The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.

Physical activity in Black breast cancer survivors: implications for quality of life and mood at baseline and 6-month follow-up.

BACKGROUND: The present study sought to examine the influence of physical activity on quality of life and negative mood in a sample of Black breast cancer survivors to determine if physical activity (dichotomized) predicted mean differences in negative mood and quality of life in this population. METHODS: Study participants include 114 women diagnosed with breast cancer (any stage of disease, any type of breast cancer) recruited to participate in an adaptive cognitive-behavioral stress management intervention. The mean body mass index of the sample at baseline was 31.39 (standard deviation = 7.17). RESULTS: A multivariate analysis of covariance (MANCOVA) was conducted to determine if baseline physical activity predicted mean differences in negative mood and quality of life at baseline and at follow ups while controlling for relevant covariates. A one-way MANCOVA revealed a significant multivariate effect by physical activity group for the combined dependent variables at Time 2 (post 10-week intervention), p = .039. The second one-way MANCOVA revealed a significant multivariate effect at Time 3 (6 months after Time 2), p = .034. Specifically, Black breast cancer survivors who engaged in physical activity experienced significantly lower negative mood and higher social/family well-being at Time 2 and higher spiritual and functional well-being at Times 2 and 3. CONCLUSIONS: Results show that baseline physical activity served protective functions for breast cancer survivors over time. Developing culturally relevant physical activity interventions specifically for Black breast cancer survivors may prove vital to improving quality of life and mood in this population. Copyright © 2016 John Wiley & Sons, Ltd.

Contextualizing Psychosocial Determinants of Alcohol Use by Age Cohorts of Adults Living With HIV, Ages 50 and Older.

We examined the influence of age on associations between affective states, social support, and alcohol use by age cohorts. We recruited 96 older Black adults living with HIV from the southeastern United States in 2013 and 2014. Participants completed questionnaires assessing demographics, psychological function, and substance use. Hierarchical regression analyses assessed the relationship between psychosocial factors and alcohol use in a 50- to 59-year-old group, and a 60-years-and-older age group. After controlling for covariates, trait anger, state anger, and life stress were positively associated with alcohol consumption in the younger group, while social support was negatively associated with alcohol consumption in the older group. Interventions should target negative affective states in 50- to 59-year-old adults with HIV, and preserve social support for adults with HIV as they age, as such interventions will likely have an impact on these individuals' alcohol consumption and longstanding quality of life.

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users.

BACKGROUND: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS: Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.

Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+.

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR = 3.37, 95% CI: 1.23-9.21, p = .018 and heavy drinking, AOR = 2.47, 95% CI: 1.07-5.71, p = .033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.

Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs.

BACKGROUND: Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort. OBJECTIVES: This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use. METHODS: The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older"). RESULTS: Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior. CONCLUSIONS/IMPORTANCE: Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.

Increased risk for substance use and health-related problems among homeless veterans.

BACKGROUND AND OBJECTIVES: The first aim of this study was to compare self-reported causes of homelessness between veterans and nonveterans. A second aim examined whether homeless male veterans were more likely than homeless male nonveterans to experience current problems with addictions, mental health, and physical health. Additionally, a third aim was to compare frequency of emergency room visits and treatment needs between the two groups. METHODS: Secondary data analyses compared male homeless veterans and nonveterans (N = 353) enrolled in the Alachua County Point in Time study in central Florida. Participants completed a questionnaire on demographics and health variables. Additional questions included recent emergency room visits and medical or other needs not being met. RESULTS: Veterans reported higher rates of substance use and mental health problems as a primary cause of homelessness when compared to nonveterans. Homeless veterans were more likely than nonveterans to report current problems with addictions (OR = 6.29, 95% CI: 3.43-11.53, p < .001), mental health problems (OR = 4.12, 95% CI: 2.28-7.42, p < .001), and physical problems (OR = 1.83, 95% CI: 1.08-3.67, p < .01). Finally, over half of homeless veterans (53.1%) reported an ER visit in the past year compared to only 40.9% of nonveterans (OR = 1.73, 95% CI: 1.07-2.80, p < .05). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Veterans may be more likely to become homeless due to addiction and mental health and over half of homeless veterans are presenting to hospital emergency rooms. Given the greater utilization among homeless veterans, emergency rooms may serve as a prime opportunity to provide brief treatment and referrals for needed services.

Psychosocial interventions addressing the needs of Black women diagnosed with breast cancer: a review of the current landscape.

BACKGROUND: Poorer health outcomes and lower survival rates have been well documented among African American/Black (Black) women diagnosed with breast cancer. Black women are 41% more likely to die from breast cancer than White women despite a lower incidence rate. Apart from pharmacotherapy, psychosocial interventions are recommended by the Institute of Medicine as standard medical care for breast cancer patients at all phases of treatment. The current review is the first attempt to systematically evaluate the literature on the influence of psychosocial interventions for Black women diagnosed with breast cancer. METHODS: This systematic review aimed to adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive computerized literature search of CINAHL, PsycINFO, PubMed, and Web of Science was conducted to obtain relevant studies. RESULTS: Interventions demonstrated improved mood, decreased distress, increased ability to cope with intrusive thoughts and cancer-related stress, personal growth, and improved social well-being. However, aspects unique to this population require additional scientific inquiry. Over 80% of empirical interventions focused on Black women diagnosed with breast cancer have been concentrated on the posttreatment phase. There is a paucity of work at the time of diagnosis and during treatment. CONCLUSIONS: To address gaps in the scientific literature, more work is needed to better understand how psychosocial interventions can improve the health trajectory for Black women diagnosed with breast cancer particularly in the areas of seeking help and support, identifying culturally acceptable methods for engaging support networks, and identifying best practices for enhancing coping skills.

Time Since Release from Incarceration and HIV Risk Behaviors Among Women: The Potential Protective Role of Committed Partners During Re-entry.

After release from incarceration, former female inmates face considerable stressors, which may influence drug use and other risk behaviors that increase risk for HIV infection. Involvement in a committed partnership may protect women against re-entry stressors that may lead to risky behaviors. This study measured the association between time since release from incarceration (1-6 months ago, and >6 months ago versus never incarcerated) and HIV risk behaviors and evaluated whether these associations differed by involvement in a committed partnership. Women released within the past 6 months were significantly more likely to have smoked crack cocaine, used injection drugs and engaged in transactional sex in the past month compared to never-incarcerated women and women released more distally. Stratified analyses indicated that incarceration within the past 6 months was associated with crack cocaine smoking, injection drug use and transactional sex among women without a committed partner yet unassociated with these risk behaviors among those with a committed partner.

Perceived barriers to treatment in a community-based sample of illicit-drug-using African American men and women.

This study examines perceived substance use treatment barriers in a community-based sample of 267 African Americans from Baltimore, MD. Both men and women endorsed "they can handle it alone" as a primary reason they were not currently in treatment. However, men were two times more likely (AOR = 2.29 CI = 1.05, 5.02) to endorse "concerns about losing family" as the reason they are not currently in treatment. The present study yields interesting findings among African Americans, which should be considered when creating interventions for particular groups of African Americans.

Age cohort differences in illicit drug use and hepatitis C among African American substance users.

Identifying prognostic indicators for undiagnosed Hepatitis C is crucial to attenuate the negative impact of this disease. This study explored the influence of recent and more distal injection drug use on biologically confirmed Hepatitis C infection among a sample (N = 260) of older and younger African Americans. Data from the baseline assessment of the NEURO-HIV epidemiologic study was analyzed using confounder adjusted regression techniques. Older adults were more likely to test positive for Hepatitis C (OR = 2.80, 95% CI = 1.53-5.11) due to lifetime injection drug use (AOR = 5.37, 95% CI = 3.10-9.28). Clinical implications are discussed.

The association between depressive symptoms, anger, and perceived support resources among underserved older HIV positive black/African American adults.

By 2015, half of those living with HIV in the United States will be ≥50 years of age. Research suggests that perceived social support is an important factor in maintaining positive health behaviors in this population. The present study examined the relationship between depressive symptoms and trait anger on perceived social support in a sample of low-income HIV positive (HIV+) African Americans ≥50 years of age. Additionally, we examined life stressors moderated the relationship between mental health and perceived support. This study includes 95 HIV+ men and women ≥50 years of age who identify as black/African American. As expected, depressive symptoms and trait anger showed a strong inverse relationship with perceived support resources. Furthermore, life stressors also showed a strong inverse relationship with perceived support. However, life stressors did not moderate the relationship between depressive symptoms and anger. Instead life stressors demonstrated a strong independent relationship with perceived support. The association between depressive symptoms, trait anger, life stressors, and lower perceived support suggests that these factors play a role in one's ability to access needed support resources. Greater perceived support is associated with improved health in HIV+ persons, and may be especially important in tailoring interventions for those ≥50 years of age.

Brain derived neurotrophic factor and cognitive status: the delicate balance among people living with HIV, with and without alcohol abuse.

INTRODUCTION: The advent of combination antiretroviral therapy(cART) has lead to a significant reduction in morbidity and mortality among people living with HIV(PLWH). However, HIV-associated neurocognitive disorders (HAND) still remain a significant problem. One possible mechanism for the persistence of these disorders is through the effect of HIV on brain-derived neurotrophic factor (BDNF). BDNF is influenced by various factors including hazardous alcohol use (HAU), which is prevalent among PLWH. This study attempts to elucidate the relationships between HAU, BDNF and HAND. METHODS: Cross-sectional analyses were conducted on a sample of 199 hazardous alcohol users and 198 non-HAU living with HIV. Members of each group were matched according to sociodemographic characteristics and CD4 count. Research procedures included validated questionnaires, neuropsychological assessments and a blood sample to obtain BDNF and immune measurements. RESULTS: Hazardous alcohol users showed either significantly lower or significantly higher BDNF levels compared to the Non-hazardous (OR=1,4; 95% CI: 1-2.1, p = 0.003). Therefore, for additional analyses, subjects were categorized based on BDNF values in: Group 1 < 4000, Group 2: 4001-7,999 (reference group), and Group 3 for those >8,000 pg/mL. Groups 1 and 3 performed significantly worse than those in Group 2 in the domains of processing speed, auditory-verbal and visuospatial learning and memory. Multivariate analyses confirmed that HAU and BDNF are significant contributors of HAND. CONCLUSION: Our findings offer novel insights into the relationships between BDNF, and alcohol use among PLWH. Our results also lend support to expanding clinical movement to use BDNF as an intervention target for PLWH, in those with evidence of deficiencies, and highlight the importance of including HAUat the inception of clinical trials.

Younger versus older African Americans: patterns and prevalence of recent illicit drug use.

OBJECTIVES: The current study examined recent substance use among younger and older African Americans and factors associated with recent use. METHODS: The current study used a subset of African American men and women (N = 260) from the NEURO-HIV Epidemiological Study (Mage = 42, SD = 9.27; 59% female). Self-report of past 6 month substance use was evaluated for 21 different substances by routes of administration (ROA). RESULTS: Older adults were 1.9 times (AOR = 1.92, 95% CI = 1.13-3.26) more likely to have used crack in the past 6 months and half as likely to have used marijuana (AOR = .44, 95% CI = .25-.77). There were no significant differences for heroin use. DISCUSSION: Substance use at midlife may have significant implications for adverse social and health outcomes among African Americans. Findings support the need to better understand the developmental pathways of drug use and dependence among African Americans.

Binge drinking, stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men.

BACKGROUND: Relatively little research has examined the effects of binge drinking and HIV risk in heterosexual Black men. Even less research has explored this relationship in illicit drug using heterosexual Black men who are at an elevated risk of contracting and transmitting HIV through various vectors, including risky sexual behavior, in the Black community. PURPOSE: The purpose of the current study is to examine the associations between binge drinking, drug use and HIV status in a community-based sample of 127 self-identified heterosexual Black men. RESULTS: Overall, 17% reported binge drinking in the past month. Both stimulant use (AOR 7.29; 95%; CIs, 2.07, 25.70), and binge drinking (AOR=5.28; 95% CIs, 1.34, 20.91) were associated with HIV status. CONCLUSION: These findings will inform prevention interventions to reduce the HIV risk among Black heterosexual men.

Awareness of biologically confirmed HCV among a community residing sample of drug users in Baltimore City.

The present study sought to examine: (1) the prevalence and correlates of biologically confirmed Hepatitis C (HCV) and (2) the prevalence and correlates of prior HCV diagnosis and an unmet need for HCV treatment, among a community residing sample of drug users. The current study used a subset of HCV tested participants from the larger NEURO-HIV Epidemiologic Study from Baltimore, Maryland (M(age) = 34.81, SD = 9.25; 46% female). All participants were tested for HCV at baseline. Self-report was used to assess awareness of an HCV diagnosis and participation in treatment. Of the 782 participants tested for HCV, 19% reported having received an HCV diagnosis in the past while 48% tested positive for HCV. Only 6% reported having received treatment for any form of hepatitis. Of those who tested HCV positive, 63% reported never being diagnosed, and only 13% received any treatment for HCV. We found that only 35% of those who reported a prior HCV diagnosis received any treatment. The findings regarding lack of HCV awareness and diagnosis were considerable as expected. These deficits suggest that there are numerous gaps in patients' knowledge and beliefs regarding HCV that may interfere at multiple steps along the path from diagnosis to treatment. This study clearly demonstrates that a critical need exists to improve public knowledge of HCV risk factors, the need for testing, and the availability of effective treatment.