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Open Access Publications from the University of California

Scholarly Works (19 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2022)

Background. HIV rates among young adults remain high, and those impacted by the justice system are at particular risk. Understanding the factors associated with HIV testing, as well as determining changes in risk behavior after an HIV test, may inform interventions to reduce HIV prevalence among this population. Objective. To determine the individual, contextual, and demographic factors associated with HIV testing among legal-system-impacted young adults, and to explore whether a first HIV test is associated with future risky behavior when compared to never-tested individuals. Design. This retrospective longitudinal study included those adjudicated by the criminal legal system between ages 14-17. Data were collected between 2000-2010; analyses were completed in 2021-2022. Setting. Interviews occurred in participants’ homes and community and correctional settings. Participants. Participants were enrolled in Pathways to Desistance, a study that followed adolescents for seven years after an arrest for a serious offense. In total, 1,354 eligible and interested youth in Pennsylvania and Arizona were enrolled in Pathways, and a diverse subset of 981 male participants were included in this study. Main Outcomes and Measures. Receipt of HIV testing served as the primary outcome; secondary outcomes included frequency of unprotected sex, number of unprotected sexual partners, and alcohol, marijuana, cigarette, and illicit drug use. Hypotheses were generated after data collection was completed. Results. Significant predictors of HIV testing included the total number of sexual partners (OR=1.05, p=0.04), the absence of a biological father (OR=0.50, p=0.003), and living in Arizona vs. Pennsylvania (OR=0.272, p<0.001). Compared to those never tested for HIV, those newly tested significantly differed in the number of unprotected sexual partners (b=0.28, p<0.001), frequency of unprotected sex (b=0.36, p<0.001), and frequency of alcohol (b=0.28, p<0.001) and cigarette use (b=0.27, p<0.001) one year later. Conclusions and Relevance. This study is one of the first to assess predictors of HIV testing among legal-system-impacted young adults living in community and carceral settings, and to assess changes in risk behavior before and after a first HIV test. Future studies should investigate changes in risk behavior among those newly tested to inform HIV testing and care improvement interventions for this population.

    Cover page: HIV Testing and Future Risk Behavior Among Legal-System-Impacted Young Adults
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2017)
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2018)
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2018)
        UNLABELLED: ABSTRACTObjective:Pediatric bone marrow transplants represent a medically stressful, potentially traumatic experience for children and caregivers, and psychological support for parental caregivers is paramount to their long-term well-being. However, many medical centers do not have protocols in place to sustain caregiver well-being during these distressing experiences. METHOD: We report on a case of a 10-month-old infant with Wiskott Aldrich Syndrome who was hospitalized for bone marrow transplantation. RESULT: We describe the significant burden that fell upon caregivers during and after a bone marrow transplantation. SIGNIFICANCE OF RESULTS: This case helped guide our suggestions to improve care for caregivers. Several logistical hurdles could be overcome to alleviate some of these burdens. We suggest that a child psychologist or psychiatrist should be on patient care teams and be attentive to parental stress, impairments, or impediments to self-care, and signs of emergency of mental illness in this setting of medical trauma. Additionally, promotion of sleep hygiene and linkage to support systems can maximize resiliency. Finally, we believe that hospital administrators should partner with clinicians to facilitate routine support during highly stressful transitions of care.
          Cover page: The need to support caregivers during pediatric bone marrow transplantation (BMT): A case report.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2017)
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2018)
            ABSTRACTObjective:Pediatric bone marrow transplants represent a medically stressful, potentially traumatic experience for children and caregivers, and psychological support for parental caregivers is paramount to their long-term well-being. However, many medical centers do not have protocols in place to sustain caregiver well-being during these distressing experiences.

            Method

            We report on a case of a 10-month-old infant with Wiskott Aldrich Syndrome who was hospitalized for bone marrow transplantation.

            Result

            We describe the significant burden that fell upon caregivers during and after a bone marrow transplantation.

            Significance of results

            This case helped guide our suggestions to improve care for caregivers. Several logistical hurdles could be overcome to alleviate some of these burdens. We suggest that a child psychologist or psychiatrist should be on patient care teams and be attentive to parental stress, impairments, or impediments to self-care, and signs of emergency of mental illness in this setting of medical trauma. Additionally, promotion of sleep hygiene and linkage to support systems can maximize resiliency. Finally, we believe that hospital administrators should partner with clinicians to facilitate routine support during highly stressful transitions of care.
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2024)

              Background

              There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic.

              Methods

              We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis.

              Results

              Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices.

              Conclusions

              Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
                Cover page: Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2024)
                Abstract: People with schizophrenia are at increased risk for contracting HIV and face higher mortality rates compared with the general population. Viral suppression is key to HIV care, yet little is known about this metric among people with HIV and schizophrenia. A chart review was conducted among people with HIV/AIDS and schizophrenia living in San Francisco who had received inpatient mental health services between 2010 and 2016. Demographic, laboratory, medication, encounter, and discharge data were collected, and were compared with all people living with HIV in San Francisco (PLWH-SF). Among 153 people living with HIV and comorbid schizophrenia, 77% were virally suppressed, compared to 67% for all PLWH-SF. Viral suppression for people with comorbid HIV and schizophrenia living in San Francisco appears higher than PLWH-SF. Further research is needed to confirm the association and mechanisms behind better treatment outcomes for people living with HIV and comorbid schizophrenia.
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2019)
                  Despite the tremendous growth of the peer specialist workforce in recent decades, significant ethical, political, and procedural challenges remain regarding recruitment and retention of peer staff. This column explores such challenges and potential pitfalls by examining the limits of current accommodation practices, the complexity of "shared identities," and the fraught interplay of disability, stigma, and employee misconduct. Implications for human resources, the importance of proactively addressing power dynamics between peer and nonpeer staff, and potential structural stigma in mental health settings are discussed.
                    • Article
                    • Peer Reviewed
                    UC Berkeley Previously Published Works (2019)
                    Despite the tremendous growth of the peer specialist workforce in recent decades, significant ethical, political, and procedural challenges remain regarding recruitment and retention of peer staff. This column explores such challenges and potential pitfalls by examining the limits of current accommodation practices, the complexity of shared identities, and the fraught interplay of disability, stigma, and employee misconduct. Implications for human resources, the importance of proactively addressing power dynamics between peer and nonpeer staff, and potential structural stigma in mental health settings are discussed.
                      Cover page: Peer Specialists in Community Mental Health: Ongoing Challenges of Inclusion.
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