Lina Bofill

Demographic and psychosocial factors associated with appointment attendance among HIV-positive outpatients

Abstract Non-adherence to medical regimens is a critical threat to HIV-infected individuals. Persons living with HIV/AIDS must adhere to their outpatient medical appointments to benefit from continually improving HIV care regimens. The primary purpose of the present study was to identify individual and psychosocial characteristics associated with HIV-related medical appointment non-attendance. One hundred seventy eight adult participants attending the Outpatient Adult HIV/AIDS Immunology Clinic at Jackson Memorial Hospital (JMH) in Miami, Florida participated in the study. Scheduled and missed appointments obtained retrospectively over a 12-month period indicated that medical appointment non-attendance was a significant problem. Overall, 27.9% of scheduled appointments were missed during the study period. Young age and limited family support were predictors of non-attendance. These findings support those of others and highlight targeted intervention efforts to reduce appointment non-attendance among persons living with HIV/AIDS.

Sex risk practices among HIV-positive individuals in Buenos Aires, Argentina.

We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random sample of 140 HIV-positive individuals was recruited from an HIV primary care clinic in Buenos Aires, Argentina, between August and September 2005. Participants responded survey questions regarding their sexual behaviors in the previous three months. Logistic regression analysis was used to determine factors associated with inconsistent condom use during vaginal, anal, and oral sex. Of the 140 participants surveyed, 69% were male, the mean age was 38 years old, 29% reported having less than a high school education, and 84% reported having engaged in vaginal, anal, and/or oral sex in the past 3 months. Of 53 participants who reported engaging in anal sex, 60% were men who have sex with men, and 40% were heterosexuals. Inconsistent condom use was reported by 31% of participants engaging in anal sex, 39% of participants engaging in vaginal sex, and 71% of participants engaging in oral sex. When adjusting for other factors, participants reporting symptoms of depression were 5.2 times more likely to use condoms inconsistently during vaginal sex, and 4.3 times more likely to use condoms inconsistently during anal sex compared to participants reporting no depression symptoms. Providers should assess sexual risk practices of HIV-positive individuals reporting symptoms of depression, and provide counseling regarding the importance of consistent condom use to those patients who are engaging in unsafe sex practices.

Motivational Interviewing among HIV Health Care Providers: Challenges and Opportunities to Enhance Engagement and Retention in Care in Buenos Aires, Argentina.

In Argentina, providers’ response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = −2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.

The ever changing landscape of Zika virus infection. Learning on the fly

Zika virus (ZIKV) has gone a long way since its humble discovery in a Rhesus sentinel primate in the Zika Forest of Uganda in 1947, to become a potentially devastating international health threat nowadays. For more than half a century ZIKV virus seemed to pose little threat to human beings and for that reason, epidemiological, clinical and therapeutic advances for ZIKV infection have been slow, as a reflection of the relatively small amount of research carried out on the subject as compared with other mosquito-borne viral diseases. Historically restricted to Africa and Asia, outbreaks with variable impact of autochthonous Zika Fever (ZIKF) were reported in the Pacific region since 2007 and then, as predicted from the distribution of the vectors Aedes aegypti and Aedes albopictus, ZIKV began to infect patients in South America in 2014, and eventually spread to Central and North America. The first molecularly confirmed case of Zika virus infection in the Americas Region was reported from Brazil in March 2015. In contrast to the relatively slow spread of Ebola virus through West Africa, the ZIKF epidemics in the Pacific and Americas regions moved very rapidly. Indeed, based on the severity of the health threat associated with the continuing spread of ZIKV disease in Latin America and the Caribbean, on 1 February 2016, the World Health Organization declared Zika virus-associated clusters of microcephaly and related neurological disorders a ‘Public Health Emergency of International Concern’. The number of patients affected by ZIKF in the Western Hemisphere increased sharply. As of August 22, 2016 45 countries and Territories throughout the Americas have reported more than 577,000 locally-acquired cases, with estimates of several million real cases, over a period of about one year and a half. Mathematical models have estimated the basic reproduction number (R0), or number of cases one case generates on average over the course of its infectious period in an otherwise uninfected population, for ZIKV in the region from 1.4 to 6.6 as key measure of transmissibility in a number of settings. The underlying reasons for the observed global spread of ZIKV are not fully understood highlighting how little we still understand about the global spread of flaviviruses and other vector-borne diseases. Hypotheses currently under consideration include possibilities as diverse as adaptive evolution of ZIKV allowing for an enhanced infectivity to urban Aedes species vectors, or alternatively, adaptive evolution in the human host, leading to higher levels of viremia which would instead enhance both the transmission by the biting mosquitos and the risk of transplacental fetal transmission. Not least important appears to be the

Congenital Chagas’ disease transmission in the United States: Diagnosis in adulthood

Two brothers with congenitally-acquired Chagas’ disease (CD) diagnosed during adulthood are reported. The patients were born in the USA to a mother from Bolivia who on subsequent assessment was found to be serologically positive for Trypanosoma cruzi. Serologic screening of all pregnant women who migrated from countries with endemic CD is strongly recommended.

Suicidality among nonadherent patients living with HIV in Buenos Aires, Argentina: prevalence and correlates

ABSTRACT Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD

Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability.

221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.

Skin and Wound Infection by Rapidly Growing Mycobacteria An Unexpected Complication of Liposuction and Liposculpture

ABSTRACT Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.