Caregiver Burden Among Informal Caregivers of Persons Living with HIV/AIDS in Liangshan Prefecture, China.

Purpose: Previous studies revealed that informal caregivers for persons living with HIV/AIDS (PLWHA) experience perceived caregiver burden. Although Liangshan prefecture is one of the areas with the fastest growing HIV/AIDS epidemics in China, little is known about burden of informal caregivers for PLWHA. This study aimed to evaluate caregiver burden and these predictors among informal caregivers of PLWHA in Liangshan prefecture, China. Methods: This was a cross-sectional study conducted from August to December 2017. We used convenience sampling to recruit informal caregivers of PLWHA. A total of 222 participants completed questionnaires including demographic information, caregiving-related information, and caregiver burden (measured by Zarit Burden Interview, ZBI). SPSS software was used to analyze the data. Independent student's t-test, one-way analysis of variance (one-way ANOVA), Spearman rank correlation, and multiple linear regression analysis were performed. Results: The mean ZBI score was 40.61 (SD = 14.47), and 199 (89.6%) informal caregivers had a mild or above caregiver burden. Multiple linear regression analysis revealed that older age (P=0.003), caregivers with poor health (P=0.002), parent-caregivers (P=0.001), poorer ability in 'balancing caregiving needs and their own needs' (P<0.001), and 'managing emotional needs' (P=0.014) were significantly associated with higher level of caregiver burden. Conclusion: The majority of informal caregivers had perceived caregiver burden in Liangshan prefecture of China. Findings emphasize that health-care providers, medical institutions and government should develop educational programs and policy to improve caregiver's ability to cope with caregiving for PLWHA, and take more attention to caregivers with health problem, at older age, parent-caregivers. These may contribute to reducing caregiver burden among informal caregivers of PLWHA.

Internet Use for Health-Related Information: Self-Care Agency of Lower Income Persons Living With HIV/AIDS.

Chronically ill persons with a condition requiring self-care activities can benefit from learning from reliable internet sources. Orem's theory of self-care was used to answer the question: Does increasing technical knowledge about reliable internet sites for health information increase self-care agency of low-income persons living with HIV/AIDS (N = 100)? Self-care agency, as measured by the Self-As-Carer Inventory, increased but not significantly, after two educational interventions. We hoped to gain insight into the measurement of self-care agency in our African American and Hispanic population. The only significantly different basic conditioning factor was ethnicity in that non-Hispanic/Latinos scored higher on self-care agency than Hispanic/Latinos; the only significantly different subscale was the Judgment and Decisions Affecting Production of Self-care subscale. Self-care agency remained stable over the 1-week period, pointing to two possible conclusions: Scores accurately reflect self-care agency, and a more intensive, longer intervention may be needed to change self-care agency.

Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial.

BACKGROUND: Psychosocial characteristics, including self-esteem, perceived social support, coping skills, stigma, discrimination, and poverty, are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV and the associations between psychosocial characteristics and HIV treatment outcomes are limited in sub-Saharan Africa. OBJECTIVE: This paper aims to describe the recruitment process and baseline characteristics associated with depression in a sample of HIV-positive people in a cluster randomized trial of group support psychotherapy (GSP) for depression delivered by trained lay health workers (LHWs). METHODS: Thirty eligible primary care health centers across three districts in Uganda were randomly allocated to have their LHWs trained to deliver GSP (intervention arm) or group HIV education and treatment as usual (control arm) to persons living with HIV comorbid with depression. Baseline demographic, socioeconomic, and psychosocial characteristics were collected via interviewer-administered questionnaires. Among eligible participants, differences between those enrolled versus those who refused enrollment were assessed using chi square for categorical variables and t tests for continuous variables. Spearman rank order correlation analyses were conducted to determine associations between baseline depression symptoms and adherence to antiretroviral therapy (ART), viral load suppression, and other psychosocial variables. RESULTS: The study screened 1473 people and 1140 were found to be eligible and enrolled over 14 weeks. Participants recruited comprised 95% of the target sample size of 1200. The sample's mean age was 38.5 (SD 10.9) years and both genders were well represented (males: 46.32%, 528/1140). Most participants met the diagnostic criteria for major depressive disorder (96.92%, 1105/1140), had significant posttraumatic stress symptoms (72.46%, 826/1140), reported moderate suicide risk (52.54%, 599/1140), had primary or no formal education (86.22%, 983/1140), and reported no income-generating activity (72.63%, 828/1140) and no food insecurity (81.67%, 931/1140). Among eligible participants, 48 of 1140 (4.21%) refused to participate in the interventions; these participants were more likely to be males (χ21=4.0, P=.045) and have significantly lower depression symptoms scores (t2=2.36, P=.01) than those who participated in the interventions. There was a significant positive correlation between viral load and number of traumatic experiences (ρ=.12, P=.05). Adherence to ART was positively correlated with perceived social support (ρ=.15, P<.001), but negatively correlated with depression symptoms (ρ=-.11, P=.05) and stigma (ρ=-.14, P<.001). CONCLUSIONS: Men and women with HIV and depression experience multiple social and economic vulnerabilities and disadvantages. Culturally tailored psychological interventions aimed at these individuals should address these socioeconomic disadvantages in addition to addressing their mental health care needs. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201608001738234; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1738 (Archived by WebCite at http://www.webcitation.org/74NtMphom).

Managing HIV-positive sero-status in Ghana's most HIV concentrated district: self-perceived explanations and theoretical discourse.

As of December 2015 there were 37 million persons living with HIV/AIDS (PLWHAs), 70% of whom are in sub-Saharan Africa. Ghana, which contributes a relatively small number to Africa's HIV burden, has a generalised HIV epidemic. The current national prevalence is 1.47%. Agormanya, one of the HIV sentinel sites in the county and where this study was conducted, has current prevalence of 11.6%. This makes it critical to explore how persons infected with HIV manage their lives, especially in the midst of entrenched stigma and discrimination. However, available information on how PLWHAs in sub-Saharan Africa handle their day-to-day lives mostly dwell on food and nutrition. Thus, there is dearth of information on how PLWHAs in Ghana particularly handle the circumstances of their daily lives which are mostly coloured by their HIV-positive statuses, given their stigmatised identity. We explore how PLWHAs respond to the experiences and challenges of living with HIV/AIDS in Lower Manya Krobo, consistently most HIV-infected district in Ghana. Data were collected from 38 combined purposive and randomly selected HIV-positive persons in two leading hospitals (St Martins Depores Agormanya and Atua Government hospitals which provide specialised HIV care in the district. Using in-depth interviews, we studied how PLWHAs managed their routine livelihoods in the midst of extreme stigma. We combined the social capital and resilience theoretical frameworks to show that our respondents were mostly resilient and strategically mostly drew upon extended family social support to cope with their livelihood challenges. We recommend that community opinion leaders and other stakeholders sensitise community members in Lower Manya Krobo to better understand the mode of HIV infection and encourage/strengthen family and community cohesion and social support.

The Effect of Group Support Psychotherapy Delivered by Trained Lay Health Workers for Depression Treatment Among People with HIV in Uganda: Protocol of a Pragmatic, Cluster Randomized Trial.

BACKGROUND: There is limited information on the effectiveness of task shifting of mental health services in populations with HIV. OBJECTIVE: This trial aims to evaluate the effectiveness of group support psychotherapy delivered by trained lay health workers to persons living with HIV (PLWH) with depression in primary care. METHODS: Thirty eligible primary care health centers across three districts were randomly allocated to have their lay health workers trained to deliver group support psychotherapy (intervention arm) or group HIV education and treatment as usual (control arm) to PLWH with depression. Treated PLWH will be evaluated at baseline, after the end of treatment, and at 6-month intervals thereafter for 2 years. Primary outcomes will be the difference in follow-up proportions of participants with Mini International Neuropsychiatric Interview criteria for major depression and difference in follow-up function scores of participants in the intervention and control arms 6 months after the end of treatment. Secondary outcomes will include measures of self-esteem, posttraumatic stress symptoms, social support, stigma, adherence to antiretroviral therapy, viral load, and number of disability days, asset possession indices, and cost-effectiveness data. Primary and secondary outcomes as well as subgroup analyses will be conducted at the individual level using multilevel random effects regression analyses adjusting for clustering in health centers. A process evaluation using mixed methods to assess acceptability, feasibility, fidelity, causal mediating processes, and contextual influences in the trial will be conducted. RESULTS: The trial has been approved by the Makerere College of Health Sciences School of Health Sciences Research Ethics Committee, the AIDS Support Organization, and the Uganda National Council of Science and Technology. A data and safety monitoring board has been put in place to monitor trial progress. A total of 1140 persons living with HIV have been recruited to the trial. An analysis of baseline and 6-month data is in progress. The results of this trial will not only be presented at national and international conferences but also submitted for publication in peer-reviewed journals and as a report to the funding agencies. CONCLUSIONS: This cluster randomized trial will provide critical evidence to support culturally sensitive group-based psychotherapy for depression treatment in sub-Saharan Africa. Process evaluation outcomes will provide contextual information that health care and public health stakeholders can use to guide implementation decisions for their particular setting. TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR): 201608001738234; http://www.pactr.org/ATMWeb/ appmanager/atm/atmregistry?dar=true&tNo=PACTR201608001738234 (Archived by WebCite at http://www.webcitation.org/ 6vUAgAQlj).

Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians.

BACKGROUND: Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle. METHODS: Two anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013-January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing). RESULTS: Eighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% "had heard" of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor. CONCLUSIONS: At a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of PLWHA were aware of it, and approximately 10% reported PrEP use in their close circle, although they rarely shared their ARVs with uninfected people for this purpose. Official policies and PrEP availability, along with implementation programs, could avoid risks from uncontrolled PrEP procurement and self-administration practices.

Process Evaluation of a Randomized Controlled Trial of Group Support Psychotherapy for Depression Treatment Among People with HIV/AIDS in Northern Uganda.

We describe the process evaluation for a randomized controlled trial that compared group support psychotherapy (GSP) with group HIV education for treatment of depression among people with HIV. Process data were obtained using mixed methods. Variables evaluated were indicators of feasibility and acceptability; causal mediating processes and contextual influences. GSP was feasible and acceptable. Potential mediating variables between GSP and reduction of depression were improved emotional and social support, better coping strategies, and pursuit of livelihoods. Culturally sensitive intervention content facilitated intervention delivery. These data complement the trial outcomes, and may provide a contextualized description of how GSP treats depression.

Caregiving to persons living with HIV/AIDS: experiences of Vietnamese family members.

AIMS AND OBJECTIVES: To examine the experiences of caregiving among Vietnamese family members of persons living with HIV/AIDS. BACKGROUND: As the number of persons living with HIV/AIDS increases, the need of family caregivers who can take responsibility for the home care of these persons increases. Vietnam has one of the fastest growing HIV epidemics in Asia. DESIGN: A descriptive cross-sectional study with quantitative and qualitative methods was used. METHODS: A purposive sample of 104 family caregivers, both male and female, participated voluntarily by answering a questionnaire of caregiver burden, and 20 of them participated in in-depth interview. RESULTS: Female caregivers were mainly mothers and wives while male caregivers were mainly husbands, fathers and siblings. The largest group of family caregivers reported moderate to severe burden. There was no difference between genders in total caregiver burden, but there were several differences between older and younger caregivers in some items of caregiver burden. Five categories of experiences emerged: Different types of caregiving to persons living with HIV/AIDS, cultural and religious issues associated with caregiving, keeping secret to avoid stigma and discrimination, lack of knowledge about disease and provision of care, and fear, anxiety and frustration. CONCLUSIONS: Stigma and discrimination should be decreased by providing knowledge to the general public about HIV/AIDS, in particular about ways of transmission and protection. Special knowledge should be given to family caregivers to enable them to give care to persons living with HIV/AIDS at home. This could be done through culturally appropriate training/intervention programmes in which coping methods should be included. Support group interventions should also be carried through. The results obtained can be used as baseline information. RELEVANCE TO CLINICAL PRACTICE: Health care providers should consider gender, age and culture of family members of persons living with HIV/AIDS. Knowledge about HIV/AIDS, provision of care at home and in hospital, and support groups should be developed and implemented.

Cigarette smoking among Chinese PLWHA: An exploration of changes in smoking after being tested HIV positive.

Prevention and cessation of Tobacco use among persons living with HIV/AIDS (PLWHA) represents a significant challenge for HIV/AIDS patient care in China and across the globe. Awareness of HIV-positive status may alter the likelihood for PLWHA smokers to change their smoking habit. In this study, we tested the risk enhancement and risk reduction hypotheses by assessing changes in cigarette smoking behavior among PLWHA after they received the positive results of their HIV tests. Cross-sectional survey data collected from a random sample of 2973 PLWHA in care in Guangxi, China were analyzed. Changes in cigarette smoking after receiving the HIV-positive test results, as well as the current levels of cigarette smoking were measured. Among the total participants, 1529 (51.7%) were self-identified as cigarette smokers, of whom 436 (28.9%) reduced smoking and 286 (19.0%) quit after receiving their HIV-positive test results. Among the quitters, 210 (73.9%) remained abstinent for a median duration of two years. There were also 124 (8.2%) who increased cigarette smoking. Older age, female gender, more education, and receiving antiretroviral therapy were associated with quitting. In conclusion, our study findings support the risk reduction and risk enhancement hypotheses. A large proportion of smoking PLWHA reduced or quit smoking, while a small proportion increased smoking. Findings of this study suggest that the timing when a person receives his or her HIV-positive test result may be an ideal opportunity for care providers to deliver tobacco cessation interventions. Longitudinal studies are indicated to verify the findings of this study and to support smoking cessation intervention among PLWHA in the future.

Bem-estar psicológico, enfrentamento e lipodistrofia em pessoas vivendo com HIV/AIDS / Bienestar psicológico, afrontamiento y lipodistrofia en personas que viven con VIH/Sida / Psychological well-being, coping and lipodystrophy in HIV/AIDS people

Os objetivos do estudo foram investigar os efeitos da lipodistrofia sobre o bem-estar psicológico e a adesão ao tratamento anti-retroviral, e identificar as estratégias de enfrentamento utilizadas por pessoas soropositivas afetadas pela síndrome. Participaram 21 pessoas, com idades entre 29 e 52 anos, das quais quatorze eram homens. As entrevistas foram analisadas com base na análise de conteúdo categorial. Os resultados apontaram que a descoberta e a vivência da lipodistrofia podem afetar o bem-estar psicológico, ocasionando redução da auto-estima, percepção negativa da imagem corporal e evitação de contatos sociais. Não se observou impacto negativo sobre a conduta de adesão. As estratégias de enfrentamento relatadas com maior freqüência foram: prática de atividade física, uso de roupas que escondam as mudanças corporais, realização de procedimentos estéticos e adoção de novos hábitos alimentares. Conclui-se que a ocorrência da lipodistrofia pode acarretar dificuldades psicológicas, merecendo atenção das equipes de saúde que atuam em HIV/aids.(AU)

The study investigates the effects of the HIV lipodystrophy syndrome on the psychological well-being and on the adherence to anti-retroviral treatment. It also identifies the coping strategies used. Twenty-one people, age bracket 29 - 52 years old, including fourteen males, took part in the research. Data procedures included structured and semi-structured interview. Results showed that disclosure of lipodystrophy may affect the psychological well-being, leading towards a decrease in self-esteem, negative perception of body image and avoidance of social relationships. The most related coping strategies consisted of practice of physical activities, usage of clothing which can hide body changes, realization of esthetic procedures and the adoption of new feeding habits. Results show that lipodystrophy experience may cause relevant emotional and psychological difficulties to affected people. This fact suggests that it should be given more attention to health professionals who deal with HIV/AIDS.(AU)

Los objetivos del estudio fueron explorar los efectos de la lipodistrofia en el bienestar psicológico, la adhesión al tratamiento antirretroviral, bien como identificar las estrategias de afrontamiento utilizadas por personas soropositivas con lipodistrofia. Participaran de la investigación 21 personas, con edades entre 29 y 52 años, catorce hombres. El análisis de las entrevistas siguió la técnica de análisis de contenido categorial. Los resultados indican que la descubierta y vivencia de la lipodistrofia pueden afectan el bienestar psicológico, lo que ocasiona reducción en la autoestima, percepción negativa de la imagen corporal y evitación de personas de la red social. No se ha observado impacto negativo en las conductas de adhesión al tratamiento. Las más frecuentes estrategias de afrontamiento relatadas fueron: práctica de actividad física, uso de ropas que disfrazan los cambios corporales, realización de procedimientos estéticos y adopción de nuevos hábitos alimentares. Se ha concluido que la lipodistrofia puede causar dificultades psicológicas, lo que justifica una atención especial de los equipos de salud que actúan en VIH/Sida.(AU)

Bem-estar psicológico, enfrentamento e lipodistrofia em pessoas vivendo com HIV/AIDS / Bienestar psicológico, afrontamiento y lipodistrofia en personas que viven con VIH/Sida / Psychological well-being, coping and lipodystrophy in HIV/AIDS people

Os objetivos do estudo foram investigar os efeitos da lipodistrofia sobre o bem-estar psicológico e a adesão ao tratamento anti-retroviral, e identificar as estratégias de enfrentamento utilizadas por pessoas soropositivas afetadas pela síndrome. Participaram 21 pessoas, com idades entre 29 e 52 anos, das quais quatorze eram homens. As entrevistas foram analisadas com base na análise de conteúdo categorial. Os resultados apontaram que a descoberta e a vivência da lipodistrofia podem afetar o bem-estar psicológico, ocasionando redução da auto-estima, percepção negativa da imagem corporal e evitação de contatos sociais. Não se observou impacto negativo sobre a conduta de adesão. As estratégias de enfrentamento relatadas com maior freqüência foram: prática de atividade física, uso de roupas que escondam as mudanças corporais, realização de procedimentos estéticos e adoção de novos hábitos alimentares. Conclui-se que a ocorrência da lipodistrofia pode acarretar dificuldades psicológicas, merecendo atenção das equipes de saúde que atuam em HIV/aids.

The study investigates the effects of the HIV lipodystrophy syndrome on the psychological well-being and on the adherence to anti-retroviral treatment. It also identifies the coping strategies used. Twenty-one people, age bracket 29 - 52 years old, including fourteen males, took part in the research. Data procedures included structured and semi-structured interview. Results showed that disclosure of lipodystrophy may affect the psychological well-being, leading towards a decrease in self-esteem, negative perception of body image and avoidance of social relationships. The most related coping strategies consisted of practice of physical activities, usage of clothing which can hide body changes, realization of esthetic procedures and the adoption of new feeding habits. Results show that lipodystrophy experience may cause relevant emotional and psychological difficulties to affected people. This fact suggests that it should be given more attention to health professionals who deal with HIV/AIDS.

Los objetivos del estudio fueron explorar los efectos de la lipodistrofia en el bienestar psicológico, la adhesión al tratamiento antirretroviral, bien como identificar las estrategias de afrontamiento utilizadas por personas soropositivas con lipodistrofia. Participaran de la investigación 21 personas, con edades entre 29 y 52 años, catorce hombres. El análisis de las entrevistas siguió la técnica de análisis de contenido categorial. Los resultados indican que la descubierta y vivencia de la lipodistrofia pueden afectan el bienestar psicológico, lo que ocasiona reducción en la autoestima, percepción negativa de la imagen corporal y evitación de personas de la red social. No se ha observado impacto negativo en las conductas de adhesión al tratamiento. Las más frecuentes estrategias de afrontamiento relatadas fueron: práctica de actividad física, uso de ropas que disfrazan los cambios corporales, realización de procedimientos estéticos y adopción de nuevos hábitos alimentares. Se ha concluido que la lipodistrofia puede causar dificultades psicológicas, lo que justifica una atención especial de los equipos de salud que actúan en VIH/Sida.