continuum of care is a concept that has been widely applied in HIV prevention and treatment studies. However, measuring care continuum can be challenging because it involves multiple stages and multiple components or domains at each stage of care. In this study, we introduced an analytical framework to (1) estimate intervention effects overall and by domain using a multi-level modeling approach, and (2) learn possible patterns of domains over time utilizing a multi-layer heatmap visualization. Longitudinal data from an intervention study conducted among people who use drugs in Vietnam were used to construct Seek, Test, Treat, and Retain (STTR) domain and overall scores. Findings from the adjusted analysis showed that people who use drugs in the intervention exhibited a significantly greater improvement in the overall STTR score than those in the control (p-values < .0001). The multi-layer heatmap revealed different patterns of the individual domains over time and the inter-relationships among the individual domains. This study demonstrates the feasibility of constructing a general fulfillment score and domain specific scores to measure care continuum among people who use drugs. The analytical framework can be readily extended to evaluate service fulfillment outcomes in health services and treatment studies for other key populations.

Loss of lean muscle mass and accumulation of adipose tissue are changes associated with aging. Previous studies have documented various components of body composition as predictors for insulin resistance. The objective of this study was to investigate whether components of body composition-appendicular lean mass (ALM) and/or abdominal fat mass (AFM)-correlate with insulin resistance in older men and women. This was a cross-sectional study of 92 older men and women. Weight was classified according to body mass index (BMI)-normal (BMI <25), overweight (BMI 25-30), and obese (BMI >30). All body composition data was determined by dual energy x-ray absorptiometry (DEXA), and insulin resistance was assessed by the homeostatic model assessment of insulin resistance (HOMA-IR). Multivariable regression models with two-way interaction terms were employed to assess whether the associations between components of body composition and log HOMA varied by BMI categories. Adjusted regression showed that log HOMA was significantly associated with AFM (estimate ± standard error: 0.055 ± 0.026) and ALM (0.057 ± 0.029) for the overweight participants (p-values <0.05). Additionally, the adjusted associations between log HOMA and ALM were significantly greater for participants who were either obese or overweight compared to those with a normal BMI (p<0.002). Less consistent relationships were observed between insulin resistance and abdominal fat mass across BMI categories, whereas more consistent associations were observed between insulin resistance and appendicular lean mass in individuals with greater BMI. Further research is needed to clarify if lipid deposition within muscle tissue promotes muscle dysfunction and thereby increases risk for insulin resistance.

Social support promotes positive coping strategies among people living with HIV (PLH); however, little is known about the various aspects of social support and their distinct effects on coping. The present study investigates the specific links between coping and perceived social support with respect to gender and education among PLH. A total of 522 PLH in Anhui, China, participated in an assessment that collected data on demographics, perceived tangible and emotional support, and cognitive and behavioral coping. The assessment was conducted using the computer-assisted personal interviewing method. The data were analyzed using linear mixed models. Emotional support was significantly associated with both cognitive and behavioral coping. Tangible support was significantly associated with behavioral coping but not with emotional coping. Women reported significantly lower levels of emotional support, cognitive coping, and behavioral coping than men did. Significant associations between tangible support and coping were found only among illiterate males. Women living with HIV are in greater need of social support and coping strategies. Future interventions should be gender specific, with targeted support for women with lower education levels to enhance their coping strategies.

Previous studies suggest that the implementation of universal precaution (UP) plays a role in reducing HIV stigma. In this study we investigate the efficacy of a stigma reduction intervention on UP compliance and explore whether UP compliance could potentially influence HIV stigma reduction in medical settings. A randomized controlled intervention trial was conducted in two provinces of China with 1760 healthcare service providers recruited from 40 county-level hospitals. Longitudinal analyses included data collection at baseline, 6-, and 12-month follow-up assessments. Using a hierarchical modeling approach, we estimated the intervention effect for each provider's UP compliance and its potential mediating role on HIV stigma with the bootstrapping method. A significant intervention effect on UP compliance was observed at both the 6- and 12-month follow-up assessments. The intervention effect on provider avoidance intent was partially mediated by the provider's own UP compliance at the two follow-up points. This study provides evidence that UP compliance should be part of HIV stigma reduction programs, especially in resource-restrained countries. Findings suggest that a protected work environment may be necessary but not sufficient to address HIV stigma in medical settings.

BACKGROUND: Little 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 SETTING: Serial cross-sectional analysis of self-reported data from the National Health and Examination Survey (NHANES), 1999-2014. PARTICIPANTS: 20,585 participants aged ≥45 years during 1999-2014, who reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Latino/Hispanic. MEASUREMENTS: The 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. RESULTS: In 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. CONCLUSIONS: The 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.

Background

Little 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 setting

Serial cross-sectional analysis of self-reported data from the National Health and Examination Survey (NHANES), 1999-2014.

Participants

20,585 participants aged ≥45 years during 1999-2014, who reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Latino/Hispanic.

Measurements

The 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.

Results

In 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.

Conclusions

The 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.

Background

The current study was performed to identify risk factors for a lower quality of life (QOL) among low-income women with breast cancer (BC), with an emphasis on the impact of patient-physician communication. In addition, ethnic/racial group differences in QOL changes over time were examined.

Methods

A longitudinal study was conducted among 921 low-income women with BC. Patients were interviewed at 6 months, 18 months, 36 months, and 60 months after their diagnosis of BC. Mixed-effect regression models were performed to investigate predictors for and time effects on QOL. The main outcomes included the Medical Outcomes Study Health Survey Short Form-36 Mental Component Summary scale (SF-36 MCS), Medical Outcomes Study Health Survey Short Form-36 Physical Component Summary scale (SF-36 PCS), and the Ladder of Life scale. Chief independent variables included physician information-giving and patient self-efficacy in interacting with physicians.

Results

There were no significant changes noted over time in QOL except with regard to physical functioning, with survivors reporting a significant decrease over time (P<.0001). Mean SF-36 MCS and SF-36 PCS scores were lower than national general population norms at all time points. Both patient self-efficacy in interacting with physicians and physician information-giving were found to be positively associated with the SF-36 MCS (P = .03 and P = .02, respectively) and Ladder of Life (P = .01 and P = .03, respectively) scales. Latinas who were less acculturated reported higher SF-36 MCS and SF-36 PCS scores (P<.0001 and P = .01, respectively) and better global QOL (P<.0001) than white women.

Conclusions

Low-income women with BC experienced poor physical and mental health. The results of the current study suggest that QOL among low-income women with BC would be enhanced by interventions aimed at empowering patients in communicating with physicians and increasing the amount of information provided by physicians.

This study compared community health workers' (CHW) stigma towards people living with HIV (PLH) and people who use drugs (PWUD) and explored the relationship between stigma and CHWs' confidence level in providing HIV/drug-related services. Using two sets of identically worded questions, levels of stigma towards PWUD and PLH were measured among 120 CHW from 60 communes in Vietnam. The associations between CHWs' confidence in service provision and stigma towards PWUD and PLH were examined using a linear mixed-effects regression model. The majority of the CHW reported higher levels of stigma towards PWUD than towards PLH. Compared to the CHW reporting higher stigma towards PWUD, those with higher stigma towards PLH were significantly less confident in service provision. Social opprobrium attached to drug-using behaviors can be a major driver behind the overall HIV stigma. CHWs' fear of HIV infection should be tackled to boost their confidence in HIV/drug-related care provision.

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.