Sanford School of Public Policy
Duke University
Publications of Kathryn Whetten :chronological alphabetical combined listing:
We've launched a new site so please go to People & Research for current information on our faculty and staff.
%% Books
@book{fds12777,
Author = {Kathryn Whetten and Brian Pence},
Title = {You're the first one I've told: New Faces of HIV in the
South.},
Series = {Second Edition},
Publisher = {Rutgers University Press},
Year = {2013},
Month = {February},
Key = {fds12777}
}
@book{fds301056,
Author = {Whetten, K and Pence, BW},
Title = {You're the first one i've told: The faces of HIV in the deep
south, second edition},
Pages = {1-256},
Year = {2012},
Month = {January},
ISBN = {9780813554532},
Abstract = {The Deep South has seen a 36 percent increase in AIDS cases
while the rest of the nation has seen a 2 percent decline.
Many of the underlying reasons for the disease’s continued
spread in the region—ignorance about HIV, reluctance to
get tested, non-adherence to treatment protocols, resistance
to behavioral changes—remain unaddressed by policymakers.
In this extensively revised second edition, Kathryn Whetten
and Brian Wells Pence present a rich discussion of
twenty-five ethnographic life stories of people living with
HIV in the South. Most importantly, they incorporate
research from their recent quantitative study, “Coping
with HIV/AIDS in the Southeast” (CHASE), which includes
611 HIV-positive patients from North Carolina, South
Carolina, Georgia, Alabama, and Louisiana. This new edition
continues to bring the participants’ voices to life while
highlighting how the CHASE study confirmed many of the
themes that originally emerged from the life histories. This
is the first cohesive compilation of up–to–date evidence
on the unique and difficult aspects of living with HIV in
the Deep South.},
Key = {fds301056}
}
@book{fds153258,
Author = {Buhl, LC and Whetten K. and Whetten R},
Title = {Renewing Struggles for Social Justice: A Primer for
Transformative Leaders},
Publisher = {Compress, Inc.},
Address = {Stellenbosch, South Africa},
Year = {2008},
Key = {fds153258}
}
@book{fds12778,
Author = {Sloan, F.A. and E.M. Stout and K. Whetten-Goldstein and L.
Liang},
Title = {Drinkers, Drivers, and Bartenders: Balancing Private Choices
and Public Accountability},
Publisher = {University of Chicago Press},
Year = {2000},
Key = {fds12778}
}
%% Journal Articles
@article{fds376819,
Author = {Enogieru, I and Blewitt-Golsch, AL and Hart, LJ and LeGrand, S and Whetten, K and Ostbye, T and Johnson, CY},
Title = {Prevalence and correlates of workplace violence: descriptive
results from the National Transgender Discrimination
Survey.},
Journal = {Occup Environ Med},
Year = {2024},
Month = {March},
url = {http://dx.doi.org/10.1136/oemed-2023-109197},
Abstract = {OBJECTIVE: To describe the lifetime prevalence of workplace
harassment, physical violence and sexual assault against
transgender and non-binary workers targeted due to their
gender identity and to identify correlates of this workplace
violence. METHODS: This descriptive cross-sectional study
used data from 4597 transgender or non-binary respondents
from the 2008-2009 National Transgender Discrimination
Survey. Respondents reported if they had ever experienced
harassment, physical violence or sexual assault at work
specifically because of their gender identity. We estimated
the prevalence of each type of violence stratified by gender
identity, race/ethnicity, age, educational attainment,
history of working in the street economy (eg, sex industry,
drug sales) and if people at work knew their gender
identity. RESULTS: Workplace violence was prevalent, with
50% of transgender and non-binary workers having ever
experienced harassment, 7% physical violence and 6% sexual
assault at work because of their gender identity. Harassment
was common among all of these workers, but physical violence
and sexual assault were more than twice as common among
transfeminine and non-binary workers assigned male at birth,
workers of colour, workers with low educational attainment
and those who had ever worked in the street economy.
CONCLUSIONS: Transgender and non-binary workers commonly
face violence at work because of their gender identity.
Workplace violence prevention programmes should incorporate
ways to prevent gender identity-based violence and
facilitate channels for workers to report the occurrence of
discrimination and violence.},
Doi = {10.1136/oemed-2023-109197},
Key = {fds376819}
}
@article{fds373518,
Author = {Kane, JC and Figge, C and Paniagua-Avila, A and Michaels-Strasser, S and Akiba, C and Mwenge, M and Munthali, S and Bolton, P and Skavenski, S and Paul, R and Simenda, F and Whetten, K and Cohen, J and Metz, K and Murray,
LK},
Title = {Effectiveness of trauma-focused cognitive behavioral therapy
compared to psychosocial counseling in reducing HIV risk
behaviors, substance use, and mental health problems among
orphans and vulnerable children in Zambia: a community-based
randomized controlled trial.},
Journal = {AIDS and behavior},
Volume = {28},
Number = {1},
Pages = {245-263},
Year = {2024},
Month = {January},
url = {http://dx.doi.org/10.1007/s10461-023-04179-w},
Abstract = {Orphans and vulnerable children (OVC) in sub-Saharan Africa
are at high risk for HIV infection and transmission. HIV
prevention and treatment efforts with OVC are hindered by
mental health and substance use problems. This randomized
controlled trial compared a mental health intervention,
Trauma Focused Cognitive Behavioral Therapy (TF-CBT), to an
enhanced version of an existing HIV Psychosocial Counseling
(PC+) program among 610 adolescents who met PEPFAR criteria
for OVC and had HIV risk behaviors in Lusaka, Zambia.
Outcomes included HIV risk behaviors (e.g., risky sexual
behaviors), mental health (internalizing symptoms,
externalizing behaviors, PTSD) and substance use. At
12-month follow-up, there were significant within group
reductions in both groups for all outcomes, with the only
significant between group difference being for substance
use, in which OVC who received TF-CBT had significantly
greater reductions than OVC who received PC+. In a subgroup
analysis of OVC with high levels of PTSD symptoms, TF-CBT
was superior to PC + in reducing internalizing symptoms,
functional impairment, and substance use. Findings support
TF-CBT for reducing substance use among OVC. Subgroup
analysis results suggest that a robust intervention such as
TF-CBT is warranted for OVC with significant mental and
behavioral health comorbidities. The similar performance of
TF-CBT and PC + in the overall sample for risky sexual
behavior and mild mental health problems indicates that
enhancing existing psychosocial programs, such as PC, with
standard implementation factors like having a defined
training and supervision schedule (as was done to create
PC+) may improve the efficacy of HIV risk reduction
efforts.Clinical Trials Number: NCT02054780.},
Doi = {10.1007/s10461-023-04179-w},
Key = {fds373518}
}
@article{fds375315,
Author = {Johnson, C and AlRasheed, R and Gray, C and Triplett, N and Mbwayo, A and Weinhold, A and Whetten, K and Dorsey, S},
Title = {Uncovering determinants of perceived feasibility of TF-CBT
through coincidence analysis.},
Journal = {Implementation research and practice},
Volume = {5},
Pages = {26334895231220277},
Year = {2024},
Month = {January},
url = {http://dx.doi.org/10.1177/26334895231220277},
Abstract = {<h4>Introduction</h4>A mental health provider's perception
of how well an intervention can be carried out in their
context (i.e., feasibility) is an important implementation
outcome. This article aims to identify determinants of
feasibility of trauma-focused cognitive behavioral therapy
(TF-CBT) through a case-based causal approach.<h4>Method</h4>Data
come from an implementation-effectiveness study in which lay
counselors (teachers and community health volunteers)
implemented a culturally adapted manualized mental health
intervention, TF-CBT, delivered to teens who were previously
orphaned and were experiencing posttraumatic stress symptoms
and prolonged grief in Western Kenya. The intervention team
identified combinations of determinants that led to
feasibility among teacher- and community health
volunteer-counselors through coincidence
analysis.<h4>Results</h4>Among teacher-counselors,
organizational-level factors (implementation climate,
implementation leadership) determined moderate and high
levels of feasibility. Among community health
volunteer-counselors, a strong relationship between a
clinical supervisor and the supervisee was the most
influential determinant of feasibility.<h4>Conclusion</h4>Methodology
and findings from this article can guide the assessment of
determinants of feasibility and the development of
implementation strategies for manualized mental health
interventions in contexts like Western Kenya.<h4>Plain
language summary</h4>A mental health provider's perception
of how easy a therapy is to use in their work setting (i.e.,
feasibility) can impact whether the provider uses the
therapy in their setting. Implementation researchers have
recommended finding practices and constructs that lead to
important indicators that a therapy will be used. However,
limited research to our knowledge has searched and found
practices and constructs that might determine feasibility of
a therapy. This article uses existing data from a large
trial looking at the continued use of a trauma-focused
therapy to find practices and constructs that lead to
moderate and high levels of feasibility. We found that in
settings with a strong organizational structure that
organization and leadership support for the therapy led to
teachers in Kenya to perceive the therapy as easy to use. On
the other hand, in settings with a weaker organizational
structure, outside support from a clinical supervisor led to
community health volunteers in Kenya perceiving the therapy
as easy to use. The findings from this article can guide
context-specific recommendations for increasing perceived
therapy feasibility at the provider-, organization-, and
policy levels.},
Doi = {10.1177/26334895231220277},
Key = {fds375315}
}
@article{fds372429,
Author = {Huynh, HV and Proeschold-Bell, RJ and Sohail, MM and Nalianya, M and Wafula, S and Amanya, C and Vann, V and Loem, P and Baghdady, AM and Al-Khalaf, MS and Namestnik, A and Whetten, K},
Title = {What processes or key components do teachers attribute to
their well-being? A cross-cultural qualitative study of
teacher well-being in Cambodia, Kenya, and
Qatar},
Journal = {Psychology in the Schools},
Volume = {60},
Number = {12},
Pages = {4967-4987},
Year = {2023},
Month = {December},
url = {http://dx.doi.org/10.1002/pits.23043},
Abstract = {The study of teacher well-being is critically important.
However, teacher well-being studies are lacking in Africa,
Asia, and the Middle East, and also generally in low-income
countries. This exploratory case study sought to identify
teachers' perceptions of work-related characteristics and
personal practices associated with well-being and burnout in
three underrepresented, diverse sites: Battambang, Cambodia;
Bungoma, Kenya; and Doha, Qatar. Ninety teachers
participated in in-depth interviews (Qatar N = 21, Cambodia
N = 33, Kenya N = 36), as well as 16 principals and 11
policymakers. Qualitative analysis was conducted using
data-driven, emergent codes. Findings revealed that teachers
attributed remarkably similar processes and key components
to their well-being (e.g., engagement school-wide or
district-wide, schools attending to teachers' personal
needs) and burnout (e.g., administrative burden, student
misbehavior) across all three sites, with a few notable
differences worthy of future follow-up. Few teachers could
name any well-being programs at their school.},
Doi = {10.1002/pits.23043},
Key = {fds372429}
}
@article{fds373519,
Author = {Malta, M and da Silva, AB and da Silva, CMF and LeGrand, S and Seixas,
M and Benevides, B and Kalume, C and Whetten, K},
Title = {Addressing discrimination and violence against Lesbian, Gay,
Bisexual, Transgender, and Queer (LGBTQ) persons from
Brazil: a mobile health intervention.},
Journal = {BMC public health},
Volume = {23},
Number = {1},
Pages = {2069},
Year = {2023},
Month = {October},
url = {http://dx.doi.org/10.1186/s12889-023-16857-4},
Abstract = {<h4>Background</h4>Sexual and gender minorities (SGM)
experience higher rates of discrimination and violence when
compared to cis, heterosexual peers. However, violent crimes
and other hate incidents against SGM persons are
consistently not reported and prosecuted because of chronic
distrust between the SGM community and police. Brazil is one
of the most dangerous countries for SGM persons globally.
Herein, we describe the development of a mobile health
intervention to address the rampant violence against this
population, the Rainbow Resistance-Dandarah
app.<h4>Methods</h4>We conducted community-based
participatory research (CBPR) between 2019 and 2020. The
study started with in-depth interviews (IDIs) and focus
group discussions (FGDs) with representatives of the SGM
community from Brazil. Descriptive qualitative data analysis
included the plotting of a 'word cloud', to visually
represent word frequency, data coding and analysis of more
frequent themes related to app acceptability, usability, and
feasibility. A sub-sample of SGM tested the app and
suggested improvements, and the final version was launched
in December 2019.<h4>Results</h4>Since the app was launched
in December 2019, the app recorded 4,114 active SGM users.
Most participants are cisgender men (50.9%), self-identified
as gay (43.5%), White (47.3%), and aged 29 or less (60.9%).
FGDs and IDIs participants discussed the importance of the
app in the context of widespread violence toward SGM
persons. Study participants perceived this mHealth strategy
as an important, effective, and accessible for SGM surviving
violence. The CBPR design was highlighted as a key strategy
that allowed SGM persons to collaborate in the design of
this intervention actively. Some users reported how the
panic button saved their lives during violent
attacks.<h4>Conclusions</h4>Rainbow Resistance-Dandarah app
was endorsed as a powerful tool for enhancing reporting
episodes of violence/discrimination against SGM persons and
a key strategy to connect users with a safe network of
supportive services. Results indicate that the app is an
engaging, acceptable, and potentially effective mHealth
intervention. Participants reported many advantages of using
it, such as being able to report harassment and violence,
connect with a safe network and receive immediate
support.},
Doi = {10.1186/s12889-023-16857-4},
Key = {fds373519}
}
@article{fds370842,
Author = {Ostermann, J and Hair, N and Grzimek, V and Zheng, S and Gong, W and Whetten, K and Thielman, N},
Title = {How Poor Is Your Sample? A Simple Approach for Estimating
the Relative Economic Status of Small and Nonrepresentative
Samples.},
Journal = {Glob Health Sci Pract},
Volume = {11},
Number = {2},
Pages = {e2200394},
Year = {2023},
Month = {April},
url = {http://dx.doi.org/10.9745/GHSP-D-22-00394},
Abstract = {BACKGROUND: Asset-based indices of living standards, or
wealth indices, are widely used proxies for economic status;
however, such indices are not readily available for small
and nonrepresentative samples. METHODS: We describe a simple
out-of-sample prediction approach that uses estimates from
large and representative "reference" samples to calculate
measures of relative economic status (e.g., wealth index
scores) for small and/or nonrepresentative "target" samples.
The method relies on the availability of common variables
and assumptions about comparable associations between these
variables and the underlying construct of interest (e.g.,
household wealth). We provide 2 sample applications that use
Demographic and Health Surveys (DHS) from 5 countries as
reference samples. Using ordinary least squares regression,
we estimate associations between household characteristics
and the DHS wealth index. We use parameter estimates to
predict wealth index scores for small nonrepresentative
target samples. Comparisons of wealth distributions in the
reference and target samples highlight selection effects.
RESULTS: Applications of the approach to diverse
populations, including populations at high risk of HIV
infection and households with orphaned and separated
children, demonstrate its usefulness for characterizing the
economic status of small and nonrepresentative samples
relative to existing reference samples. Women and men in
northern Tanzania at high risk of HIV infection were
concentrated in the upper half of the wealth distribution.
By contrast, the relative distribution of household wealth
among households with orphaned and separated children varied
greatly across countries and rural versus urban settings.
CONCLUSIONS: Public health professionals who implement,
manage, and evaluate programs in low- and middle-income
countries may find this approach applicable because of the
simplicity of the estimation methods, low marginal cost of
primary data acquisition, and availability of established
measures of relative economic status in many publicly
available household surveys (e.g., those administered by the
DHS Program, World Bank, International Labour Organization,
and UNICEF).},
Doi = {10.9745/GHSP-D-22-00394},
Key = {fds370842}
}
@article{fds371227,
Author = {Dorsey, S and Johnson, C and Soi, C and Meza, RD and Whetten, K and Mbwayo,
A},
Title = {Implementation science in plain language: The use of
nonjargon terms to facilitate collaboration.},
Journal = {Implementation research and practice},
Volume = {4},
Pages = {26334895231177474},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.1177/26334895231177474},
Abstract = {<h4>Background</h4>Interdisciplinary collaboration and
stakeholder engagement are key ingredients in implementation
science research. However, effective and efficient
collaboration can be limited by the complexity of
implementation science terms. In this article, we argue that
the development and use of plain language implementation
science terms is an essential step to facilitate
collaboration and engagement.<h4>Method</h4>We present an
example of plain language development to portray the process
and the potential benefits plain language can have on
implementation science research. Implementation scientists
and intervention experts codeveloped plain language
implementation terms as a part of an implementation-effectiveness
trial in western Kenya and in preparation for a stakeholder
collaborative design meeting.<h4>Results</h4>The developed
plain language terms facilitated wider stakeholder
understanding and integration of implementation science
findings that could inform the design of a stakeholder-led
implementation coaching program.<h4>Conclusions</h4>We
encourage the use of the plain language terms presented in
this article, further translation, and additional
development of other plain language terms for implementation
science constructs.},
Doi = {10.1177/26334895231177474},
Key = {fds371227}
}
@article{fds374930,
Author = {Sohail, MM and Baghdady, A and Choi, J and Huynh, HV and Whetten, K and Proeschold-Bell, RJ},
Title = {Factors influencing teacher wellbeing and burnout in
schools: A scoping review.},
Journal = {Work (Reading, Mass.)},
Volume = {76},
Number = {4},
Pages = {1317-1331},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.3233/wor-220234},
Abstract = {<h4>Background</h4>Teacher's wellbeing and mental health
play a pivotal role in learning experiences and educational
environment. For a better future, we need thriving teachers
with strong wellbeing.<h4>Objective</h4>The current scoping
literature review aimed to explore the factors fostering
wellbeing and causing burnout among school
teachers.<h4>Methods</h4>Applying appropriate search terms
to relevant databases for the years 2016-2020 yielded 934
potentially relevant research articles which were further
filtered to 102 articles.<h4>Results</h4>The findings of
this review suggested that emotion regulation, positive
workplace milieu and teacher self-efficacy (feeling
successful as a teacher) are important factors fostering
teachers' wellbeing whilst negative workplace environment
and negative emotions along with feeling marginalized or
bullied by coworkers are factors behind teacher burnout. The
strengths of this study include a rigorous research design
and relational analysis approach.<h4>Conclusion</h4>Teacher
wellbeing needs a workplace environment with minimum
bullying and marginalization. An atmosphere of respect,
inclusion, and mutual teacher support is needed to promote
wellbeing.},
Doi = {10.3233/wor-220234},
Key = {fds374930}
}
@article{fds368870,
Author = {Baptista Silva and A and Malta, M and da Silva, CMFP and Kalume, CC and Filha, IGA and LeGrand, S and Whetten, K},
Title = {The Dandarah App: An mHealth Platform to Tackle Violence and
Discrimination of Sexual and Gender Minority Persons Living
in Brazil.},
Journal = {International journal of environmental research and public
health},
Volume = {20},
Number = {1},
Pages = {280},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.3390/ijerph20010280},
Abstract = {Discrimination and violence are widely experienced by sexual
and gender minority (SGM) persons worldwide. More than one
SGM person is murdered every day in Brazil because of their
sexuality or gender identity, which is the highest reported
homicide rate in the world. Alt-hough discrimination and
violence against SGM persons in Brazil are considered to be
hate crimes, reporting is still suboptimal due to fear of
police SGM phobia and victim blaming. Accessible and easily
disseminated interventions are urgently needed. Herein, we
describe the develop-ment of an mHealth solution to help
address violence against SGM persons, namely the Rainbow
Resistance: Dandarah App, with a synthesis of key results
and feedback from the SGM community after 24 months of using
the app. Twenty-two focus group discussions (FGDs) were
conducted with SGM persons living in six Brazilian states:
Bahia, Federal District, São Paulo, Rio de Janeiro, Minas
Gerais, Sergipe, and Pará. A total of 300 SGM persons
participated in the FGDs. A thematic analysis was performed
to interpret the qualitative data. Content themes related to
aesthetics, us-ability, barriers to resources, and
likes/dislikes about the intervention arose from the FGDs.
Participants found the intervention to be user-friendly,
endorsed more likes than dislikes, and suggested a few
changes to the app. The findings suggest that the
intervention is usable and fit for future ef-fectiveness
testing, and that it could fill an important gap in the
well-being of SGM persons living in a country with high
levels of discrimination and violence towards this
community, i.e., Brazil.},
Doi = {10.3390/ijerph20010280},
Key = {fds368870}
}
@article{fds366172,
Author = {Zewdie, HY and Whetten, K and Dubie, ME and Kenea, B and Bekele, T and Temesgen, C and Molla, W and Puffer, ES and Ostermann, J and Hobbie, AM and Gray, CL},
Title = {The association between urban greenspace and psychological
health among young adults in Addis Ababa,
Ethiopia.},
Journal = {Environmental research},
Volume = {215},
Number = {Pt 1},
Pages = {114258},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.1016/j.envres.2022.114258},
Abstract = {<h4>Introduction</h4>Psychological disorders are emerging as
health priorities in Sub-Saharan Africa, specifically
Ethiopia. Urban greenspace - parks, trees, and other
vegetation integrated into urban form - may facilitate
population psychological health, but is largely understudied
outside high-income countries. We explore greenspace in
relation to psychological health among young adults in Addis
Ababa, Ethiopia.<h4>Method</h4>Greenspace exposure was
calculated using the normalized difference vegetation index
(NDVI) derived from publicly available satellite imagery
(2018-2019). We used tests of spatial clustering to
characterize greenspace distribution. Derived NDVI values
were linked to Positive Outcomes for Orphans study
participants to explore cross-sectional associations between
greenspace exposure and psychological health (measured
2019-2021). Two continuous scores of psychological health
were examined: total difficulties from the Strengths and
Difficulties Questionnaire and depressive symptoms from the
8-item Patient Health Questionnaire. Multilevel generalized
linear regression, nested by administrative units, was used
to estimate the association between greenspace and
psychological health. We also explored effect modification
by gender and having income.<h4>Results</h4>We found
greenspace is spatially clustered in Addis Ababa, with high
greenspace density in the northeast region and low
greenspace density in the center of the city. Our findings
suggest residing in greener areas is associated with fewer
emotional and behavioral difficulties (β = -1.89; 95% CI:
-3.50, -0.29), but not significantly associated with
depressive symptomology (β = -0.61; 95% CI: -2.33, 1.11).
We observed stronger associations between greenspace and
total difficulties among those reporting any income and
among males, and for the association between greenspace and
depression symptomology among males.<h4>Conclusion</h4>We
offer initial exploration into the role of greenspace in
psychological well-being in Addis Ababa, with potential
implications for urban communities across Sub-Saharan
Africa. Further research should continue to explore how the
built and natural environment could be leveraged in similar
settings to promote population psychological
health.},
Doi = {10.1016/j.envres.2022.114258},
Key = {fds366172}
}
@article{fds350199,
Author = {Agala, CB and Fried, BJ and Thomas, JC and Reynolds, HW and Lich, KH and Whetten, K and Zimmer, C and Morrissey, JP},
Title = {Reliability, Validity and Measurement Invariance of the
WHO’s Quality of Life Scale among Women of Reproductive
Age Living with HIV in Ethiopia - a Quasi-Experimental
Study},
Journal = {Applied Research in Quality of Life},
Volume = {16},
Number = {4},
Pages = {1785-1812},
Year = {2021},
Month = {August},
url = {http://dx.doi.org/10.1007/s11482-020-09844-z},
Abstract = {Despite its widespread global adoption and use, studies have
not examined measurement invariance of the 31-question World
Health Organization Quality of Life–HIV BREF scale among
HIV/AIDS patients. The current study seeks to (a) evaluate
the scale’s internal consistency reliability, and
concurrent validity, and (b) test if the same latent
construct of quality of life was consistently measured at
two time-points, for a sample of HIV-positive women from two
sites in Addis Ababa, Ethiopia. The study used data from two
cross-sectional interviews with 926 HIV-positive women of
reproductive age who participated in a quasi-experimental
study. All participants were receiving antiretroviral
therapy and related treatment support services from 51
service providers in two non-contiguous sub-cities. We used
One-Way ANOVA, chi square test and Kruskal Wallis test to
compare demographic characteristics and quality of life
scores of study participants. Further, we used Cronbach’s
coefficient alpha (α) to assess internal consistency
reliability and Pearson product-moment correlation (r) to
assess concurrent validity. Finally, multiple-group
confirmatory factor analysis with maximum likelihood
estimation was used to assess measurement invariance of the
quality of life scale. Findings suggest that the WHOQOL-HIV
BREF exhibited acceptable psychometric properties. There was
evidence for strong internal consistency reliability
demonstrated by Cronbach’s α >0.80 and coefficient ω
>0.80. The scale’s six domains also exhibited good
concurrent validity, with coefficient r = 0.63–0.82. In
measurement invariance analysis, configural invariance was
found for the scale’s six domains, suggesting measurement
noninvariance for factor loadings, item intercepts and
factor variances when comparing QOL among participants in
the two sites at baseline and follow-up. Our findings
suggest that the WHOQOL-HIV BREF has internal consistency
reliability and concurrent validity in this study sample.
The differences in the levels of observed responses for QOL
across intervention and non-intervention groups at baseline
and follow-up suggest participants had dissimilar
understanding, interpretation, and responses to the
scale’s items, which may have resulted from significant
measurement, cultural, and developmental differences between
study groups. The WHOQOL-HIV BREF exhibited internal
consistency reliability, concurrent validity and configural
invariance. However, strong invariance was not achieved,
making it difficult to compare levels of QOL between groups
in this study sample.},
Doi = {10.1007/s11482-020-09844-z},
Key = {fds350199}
}
@article{fds370176,
Author = {Biru, BM and Proeschold-Bell, RJ and Kaiser, BN and E. Parnell and H and Kaza, VGK and Madan, I and Dubie, ME and Vann, V and Amanya, C and Whetten,
K},
Title = {Residential Care Directors’ Perceptions of Desirable
Characteristics of Caregivers for Orphaned and Separated
Children},
Journal = {International Journal of Applied Positive
Psychology},
Volume = {6},
Number = {2},
Pages = {113-131},
Year = {2021},
Month = {July},
url = {http://dx.doi.org/10.1007/s41042-020-00041-9},
Abstract = {Caring for, raising, and educating orphaned and separated
children (OSC) is important work that is critical to the
long-term well-being of those children. Despite the
importance of caregiving, it can be overwhelming and
stressful. Much of the available literature addresses the
burdens of caregiving, without addressing the positive
characteristics that caregivers need to deliver care in
residences for OSC. This study’s objective was to identify
the desirable characteristics of caregivers through
qualitative interviews with directors of residences for OSC
across four countries: Cambodia, Ethiopia, India and Kenya.
A total of 28 interviews were conducted in the directors’
local languages. Interviews were transcribed, translated
into English, and analyzed using NVivo software. A thematic
analysis of the data yielded three domains: personal
qualities, skills, and religion. Across all the study
geographic regions, most participants looked for similar
characteristics in caregivers, such as love, patience,
teamwork and communication skills, especially communicating
about difficult child behaviors. These findings can inform
plans to enhance effective and sustainable caregiving at
residential care sites for OSC and simultaneously benefit
the well-being of caregivers. Residential care directors may
consider organizing workshops on teamwork and communication
skills that will help improve the quality of
caregiving.},
Doi = {10.1007/s41042-020-00041-9},
Key = {fds370176}
}
@article{fds353304,
Author = {Pack, A and Maman, S and Reyes, HLM and Nyblade, L and Whetten, K and Zimmer, C and Gray, CL and Golin, C},
Title = {Predictors of HIV Testing among Orphaned Youths in Three
East African Countries.},
Journal = {AIDS and behavior},
Volume = {25},
Number = {4},
Pages = {1257-1266},
Year = {2021},
Month = {April},
url = {http://dx.doi.org/10.1007/s10461-020-03104-9},
Abstract = {In parts of sub-Saharan Africa, where HIV prevalence is
high, HIV is a leading cause of death among youths. Orphaned
and separated youths are an especially vulnerable group, yet
we know little about what influences their testing behavior.
We conducted multiple logistical regression to examine
theory-based predictors of past-year HIV testing among 423
orphaned and separated youths in Ethiopia, Kenya and
Tanzania. We also conducted moderation, assessing whether
predictors varied by sex. Over one-third of our sample
reported past-year HIV testing. Those with greater perceived
social support and those who reported sexual HIV risk
behavior were more likely to report past-year testing.
Furthermore, boys who reported ever previously testing for
HIV were more likely, a year later, to report past-year HIV
testing. In conclusion, our findings have important
implications for intervention development, including the
potential for enhanced perceived social support to
positively influence HIV testing among orphaned and
separated youths.},
Doi = {10.1007/s10461-020-03104-9},
Key = {fds353304}
}
@article{fds361322,
Author = {Gray, CL and Whetten, K and Daniels, JL and Hudgens, MG and Pettifor,
AE and Hobbie, AM and Thielman, NM and Dubie, ME and Itemba, D and Madan,
I and Vann, V and Wasonga, AI and Manongi, R and Ostermann, J and Whetten,
RA and Pence, BW},
Title = {Family Composition and Stability for Orphans: A Longitudinal
Study of Well-Being in 5 Low- and Middle-Income
Countries.},
Journal = {Int J Public Health},
Volume = {66},
Pages = {1604057},
Year = {2021},
url = {http://dx.doi.org/10.3389/ijph.2021.1604057},
Abstract = {Objectives: Many orphaned children in low- and middle-income
countries live with family. Yet, their household composition
and its stability are not well-characterized, nor is impact
of stability on longer-term outcomes. Methods: We used the
longitudinal, multi-country Positive Outcomes for Orphans
cohort to describe adult family living with orphans.
Stability was measured by changes in presence of six
familial relations over time, and related to three outcomes:
1) incident abuse, 2) cognitive functioning, 3) emotional
difficulties. Associations were estimated using generalized
linear models fit with generalized estimating equations. For
abuse, Poisson regression estimated risk ratios. For
continuous scores of cognitive functioning and emotional
difficulties, linear models estimated mean differences (MDs)
with 95% confidence intervals. Results: Among 1,359 orphans,
53-61% reported living with their mother each year; 7-13%
with father; nearly 60% reported ≥1 change in composition
over follow-up. Compared to 0 changes, difficulties
increased with 1 change [MD: 0.23 (-0.33, 0.79)], 2 changes
[MD: 0.57 (0.00, 1.16)] and ≥3 changes [MD: 0.73 (0.18,
1.29)]. No associations were found with abuse or cognitive
functioning. Conclusion: Orphan well-being may be improved
through supports stabilizing household composition or
targeting emotional resilience.},
Doi = {10.3389/ijph.2021.1604057},
Key = {fds361322}
}
@article{fds349760,
Author = {Malta, M and Gomes de Jesus and J and LeGrand, S and Seixas, M and Benevides, B and Silva, MDD and Lana, JS and Huynh, HV and Belden, CM and Whetten, K},
Title = {'Our life is pointless … ': Exploring discrimination,
violence and mental health challenges among sexual and
gender minorities from Brazil.},
Journal = {Global public health},
Volume = {15},
Number = {10},
Pages = {1463-1478},
Year = {2020},
Month = {October},
url = {http://dx.doi.org/10.1080/17441692.2020.1767676},
Abstract = {Worldwide, Brazil has the highest prevalence of violence and
hate crimes against sexual and gender minorities (SGMs)
among countries with available data. To explore the impact
of this scenario, we conducted a qualitative study with 50
SGMs from Rio de Janeiro, Brazil. Among the participants,
66% screened positive for generalised anxiety disorder, 46%
for major depressive disorder and 39% for PTSD. A third
reported low self-esteem (32%) and one quarter low social
support (26%). Experiences of interpersonal discrimination
were highly prevalent (>60%), while institutional
discrimination related to employment or healthcare was
reported by 46% of participants. Verbal abuse is very common
(80%), followed by physical assault (40%). Sexual violence
is highly frequent among women. Focus groups analysis
highlighted three major domains: (1) stigma and
discrimination (family, friends and partners, in schools and
health services, influencing social isolation); (2) violence
(bullying, harassment, physical and sexual violence); and
(3) mental suffering (alcohol and drug abuse, depression,
suicidality, anxiety). Our findings suggest a close synergy
between experiences of discrimination and violence with
selected mental disorders. This complex synergy might be
better addressed by longer-term individual and group-level
interventions that could foster social solidarity among the
different groups that comprise SGMs.},
Doi = {10.1080/17441692.2020.1767676},
Key = {fds349760}
}
@article{fds349877,
Author = {Liu, X and Whetten, K and Prose, NS and Eagle, D and Parnell, HE and Amanya, C and Vann, V and Dubie, ME and Kaza, VGK and Tzudir, S and Proeschold-Bell, RJ},
Title = {Enjoyment and meaning in daily activities among caregivers
of orphaned and separated children in four
countries},
Journal = {Children and Youth Services Review},
Volume = {116},
Year = {2020},
Month = {September},
url = {http://dx.doi.org/10.1016/j.childyouth.2020.105103},
Abstract = {Introduction: There are many orphaned and separated children
(OSC) in the world and caregivers play a crucial role in
raising them. Frameworks on employee mental health
incorporate elements of both enjoyment/difficulties and
values (i.e., hedonic and eudaimonic elements), yet existing
studies focus on caregivers’ mental illness and overlook
their specific work activities. Methods: We collected diary
activity log, survey, and interview data from caregivers
from five geographic locations: Hyderabad, India; Nagaland,
India; Ethiopia; Kenya; and Cambodia. We coded and
calculated the amount of time spent on five frequent
activities: cleaning, cooking, caring for children,
supervising children, and informal educational activities.
We calculated the mean scores of perceived importance,
meaningfulness, enjoyment, and unpleasantness for each of
the five activities by geographic location. Results: A total
of 82 participants completed surveys and activity logs, and
69 of them participated in interviews. Mean time spent per
day for the five activities combined ranged from 4.4 h
(Nagaland) to 9.0 h (Ethiopia). Cooking and cleaning
constituted a large portion of caregivers’ days, ranging
from 0.8 h per caregiver per day in Nagaland to 4.7 h in
Cambodia, and informal educational activities (such as
advising, teaching children their letters, and teaching from
religious texts) constituted the least time, ranging from
0.1 h per caregiver per day in Hyderabad to 1.1 h in
Nagaland. Participants rated all activities high in
importance, with cleaning being relatively lower. Overall,
enjoyment scores were lower than importance and
meaningfulness scores. Informal educational activities had
the highest enjoyment scores in three locations, whereas
supervising children did in two locations. Participants
rated cleaning as the most unpleasant activity in each
geographic region except Cambodia, where it was rated on par
with educational activities. Discussion: OSC caregivers
consider several regular activities to be very important and
meaningful. Enjoyment may be improved through additional
support in child behavior management or spending more time
providing informal educational activities; at minimum,
caregiver mental health should be considered before turning
informal educational activities over to volunteers.},
Doi = {10.1016/j.childyouth.2020.105103},
Key = {fds349877}
}
@article{fds347597,
Author = {Eagle, DE and Kinghorn, WA and Parnell, H and Amanya, C and Vann, V and Tzudir, S and Kaza, VGK and Safu, CT and Whetten, K and Proeschold-Bell,
RJ},
Title = {Religion and Caregiving for Orphans and Vulnerable Children:
A Qualitative Study of Caregivers Across Four Religious
Traditions and Five Global Contexts.},
Journal = {J Relig Health},
Volume = {59},
Number = {3},
Pages = {1666-1686},
Year = {2020},
Month = {June},
url = {http://dx.doi.org/10.1007/s10943-019-00955-y},
Abstract = {Studies of caregivers of orphans and vulnerable children
(OVC) rarely examine the role religion plays in their lives.
We conducted qualitative interviews of 69 caregivers in four
countries: Ethiopia, Kenya, Cambodia, and India (Hyderabad
and Nagaland), and across four religious traditions:
Christian (Orthodox, Roman Catholic, and Protestant),
Muslim, Buddhist, and Hindu. We asked respondents to
describe the importance of religion for their becoming a
caregiver, the way in which religion has helped them make
sense of why children are orphans, and how religion helps
them face the challenges of their occupation. Using
qualitative descriptive analysis, three major themes
emerged. Respondents discussed how religion provided a
strong motivation for their work, reported that religious
institutions were often the way in which they were
introduced to caregiving as an occupation, and spoke of the
ways religious practices sustain them in their work. They
rarely advanced religion as an explanation for why OVC
exist-only when pressed did they offer explicitly religious
accounts. This study has implications for OVC care,
including the importance of engaging religious institutions
to support caregivers, the significance of attending to
local religious context, and the vital need for research
outside of Christian contexts.},
Doi = {10.1007/s10943-019-00955-y},
Key = {fds347597}
}
@article{fds366220,
Author = {Dorsey, S and Lucid, L and Martin, P and King, KM and O'Donnell, K and Murray, LK and Wasonga, AI and Itemba, DK and Cohen, JA and Manongi, R and Whetten, K},
Title = {Effectiveness of Task-Shifted Trauma-Focused Cognitive
Behavioral Therapy for Children Who Experienced Parental
Death and Posttraumatic Stress in Kenya and Tanzania: A
Randomized Clinical Trial.},
Journal = {JAMA psychiatry},
Volume = {77},
Number = {5},
Pages = {464-473},
Year = {2020},
Month = {May},
url = {http://dx.doi.org/10.1001/jamapsychiatry.2019.4475},
Abstract = {<h4>Importance</h4>Approximately 140 million children
worldwide have experienced the death of one or both parents.
These children, mostly in low- and middle-income countries,
have higher rates of mental health problems than those who
have not experienced parental death. Cognitive behavioral
therapy (CBT) may improve the well-being of these children,
but to our knowledge there have been no randomized clinical
trials specifically focused on this population.<h4>Objectives</h4>To
test the effectiveness of trauma-focused CBT (TF-CBT) for
improving posttraumatic stress (PTS) in children in Kenya
and Tanzania who have experienced parental death, to test
the effects of TF-CBT on other mental health symptoms, and
to examine the feasibility of task-shifting with greater
reliance on experienced, local lay counselors as trainers
and supervisors.<h4>Design, setting, and participants</h4>A
randomized clinical trial conducted in urban and rural areas
of Tanzania and Kenya compared TF-CBT and usual care (UC)
for 640 children aged 7 to 13 years who were recruited from
February 13, 2013, to July 24, 2015. All children had
experienced the death of one or both parents and had
elevated PTS and/or prolonged grief. Interviewers were
masked to study condition. Participants were followed up for
12 months after the randomized clinical trial. Statistical
analysis was performed from February 3, 2017, to August 26,
2019. All analyses were on an intent-to-treat
basis.<h4>Interventions</h4>In the intervention condition,
320 children received 12 weeks of group TF-CBT delivered by
lay counselors who were supervised weekly. In the UC
condition, 320 children received community services
typically offered to this population.<h4>Main outcomes and
measures</h4>The primary outcome was PTS, evaluated using a
continuous, standardized measure. Other mental health
symptoms and child-guardian relationship were also
measured.<h4>Results</h4>A total of 640 children (320 girls
and 320 boys; mean [SD] age, 10.6 [1.6] years) were included
in the study. Trauma-focused CBT was more effective than UC
for PTS in 3 of 4 sites after treatment (end of 3-month
randomized clinical trial): rural Kenya (Cohen d = 1.04
[95% CI, 0.72-1.36]), urban Kenya (Cohen d = 0.56 [95%
CI, 0.29-0.83]), and urban Tanzania (Cohen d = 0.45 [95%
CI, 0.10-0.80]). At 12-month follow-up, TF-CBT remained more
effective than UC in both rural (Cohen d = 0.86 [95% CI,
0.64-1.07]) and urban (Cohen d = 0.99 [95% CI,
0.75-1.23]) Kenya. At 12-month follow-up in Tanzania,
children who received TF-CBT and UC had comparable rates of
improvement (rural Tanzania, Cohen d = 0.09 [95% CI,
-0.08 to 0.26]; urban Tanzania, Cohen d = 0.11 [95% CI,
-0.09 to 0.31]). A similar pattern was seen for secondary
outcomes, with stronger effects observed in Kenya, where
children experienced greater stress and adversity (eg, more
food scarcity, poorer guardian health, and greater exposure
to traumatic events).<h4>Conclusions and relevance</h4>This
study found that TF-CBT was more effective than UC in
reducing PTS among children who experienced parental death
in 3 of 4 sites in Kenya and Tanzania. At 12-month
follow-up, TF-CBT was more effective in reducing PTS only
among children in rural and urban Kenya.<h4>Trial
registration</h4>ClinicalTrials.gov identifier:
NCT01822366.},
Doi = {10.1001/jamapsychiatry.2019.4475},
Key = {fds366220}
}
@article{fds349079,
Author = {Malta, M and LeGrand, S and Turban, J and Poteat, T and Whetten,
K},
Title = {Gender-congruent government identification is crucial for
gender affirmation.},
Journal = {The Lancet. Public health},
Volume = {5},
Number = {4},
Pages = {e178-e179},
Year = {2020},
Month = {April},
url = {http://dx.doi.org/10.1016/s2468-2667(20)30054-2},
Doi = {10.1016/s2468-2667(20)30054-2},
Key = {fds349079}
}
@article{fds349676,
Author = {Agala, CB and Fried, BJ and Thomas, JC and Reynolds, HW and Lich, KH and Whetten, K and Zimmer, C and Morrissey, JP},
Title = {Reliability, validity and measurement invariance of the
Simplified Medication Adherence Questionnaire (SMAQ) among
HIV-positive women in Ethiopia: a quasi-experimental
study.},
Journal = {BMC public health},
Volume = {20},
Number = {1},
Pages = {567},
Year = {2020},
Month = {April},
url = {http://dx.doi.org/10.1186/s12889-020-08585-w},
Abstract = {<h4>Background</h4>Adherence to antiretroviral therapy is
critical to the achievement of the third target of the
UNAIDS Fast-Track Initiative goals of 2020-2030. Reliable,
valid and accurate measurement of adherence are important
for correct assessment of adherence and in predicting the
efficacy of ART. The Simplified Medication Adherence
Questionnaire is a six-item scale which assesses the
perception of persons living with HIV about their adherence
to ART. Despite recent widespread use, its measurement
properties have yet to be carefully documented beyond the
original study in Spain. The objective of this paper was to
conduct internal consistency reliability, concurrent
validity and measurement invariance tests for the
SMAQ.<h4>Methods</h4>HIV-positive women who were receiving
ART services from 51 service providers in two sub-cities of
Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment
referral network study between 2011 and 2012. Two
cross-sections of 402 and 524 female patients of
reproductive age, respectively, from the two sub-cities were
randomly selected and interviewed at baseline and follow-up.
We used Cronbach's coefficient alpha (α) to assess internal
consistency reliability, Pearson product-moment correlation
(r) to assess concurrent validity and multiple-group
confirmatory factor analysis to analyze factorial structure
and measurement invariance of the SMAQ.<h4>Results</h4>All
participants were female with a mean age of 33; median:
34 years; range 18-45 years. Cronbach's alphas for the
six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1
control, T1 intervention, T2 control, and T2 intervention
groups, respectively. Pearson correlation coefficients were
0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6,
respectively, between T1 compared to T2. We found invariance
for factor loadings, observed item intercepts and factor
variances, also known as strong measurement invariance, when
we compared latent adherence levels between and across
patient-groups.<h4>Conclusions</h4>Our results show that the
six-item SMAQ scale has adequate reliability and validity
indices for this sample, in addition to being invariant
across comparison groups. The findings of this study
strengthen the evidence in support of the increasing use of
SMAQ by interventionists and researchers to examine, pool
and compare adherence scores across groups and time
periods.},
Doi = {10.1186/s12889-020-08585-w},
Key = {fds349676}
}
@article{fds348360,
Author = {Dorsey, S and Gray, CL and Wasonga, AI and Amanya, C and Weiner, BJ and Belden, CM and Martin, P and Meza, RD and Weinhold, AK and Soi, C and Murray, LK and Lucid, L and Turner, EL and Mildon, R and Whetten,
K},
Title = {Advancing successful implementation of task-shifted mental
health care in low-resource settings (BASIC): protocol for a
stepped wedge cluster randomized trial.},
Journal = {BMC Psychiatry},
Volume = {20},
Number = {1},
Pages = {10},
Year = {2020},
Month = {January},
url = {http://dx.doi.org/10.1186/s12888-019-2364-4},
Abstract = {BACKGROUND: The mental health treatment gap-the difference
between those with mental health need and those who receive
treatment-is high in low- and middle-income countries.
Task-shifting has been used to address the shortage of
mental health professionals, with a growing body of research
demonstrating the effectiveness of mental health
interventions delivered through task-shifting. However, very
little research has focused on how to embed, support, and
sustain task-shifting in government-funded systems with
potential for scale up. The goal of the Building and
Sustaining Interventions for Children (BASIC) study is to
examine implementation policies and practices that predict
adoption, fidelity, and sustainment of a mental health
intervention in the education sector via teacher delivery
and the health sector via community health volunteer
delivery. METHODS: BASIC is a Hybrid Type II
Implementation-Effectiveness trial. The study design is a
stepped wedge, cluster randomized trial involving 7
sequences of 40 schools and 40 communities surrounding the
schools. Enrollment consists of 120 teachers, 120 community
health volunteers, up to 80 site leaders, and up to 1280
youth and one of their primary guardians. The
evidence-based mental health intervention is a locally
adapted version of Trauma-focused Cognitive Behavioral
Therapy, called Pamoja Tunaweza. Lay counselors are trained
and supervised in Pamoja Tunaweza by local trainers who are
experienced in delivering the intervention and who
participated in a Train-the-Trainer model of skills
transfer. After the first sequence completes implementation,
in-depth interviews are conducted with initial implementing
sites' counselors and leaders. Findings are used to inform
delivery of implementation facilitation for subsequent
sequences' sites. We use a mixed methods approach including
qualitative comparative analysis to identify necessary and
sufficient implementation policies and practices that
predict 3 implementation outcomes of interest: adoption,
fidelity, and sustainment. We also examine child mental
health outcomes and cost of the intervention in both
the education and health sectors. DISCUSSION: The BASIC
study will provide knowledge about how implementation of
task-shifted mental health care can be supported in
government systems that already serve children and
adolescents. Knowledge about implementation policies and
practices from BASIC can advance the science of
implementation in low-resource contexts. TRIAL REGISTRATION:
Trial Registration: ClinicalTrials.gov Identifier:
NCT03243396. Registered 9th August 2017,
https://clinicaltrials.gov/ct2/show/NCT03243396.},
Doi = {10.1186/s12888-019-2364-4},
Key = {fds348360}
}
@article{fds342440,
Author = {Montenegro, L and Velasque, L and LeGrand, S and Whetten, K and de
Mattos Russo Rafael and R and Malta, M},
Title = {Public Health, HIV Care and Prevention, Human Rights and
Democracy at a Crossroad in Brazil.},
Journal = {AIDS and behavior},
Volume = {24},
Number = {1},
Pages = {1-4},
Year = {2020},
Month = {January},
url = {http://dx.doi.org/10.1007/s10461-019-02470-3},
Abstract = {On January 2019, Brazil's new far-right president Jair
Bolsonaro was sworn into office. Bolsonaro's administration
supports downsizing the Brazilian Unified Health System
(SUS), while increasing the size of the private health
sector. The new administration might leave millions of
Brazilians without medical care, including hundreds of
thousands of people living with HIV/AIDS. Bolsonaro's
administration, allied with a highly conservative Congress
and sharp decreases in federal funding for public health,
education and research, could jeopardize key health and
human rights strategies focused on women,
LGBTQ + individuals, Indigenous populations, and people
living with HIV/AIDS.},
Doi = {10.1007/s10461-019-02470-3},
Key = {fds342440}
}
@article{fds352615,
Author = {Gomes de Jesus and J and Belden, CM and Huynh, HV and Malta, M and LeGrand,
S and Kaza, VGK and Whetten, K},
Title = {Mental health and challenges of transgender women: A
qualitative study in Brazil and India.},
Journal = {International journal of transgender health},
Volume = {21},
Number = {4},
Pages = {418-430},
Year = {2020},
Month = {January},
url = {http://dx.doi.org/10.1080/26895269.2020.1761923},
Abstract = {<b><i>Background</i>:</b> Transgender women from low- and
middle-income countries (LMICs) are understudied, their
coping strategies and struggles underrecognised.
<b><i>Aims</i>:</b> This study aimed to explore the lived
experiences of transgender women from two major cities
located in Brazil and India, LMICs with high rates of
transphobia and gender-based violence. <b><i>Methods</i>:</b>
We conducted a mixed-methods, exploratory study, including
focus group discussions (FGDs) and brief survey interviews
with 23 transgender women from Hyderabad, India and 12
transgender women from Rio de Janeiro, Brazil. Herein we
present the combined (qualitative and quantitative) results
related to discrimination, stigma, violence, and suicidality
in transgender women's lives. <b><i>Results</i>:</b> Three
major themes emerged from FGDs: stigma and discrimination;
violence, and suicidality. Lack of education and working
opportunities influence high levels of poverty and
engagement in survival sex work by transgender women in both
cities. Study participants live in large cities with more
than 6 million inhabitants, but transgender women reported
chronic social isolation. Participants disclosed frequent
suicide ideation and suicide attempts. Brief surveys
corroborate FGD findings, identifying high prevalence of
discrimination, intimate partner violence, suicidality and
low social support. <b><i>Discussion</i>:</b> Multiple
layers of stigma, discrimination, violence and social
isolation affect transgender women's quality of life in
Hyderabad and Rio de Janeiro. Strategies sensitive to gender
and culture should be implemented to tackle entrenched
prejudice and social exclusion reported by transgender
women. Additional social support strategies, better access
to education and employment opportunities are also urgently
needed. Improving the availability of evidence-based mental
health interventions addressing the high prevalence of
suicidality among transgender women from Hyderabad, India
and Rio de Janeiro, Brazil should be prioritized.},
Doi = {10.1080/26895269.2020.1761923},
Key = {fds352615}
}
@article{fds352746,
Author = {Madut, DB and Park, LP and Yao, J and Reddy, EA and Njau, B and Ostermann,
J and Whetten, K and Thielman, NM},
Title = {Predictors of mortality in treatment experienced
HIV-infected patients in northern Tanzania.},
Journal = {PLoS One},
Volume = {15},
Number = {10},
Pages = {e0240293},
Year = {2020},
url = {http://dx.doi.org/10.1371/journal.pone.0240293},
Abstract = {BACKGROUND: While factors that drive early mortality among
people living with HIV (PLWH) initiating antiretroviral
therapy (ART) in sub-Saharan Africa (SSA) have been
described, less is known about the predictors of long-term
mortality for those with ART experience. METHODS: PLWH and
on ART attending two HIV treatment clinics in Moshi,
Tanzania were enrolled from 2008 through 2009 and followed
for 3.5 years. Demographic, psychosocial, and clinical
information were collected at enrollment. Plasma HIV RNA
measurements were collected annually. Cause of death was
adjudicated by two independent reviewers based on verbal
autopsy information and medical records. Bivariable and
multivariable analyses were conducted using Cox proportional
hazard models to identify predictors of mortality. RESULTS:
The analysis included 403 participants. The median (IQR) age
in years was 42 (36-48) and 277 (68.7%) participants were
female. The proportion of participants virologically
suppressed during the 4 collection time points was 88.5%,
94.7%, 91.5%, and 94.5%. During follow-up, 24 participants
died; the overall mortality rate was 1.8 deaths per 100
person-years. Of the deaths, 14 (58.3%) were suspected to be
HIV/AIDS related. Predictors of mortality (adjusted hazard
ratio, 95% confidence interval) were male sex (2.63,
1.01-6.83), secondary or higher education (7.70,
3.02-19.60), receiving care at the regional referral
hospital in comparison to the larger zonal referral hospital
(6.33, 1.93-20.76), and moderate to severe depression
symptoms (6.35, 1.69-23.87). CONCLUSIONS: As ART coverage
continues to expand in SSA, HIV programs should recognize
the need for interventions to promote HIV care engagement
for men and the integration of mental health screening and
treatment with HIV care. Facility-level barriers may
contribute to challenges faced by PLWH as they progress
through the HIV care continuum, and further understanding of
these barriers is needed. The association of higher
educational attainment with mortality merits further
investigation.},
Doi = {10.1371/journal.pone.0240293},
Key = {fds352746}
}
@article{fds372752,
Author = {Hunter, K and Knettel, B and Reisinger, D and Ganapathy, P and Lian, T and Wong, J and Mayorga-Young, D and Zhou, A and Elnagheeb, M and McGovern,
M and Thielman, N and Whetten, K and Esmaili, E},
Title = {Examining Health Care Access for Refugee Children and
Families in the North Carolina Triangle Area.},
Journal = {N C Med J},
Volume = {81},
Number = {6},
Pages = {348-354},
Year = {2020},
url = {http://dx.doi.org/10.18043/ncm.81.6.348},
Abstract = {BACKGROUND Resettled refugees are at increased risk of poor
health outcomes due to acculturation challenges, logistical
barriers, experiences of trauma, and other barriers to care
that are poorly understood. Refugee children may be
particularly vulnerable due to disruptions in health,
well-being, education, and nutrition during the resettlement
process.METHOD To describe the health care barriers facing
refugees in the North Carolina Triangle area (comprised of
Durham, Chapel Hill, Raleigh, and their surrounding areas),
we conducted three focus group interviews (in Arabic,
French, and Swahili) with 25 refugee parents from Syria,
Iraq, Central African Republic, the Democratic Republic of
the Congo, and Chad. We also administered a survey to nine
organizations that provide services for refugees.RESULTS
Focus group responses highlighted the multidimensional
nature of health care barriers for refugee families and
children, encompassing challenges with acculturation,
communication, transportation, finances, and health
literacy. Organizations emphasized similar challenges and
described their efforts to improve access to services
through increased communication, coordination, and seeking
new financial support for programs.LIMITATIONS Given the
geographic focus of the study, results may not be
generalizable to other populations and settings. Men spoke
more than women in some focus groups, and participants may
have been influenced by more vocal contributors.
Furthermore, this study is limited by a lack of health
outcomes data.CONCLUSIONS This study suggests that the
health care needs of refugees living in the North Carolina
Triangle area can be better met by providing comprehensive,
coordinated, and culturally relevant care. This could
include minimizing the number of visits by integrating
multiple services under one roof, providing trauma-informed
interpreters, and offering accessible transportation
services.},
Doi = {10.18043/ncm.81.6.348},
Key = {fds372752}
}
@article{fds341861,
Author = {Kinghorn, WA and Keyes, CLM and Parnell, HE and Eagle, DE and Biru, BM and Amanya, C and Vann, V and Krishna Kaza and VG and Tzudir, S and Saddo, YB and Whetten, K and Proeschold-Bell, RJ},
Title = {Putting virtues in context: engaging the VIA classification
of character strengths in caregiving for orphans and
vulnerable children across cultures},
Journal = {Journal of Positive Psychology},
Volume = {14},
Number = {6},
Pages = {845-853},
Year = {2019},
Month = {November},
url = {http://dx.doi.org/10.1080/17439760.2019.1579363},
Abstract = {The VIA Classification of Character Strengths has broken
important ground for measuring character strengths across
cultures. Because the VIA Classification is a closed system
of abstract strengths, however, it is unknown how end-users
engage strengths in particular cultural and practical
contexts, define strengths for themselves, or identify
additional strengths. In this study, residential care
directors (n = 18) and other caregivers (n = 64) for
orphans and vulnerable children (OVCs) in five distinct
global locations prioritized with a card-sort the VIA
Character Strengths most important for the work of
caregiving, defined these strengths, and proposed additional
strengths. Supervisors were then asked how caregivers
embodied their prioritized strengths. Participants most
frequently prioritized Love, Honesty, Forgiveness, and
Kindness as important for caregiving; demonstrated high
concordance but also some deviation from the definitions of
the VIA Classification; and proposed additional strengths
(e.g. Caring, Self-drive, and Initiative) that were
perceived not to overlap with existing VIA Character
Strengths.},
Doi = {10.1080/17439760.2019.1579363},
Key = {fds341861}
}
@article{fds347071,
Author = {Malta, M and Cardoso, R and Montenegro, L and de Jesus, JG and Seixas,
M and Benevides, B and das Dores Silva and M and LeGrand, S and Whetten,
K},
Title = {Sexual and gender minorities rights in Latin America and the
Caribbean: a multi-country evaluation.},
Journal = {BMC international health and human rights},
Volume = {19},
Number = {1},
Pages = {31},
Year = {2019},
Month = {November},
url = {http://dx.doi.org/10.1186/s12914-019-0217-3},
Abstract = {<h4>Background</h4>Although the extent of legal inequities
experienced by sexual and gender minorities (SGM) has
declined during recent decades, this population still enjoys
fewer legal protections and benefits than the
non-gender-variant, heterosexual population. Herein we
analyze the current scenario of SGM rights in Latin America
and the Caribbean (LAC).<h4>Methods</h4>Policy documents and
governmental strategies addressing SGM rights were analyzed
within a timeline framework by three major LAC sub-regions:
the Caribbean, Mesoamerica and South America.<h4>Results</h4>Our
search identified 88 eligible documents addressing the
following categories: (1) legal protections towards same-sex
couples (decriminalization of same-sex acts among consenting
adults, legal recognition of same-sex unions, same-sex
marriage, adoption by same-sex couples), and (2)
anti-discrimination laws (SGM allowed to serve openly in the
military and anti-discrimination laws related to sexual
orientation, gender identity and/or expression). The
majority of Caribbean countries prohibit same-sex acts
between consenting adults, while in Mesoamerica same-sex
couples do not have equal marriage rights and are not
allowed to adopt as a couple. In the Caribbean and
Mesoamerica transgender people lack proper legal protection.
Legislation to protect SGM rights in South America is the
most inclusive and progressive in LAC. Several countries
recognize same-sex marriage and the right of transgender
people to legally change their name and gender. The majority
of South American countries have some kind of
anti-discrimination law, but no effective mechanisms to
enforce these laws. In spite of those progresses, the LAC
region registers the highest rate of violence and hate
crimes against SGM in the world.<h4>Conclusion</h4>In the
Caribbean and Mesoamerica the overall discriminatory
legislation exacerbates violence against SGM within a social
and cultural context of strong sexist, gender stereotypes
and widespread violence. This scenario is driving hundreds
of SGM to leave their home countries. In spite of
progressive legislations, several South American countries
are currently controlled either by highly conservative
leaders (e.g. Brazil and Chile) or by repressive dictators
(Venezuela). The near future of the LAC region is unknown,
but if such trends continue, severe human rights problems,
including setbacks in SGM legal protections, are
likely.},
Doi = {10.1186/s12914-019-0217-3},
Key = {fds347071}
}
@article{fds346915,
Author = {Malta, M and Wells, S and LeGrand, S and Seixas, M and Baptista, A and da
Silva, CMFP and Kalume, C and Whetten, K},
Title = {Abortion in Brazil: the case for women's rights, lives, and
choices.},
Journal = {The Lancet. Public health},
Volume = {4},
Number = {11},
Pages = {e552},
Year = {2019},
Month = {November},
url = {http://dx.doi.org/10.1016/s2468-2667(19)30204-x},
Doi = {10.1016/s2468-2667(19)30204-x},
Key = {fds346915}
}
@article{fds343561,
Author = {Malta, M and Silva, AB and LeGrand, S and Whetten, K and Wells,
S},
Title = {HIV/AIDS, human rights, and transgender people in Latin
America.},
Journal = {The Lancet. Public health},
Volume = {4},
Number = {6},
Pages = {e279},
Year = {2019},
Month = {June},
url = {http://dx.doi.org/10.1016/s2468-2667(19)30082-9},
Doi = {10.1016/s2468-2667(19)30082-9},
Key = {fds343561}
}
@article{fds340819,
Author = {Proeschold-Bell, RJ and Molokwu, NJ and Keyes, CLM and Sohail, MM and Eagle, DE and Parnell, HE and Kinghorn, WA and Amanya, C and Vann, V and Madan, I and Biru, BM and Lewis, D and Dubie, ME and Whetten,
K},
Title = {Caring and thriving: An international qualitative study of
caregivers of orphaned and vulnerable children and
strategies to sustain positive mental health},
Volume = {98},
Pages = {143-153},
Publisher = {Elsevier BV},
Year = {2019},
Month = {March},
url = {http://dx.doi.org/10.1016/j.childyouth.2018.12.024},
Abstract = {© 2018 Background: Child well-being is associated with
caregiver mental health. Research has focused on the absence
or presence of mental health problems, such as depression,
in caregivers. However, positive mental health – defined
as the presence of positive emotions, psychological
functioning, and social functioning – likely prevents
depression and in caregivers may benefit children more than
the mere absence of mental health problems. Little attention
has been given to how caregivers sustain positive mental
health, particularly when doing challenging work in
impoverished settings. Objective: The study's objective was
to determine what successful caregivers of orphaned and
vulnerable children (OVC) in diverse countries do to sustain
their positive mental health. Methods: Using a
mixed-methods, cross-sectional study design, trained local
interviewers recruited a convenience sample of OVC
caregivers through residential care institutions from five
geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad,
India; and Nagaland, India). Participants completed surveys
and in-depth interviews about strategies used to sustain
their mental health over time or improve it during
challenging times. Results: Sixty-nine OVC caregivers from
28 residential care institutions participated. Positive
mental health survey scores were high. We organized the
strategies named into six categories ordered from most to
least frequently named: Religious Practices; Engaging in
Caregiving; Social Support; Pleasurable Activities; Emotion
Regulation; and Removing Oneself from Work. Prayer and
reading religious texts arose as common strategies.
Participants reported promoting positive emotions by
focusing on their work's meaning and playing with children.
The similar findings across diverse regions were striking.
Some differences included more emphasis on emotion control
in Ethiopia; listening to music/singing in Kenya and
Hyderabad; and involving children in the tasks the
participants enjoyed less (e.g., cleaning) in Cambodia.
Conclusions: Under real-world conditions, small daily
activities appeared to help sustain positive mental health.
In addition, fostering structures that allow caregivers to
engage regularly in rewarding caregiving tasks may be an
affordable and scalable idea which could potentially benefit
caregivers, children, and employers.},
Doi = {10.1016/j.childyouth.2018.12.024},
Key = {fds340819}
}
@article{fds344725,
Author = {Huynh, HV and Limber, SP and Gray, CL and Thompson, MP and Wasonga, AI and Vann, V and Itemba, D and Eticha, M and Madan, I and Whetten,
K},
Title = {Factors affecting the psychosocial well-being of orphan and
separated children in five low- and middle-income countries:
Which is more important, quality of care or care
setting?},
Journal = {PloS one},
Volume = {14},
Number = {6},
Pages = {e0218100},
Year = {2019},
Month = {January},
url = {http://dx.doi.org/10.1371/journal.pone.0218100},
Abstract = {As millions of children continue to live without parental
care in under-resourced societies in low- and middle-income
countries (LMICs), it is important for policymakers and
practitioners to understand the specific characteristics
within different care settings and the extent to which they
are associated with outcomes of orphan and separated
children (OSC). This study was designed to (1) examine if
the psychosocial well-being of OSC in under-resourced
societies in LMICs is more dependent on the availability of
certain components of quality of care rather than the care
setting itself (i.e. the residential care-based or community
family-based setting), and (2) identify the relative
significance of certain components of quality of care that
are associated with a child's psychosocial well-being across
different OSC care settings. This study drew from 36-month
follow-up data from the Positive Outcomes for Orphans (POFO)
Study and used a sample population of 2,013 (923
institution- and 1,090 community-based) OSC among six
diverse study sites across five LMICs: Cambodia, India
(Hyderabad and Nagaland), Kenya, Tanzania, and Ethiopia.
Analyses showed that all four components of quality of care
significantly predicted child psychosocial well-being. Child
psychosocial well-being across "high" and "low" levels of
quality of care showed negligible differences between
residential- and community-based care settings, suggesting
the important factor in child well-being is quality of care
rather than setting of care. Practical and policy
implications and future research are discussed.},
Doi = {10.1371/journal.pone.0218100},
Key = {fds344725}
}
@article{fds348023,
Author = {Dorsey, S and Meza, RD and Martin, P and Gray, CL and Triplett, NS and Soi,
C and Woodard, GS and Lucid, L and Amanya, C and Wasonga, A and Whetten,
K},
Title = {Lay Counselor Perspectives of Providing a Child-Focused
Mental Health Intervention for Children: Task-Shifting in
the Education and Health Sectors in Kenya.},
Journal = {Frontiers in psychiatry},
Volume = {10},
Pages = {860},
Year = {2019},
Month = {January},
url = {http://dx.doi.org/10.3389/fpsyt.2019.00860},
Abstract = {The global mental health treatment gap has increasingly been
addressed using task-shifting; however, very little research
has focused on lay counselors' perspectives on the
acceptability, feasibility, and appropriateness of mental
health interventions in specific government-supported
sectors that might scale up and sustain mental health care
for children and adolescents. In western Kenya, these
sectors include Education and Health. Data come from a large
hybrid effectiveness-implementation study examining
implementation practices and policies in either or both
sectors that support successful implementation of a
child-focused intervention, Trauma-focused Cognitive
Behavioral Therapy (TF-CBT), for children and adolescents
who had experienced parental death. We examined lay
counselors' self-report of acceptability, feasibility, and
appropriateness of TF-CBT. Lay counselors were teachers (n =
30) from the Education sector and Community Health
Volunteers (CHVs; n = 30) from the Health sector, who were
part of Sequence 1 of a large stepped-wedge, cluster
randomized trial. Lay counselor self-report surveys included
reflective and formative measurement of acceptability,
feasibility, and appropriateness administered after lay
counselors in both sectors had experience delivering the
locally-adapted, group-based TF-CBT intervention.
Descriptive statistics (means, standard deviations) were
used to understand counselors' perspectives stratified by
sector. Both teachers and CHVs endorsed high acceptability,
feasibility, and appropriateness of TF-CBT, with lay
counselors' responses on items from the formative measures
providing some insight into specific aspects of
acceptability, feasibility, and appropriateness that may be
important to consider when planning for implementation
support. These early findings suggest that both sectors may
hold promise for task-shifting of mental health care for
children and adolescents but also underline the importance
of considering the multiple facets of these three
implementation outcomes as well as lay counselor context
(Education vs. Health).},
Doi = {10.3389/fpsyt.2019.00860},
Key = {fds348023}
}
@article{fds337379,
Author = {Agala, CB and Thomas, JC and Fried, BJ and Lich, KH and Morrissey, J and Zimmer, C and Whetten, K and Reynolds, HW},
Title = {Organizational network strengthening effects on
antiretroviral therapy initiation and adherence.},
Journal = {Translational behavioral medicine},
Volume = {8},
Number = {4},
Pages = {585-597},
Year = {2018},
Month = {July},
url = {http://dx.doi.org/10.1093/tbm/ibx058},
Abstract = {The WHO recommends antiretroviral therapy (ART) initiation
immediately after HIV diagnosis. When HIV services are
fragmented and poorly coordinated, initiation of ART can be
delayed. MEASURE Evaluation conducted an organizational
network intervention in Addis Ababa, Ethiopia, which
increased referral network density and client satisfaction
in the intervention versus control networks. The objective
of our study was to extend the parent study by assessing
effects of network density on the speed of ART initiation
and adherence to ART. Measures of client-time since HIV
diagnosis, use of ART, satisfaction with HIV-related
services, and adherence were obtained from cross-sectional
interviews with female service recipients with HIV/AIDS at
baseline (T1, 402) and at 18-month follow-up (T2, 524) and
compared between network sites. We used weighted least
squares estimation with probit regression techniques in a
structural equation modeling framework for analyses. On
average at follow-up, clients in the intervention network
were more likely to have quicker ART initiation, and were
initiated on ART 15 days faster than clients in the control
network. Moreover, quicker ART initiation was associated
with higher adherence. A unit increase in speed of ART
initiation was associated with 0.5 points increase in latent
adherence score in the intervention group (p < .05).
Satisfaction with care positively predicted adherence to
ART. Network density had no direct effect on ART adherence.
This quasi-experiment demonstrated that increased referral
network density, through improved HIV client referrals, can
enhance speed of ART initiation, resulting in improved
adherence.},
Doi = {10.1093/tbm/ibx058},
Key = {fds337379}
}
@article{fds335209,
Author = {Rivenbark, J and Martyn, L and Whetten, K and Vasudevan,
L},
Title = {A survey of healthcare-seeking practices and related stigma
among community- and street-based children in
Cambodia.},
Journal = {International health},
Volume = {10},
Number = {3},
Pages = {211-213},
Year = {2018},
Month = {May},
url = {http://dx.doi.org/10.1093/inthealth/ihy008},
Abstract = {<h4>Background</h4>Globally, street children comprise a
growing population of vulnerable children. Understanding how
they interact with healthcare systems is fundamental to
efforts to improve their health and well-being.<h4>Methods</h4>We
surveyed 75 street- and community-based children in
Battambang, Cambodia regarding their healthcare-seeking
practices and related stigma.<h4>Results</h4>For
demographically similar street and community children,
hospitals and pharmacies were preferred healthcare
institutions, with this choice being motivated by the
caretaker's decision or cost. Street children reported
increased fear of being refused treatment.<h4>Conclusions</h4>Street
children and demographically similar community children have
similar healthcare-seeking practices and preferences,
although street children face increased stigmatization.},
Doi = {10.1093/inthealth/ihy008},
Key = {fds335209}
}
@article{fds329332,
Author = {Kane, JC and Bolton, P and Murray, SM and Bass, JK and Lakin, D and Whetten, K and Skavenski van Wyk and S and Murray,
LK},
Title = {Psychometric evaluation of HIV risk behavior assessments
using Audio Computer Assisted Self-Interviewing (ACASI)
among orphans and vulnerable children in
Zambia.},
Journal = {AIDS care},
Volume = {30},
Number = {2},
Pages = {160-167},
Year = {2018},
Month = {February},
url = {http://dx.doi.org/10.1080/09540121.2017.1384787},
Abstract = {Social desirability bias and underreporting of HIV risk
behaviors are significant challenges to the accurate
evaluation of HIV prevention programs for orphans and
vulnerable children (OVC) in sub-Saharan Africa. Valid and
reliable HIV risk behavior instruments are critical to
address these challenges. We assessed the psychometric
properties of two risk behavior measures, the World Aids
Foundation Survey (WAF) and the Peer HIV Risk Behavior
Screener (PHRBS), administered to 210 OVC in Zambia using
Audio Computer Assisted Self-Interviewing. All WAF subscales
exhibited good internal reliability (α > .80); only the
Sexual Behavior Practices subscale strongly distinguished (P
< .01) adolescents who engaged in HIV risk behaviors
("cases") from those who did not ("non-cases"). An 8-item
version of the PHRBS, refined using exploratory factor
analysis, demonstrated good internal reliability (α = 87),
differentiated "cases" from "non-cases" (P < .01), and
correlated strongly with the Sexual Behavior Practices
subcale (r = .34, P < .01). Results suggest that report of
peers' sexual behaviors can serve as a proxy for OVCs' own
behavior in contexts where social desirability bias affects
reporting.},
Doi = {10.1080/09540121.2017.1384787},
Key = {fds329332}
}
@article{fds324865,
Author = {Reif, S and Safley, D and McAllaster, C and Wilson, E and Whetten,
K},
Title = {State of HIV in the US Deep South},
Journal = {Journal of Community Health},
Volume = {42},
Number = {5},
Pages = {844-853},
Publisher = {Kluwer Academic Publishers},
Year = {2017},
Month = {February},
url = {http://dx.doi.org/10.1007/s10900-017-0325-8},
Abstract = {The Southern United States has been disproportionately
affected by HIV diagnoses and mortality. To inform efforts
to effectively address HIV in the South, this manuscript
synthesizes recent data on HIV epidemiology, care financing,
and current research literature on factors that predispose
this region to experience a greater impact of HIV. The
manuscript focuses on a specific Southern region, the Deep
South, which has been particularly affected by HIV.
Epidemiologic data from the Centers from Disease Control and
Prevention indicate that the Deep South had the highest HIV
diagnosis rate and the highest number of individuals
diagnosed with HIV (18,087) in 2014. The percentage of new
HIV diagnoses that were female has decreased over time
(2008–2014) while increasing among minority MSM. The Deep
South also had the highest death rates with HIV as an
underlying cause of any US region in 2014. Despite higher
diagnosis and death rates, the Deep South received less
federal government and private foundation funding per person
living with HIV than the US overall. Factors that have been
identified as contributors to the disproportionate effects
of HIV in the Deep South include pervasive HIV-related
stigma, poverty, higher levels of sexually transmitted
infections, racial inequality and bias, and laws that
further HIV-related stigma and fear. Interventions that
address and abate the contributors to the spread of HIV
disease and the poorer HIV-related outcomes in the Deep
South are warranted. Funding inequalities by region must
also be examined and addressed to reduce the regional
disparities in HIV incidence and mortality.},
Doi = {10.1007/s10900-017-0325-8},
Key = {fds324865}
}
@article{fds322162,
Author = {Gray, CL and Pence, BW and Messer, LC and Ostermann, J and Whetten, RA and Thielman, NM and O'Donnell, K and Whetten, K},
Title = {Civic engagement among orphans and non-orphans in five low-
and middle-income countries.},
Journal = {Global Health},
Volume = {12},
Number = {1},
Pages = {61},
Year = {2016},
Month = {October},
url = {http://dx.doi.org/10.1186/s12992-016-0202-8},
Abstract = {BACKGROUND: Communities and nations seeking to foster social
responsibility in their youth are interested in
understanding factors that predict and promote youth
involvement in public activities. Orphans and separated
children (OSC) are a vulnerable population whose numbers are
increasing, particularly in resource-poor settings.
Understanding whether and how OSC are engaged in civic
activities is important for community and world leaders who
need to provide care for OSC and ensure their involvement in
sustainable development. METHODS: The Positive Outcomes for
Orphans study (POFO) is a multi-country, longitudinal cohort
study of OSC randomly sampled from institution-based care
and from family-based care, and of non-OSC sampled from the
same study regions. Participants represent six sites in five
low-and middle-income countries. We examined civic
engagement activities and government trust among
subjects > =16 years old at 90-month follow-up
(approximately 7.5 years after baseline). We calculated
prevalences and estimated the association between key
demographic variables and prevalence of regular volunteer
work using multivariable Poisson regression, with sampling
weights to accounting for the complex sampling design.
RESULTS: Among the 1,281 POFO participants > =16 who
were assessed at 90-month follow-up, 45 % participated in
regular community service or volunteer work; two-thirds of
those volunteers did so on a strictly voluntary basis. While
government trust was fairly high, at approximately 70 % for
each level of government, participation in voting was only
15 % among those who were > =18 years old. We did not
observe significant associations between demographic
characteristics and regular volunteer work, with the
exception of large variation by study site. CONCLUSION: As
the world's leaders grapple with the many competing demands
of global health, economic security, and governmental
stability, the participation of today's youth in community
and governance is essential for sustainability. This study
provides a first step in understanding the degree to which
OSC from different care settings across multiple low- and
middle-income countries are engaged in their
communities.},
Doi = {10.1186/s12992-016-0202-8},
Key = {fds322162}
}
@article{fds322163,
Author = {Reddy, EA and Agala, CB and Maro, VP and Ostermann, J and Pence, BW and Itemba, DK and Safley, D and Yao, J and Thielman, NM and Whetten,
K},
Title = {Test site predicts HIV care linkage and antiretroviral
therapy initiation: a prospective 3.5 year cohort study of
HIV-positive testers in northern Tanzania.},
Journal = {BMC Infect Dis},
Volume = {16},
Pages = {497},
Year = {2016},
Month = {September},
url = {http://dx.doi.org/10.1186/s12879-016-1804-8},
Abstract = {BACKGROUND: Linkage to HIV care is crucial to the success of
antiretroviral therapy (ART) programs worldwide, loss to
follow up at all stages of the care continuum is frequent,
and long-term prospective studies of care linkage are
currently lacking. METHODS: Consecutive clients who tested
HIV-positive were enrolled from four HIV testing centers (1
health facility and 3 community-based centers) in the
Kilimanjaro region of Tanzania as part of the larger Coping
with HIV/AIDS in Tanzania (CHAT) prospective observational
study. Biannual interviews were conducted over 3.5 years,
assessing care linkage, retention, and mental health.
Bivariable and multivariate logistic regression analyses
were conducted to determine associations with early death
(prior to the second follow up interview) and delayed
(>6 months post-test) or failed care linkage. RESULTS: A
total of 263 participants were enrolled between November,
2008 and August, 2009 and 240 participants not already
linked to care were retained in the final dataset. By
6 months after enrollment, 169 (70.4 %) of 240
participants had presented to an HIV care and treatment
facility; 41 (17.1 %) delayed more than 6 months, 15
(6.3 %) died, and 15 (6.3 %) were lost to follow up.
Twenty-six patients died before their second follow up visit
and were analyzed in the early death group (10.8 %). Just
15 (9.6 %) of those linked to care had started ART within
6 months, but 123 (89.1 %) of patients documented to be
ART eligible by local guidelines had started ART by the end
of 3.5 years. On multivariate analysis, male gender (OR
1.72; 95 % CI 1.08, 2.75), testing due to illness (OR 1.63;
95 % CI 1.01, 2.63), and higher mean depression scale
scores (4 % increased risk per increase in depression
score; 95 % CI 1 %, 8 %) were associated with early
death. Testing at a community versus a hospital-based site
(OR 2.89; 95 % CI 1.79, 4.66) was strongly associated with
delaying or never entering care. CONCLUSIONS: Nearly 30 %
of the cohort did not have timely care linkage, ART
initiation was frequently delayed, and testing at a hospital
outpatient department versus community-based testing centers
was strongly associated with successful care
linkage.},
Doi = {10.1186/s12879-016-1804-8},
Key = {fds322163}
}
@article{fds317891,
Author = {Gray, CL and Whetten, K and Messer, LC and Whetten, RA and Ostermann, J and O'Donnell, K and Thielman, NM and Pence, BW},
Title = {Potentially traumatic experiences and sexual health among
orphaned and separated adolescents in five low- and
middle-income countries.},
Journal = {AIDS Care},
Volume = {28},
Number = {7},
Pages = {857-865},
Year = {2016},
Month = {July},
url = {http://dx.doi.org/10.1080/09540121.2016.1147013},
Abstract = {Orphans and separated children (OSC) are a vulnerable
population whose numbers are increasing, particularly in
sub-Saharan Africa and Asia. Over 153 million children
worldwide have lost one or both parents, including 17
million orphaned by AIDS, and millions more have been
separated from their parents. As younger orphans enter
adolescence, their sexual health and HIV-related risk
behaviors become key considerations for their overall
health. Importantly, their high prevalence of exposure to
potentially traumatic events (PTEs) may put OSC at
additional risk for adverse sexual health outcomes. The
Positive Outcomes for Orphans study followed OSC randomly
sampled from institution-based care and from family-based
care, as well as a convenience sample of non-OSC, at six
sites in five low-and middle-income countries. This analysis
focused on the 90-month follow-up, during which adolescents
16 and older were assessed for sexual health, including age
at sexual debut, past-year sex, past-year condom use, and
perceptions of condom use. We specifically examined the
relationship between PTEs and sexual health outcomes. Of the
1258 OSC and 138 non-OSC assessed, 11% reported ever having
sex. Approximately 6% of participants reported recent sex
and 5% reported having recent unprotected sex. However, 70%
of those who had recent sex reported that they did not use a
condom every time, and perceptions of condom use tended to
be unfavorable for protection against sexual risk behavior.
Nearly all (90%) of participants reported experiencing at
least one lifetime PTE. For those who experienced "any" PTE,
we found increased prevalence of recent sex (PR = 1.39
[0.47, 4.07]) and of recent unprotected sex (PR = 3.47
[0.60, 19.91]). This study highlights the need for
caregivers, program managers, and policymakers to promote
condom use for sexually active OSC and identify
interventions for trauma support services. Orphans living in
family-based care may also be particularly vulnerable to
early sexual debut and unprotected sexual
activity.},
Doi = {10.1080/09540121.2016.1147013},
Key = {fds317891}
}
@article{fds317892,
Author = {Lee, C and Whetten, K and Omer, S and Pan, W and Salmon,
D},
Title = {Hurdles to herd immunity: Distrust of government and vaccine
refusal in the US, 2002-2003.},
Journal = {Vaccine},
Volume = {34},
Number = {34},
Pages = {3972-3978},
Year = {2016},
Month = {July},
url = {http://dx.doi.org/10.1016/j.vaccine.2016.06.048},
Abstract = {High rates of nonmedical exemptions (NMEs) from required
childhood vaccinations have contributed to outbreaks of
vaccine-preventable diseases, such as measles and pertussis.
Understanding the parental decision to obtain an NME could
help health professionals and public health programs improve
vaccination rates in areas with high vaccine refusal. Using
a 2002-2003 multi-state survey of parents of school age
children (n=2445), this study found that parental
distrust of the government and of healthcare providers is a
significant factor related to a number of vaccine-related
beliefs and behaviors. The odds that parents who distrust
the government have seen a complementary/alternative
medicine (CAM) provider were 2.11 times greater than those
of parents who trust the government (70.1% vs 52.6%; OR,
2.11; 95% CI, 1.59-2.84; P<0.01). Parents who distrust the
government had increased odds of trusting vaccine
information from CAM providers compared to trusting parents
(57.9% vs 46.3%; OR, 1.53; 95% CI, 1.16-2.01; P<0.01).
Parents who distrust the government also had increased odds
of distrusting vaccine information acquired at their
healthcare providers' offices (12.6% vs 4.7%; OR, 2.64; 95%
CI, 1.64-4.24; P<0.01). Distrustful parents had increased
odds of thinking government sources of information about
vaccines were unreliable, categorizing the CDC, the Food and
Drug Administration (FDA), or local and state health
departments as poor or very poor sources (distrust
government vs trust government: 25.2% vs 11.7%; OR, 2.39;
95% CI, 1.70-3.36; P<0.01; distrust healthcare providers vs
trust healthcare providers: 24.4% vs 11.4%; OR, 2.44; 95%
CI, 1.75-3.38; P<0.01). These findings indicate that
distrustful parent populations may need to be reached
through modalities outside of traditional government and
healthcare provider communications. Research into new and
more effective techniques for delivering pro-vaccine
messages is warranted.},
Doi = {10.1016/j.vaccine.2016.06.048},
Key = {fds317892}
}
@article{fds317893,
Author = {Sinha, A and Lombe, M and Saltzman, LY and Whetten, K and Whetten, R and Positive Outcomes for Orphans Research Team},
Title = {Exploring Factors Associated with Educational Outcomes for
Orphan and Abandoned Children in India.},
Journal = {Global social welfare : research, policy &
practice},
Volume = {3},
Number = {1},
Pages = {23-32},
Year = {2016},
Month = {March},
url = {http://dx.doi.org/10.1007/s40609-016-0043-7},
Abstract = {India has more than 25 million orphan and abandoned children
(UNICEF, 2012). The burden of care for these OAC is on
caregivers that are often ill equipped to meet their needs
due to inadequate assets. Previous studies suggest that in
communities with limited resources, OAC residing with
non-biological caregivers are more at risk than those
fostered by a biological parent. This study explores the
association of caregiver and child characteristics with OAC
educational outcome in India. The analysis was conducted
using hierarchical logistic regression. The findings have
implications for practice and policy in the global child
welfare field.},
Doi = {10.1007/s40609-016-0043-7},
Key = {fds317893}
}
@article{fds323147,
Author = {Grand, SL and Scheid, TL and Whetten, K},
Title = {The differential impact of social relationships on health
outcomes for HIV positive men and women},
Journal = {Research in the Sociology of Health Care},
Volume = {34},
Pages = {153-174},
Publisher = {Emerald Group Publishing Limited},
Year = {2016},
Month = {January},
url = {http://dx.doi.org/10.1108/S0275-495920160000034009},
Abstract = {Purpose - This chapter examines the associations between
gender, social support, and health outcomes for individuals
living with HIV disease. We include social integration and
social isolation as structural measures of social support as
well as perceived social support and social conflict as
functional measures of social support. We include both
mental health and physical health outcomes, which are too
often studied in isolation of each other.
Methodology/approach - Data are from the Coping with
HIV/AIDS in the Southeast (CHASE) study; this study reports
on baseline data from 611 participants collected from 2001
to 2002. We first examined differences by gender and race,
and then used blocked linear regression to determine the
additive effects of the social support variables on both
mental and physical health outcomes while controlling for
potential confounders. Findings - There were notable
differences in the significance and strength of social
support variables in health outcome models for men and
women. Unlike men, social conflict was the strongest
predictor of greater psychological distress and poorer
physical health-related quality of life among women.
Research limitations/implications - While the results from
this study contribute to a greater understanding of gender
differences in the relationships between social support and
health outcomes, the data used for this study are limited to
those living with HIV/AIDS in the Southeast.
Originality/value - Our findings suggest that social
conflict may be more detrimental for the health of women
than men.},
Doi = {10.1108/S0275-495920160000034009},
Key = {fds323147}
}
@article{fds301057,
Author = {LeGrand, S and Reif, S and Sullivan, K and Murray, K and Barlow, ML and Whetten, K},
Title = {A Review of Recent Literature on Trauma Among Individuals
Living with HIV.},
Journal = {Current HIV/AIDS reports},
Volume = {12},
Number = {4},
Pages = {397-405},
Year = {2015},
Month = {December},
ISSN = {1548-3568},
url = {http://dx.doi.org/10.1007/s11904-015-0288-2},
Abstract = {Persons living with HIV (PLWH) report disproportionately
high levels of exposure to traumatic events in childhood and
adulthood. Traumatic experiences are associated with
negative health and behavioral outcomes. Current research in
this area seeks to further explicate the myriad health
effects of trauma on PLWH and the pathways through which
trauma operates. In this paper, we review articles published
in English between January 2014 and June 2015 that examine
traumatic experiences among PLWH, including intimate partner
violence (IPV), domestic abuse, child abuse, and other forms
of violence. A selection of studies examining trauma among
PLWH and its associations with mental health, antiretroviral
medication adherence, clinical outcomes, HIV disclosure, and
sexual risk behaviors were included. Studies describing
trauma coping strategies and interventions were also
included. We conclude with recommendations for care of
trauma-exposed PLWH and directions for future
research.},
Doi = {10.1007/s11904-015-0288-2},
Key = {fds301057}
}
@article{fds301058,
Author = {Dorsey, S and Lucid, L and Murray, L and Bolton, P and Itemba, D and Manongi, R and Whetten, K},
Title = {A Qualitative Study of Mental Health Problems Among Orphaned
Children and Adolescents in Tanzania.},
Journal = {The Journal of nervous and mental disease},
Volume = {203},
Number = {11},
Pages = {864-870},
Year = {2015},
Month = {November},
ISSN = {0022-3018},
url = {http://dx.doi.org/10.1097/nmd.0000000000000388},
Abstract = {Low- and middle-income countries have a high number of
orphans, many of whom have unmet mental health needs.
Effective mental health interventions are needed; however,
it is necessary to understand how mental health symptoms and
needs are perceived locally to tailor interventions and
refine measurement of intervention effects. We used an
existing rapid ethnographic assessment approach to identify
mental health problems from the perspective of orphans and
guardians to inform a subsequent randomized controlled trial
of a Western-developed, evidence-based psychosocial
intervention, Trauma-focused Cognitive Behavioral Therapy.
Local Kiswahili-speaking interviewers conducted 73 free list
interviews and 34 key informant interviews. Results
identified both common cross-cultural experiences and
symptoms as well as uniquely described symptoms (e.g.,
lacking peace, being discriminated against) not typically
targeted by the intervention or included on standardized
measures of intervention effects. We discuss implications
for adapting mental health interventions in low- and
middle-income countries and assessing effectiveness.},
Doi = {10.1097/nmd.0000000000000388},
Key = {fds301058}
}
@article{fds301060,
Author = {Culver, KA and Whetten, K and Boyd, DL and O'Donnell,
K},
Title = {Yoga to Reduce Trauma-Related Distress and Emotional and
Behavioral Difficulties Among Children Living in Orphanages
in Haiti: A Pilot Study.},
Journal = {Journal of alternative and complementary medicine (New York,
N.Y.)},
Volume = {21},
Number = {9},
Pages = {539-545},
Year = {2015},
Month = {September},
ISSN = {1075-5535},
url = {http://dx.doi.org/10.1089/acm.2015.0017},
Abstract = {<h4>Objectives</h4>To measure trauma-related distress and
evaluate the feasibility, acceptability, and preliminary
efficacy of an 8-week yoga intervention (YI) in reducing
trauma-related symptoms and emotional and behavioral
difficulties (EBD) among children living in orphanages in
Haiti.<h4>Design</h4>Case comparison with random assignment
to YI or aerobic dance control (DC) plus a nonrandomized
wait-list control (WLC) group.<h4>Setting</h4>Two orphanages
for children in Haiti.<h4>Participants</h4>76 children age 7
to 17 years.<h4>Intervention</h4>The YI included yoga
postures, breathing exercises, and meditation. The DC group
learned a series of dance routines. The WLC group received
services as usual in the institutional setting. After
completion of data collection, the WLC group received both
yoga and dance classes for 8 weeks.<h4>Outcome
measures</h4>The UCLA PTSD Reaction Index and the Strengths
and Difficulties Questionnaire were used to indicate
trauma-related symptoms and EBD, respectively. A
within-subject analysis was conducted to compare pre- and
post-treatment scores. A post-treatment yoga experience
questionnaire evaluated acceptability of the
YI.<h4>Results</h4>Analyses of variance revealed a
significant effect (F[2,28]=3.30; p=0.05) of the YI on the
trauma-related symptom scores. Regression analyses showed
that participation in either 8 weeks of yoga or dance
classes suggested a reduction in trauma-related symptoms and
EBD, although this finding was not statistically significant
(p>0.05). Respondents reported satisfaction with the yoga
program and improved well-being.<h4>Conclusions</h4>Children
with trauma-related distress showed improvements in symptoms
after participation in an 8-week yoga program compared to
controls. Yoga is a feasible and acceptable activity with
self-reported benefits to child mental and physical health.
Additional research is needed to further evaluate the effect
of yoga to relieve trauma-related distress and promote
well-being among children.},
Doi = {10.1089/acm.2015.0017},
Key = {fds301060}
}
@article{fds317894,
Author = {Gray, CL and Pence, BW and Ostermann, J and Whetten, RA and O'Donnell,
K and Thielman, NM and Whetten, K},
Title = {Prevalence and Incidence of Traumatic Experiences Among
Orphans in Institutional and Family-Based Settings in 5 Low-
and Middle-Income Countries: A Longitudinal
Study.},
Journal = {Glob Health Sci Pract},
Volume = {3},
Number = {3},
Pages = {395-404},
Year = {2015},
Month = {August},
url = {http://dx.doi.org/10.9745/GHSP-D-15-00093},
Abstract = {BACKGROUND: Policy makers struggling to protect the 153
million orphaned and separated children (OSC) worldwide need
evidence-based research on the burden of potentially
traumatic events (PTEs) and the relative risk of PTEs across
different types of care settings. METHODS: The Positive
Outcomes for Orphans study used a 2-stage,
cluster-randomized sampling design to identify 1,357
institution-dwelling and 1,480 family-dwelling orphaned and
separated children in 5 low- and middle-income countries
(LMICs) in sub-Saharan Africa and Asia. We used the Life
Events Checklist developed by the National Center for
Posttraumatic Stress Disorder to examine self-reported PTEs
among 2,235 OSC ages 10-13 at baseline. We estimated
prevalence and incidence during 36-months of follow-up and
compared the risk of PTEs across care settings. Data
collection began between May 2006 and February 2008,
depending on the site. RESULTS: Lifetime prevalence by age
13 of any PTE, excluding loss of a parent, was 91.0% (95%
confidence interval (CI) = 85.6, 94.5) in
institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0)
in family-dwelling OSC; annual incidence of any PTE was
lower in institution-dwelling (23.6% [95% CI = 19.4,
28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1,
32.2]). More than half of children in institutions (50.3%
[95% CI = 42.5, 58.0]) and in family-based care (54.0%
[95% CI = 50.2, 57.7]) had experienced physical or
sexual abuse by age 13. Annual incidence of physical or
sexual abuse was lower in institution-dwelling (12.9% [95%
CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95%
CI = 17.7, 21.3]), indicating statistically lower risk
in institution-dwelling OSC (risk difference = 6.5% [95%
CI = 1.4, 11.7]). CONCLUSION: Prevalence and incidence
of PTEs were high among OSC, but contrary to common
assumptions, OSC living in institutions did not report more
PTEs or more abuse than OSC living with families. Current
efforts to reduce the number of institution-dwelling OSC may
not reduce incidence of PTEs in this vulnerable population.
Protection of children from PTEs should be a primary
consideration, regardless of the care setting.},
Doi = {10.9745/GHSP-D-15-00093},
Key = {fds317894}
}
@article{fds301061,
Author = {Reif, S and Pence, BW and Hall, I and Hu, X and Whetten, K and Wilson,
E},
Title = {HIV Diagnoses, Prevalence and Outcomes in Nine Southern
States.},
Journal = {J Community Health},
Volume = {40},
Number = {4},
Pages = {642-651},
Year = {2015},
Month = {August},
ISSN = {0094-5145},
url = {http://dx.doi.org/10.1007/s10900-014-9979-7},
Abstract = {A group of nine states in the Southern United States,
hereafter referred to as the targeted states, has
experienced particularly high HIV diagnosis and case
fatality rates. To provide additional information about the
HIV burden in this region, we used CDC HIV surveillance data
to examine characteristics of individuals diagnosed with HIV
in the targeted states (2011), 5-year HIV and AIDS survival,
and deaths among persons living with HIV (2010). We used
multivariable analyses to explore the influence of residing
in the targeted states at diagnosis on deaths among persons
living with HIV after adjustment for demographics and
transmission risk. In 2011, the targeted states had a higher
HIV diagnosis rate (24.5/100,000 population) than the US
overall (18.0/100,000) and higher proportions than other
regions of individuals diagnosed with HIV who were black,
female, younger, and living in suburban and rural areas.
Furthermore, the targeted states had lower HIV and AIDS
survival proportions (0.85, 0.73, respectively) than the US
overall (0.86, 0.77, respectively) and the highest death
rate among persons living with HIV of any US region.
Regional differences in demographics and transmission risk
did not explain the higher death rate among persons living
with HIV in the targeted states indicating that other
factors contribute to this disparity. Differences in
characteristics and outcomes of individuals with HIV in the
targeted states are critical to consider when creating
strategies to address HIV in the region, as are other
factors identified in previous research to be prominent in
the region including poverty and stigma.},
Doi = {10.1007/s10900-014-9979-7},
Key = {fds301061}
}
@article{fds317895,
Author = {Gray, CL and Pence, BW and Ostermann, J and Whetten, RA and O'Donnell,
K and Thielman, NM and Whetten, K},
Title = {Gender (in) differences in prevalence and incidence of
traumatic experiences among orphaned and separated children
living in five low- and middle-income countries.},
Journal = {Glob Ment Health (Camb)},
Volume = {2},
Pages = {e3},
Year = {2015},
Month = {January},
url = {http://dx.doi.org/10.1017/gmh.2015.1},
Abstract = {BACKGROUND: Approximately 153 million children worldwide are
orphaned and vulnerable to potentially traumatic events
(PTEs). Gender differences in PTEs in low- and middle-income
countries (LMIC) are not well-understood, although support
services and prevention programs often primarily involve
girls. METHODS: The Positive Outcomes for Orphans study used
a two-stage, cluster-randomized sampling design to identify
2837 orphaned and separated children (OSC) in five LMIC in
sub-Saharan Africa and Asia. We examined self-reported
prevalence and incidence of several PTE types, including
physical and sexual abuse, among 2235 children who were
≥10 years at baseline or follow-up, with a focus on gender
comparisons. RESULTS: Lifetime prevalence by age 13 of any
PTE other than loss of a parent was similar in both boys
[91.7% (95% confidence interval (CI) (85.0-95.5)] and girls
[90.3% CI (84.2-94.1)] in institutional-based care, and boys
[92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in
family-based care; annual incidence was similarly comparable
between institution dwelling boys [23.6% CI (19.1, -29.3)]
and girls [23.6% CI (18.6, -30.0)], as well as between
family-dwelling boys [30.7% CI (28.0, -33.6)] and girls
[29.3% CI (26.8,-32.0)]. Physical and sexual abuse had the
highest overall annual incidence of any trauma type for
institution-based OSC [12.9% CI (9.6-17.4)] and family-based
OSC [19.4% CI (14.5-26.1)], although estimates in each
setting were no different between genders. CONCLUSION:
Prevalence and annual incidence of PTEs were high among OSC
in general, but gender-specific estimates were comparable.
Although support services and prevention programs are
essential for female OSC, programs for male OSC are equally
important.},
Doi = {10.1017/gmh.2015.1},
Key = {fds317895}
}
@article{fds301055,
Author = {Reif, S and Pence, BW and Hall, I and Hu, X and Whetten, K and Wilson,
E},
Title = {HIV diagnoses, prevalence and outcomes in nine southern
states},
Journal = {Journal of Community Health},
Volume = {40},
Number = {4},
Pages = {642-651},
Year = {2015},
ISSN = {0094-5145},
url = {http://dx.doi.org/10.1007/s10900-014-9979-7},
Abstract = {© 2014, Springer Science+Business Media New York (outside
the USA).A group of nine states in the Southern United
States, hereafter referred to as the targeted states, has
experienced particularly high HIV diagnosis and case
fatality rates. To provide additional information about the
HIV burden in this region, we used CDC HIV surveillance data
to examine characteristics of individuals diagnosed with HIV
in the targeted states (2011), 5-year HIV and AIDS survival,
and deaths among persons living with HIV (2010). We used
multivariable analyses to explore the influence of residing
in the targeted states at diagnosis on deaths among persons
living with HIV after adjustment for demographics and
transmission risk. In 2011, the targeted states had a higher
HIV diagnosis rate (24.5/100,000 population) than the US
overall (18.0/100,000) and higher proportions than other
regions of individuals diagnosed with HIV who were black,
female, younger, and living in suburban and rural areas.
Furthermore, the targeted states had lower HIV and AIDS
survival proportions (0.85, 0.73, respectively) than the US
overall (0.86, 0.77, respectively) and the highest death
rate among persons living with HIV of any US region.
Regional differences in demographics and transmission risk
did not explain the higher death rate among persons living
with HIV in the targeted states indicating that other
factors contribute to this disparity. Differences in
characteristics and outcomes of individuals with HIV in the
targeted states are critical to consider when creating
strategies to address HIV in the region, as are other
factors identified in previous research to be prominent in
the region including poverty and stigma.},
Doi = {10.1007/s10900-014-9979-7},
Key = {fds301055}
}
@article{fds317896,
Author = {Gaynes, BN and Pence, BW and Atashili, J and O'Donnell, JK and Njamnshi,
AK and Tabenyang, ME and Arrey, CK and Whetten, R and Whetten, K and Ndumbe, P},
Title = {Changes in HIV Outcomes Following Depression Care in a
Resource-Limited Setting: Results from a Pilot Study in
Bamenda, Cameroon.},
Journal = {PLoS One},
Volume = {10},
Number = {10},
Pages = {e0140001},
Year = {2015},
url = {http://dx.doi.org/10.1371/journal.pone.0140001},
Abstract = {BACKGROUND: Little is known about how improved depression
care affects HIV-related outcomes in Africa. In a sample of
depressed HIV patients in a low income, sub-Saharan country,
we explored how implementing measurement-based
antidepressant care (MBC) affected HIV outcomes over 4
months of antidepressant treatment. METHODS: As part of a
project adapting MBC for use in Cameroon, we enrolled 41
depressed HIV patients on antiretroviral therapy in a pilot
study in which a depression care manager (DCM) provided an
outpatient HIV clinician with evidence-based decision
support for antidepressant treatment. Acute depression
management was provided for the first 12 weeks, with DCM
contact every 2 weeks and HIV clinician appointments every 4
weeks. We measured HIV clinical and psychiatric outcomes at
4 months. RESULTS: Participants were moderately depressed at
baseline (mean Patient Health Questionnaire [PHQ] score =
14.4, range 13.1, 15.6). All HIV clinical outcomes improved
by four month follow-up: mean (range) CD4 count improved
from 436 (2, 860) to 452 (132, 876), mean (range) log-viral
load decreased from 4.02 (3.86, 4.17) to 3.15 (2.81, 3.49),
the proportion with virologic suppression improved from 0%
to 18%, mean (range) HIV symptoms decreased from 6.4 (5.5,
7.3) to 3.1 (2.5, 3.7), the proportion reporting good or
excellent health improved from 18% to 70%, and the
proportion reporting any missed ARV doses in the past month
decreased from 73% to 55%. Concurrently, psychiatric
measures improved. The mean (range) PHQ score decreased from
14.4 (13.1, 15.6) to 1.6 (0.8, 2.4) and 90% achieved
depression remission, while mean maladaptive coping style
scores decreased and mean adaptive coping scores and
self-efficacy scores improved. CONCLUSION: In this pilot
study of an evidence-based depression treatment intervention
for HIV-infected patients in Cameroon, a number of HIV
behavioral and non-behavioral health outcomes improved over
4 months of effective depression treatment. These data are
consistent with the hypothesis that better depression care
can lead to improved HIV outcomes.},
Doi = {10.1371/journal.pone.0140001},
Key = {fds317896}
}
@article{fds317897,
Author = {Ostermann, J and Pence, B and Whetten, K and Yao, J and Itemba, D and Maro,
V and Reddy, E and Thielman, N},
Title = {HIV serostatus disclosure in the treatment cascade: evidence
from Northern Tanzania.},
Journal = {AIDS Care},
Volume = {27 Suppl 1},
Number = {sup1},
Pages = {59-64},
Year = {2015},
url = {http://dx.doi.org/10.1080/09540121.2015.1090534},
Abstract = {HIV serostatus disclosure plays an important role in HIV
transmission risk reduction and is positively associated
with HIV medication adherence and treatment outcomes.
However, to date, no study has quantified the role of
disclosure across the HIV treatment cascade, particularly in
Sub-Saharan Africa. We used data from a cohort of
HIV-infected adults in Northern Tanzania to describe
associations between disclosure and engagement and retention
in the HIV treatment cascade. Between 2008 and 2009, the
Coping with HIV/AIDS in Tanzania (CHAT) study enrolled 260
clients newly diagnosed with HIV and 492 HIV-infected
patients in established HIV care in two large HIV care and
treatment centers in Northern Tanzania. Participants aged 18
and older completed annual clinical assessments and
twice-annual in-person interviews for 3.5 years. Using
logistic regression models, we assessed sociodemographic
correlates of HIV serostatus disclosure to at least one
household member, and associations between this disclosure
measure and linkage to care, evaluation for antiretroviral
therapy (ART) eligibility, ART coverage, and rates of
undetectable HIV RNA levels during the follow-up period.
Married individuals and those diagnosed earlier were more
likely to have disclosed their HIV infection to at least one
household member. During follow-up, HIV serostatus
disclosure was associated with higher rates of linkage to
care, evaluation for ART eligibility, and ART coverage. No
significant association was observed with rates of
undetectable viral loads. Marginal effects estimates suggest
that a 10 percentage-point lower probability of linkage to
care for those who did not disclose their HIV serostatus
(86% vs. 96%; p = 0.035) was compounded by an 18
percentage-point lower probability of ever receiving a CD4
count (62% vs. 80%; p = .039), and a 20 percentage-point
lower probability of ever receiving ART (55% vs. 75%;
p = .029). If causal, these findings suggest an
important role for disclosure assistance efforts across the
HIV treatment cascade.},
Doi = {10.1080/09540121.2015.1090534},
Key = {fds317897}
}
@article{fds301062,
Author = {O'Donnell, K and Dorsey, S and Gong, W and Ostermann, J and Whetten, R and Cohen, JA and Itemba, D and Manongi, R and Whetten,
K},
Title = {Treating maladaptive grief and posttraumatic stress symptoms
in orphaned children in Tanzania: group-based trauma-focused
cognitive-behavioral therapy.},
Journal = {Journal of traumatic stress},
Volume = {27},
Number = {6},
Pages = {664-671},
Year = {2014},
Month = {December},
ISSN = {0894-9867},
url = {http://dx.doi.org/10.1002/jts.21970},
Abstract = {This study was designed to test the feasibility and child
clinical outcomes for group-based trauma-focused cognitive
behavior therapy (TF-CBT) for orphaned children in Tanzania.
There were 64 children with at least mild symptoms of grief
and/or traumatic stress and their guardians who participated
in this open trial. The TF-CBT for Child Traumatic Grief
protocol was adapted for use with a group, resulting in 12
weekly sessions for children and guardians separately with
conjoint activities and 3 individual visits with child and
guardian. Using a task-sharing approach, the intervention
was delivered by lay counselors with no prior mental health
experience. Primary child outcomes assessed were symptoms of
grief and posttraumatic stress (PTS); secondary outcomes
included symptoms of depression and overall behavioral
adjustment. All assessments were conducted pretreatment,
posttreatment, and 3 and 12 months after the end of
treatment. Results showed improved scores on all outcomes
posttreatment, sustained at 3 and 12 months. Effect sizes
(Cohen's d) for baseline to posttreatment were 1.36 for
child reported grief symptoms, 1.87 for child-reported PTS,
and 1.15 for guardian report of child PTS.},
Doi = {10.1002/jts.21970},
Key = {fds301062}
}
@article{fds301077,
Author = {Lichtenstein, B and Whetten, K and Rubenstein,
C},
Title = {"Notify your partners--it's the law": HIV providers and
mandatory disclosure.},
Journal = {Journal of the International Association of Providers of
AIDS Care},
Volume = {13},
Number = {4},
Pages = {372-378},
Year = {2014},
Month = {July},
ISSN = {2325-9574},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23873219},
Abstract = {HIV care providers in the United States must counsel clients
about disclosure to sexual partners and report anyone who is
suspected of noncompliance. This study compared provider
attitudes and practices in relation to counseling clients
about mandatory disclosure in North Carolina and Alabama,
the 2 states with similar HIV epidemiology but different
laws for HIV control. Personal interviews were conducted
with 20 providers in each state (n = 40). The results were
analyzed in a qualitative, cross-comparison method to
identify patterns of convergence or difference. Providers in
both states believed that clients often failed to notify
sexual partners and were secretive if questioned about
disclosure. Differences in counseling styles and procedures
for each state were noteworthy. Compared to Alabama, North
Carolina had harsher penalties for nondisclosure, stricter
and more standardized procedures for counseling, and
providers expressed greater support for HIV criminalization.
Although most North Carolina providers viewed the stricter
standards as beneficial for HIV care and control, Alabama
providers were likely to view such standards as a barrier to
patient care. These results indicated a direct relation
between state HIV law, provider attitudes, and counseling
procedures for mandatory disclosure.},
Doi = {10.1177/2325957413494481},
Key = {fds301077}
}
@article{fds301069,
Author = {Pence, BW and Gaynes, BN and Atashili, J and O'Donnell, JK and Kats, D and Whetten, K and Njamnshi, AK and Mbu, T and Kefie, C and Asanji, S and Ndumbe, P},
Title = {Feasibility, safety, acceptability, and preliminary efficacy
of measurement-based care depression treatment for HIV
patients in Bamenda, Cameroon.},
Journal = {AIDS Behav},
Volume = {18},
Number = {6},
Pages = {1142-1151},
Year = {2014},
Month = {June},
ISSN = {1090-7165},
url = {http://dx.doi.org/10.1007/s10461-014-0727-x},
Abstract = {Depression affects 18-30 % of HIV-infected patients in
Africa and is associated with greater stigma, lower
antiretroviral adherence, and faster disease progression.
However, the region's health system capacity to effectively
identify and treat depression is limited. Task-shifting
models may help address this large mental health treatment
gap. Measurement-Based Care (MBC) is a task-shifting model
in which a Depression Care Manager guides a non-psychiatric
(e.g., HIV) provider in prescribing and managing
antidepressant treatment. We adapted MBC for depressed
HIV-infected patients in Cameroon and completed a pilot
study to assess feasibility, safety, acceptability, and
preliminary efficacy. We enrolled 55 participants; all
started amitriptyline 25-50 mg daily at baseline. By
12 weeks, most remained at 50 mg daily (range 25-125 mg).
Median (interquartile range) PHQ-9 depressive severity
scores declined from 13 (12-16) (baseline) to 2 (0-3) (week
12); 87 % achieved depression remission (PHQ-9 <5) by
12 weeks. Intervention fidelity was high: HIV providers
followed MBC recommendations at 96 % of encounters. Most
divergences reflected a failure to increase dose when
indicated. No serious and few bothersome side effects were
reported. Most suicidality (prevalence 62 % at baseline;
8 % at 12 weeks) was either passive or low-risk.
Participant satisfaction was high (100 %), and most
participants (89 %) indicated willingness to pay for
medications if MBC were implemented in routine care. The
adapted MBC intervention demonstrated high feasibility,
safety, acceptability, and preliminary efficacy in this
uncontrolled pilot study. Further research should assess
whether MBC could improve adherence and HIV outcomes in this
setting.},
Doi = {10.1007/s10461-014-0727-x},
Key = {fds301069}
}
@article{fds301073,
Author = {Reif, SS and Whetten, K and Wilson, ER and McAllaster, C and Pence, BW and Legrand, S and Gong, W},
Title = {HIV/AIDS in the Southern USA: A disproportionate
epidemic},
Journal = {AIDS Care - Psychological and Socio-Medical Aspects of
AIDS/HIV},
Volume = {26},
Number = {3},
Pages = {351-359},
Year = {2014},
Month = {March},
ISSN = {0954-0121},
url = {http://dx.doi.org/10.1080/09540121.2013.824535},
Abstract = {This research synthesis examined HIV/AIDS surveillance and
health care financing data and reviewed relevant research
literature to describe HIV epidemiology, outcomes, funding,
and contributing factors to the HIV epidemic in the Southern
USA with particular focus on a group of Southern states with
similar demographic and disease characteristics and
comparable HIV epidemics (Alabama, Georgia, Florida, Los
Angeles, Mississippi, North Carolina, South Carolina,
Tennessee, and Texas). These states are hereafter referred
to as "targeted Southern states." Eight of the 10 states
with the highest HIV diagnosis rates in 2011 were in the
Southern USA; six were targeted states. Forty-nine percent
of HIV diagnoses were in the South in 2011, which contains
only 37% of the US population. The targeted states region
had the highest HIV diagnosis rate than any other US region
in 2011. The South was also found to have the highest
HIV-related mortality and morbidity rates in the USA. The
high levels of poverty, HIV-related stigma, and STDs found
in the South, particularly in the targeted Southern states,
likely contribute to greater HIV incidence and mortality.
The disproportionate impact of HIV in the South,
particularly among targeted states, demonstrates a critical
need to improve HIV prevention and care and address factors
that contribute to HIV disease in this region. © 2013
Taylor & Francis.},
Doi = {10.1080/09540121.2013.824535},
Key = {fds301073}
}
@article{fds301068,
Author = {Escueta, M and Whetten, K and Ostermann, J and O'Donnell, K and Positive
Outcomes for Orphans Research Team},
Title = {Adverse childhood experiences, psychosocial well-being and
cognitive development among orphans and abandoned children
in five low income countries.},
Journal = {BMC international health and human rights},
Volume = {14},
Pages = {6},
Year = {2014},
Month = {March},
url = {http://dx.doi.org/10.1186/1472-698x-14-6},
Abstract = {<h4>Background</h4>Development policymakers and child-care
service providers are committed to improving the educational
opportunities of the 153 million orphans worldwide.
Nevertheless, the relationship between orphanhood and
education outcomes is not well understood. Varying factors
associated with differential educational attainment leave
policymakers uncertain where to intervene. This study
examines the relationship between psychosocial well-being
and cognitive development in a cohort of orphans and
abandoned children (OAC) relative to non-OAC in five low and
middle income countries (LMICs) to understand better what
factors are associated with success in learning for these
children.<h4>Methods</h4>Positive Outcomes for Orphans
(POFO) is a longitudinal study, following a cohort of single
and double OAC in institutional and community-based settings
in five LMICs in Southeast Asia and sub-Saharan Africa:
Cambodia, Ethiopia, India, Kenya, and Tanzania. Employing
two-stage random sampling survey methodology to identify
representative samples of OAC in six sites, the POFO study
aimed to better understand factors associated with child
well-being. Using cross-sectional and child-level fixed
effects regression analyses on 1,480 community based OAC and
a comparison sample of non-OAC, this manuscript examines
associations between emotional difficulties, cognitive
development, and a variety of possible co-factors, including
potentially traumatic events.<h4>Results</h4>The most
salient finding is that increases in emotional difficulties
are associated with lags in cognitive development for two
separate measures of learning within and across multiple
study sites. Exposure to potentially traumatic events, male
gender, and lower socio-economic status are associated with
more reported emotional difficulties in some sites. Being
female and having an illiterate caregiver is associated with
lower performance on cognitive development tests in some
sites, while greater wealth is associated with higher
performance. There is no significant association between
orphan status per se and cognitive development, though the
negative and significant association between higher
emotional difficulties and lags in cognitive development
hold across all orphan subgroups.<h4>Conclusions</h4>These
findings suggest that interventions targeting psychosocial
support for vulnerable children, especially vis a vis
traumatic experiences, may ease strains inhibiting a child's
learning. Family based interventions to stabilize
socioeconomic conditions may help overcome psychosocial
challenges that otherwise would present as barriers to the
child's learning.},
Doi = {10.1186/1472-698x-14-6},
Key = {fds301068}
}
@article{fds301071,
Author = {Thielman, NM and Ostermann, J and Whetten, K and Whetten, R and Itemba,
D and Maro, V and Pence, B and Reddy, E and CHAT Research
Team},
Title = {Reduced adherence to antiretroviral therapy among
HIV-infected Tanzanians seeking cure from the Loliondo
healer.},
Journal = {J Acquir Immune Defic Syndr},
Volume = {65},
Number = {3},
Pages = {e104-e109},
Year = {2014},
Month = {March},
ISSN = {1525-4135},
url = {http://dx.doi.org/10.1097/01.qai.0000437619.23031.83},
Abstract = {: The predictors for seeking alternative therapies for
HIV-infection in sub-Saharan Africa are unknown. Among a
prospective cohort of 442 HIV-infected patients in Moshi,
Tanzania, 249 (56%) sought cure from a newly popularized
religious healer in Loliondo (450 km away), and their
adherence to antiretrovirals (ARVs) dropped precipitously
(odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P
< 0.001) after the visit. Compared with those not attending
Loliondo, attendees were more likely to have been diagnosed
with HIV more remotely (3.8 vs. 3.0 years before, P <
0.001), have taken ARVs longer (3.4 vs. 2.5 years, P <
0.001), have higher median CD4 lymphocyte counts (429 vs.
354 cells/mm, P < 0.001), be wealthier (wealth index: 10.9
vs. 8.8, P = 0.034), and receive care at the private versus
the public hospital (P = 0.012). In multivariable logistic
regression, only years since the start of ARVs remained
significant (odds ratio = 1.49, 95% confidence interval:
1.23 to 1.80). Treatment fatigue may play a role in the lure
of alternative healers.},
Doi = {10.1097/01.qai.0000437619.23031.83},
Key = {fds301071}
}
@article{fds301063,
Author = {Whetten, K and Ostermann, J and Pence, BW and Whetten, RA and Messer,
LC and Ariely, S and O'Donnell, K and Wasonga, AI and Vann, V and Itemba,
D and Eticha, M and Madan, I and Thielman, NM and Positive Outcomes for
Orphans (POFO) Research Team},
Title = {Three-year change in the wellbeing of orphaned and separated
children in institutional and family-based care settings in
five low- and middle-income countries.},
Journal = {PLoS One},
Volume = {9},
Number = {8},
Pages = {e104872},
Year = {2014},
url = {http://dx.doi.org/10.1371/journal.pone.0104872},
Abstract = {BACKGROUND: With more than 2 million children living in
group homes, or "institutions", worldwide, the extent to
which institution-based caregiving negatively affects
development and wellbeing is a central question for
international policymakers. METHODS: A two-stage random
sampling methodology identified community representative
samples of 1,357 institution-dwelling orphaned and separated
children (OSC) and 1,480 family-dwelling OSC aged 6-12 from
5 low and middle income countries. Data were collected from
children and their primary caregivers. Survey-analytic
techniques and linear mixed effects models describe child
wellbeing collected at baseline and at 36 months, including
physical and emotional health, growth, cognitive development
and memory, and the variation in outcomes between children,
care settings, and study sites. FINDINGS: At 36-month
follow-up, institution-dwelling OSC had statistically
significantly higher height-for-age Z-scores and better
caregiver-reported physical health; family-dwelling OSC had
fewer caregiver-reported emotional difficulties. There were
no statistically significant differences between the two
groups on other measures. At both baseline and follow-up,
the magnitude of the differences between the institution-
and family-dwelling groups was small. Relatively little
variation in outcomes was attributable to differences
between sites (11-27% of total variation) or care settings
within sites (8-14%), with most variation attributable to
differences between children within settings (60-75%). The
percent of variation in outcomes attributable to the care
setting type, institution- versus family-based care, ranged
from 0-4% at baseline, 0-3% at 36-month follow-up, and 0-4%
for changes between baseline and 36 months. INTERPRETATION:
These findings contradict the hypothesis that group home
placement universally adversely affects child wellbeing.
Without substantial improvements in and support for family
settings, the removal of institutions, broadly defined,
would not significantly improve child wellbeing and could
worsen outcomes of children who are moved from a setting
where they are doing relatively well to a more deprived
setting.},
Doi = {10.1371/journal.pone.0104872},
Key = {fds301063}
}
@article{fds301067,
Author = {Belenky, NM and Cole, SR and Pence, BW and Itemba, D and Maro, V and Whetten, K},
Title = {Depressive symptoms, HIV medication adherence, and HIV
clinical outcomes in Tanzania: a prospective, observational
study.},
Journal = {PLoS One},
Volume = {9},
Number = {5},
Pages = {e95469},
Year = {2014},
url = {http://dx.doi.org/10.1371/journal.pone.0095469},
Abstract = {Depressive symptoms have been shown to independently affect
both antiretroviral therapy (ART) adherence and HIV clinical
outcomes in high-income countries. We examined the
prospective relationship between depressive symptoms and
adherence, virologic failure, and suppressed immune function
in people living with HIV/AIDS in Tanzania. Data from 403
study participants who were on stable ART and engaged in HIV
clinical care were analyzed. We assessed crude and adjusted
associations of depressive symptoms and ART adherence, both
at baseline and at 12 months, using logistic regression. We
used logistic generalized estimating equations to assess the
association and 95% confidence intervals (CI) between
depressive symptoms and both virologic failure and
suppressed immune function. Ten percent of participants
reported moderate or severe depressive symptoms at baseline
and 31% of participants experienced virologic failure (>150
copies/ml) over two years. Depressive symptoms were
associated with greater odds of reported medication
nonadherence at both baseline (Odds Ratio [OR] per 1-unit
increase = 1.18, 95% CI [1.12, 1.24]) and 12 months
(OR = 1.08, 95% CI [1.03, 1.14]). By contrast, increases
in depressive symptom score were inversely related to both
virologic failure (OR = 0.93, 95% CI [0.87, 1.00]) and
immune system suppression (OR = 0.88, 95% CI [0.79,
0.99]), though the association between depressive symptoms
and clinical outcomes was less precise than for the
association with nonadherence. Findings indicate a positive
association between depressive symptoms and nonadherence,
and also an inverse relationship between depressive symptoms
and clinical outcomes, possibly due to informative loss to
follow-up.},
Doi = {10.1371/journal.pone.0095469},
Key = {fds301067}
}
@article{fds301070,
Author = {Ostermann, J and Whetten, K and Reddy, E and Pence, B and Weinhold, A and Itemba, D and Maro, V and Mosille, E and Thielman, N and CHAT Research
Team},
Title = {Treatment retention and care transitions during and after
the scale-up of HIV care and treatment in Northern
Tanzania.},
Journal = {AIDS Care},
Volume = {26},
Number = {11},
Pages = {1352-1358},
Year = {2014},
ISSN = {0954-0121},
url = {http://dx.doi.org/10.1080/09540121.2014.882493},
Abstract = {Decentralization of HIV care is promoted to improve access
to antiretroviral therapy in sub-Saharan Africa. This study
describes care transitions among HIV-infected persons in
Northern Tanzania during a period of rapid decentralization
of HIV care and treatment centers (CTCs) from hospitals to
local health centers. Between November 2008 and June 2009,
492 HIV-infected patients in established care at two
referral hospitals in Moshi, Tanzania, and 262 persons newly
diagnosed with HIV were selected for participation in a
prospective cohort study entitled Coping with HIV/AIDS in
Tanzania. Clinical records and participant self-reports,
collected between June and November 2012, were used to
describe retention in care and transitions between CTCs
during the study period. After a mean follow-up period of
3.5 years, 10% of participants had died, 9% were lost to
follow-up, and 11% had moved. Of the remaining participants
enrolled from CTCs, more than 90% reported at least one CTC
visit during the previous six months, with 98% still in care
at the CTC at which they were enrolled. Nearly three out of
four newly diagnosed clients listed a referral hospital as
their primary CTC. Fewer than 10% of participants ever
sought care at another CTC in the study area; nearly 90% of
those in care bypassed their closest CTC. Administrative
data from all facilities in the study area indicate that new
clients, even after the scale-up from 8 CTCs in 2006 to 21
CTCs in 2008, disproportionately selected established CTCs,
and client volume at newly approved facilities was highly
variable. Despite the decentralization of HIV care and
treatment in this setting, many patients continue to bypass
their closest CTC to seek care at established facilities.
Patient preferences for decentralized HIV care, which may
inform optimal resource utilization, are largely unknown and
warrant further investigation.},
Doi = {10.1080/09540121.2014.882493},
Key = {fds301070}
}
@article{fds301075,
Author = {Guru Rajan and D and Shirey, K and Ostermann, J and Whetten, R and O'Donnell, K and Whetten, K},
Title = {Child and Caregiver Concordance of Potentially Traumatic
Events Experienced by Orphaned and Abandoned
Children.},
Journal = {Vulnerable Child Youth Stud},
Volume = {9},
Number = {3},
Pages = {220-233},
Year = {2014},
ISSN = {1745-0128},
url = {http://dx.doi.org/10.1080/17450128.2013.855346},
Abstract = {Exposure to trauma is associated with significant emotional
and behavioral difficulties among children (Perepletchikova
& Kaufman, 2010). Overall, reports of trauma and violence
experienced by children are discrepant from those of their
caregivers (Lewis et al., 2012). Even less is known about
the extent of concordance between orphans and their
caregivers. This study examines the correlates of
concordance in reported traumatic experiences between 1,269
orphaned and abandoned children (OAC) and their caregivers.
The OAC lived in family-settings in 5 low and middle income
countries and were part of a longitudinal study, "Positive
Outcomes for Orphans" (POFO) that enrolled children aged 6
to 12 at baseline. By examining concordance with respect to
specific types of trauma reported, this study expands the
understanding of who reports which types of traumas
experienced by orphaned and abandoned children, thereby
improving the potential to provide targeted interventions
for children who have experienced such events. In this
study, children and caregivers were asked separately if the
child had experienced different types of potentially
traumatic events. Children were significantly more likely to
report physical abuse, sexual abuse and family violence than
were caregivers. Caregivers were significantly more likely
than children to report natural disasters and accidents.
High levels of concordance were found in the reporting of
wars, riots, killings, and deaths in the family. The impacts
of trauma on behavior and mental health are profound, and
highly effective interventions targeting sequelae of
childhood trauma are currently being developed for use in
low resource areas. Findings from this study demonstrate
that it is feasible to conduct screening for potentially
traumatic events utilizing child self-report in resource
limited settings and that child self-report is crucial in
evaluating trauma, particularly family violence and physical
or sexual assault.},
Doi = {10.1080/17450128.2013.855346},
Key = {fds301075}
}
@article{fds301076,
Author = {Reif, SS and Whetten, K and Wilson, ER and McAllaster, C and Pence, BW and Legrand, S and Gong, W},
Title = {HIV/AIDS in the Southern USA: a disproportionate
epidemic.},
Journal = {AIDS Care},
Volume = {26},
Number = {3},
Pages = {351-359},
Year = {2014},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23944833},
Abstract = {This research synthesis examined HIV/AIDS surveillance and
health care financing data and reviewed relevant research
literature to describe HIV epidemiology, outcomes, funding,
and contributing factors to the HIV epidemic in the Southern
USA with particular focus on a group of Southern states with
similar demographic and disease characteristics and
comparable HIV epidemics (Alabama, Georgia, Florida, Los
Angeles, Mississippi, North Carolina, South Carolina,
Tennessee, and Texas). These states are hereafter referred
to as "targeted Southern states." Eight of the 10 states
with the highest HIV diagnosis rates in 2011 were in the
Southern USA; six were targeted states. Forty-nine percent
of HIV diagnoses were in the South in 2011, which contains
only 37% of the US population. The targeted states region
had the highest HIV diagnosis rate than any other US region
in 2011. The South was also found to have the highest
HIV-related mortality and morbidity rates in the USA. The
high levels of poverty, HIV-related stigma, and STDs found
in the South, particularly in the targeted Southern states,
likely contribute to greater HIV incidence and mortality.
The disproportionate impact of HIV in the South,
particularly among targeted states, demonstrates a critical
need to improve HIV prevention and care and address factors
that contribute to HIV disease in this region.},
Doi = {10.1080/09540121.2013.824535},
Key = {fds301076}
}
@article{fds301078,
Author = {O'Donnell, K and Yao, J and Ostermann, J and Thielman, N and Reddy, E and Whetten, R and Maro, V and Itemba, D and Pence, B and Dow, D and Whetten,
K},
Title = {Low rates of child testing for HIV persist in a high-risk
area of East Africa.},
Journal = {AIDS Care},
Volume = {26},
Number = {3},
Pages = {326-331},
Year = {2014},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23875966},
Abstract = {Children in low- and middle-income countries (LMIC) are the
least touched by recent successes in the diagnosis and
treatment of HIV/AIDS globally. Early treatment is essential
for a child's longer and higher quality of life; however, by
2011, only a small proportion of HIV-seropositive children
in LMIC countries were receiving treatment, in part because
of persisting low rates of diagnosis. This study of the
prevalence and characteristics of children tested for HIV
was embedded in the Coping with HIV/AIDS in Tanzania (CHAT)
study in which HIV-seropositive and HIV-seronegative adults,
and adults with unknown HIV status were asked about HIV
testing for their children. Data were gathered from November
2009 to August 2010 during the scale-up of Prevention of
Mother To Child Transmission and Early Infant Diagnosis
programs in the region. Reports on 1776 children indicate
that 31.7% of all children were reported to have been
tested, including only 42.9% of children with an
HIV-seropositive caregiver. In general, children more likely
to be HIV tested were biological children of study
participants, younger, of widowed adults, living in urban
areas, and of HIV-seropositive parents/caregivers. Children
belonging to the two indigenous tribes, Chagga and Pare,
were more likely to be tested than those from other tribes.
Rates of testing among children less than two years old were
low, even for the HIV-seropositive caregiver group. The
persistence of low testing rates is discussed in terms of
the accessibility and acceptability of child testing in
resource poor settings.},
Doi = {10.1080/09540121.2013.819405},
Key = {fds301078}
}
@article{fds301079,
Author = {Whetten, K and Shirey, K and Pence, BW and Yao, J and Thielman, N and Whetten, R and Adams, J and Agala, B and Ostermann, J and O'Donnell, K and Hobbie, A and Maro, V and Itemba, D and Reddy, E and Lema, B and Madukwa,
Y and Mvungi, R and Mrema, A and Ricky, W and Samora, L and Zenze, B and Hamilton, K},
Title = {Trauma History and Depression Predict Incomplete Adherence
to Antiretroviral Therapies in a Low Income
Country},
Journal = {PLoS ONE},
Volume = {8},
Number = {10},
Pages = {e74771-e74771},
Publisher = {Public Library of Science (PLoS)},
Editor = {Dowdy, DW},
Year = {2013},
Month = {October},
ISSN = {0883-6612},
url = {http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000302092400312&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=47d3190e77e5a3a53558812f597b0b92},
Abstract = {Background:As antiretroviral therapy (ART) for HIV becomes
increasingly available in low and middle income countries
(LMICs), understanding reasons for lack of adherence is
critical to stemming the tide of infections and improving
health. Understanding the effect of psychosocial experiences
and mental health symptomatology on ART adherence can help
maximize the benefit of expanded ART programs by indicating
types of services, which could be offered in combination
with HIV care.Methodology:The Coping with HIV/AIDS in
Tanzania (CHAT) study is a longitudinal cohort study in the
Kilimanjaro Region that included randomly selected
HIV-infected (HIV+) participants from two local
hospital-based HIV clinics and four free-standing voluntary
HIV counselling and testing sites. Baseline data were
collected in 2008 and 2009; this paper used data from 36
month follow-up interviews (N = 468). Regression analyses
were used to predict factors associated with incomplete
self-reported adherence to ART.Results:Incomplete ART
adherence was significantly more likely to be reported
amongst participants who experienced a greater number of
childhood traumatic events: sexual abuse prior to puberty
and the death in childhood of an immediate family member not
from suicide or homicide were significantly more likely in
the non-adherent group and other negative childhood events
trended toward being more likely. Those with incomplete
adherence had higher depressive symptom severity and
post-traumatic stress disorder (PTSD). In multivariable
analyses, childhood trauma, depression, and financial
sacrifice remained associated with incomplete
adherence.Discussion:This is the first study to examine the
effect of childhood trauma, depression and PTSD on HIV
medication adherence in a low income country facing a
significant burden of HIV. Allocating spending on HIV/AIDS
toward integrating mental health services with HIV care is
essential to the creation of systems that enhance medication
adherence and maximize the potential of expanded
antiretroviral access to improve health and reduce new
infections. © 2013 Whetten et al.},
Doi = {10.1371/journal.pone.0074771},
Key = {fds301079}
}
@article{fds301074,
Author = {Pence, BW and Whetten, K and Shirey, KG and Yao, J and Thielman, NM and Whetten, R and Itemba, D and Maro, V},
Title = {Factors associated with change in sexual transmission risk
behavior over 3 years among HIV-infected patients in
Tanzania.},
Journal = {PLoS One},
Volume = {8},
Number = {12},
Pages = {e82974},
Year = {2013},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24367575},
Abstract = {BACKGROUND: The reduction of HIV transmission risk behaviors
among those infected with HIV remains a major global health
priority. Psychosocial characteristics have proven to be
important correlates of sexual transmission risk behaviors
in high-income countries, but little attention has focused
on the influence of psychosocial and psychological factors
on sexual transmission risk behaviors in African cohorts.
METHODOLOGY AND PRINCIPAL FINDINGS: The CHAT Study enrolled
a representative sample of 499 HIV-infected patients in
established HIV care and 267 newly diagnosed HIV-infected
individuals from the Kilimanjaro Region of Tanzania.
Participants completed in-person interviews every 6 months
for 3 years. Using logistic random effects models to account
for repeated observations, we assessed sociodemographic,
physical health, and psychosocial predictors of
self-reported unprotected sexual intercourse. Among
established patients, the proportion reporting any recent
unprotected sex was stable, ranging between 6-13% over 3
years. Among newly diagnosed patients, the proportion
reporting any unprotected sex dropped from 43% at baseline
to 11-21% at 6-36 months. In multivariable models, higher
odds of reported unprotected sex was associated with female
gender, younger age, being married, better physical health,
and greater post-traumatic stress symptoms. In addition,
within-individual changes in post-traumatic stress over time
coincided with increases in unprotected sex. CONCLUSIONS AND
SIGNIFICANCE: Changes in post-traumatic stress
symptomatology were associated with changes in sexual
transmission risk behaviors in this sample of HIV-infected
adults in Tanzania, suggesting the importance of investing
in appropriate mental health screening and intervention
services for HIV-infected patients, both to improve mental
health and to support secondary prevention
efforts.},
Doi = {10.1371/journal.pone.0082974},
Key = {fds301074}
}
@article{fds317898,
Author = {Whetten, K and Shirey, K and Pence, BW and Yao, J and Thielman, N and Whetten, R and Adams, J and Agala, B and Ostermann, J and O'Donnell, K and Hobbie, A and Maro, V and Itemba, D and Reddy, E and CHAT Research
Team},
Title = {Trauma history and depression predict incomplete adherence
to antiretroviral therapies in a low income
country.},
Journal = {PLoS One},
Volume = {8},
Number = {10},
Pages = {e74771},
Year = {2013},
url = {http://dx.doi.org/10.1371/journal.pone.0074771},
Abstract = {BACKGROUND: As antiretroviral therapy (ART) for HIV becomes
increasingly available in low and middle income countries
(LMICs), understanding reasons for lack of adherence is
critical to stemming the tide of infections and improving
health. Understanding the effect of psychosocial experiences
and mental health symptomatology on ART adherence can help
maximize the benefit of expanded ART programs by indicating
types of services, which could be offered in combination
with HIV care. METHODOLOGY: The Coping with HIV/AIDS in
Tanzania (CHAT) study is a longitudinal cohort study in the
Kilimanjaro Region that included randomly selected
HIV-infected (HIV+) participants from two local
hospital-based HIV clinics and four free-standing voluntary
HIV counselling and testing sites. Baseline data were
collected in 2008 and 2009; this paper used data from 36
month follow-up interviews (N = 468). Regression
analyses were used to predict factors associated with
incomplete self-reported adherence to ART. RESULTS:
Incomplete art adherence was significantly more likely to be
reported amongst participants who experienced a greater
number of childhood traumatic events: sexual abuse prior to
puberty and the death in childhood of an immediate family
member not from suicide or homicide were significantly more
likely in the non-adherent group and other negative
childhood events trended toward being more likely. Those
with incomplete adherence had higher depressive symptom
severity and post-traumatic stress disorder (PTSD). In
multivariable analyses, childhood trauma, depression, and
financial sacrifice remained associated with incomplete
adherence. DISCUSSION: This is the first study to examine
the effect of childhood trauma, depression and PTSD on HIV
medication adherence in a low income country facing a
significant burden of HIV. Allocating spending on HIV/AIDS
toward integrating mental health services with HIV care is
essential to the creation of systems that enhance medication
adherence and maximize the potential of expanded
antiretroviral access to improve health and reduce new
infections.},
Doi = {10.1371/journal.pone.0074771},
Key = {fds317898}
}
@article{fds301104,
Author = {Pence, BW and Gaynes, BN and Atashili, J and O'Donnell, JK and Tayong,
G and Kats, D and Whetten, R and Whetten, K and Njamnshi, AK and Ndumbe,
PM},
Title = {Validity of an interviewer-administered patient health
questionnaire-9 to screen for depression in HIV-infected
patients in Cameroon.},
Journal = {J Affect Disord},
Volume = {143},
Number = {1-3},
Pages = {208-213},
Publisher = {Journal of Affective Disorders},
Year = {2012},
Month = {December},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22840467},
Abstract = {BACKGROUND: In high-income countries, depression is
prevalent in HIV patients and is associated with lower
medication adherence and clinical outcomes. Emerging
evidence from low-income countries supports similar
relationships. Yet little research has validated rapid
depression screening tools integrated into routine HIV
clinical care. METHODS: Using qualitative methods, we
adapted the Patient Health Questionnaire-9 (PHQ-9)
depression screening instrument for use with Cameroonian
patients. We then conducted a cross-sectional validity study
comparing an interviewer-administered PHQ-9 to the reference
standard Composite International Diagnostic Interview in 400
patients on antiretroviral therapy attending a regional HIV
treatment center in Bamenda, Cameroon. RESULTS: The
prevalence of major depressive disorder (MDD) in the past
month was 3% (n=11 cases). Using a standard cutoff score of
≥10 as a positive depression screen, the PHQ-9 had
estimated sensitivity of 27% (95% confidence interval:
6-61%) and specificity of 94% (91-96%), corresponding to
positive and negative likelihood ratios of 4.5 and 0.8.
There was little evidence of variation in specificity by
gender, number of HIV symptoms, or result of a dementia
screen. LIMITATIONS: The low prevalence of MDD yielded very
imprecise sensitivity estimates. Although the PHQ-9 was
developed as a self-administered tool, we assessed an
interviewer-administered version due to the literacy level
of the target population. CONCLUSION: The PHQ-9 demonstrated
high specificity but apparently low sensitivity for
detecting MDD in this sample of HIV patients in Cameroon.
Formative work to define the performance of proven screening
tools in new settings remains important as research on
mental health expands in low-income countries.},
Doi = {10.1016/j.jad.2012.05.056},
Key = {fds301104}
}
@article{fds301103,
Author = {Reif, SS and Pence, BW and LeGrand, S and Wilson, ES and Swartz, M and Ellington, T and Whetten, K},
Title = {In-home mental health treatment for individuals with
HIV.},
Journal = {AIDS Patient Care STDS},
Volume = {26},
Number = {11},
Pages = {655-661},
Publisher = {AIDS Patient Care STDS},
Year = {2012},
Month = {November},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23050767},
Abstract = {Mental health problems are highly prevalent among
individuals with HIV and are consistently associated with
negative health outcomes. However, mental illness often
remains untreated due to significant psychosocial and
physical barriers to treatment participation. The
Collaborative HIV/AIDS Mental Health Program (CHAMP)
assessed the outcomes associated with providing 9 months of
in-home mental health counseling for 40 individuals with HIV
and a Major Axis I mental disorder. The evidence-based
Illness Management and Recovery Model was adapted for use
with HIV-positive individuals for the study using a
community-based participatory research approach. Study
participants were surveyed at baseline, 5 and 9 months to
assess for changes in health outcomes. Thirty-five percent
of study participants were female, 80% African American, 33%
self-identified as MSM and the average participant age was
43. Forty percent of participants were on psychotropic
medication at baseline. Participants had an average of 8
counseling visits (median 9). Statistically significant
decreases in the global Brief Symptom Inventory (BSI) score
and a number of BSI symptoms dimensions including anxiety,
depression, obsessive compulsive, phobic anxiety and
hostility were detected, indicating a reduction of
psychiatric symptoms. Statistically significant improvement
was also identified for the SF-12 mental health scale,
adaptive coping, overall social support and emotional
support. No differences in psychiatric outcomes were
identified by gender, race/ethnicity, or sexual preference.
Findings from the CHAMP Study suggest that the use of
in-home mental health treatment may be beneficial in
engaging and treating HIV-positive individuals with comorbid
mental health disorders.},
Doi = {10.1089/apc.2012.0242},
Key = {fds301103}
}
@article{fds301111,
Author = {Nolan, JA and McEvoy, JP and Koenig, HG and Hooten, EG and Whetten, K and Pieper, CF},
Title = {Religious coping and quality of life among individuals
living with schizophrenia.},
Journal = {Psychiatr Serv},
Volume = {63},
Number = {10},
Pages = {1051-1054},
Year = {2012},
Month = {October},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22948722},
Abstract = {OBJECTIVE This study investigated the relationship between
positive and negative religious coping and quality of life
among outpatients with schizophrenia. METHODS Interviews
were conducted with 63 adults in the southeastern United
States. Religious coping was measured by the 14-item RCOPE
and quality of life by the World Health Organization Quality
of Life-BREF. Data were examined via descriptive bivariate
statistics and controlled analyses. RESULTS Most
participants reported participation in private religious or
spiritual activities (91%) and participation in public
religious services or activities (68%). Positive religious
coping was related to the quality-of-life facet of
psychological health (r=.28, p=.03). Negative religious
coping and quality of life were inversely related (r=-.30,
p=.02). Positive religious coping was associated with
psychological health in the reduced univariate general
linear model (B=.72, p=.03, adjusted R2=.08). CONCLUSIONS
Greater awareness of the importance of religion in this
population may improve cultural competence in treatment and
community support.},
Doi = {10.1176/appi.ps.201000208},
Key = {fds301111}
}
@article{fds317899,
Author = {Reif, S and Whetten, K and Wilson, E and Legrand,
S},
Title = {Home-based mental health services are associated with
improved mental health outcomes among individuals with
HIV},
Journal = {JOURNAL OF THE INTERNATIONAL AIDS SOCIETY},
Volume = {15},
Pages = {173-173},
Publisher = {JOHN WILEY & SONS LTD},
Year = {2012},
Month = {October},
Key = {fds317899}
}
@article{fds301100,
Author = {Pence, BW and Mugavero, MJ and Carter, TJ and Leserman, J and Thielman,
NM and Raper, JL and Proeschold-Bell, RJ and Reif, S and Whetten,
K},
Title = {Childhood trauma and health outcomes in HIV-infected
patients: an exploration of causal pathways.},
Journal = {J Acquir Immune Defic Syndr},
Volume = {59},
Number = {4},
Pages = {409-416},
Publisher = {Journal of Acquired Immune Deficiency Syndromes},
Year = {2012},
Month = {April},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22107822},
Abstract = {OBJECTIVE: Traumatic life histories are highly prevalent in
people living with HIV/AIDS and predict sexual risk
behaviors, medication adherence, and all-cause mortality.
Yet the causal pathways explaining these relationships
remain poorly understood. We sought to quantify the
association of trauma with negative behavioral and health
outcomes and to assess whether those associations were
explained by mediation through psychosocial characteristics.
METHODS: In 611 outpatient people living with HIV/AIDS, we
tested whether trauma's influence on later health and
behaviors was mediated by coping styles, self-efficacy,
social support, trust in the medical system, recent
stressful life events, mental health, and substance abuse.
RESULTS: In models adjusting only for sociodemographic and
transmission category confounders (estimating total
effects), pasttrauma exposure was associated with 7
behavioral and health outcomes including increased odds or
hazard of recent unprotected sex [odds ratio (OR) = 1.17 per
each additional type of trauma, 95% confidence interval =
1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to
1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22),
and HIV disease progression (hazard ratio = 1.10, 0.98 to
1.23). When all hypothesized mediators were included, the
associations of trauma with health care utilization outcomes
were reduced by about 50%, suggesting partial mediation (eg,
OR for hospitalization changed from 1.12 to 1.07), whereas
point estimates for behavioral and incident health outcomes
remained largely unchanged, suggesting no mediation (eg, OR
for unprotected sex changed from 1.17 to 1.18). Trauma
remained associated with most outcomes even after adjusting
for all hypothesized psychosocial mediators. CONCLUSIONS:
These data suggest that past trauma influences adult health
and behaviors through pathways other than the psychosocial
mediators considered in this model.},
Doi = {10.1097/QAI.0b013e31824150bb},
Key = {fds301100}
}
@article{fds301118,
Author = {O'Donnell, K and Murphy, R and Ostermann, J and Masnick, M and Whetten,
RA and Madden, E and Thielman, NM and Whetten, K and Positive Outcomes
for Orphans (POFO) Research Team},
Title = {A brief assessment of learning for orphaned and abandoned
children in low and middle income countries.},
Journal = {AIDS Behav},
Volume = {16},
Number = {2},
Pages = {480-490},
Year = {2012},
Month = {February},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21538088},
Abstract = {Assessment of children's learning and performance in low and
middle income countries has been critiqued as lacking a gold
standard, an appropriate norm reference group, and
demonstrated applicability of assessment tasks to the
context. This study was designed to examine the performance
of three nonverbal and one adapted verbal measure of
children's problem solving, memory, motivation, and
attention across five culturally diverse sites. The goal was
to evaluate the tests as indicators of individual
differences affected by life events and care circumstances
for vulnerable children. We conclude that the measures can
be successfully employed with fidelity in non-standard
settings in LMICs, and are associated with child age and
educational experience across the settings. The tests can be
useful in evaluating variability in vulnerable child
outcomes.},
Doi = {10.1007/s10461-011-9940-z},
Key = {fds301118}
}
@article{fds215696,
Author = {Mohr S and Nolan J and Whetten K and Koenig H and Pieper
C.},
Title = {“The role of spirituality and religion in the lives of
outpatients with schizophrenia: a multi-site comparative
study of Switzerland, Canada and the United
States.”},
Volume = {44},
Number = {1},
Pages = {29-52},
Publisher = {International Journal of Psychiatry in Medicine},
Year = {2012},
Key = {fds215696}
}
@article{fds301101,
Author = {Pence, BW and Shirey, K and Whetten, K and Agala, B and Itemba, D and Adams, J and Whetten, R and Yao, J and Shao, J},
Title = {Prevalence of psychological trauma and association with
current health and functioning in a sample of HIV-infected
and HIV-uninfected Tanzanian adults.},
Journal = {PLoS One},
Volume = {7},
Number = {5},
Pages = {e36304},
Publisher = {PLOS ONE},
Year = {2012},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22606252},
Abstract = {BACKGROUND: In high income nations, traumatic life
experiences such as childhood sexual abuse are much more
common in people living with HIV/AIDS (PLWHA) than the
general population, and trauma is associated with worse
current health and functioning. Virtually no data exist on
the prevalence or consequences of trauma for PLWHA in low
income nations. METHODOLOGY/PRINCIPAL FINDINGS: We recruited
four cohorts of Tanzanian patients in established medical
care for HIV infection (n = 228), individuals newly
testing positive for HIV (n = 267), individuals testing
negative for HIV at the same sites (n = 182), and a
random sample of community-dwelling adults (n = 249). We
assessed lifetime prevalence of traumatic experiences,
recent stressful life events, and current mental health and
health-related physical functioning. Those with established
HIV infection reported a greater number of childhood and
lifetime traumatic experiences (2.1 and 3.0 respectively)
than the community cohort (1.8 and 2.3). Those with
established HIV infection reported greater post-traumatic
stress disorder (PTSD) symptomatology and worse current
health-related physical functioning. Each additional
lifetime traumatic experience was associated with increased
PTSD symptomatology and worse functioning.
CONCLUSIONS/SIGNIFICANCE: This study is the first to our
knowledge in an HIV population from a low income nation to
report the prevalence of a range of potentially traumatic
life experiences compared to a matched community sample and
to show that trauma history is associated with poorer
health-related physical functioning. Our findings underscore
the importance of considering psychosocial characteristics
when planning to meet the health needs of PLWHA in low
income countries.},
Doi = {10.1371/journal.pone.0036304},
Key = {fds301101}
}
@article{fds301102,
Author = {Whetten, K and Reif, S and Toth, M and Jain, E and Leserman, J and Pence,
BW},
Title = {Relationship between trauma and high-risk behavior among
HIV-positive men who do not have sex with men
(MDSM).},
Journal = {AIDS Care},
Volume = {24},
Number = {11},
Pages = {1453-1460},
Publisher = {AIDS CARE},
Year = {2012},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22909318},
Abstract = {The incidence of heterosexual HIV transmission continues to
increase in the USA. However, little is known about factors
that influence high-risk behavior among men who do not have
sex with men (MDSM). This study examines the association of
childhood sexual abuse and high-risk behaviors among MDSM.
The Coping with HIV/AIDS in the Southeast (CHASE) study
included 611 HIV-positive individuals in the Southeastern US
Bivariate statistics were used to examine the influence of
childhood sexual abuse among MDSM, men who have sex with men
(MSM), and women. Study findings indicated that among MDSM
with HIV, childhood sexual abuse predicted a higher number
of sexual partners, alcohol and drug use problems,
depression, post-traumatic stress disorder (PTSD), and less
trust in medical providers. Similar statistically
significant relationships between childhood sexual abuse and
negative outcomes were not found for MSM and women with the
exception of childhood sexual abuse predicting PTSD and
alcohol use in women. Study findings indicate a need for
more in-depth research to examine the role of childhood
sexual abuse in shaping adult risk behaviors among MDSM as
well as a need to assess for and address childhood sexual
abuse in this population.},
Doi = {10.1080/09540121.2012.712665},
Key = {fds301102}
}
@article{fds301107,
Author = {Thielman, N and Ostermann, J and Whetten, K and Whetten, R and O'Donnell, K and Positive Outcomes for Orphans Research
Team},
Title = {Correlates of poor health among orphans and abandoned
children in less wealthy countries: the importance of
caregiver health.},
Journal = {PLoS One},
Volume = {7},
Number = {6},
Pages = {e38109},
Publisher = {PLOS ONE},
Year = {2012},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22719867},
Abstract = {BACKGROUND: More than 153 million children worldwide have
been orphaned by the loss of one or both parents, and
millions more have been abandoned. We investigated
relationships between the health of orphaned and abandoned
children (OAC) and child, caregiver, and household
characteristics among randomly selected OAC in five
countries. METHODOLOGY: Using a two-stage random sampling
strategy in 6 study areas in Cambodia, Ethiopia, India,
Kenya, and Tanzania, the Positive Outcomes for Orphans
(POFO) study identified 1,480 community-living OAC ages 6 to
12. Detailed interviews were conducted with 1,305 primary
caregivers at baseline and after 6 and 12 months.
Multivariable logistic regression models describe
associations between the characteristics of children,
caregivers, and households and child health outcomes: fair
or poor child health; fever, cough, or diarrhea within the
past two weeks; illness in the past 6 months; and fair or
poor health on at least two assessments. PRINCIPAL FINDINGS:
Across the six study areas, 23% of OAC were reported to be
in fair or poor health; 19%, 18%, and 2% had fever, cough,
or diarrhea, respectively, within the past two weeks; 55%
had illnesses within the past 6 months; and 23% were in fair
or poor health on at least two assessments. Female gender,
suspected HIV infection, experiences of potentially
traumatic events, including the loss of both parents, urban
residence, eating fewer than 3 meals per day, and low
caregiver involvement were associated with poorer child
health outcomes. Particularly strong associations were
observed between child health measures and the health of
their primary caregivers. CONCLUSIONS: Poor caregiver health
is a strong signal for poor health of OAC. Strategies to
support OAC should target the caregiver-child dyad. Steps to
ensure food security, foster gender equality, and prevent
and treat traumatic events are needed.},
Doi = {10.1371/journal.pone.0038109},
Key = {fds301107}
}
@article{fds301110,
Author = {Mohr, S and Borras, L and Nolan, J and Gillieron, C and Brandt, P-Y and Eytan, A and Leclerc, C and Perroud, N and Whetten, K and Pieper, C and Koenig, HG and Huguelet, P},
Title = {Spirituality and religion in outpatients with schizophrenia:
a multi-site comparative study of Switzerland, Canada, and
the United States.},
Journal = {Int J Psychiatry Med},
Volume = {44},
Number = {1},
Pages = {29-52},
Year = {2012},
ISSN = {0091-2174},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23356092},
Abstract = {OBJECTIVE: To assess the importance of spirituality and
religious coping among outpatients with a DSM-IV diagnosis
of schizophrenia or schizoaffective disorder living in three
countries. METHOD: A total of 276 outpatients (92 from
Geneva, Switzerland, 121 from Trois-Rivières, Canada, and
63 from Durham, North Carolina), aged 18-65, were
administered a semi-structured interview on the role of
spirituality and religiousness in their lives and to cope
with their illness. RESULTS: Religion is important for
outpatients in each of the three country sites, and
religious involvement is higher than in the general
population. Religion was helpful (i.e., provided a positive
sense of self and positive coping with the illness) among
87% of the participants and harmful (a source of despair and
suffering) among 13%. Helpful religion was associated with
better social, clinical and psychological status. The
opposite was observed for the harmful aspects of religion.
In addition, religion sometimes conflicted with psychiatric
treatment. CONCLUSIONS: These results indicate that
outpatients with schizophrenia or schizoaffective disorder
often use spirituality and religion to cope with their
illness, basically positively, yet sometimes negatively.
These results underscore the importance of clinicians taking
into account the spiritual and religious lives of patients
with schizophrenia.},
Doi = {10.2190/PM.44.1.c},
Key = {fds301110}
}
@article{fds200067,
Author = {O'Donnell, K. and R. Murphy and J. Ostermann and M. Masnick and R.
Whetten, E. Madden and N.M. Thielman and K. Whetten},
Title = {A Brief Assessment of Learning for Orphaned and Abandoned
Children in Low and Medium Income Countries},
Journal = {AIDS and Behavior},
Year = {2011},
Month = {May},
ISSN = {1573-3254},
url = {http://dx.doi.org/10.1007/s10461-011-9940-z},
Keywords = {Orphan • Abandoned • Children •
Measurement},
Abstract = {Assessment of children’s learning and performance in low
and middle income countries has been critiqued as lacking a
gold standard, an appropriate norm reference group, and
demonstrated applicability of assessment tasks to the
context. This study was designed to examine the performance
of three nonverbal and one adapted verbal measure of
children’s problem solving, memory, motivation, and
attention across five culturally diverse sites. The goal was
to evaluate the tests as indicators of individual
differences affected by life events and care circumstances
for vulnerable children. We conclude that the measures can
be successfully employed with fidelity in non-standard
settings in LMICs, and are associated with child age and
educational experience across the settings. The tests can be
useful in evaluating variability in vulnerable child
outcomes.},
Doi = {10.1007/s10461-011-9940-z},
Key = {fds200067}
}
@article{fds301117,
Author = {Whetten, K and Ostermann, J and Whetten, R and O'Donnell, K and Thielman, N and Positive Outcomes for Orphans Research
Team},
Title = {More than the loss of a parent: potentially traumatic events
among orphaned and abandoned children.},
Journal = {J Trauma Stress},
Volume = {24},
Number = {2},
Pages = {174-182},
Year = {2011},
Month = {April},
ISSN = {1573-6598},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21442663},
Keywords = {Orphan • Abandoned • Children •
Trauma},
Abstract = {This study examines rates of potentially traumatic events
and associated anxiety and emotional/behavioral difficulties
among 1,258 orphaned and abandoned children in 5 low- and
middle-income countries. The study quantifies the types of
events the children experienced and demonstrates that
anxiety and emotional/behavioral difficulties increase with
additional exposure. As policies for orphaned and abandoned
children are being implemented, this study helps policy
makers and care providers recognize that (a) children and
caregivers are willing to report experiences of potentially
traumatic events, (b) those who report such events are at
higher risk for experiencing additional events, (c)
resulting symptomatology indicates a need for appropriate
mental health services, and (d) boys are as vulnerable as
girls, indicating an equal need for protection.},
Doi = {10.1002/jts.20625},
Key = {fds301117}
}
@article{fds301120,
Author = {Reif, S and Mugavero, M and Raper, J and Thielman, N and Leserman, J and Whetten, K and Pence, BW},
Title = {Highly stressed: stressful and traumatic experiences among
individuals with HIV/AIDS in the Deep South.},
Journal = {AIDS Care},
Volume = {23},
Number = {2},
Pages = {152-162},
Year = {2011},
Month = {February},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21259127},
Keywords = {HIV • AIDS • Deep South •
Trauma},
Abstract = {A history of traumatic and/or stressful experiences is
prevalent among HIV-infected individuals and has been
consistently associated with poorer health outcomes.
However, little is known about incident stressful
experiences and the factors that predict these experiences
among HIV-infected individuals. Data from a longitudinal
study of 611 HIV-infected individuals in the Southeastern
USA were used to examine the frequency and types of incident
stress reported in a 27-month period and to determine
predictors associated with three incident stress measures
(all stressful events, severe stressful events, and
traumatic events such as physical assault). Incident
stressful experiences frequently occurred among study
participants, as 91% reported at least one stressful
experience (median=3.5 experiences) and 10% of study
participants reported traumatic stress in any given
nine-month reporting period. Financial stressors were the
most frequently reported by study participants. Greater
emotional distress, substance use, and a higher number of
baseline stressful experiences were significantly associated
with reporting a greater number of incident stressful
experiences and any traumatic experiences. Study results
indicate that efforts are needed to identify individuals at
risk for traumatic events and/or substantial stressors and
to address the factors, including mental health and
substance abuse, that contribute to these
experiences.},
Doi = {10.1080/09540121.2010.498872},
Key = {fds301120}
}
@article{fds301116,
Author = {Whetten, R and Messer, L and Ostermann, J and Whetten, K and Pence, BW and Buckner, M and Thielman, N and O'Donnell, K and Positive Outcomes for
Orphans (POFO) Research Team},
Title = {Child work and labour among orphaned and abandoned children
in five low and middle income countries.},
Journal = {BMC Int Health Hum Rights},
Volume = {11},
Pages = {1},
Year = {2011},
Month = {January},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21232140},
Abstract = {BACKGROUND: The care and protection of the estimated
143,000,000 orphaned and abandoned children (OAC) worldwide
is of great importance to global policy makers and child
service providers in low and middle income countries
(LMICs), yet little is known about rates of child labour
among OAC, what child and caregiver characteristics predict
child engagement in work and labour, or when such work
infers with schooling. This study examines rates and
correlates of child labour among OAC and associations of
child labour with schooling in a cohort of OAC in 5 LMICs.
METHODS: The Positive Outcomes for Orphans (POFO) study
employed a two-stage random sampling survey methodology to
identify 1480 single and double orphans and children
abandoned by both parents ages 6-12 living in family
settings in five LMICs: Cambodia, Ethiopia, India, Kenya,
and Tanzania. Regression models examined child and caregiver
associations with: any work versus no work; and with working
<21, 21-27, and 28+ hours during the past week, and child
labour (UNICEF definition). RESULTS: The majority of OAC
(60.7%) engaged in work during the past week, and of those
who worked, 17.8% (10.5% of the total sample) worked 28 or
more hours. More than one-fifth (21.9%; 13% of the total
sample) met UNICEF's child labour definition. Female OAC and
those in good health had increased odds of working. OAC
living in rural areas, lower household wealth and caregivers
not earning an income were associated with increased child
labour. Child labour, but not working fewer than 28 hours
per week, was associated with decreased school attendance.
CONCLUSIONS: One in seven OAC in this study were reported to
be engaged in child labour. Policy makers and social service
providers need to pay close attention to the demands being
placed on female OAC, particularly in rural areas and poor
households with limited income sources. Programs to promote
OAC school attendance may need to focus on the needs of
families as well as the OAC.},
Doi = {10.1186/1472-698X-11-1},
Key = {fds301116}
}
@article{fds200071,
Author = {Whetten, R.A. and L. Messer and J. Ostermann and K. Whetten and B.W.
Pence, N.M. Thielman and M. Buckner and the Positive Outcomes
for Orphans (POFO) Research Team},
Title = {Child Work and Labour among Orphaned and Abandoned Children
in 5 Low and Middle Income Countries},
Journal = {BMC International Health and Human Rights},
Volume = {11},
Number = {1},
Year = {2011},
url = {http://dx.doi.org/10.1186/1472-698X-11-1},
Keywords = {Orphan • Abandoned • Children • Labor •
Labour},
Abstract = {Background The care and protection of the estimated
143,000,000 orphaned and abandoned children (OAC) worldwide
is of great importance to global policy makers and child
service providers in low and middle income countries
(LMICs), yet little is known about rates of child labour
among OAC, what child and caregiver characteristics predict
child engagement in work and labour, or when such work
infers with schooling. This study examines rates and
correlates of child labour among OAC and associations of
child labour with schooling in a cohort of OAC in 5 LMICs.
Methods The Positive Outcomes for Orphans (POFO) study
employed a two-stage random sampling survey methodology to
identify 1480 single and double orphans and children
abandoned by both parents ages 6-12 living in family
settings in five LMICs: Cambodia, Ethiopia, India, Kenya,
and Tanzania. Regression models examined child and caregiver
associations with: any work versus no work; and with working
<21, 21-27, and 28+ hours during the past week, and child
labour (UNICEF definition). Results The majority of OAC
(60.7%) engaged in work during the past week, and of those
who worked, 17.8% (10.5% of the total sample) worked 28 or
more hours. More than one-fifth (21.9%; 13% of the total
sample) met UNICEF's child labour definition. Female OAC and
those in good health had increased odds of working. OAC
living in rural areas, lower household wealth and caregivers
not earning an income were associated with increased child
labour. Child labour, but not working fewer than 28 hours
per week, was associated with decreased school attendance.
Conclusions One in seven OAC in this study were reported to
be engaged in child labour. Policy makers and social service
providers need to pay close attention to the demands being
placed on female OAC, particularly in rural areas and poor
households with limited income sources. Programs to promote
OAC school attendance may need to focus on the needs of
families as well as the OAC.},
Doi = {10.1186/1472-698X-11-1},
Key = {fds200071}
}
@article{fds301109,
Author = {Nolan, JA and Whetten, K and Koenig, HG},
Title = {Religious, spiritual, and traditional beliefs and practices
and the ethics of mental health research in less wealthy
countries.},
Journal = {Int J Psychiatry Med},
Volume = {42},
Number = {3},
Pages = {267-277},
Year = {2011},
ISSN = {0091-2174},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22439296},
Abstract = {This discussion article contributes to ethics reform by
introducing the contribution of religious, spiritual, and
traditional beliefs and practices to both subject
vulnerability and patient improvement. A growing body of
evidence suggests that religious, spiritual, and traditional
beliefs and practices may provide positive benefits,
although in some cases mixed or negative consequences to
mental and physical health. These beliefs and practices add
a new level of complexity to ethical deliberations, in terms
of what ignoring them may mean for both distributive justice
and respect for persons. International ethical guidelines
need to be created that are expansive enough to cover an
array of social groups and circumstances. It is proposed
that these guidelines incorporate the religious, spiritual,
and/or traditional principles that characterize a local
population. Providing effective mental healthcare requires
respecting and understanding how differences, including ones
that express a population's religious, spiritual, or
traditional belief systems, play into the complex
deliberations and negotiations that must be undertaken if
researchers are to adhere to ethical imperatives in research
and treatment.},
Doi = {10.2190/PM.42.3.c},
Key = {fds301109}
}
@article{fds301108,
Author = {Messer, LC and Pence, BW and Whetten, K and Whetten, R and Thielman, N and O'Donnell, K and Ostermann, J},
Title = {Prevalence and predictors of HIV-related stigma among
institutional- and community-based caregivers of orphans and
vulnerable children living in five less-wealthy
countries.},
Journal = {BMC Public Health},
Volume = {10},
Pages = {504},
Year = {2010},
Month = {August},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20723246},
Abstract = {BACKGROUND: In the face of the HIV/AIDS epidemic that has
contributed to the dramatic increase in orphans and
abandoned children (OAC) worldwide, caregiver attitudes
about HIV, and HIV-related stigma, are two attributes that
may affect caregiving. Little research has considered the
relationship between caregiver attributes and
caregiver-reported HIV-related stigma. In light of the
paucity of this literature, this paper will describe
HIV-related stigma among caregivers of OAC in five less
wealthy nations. METHODS: Baseline data were collected
between May 2006 through February 2008. The sample included
1,480 community-based and 192 institution-based caregivers.
Characteristics of the community-based and institution-based
caregivers are described using means and standard deviations
for continuous variables or counts and percentages for
categorical variables. We fit logistic regression models,
both for the full sample and separately for community-based
and institution-based caregivers, to explore predictors of
acceptance of HIV. RESULTS: Approximately 80% of both
community-based and institution-based caregivers were
female; and 84% of institution-based caregivers, compared to
66% of community-based caregivers, said that they would be
willing to care for a relative with HIV. Similar proportions
were reported when caregivers were asked if they were
willing to let their child play with an HIV-infected child.
In a multivariable model predicting willingness to care for
an HIV-infected relative, adjusted for site fixed effects,
being an institution-based caregiver was associated with
greater willingness (less stigma) than community-based
caregivers. Decreased willingness was reported by older
respondents, while willingness increased with greater formal
education. In the adjusted models predicting willingness to
allow one's child to play with an HIV-infected child, female
gender and older age was associated with less willingness.
However, willingness was positively associated with years of
formal education. CONCLUSIONS: The caregiver-child
relationship is central to a child's development. OAC
already face stigma as a result of their orphaned or
abandoned status; the addition of HIV-related stigma
represents a double burden for these children. Further
research on the prevalence of HIV-related acceptance and
stigma among caregivers and implications of such stigma for
child development will be critical as the policy community
responds to the global HIV/AIDS orphan crisis.},
Doi = {10.1186/1471-2458-10-504},
Key = {fds301108}
}
@article{fds301121,
Author = {Messer, L and Pence, BW and Whetten, K and Whetten, RA and O, DK and Thielman, NM and The, POFOPOFORT},
Title = {HIV-stigma and attributes of institutional- and
community-based caregivers of orphans and vulnerable
children living in five less-wealthy countries.},
Journal = {BMC Public Health},
Volume = {10},
Number = {504},
Year = {2010},
url = {http://www.biomedcentral.com/1471-2458/10/504},
Abstract = {BACKGROUND: In the face of the HIV/AIDS epidemic that has
contributed to the dramatic increase in orphans and
abandoned children (OAC) worldwide, caregiver attitudes
about HIV, and HIV-related stigma, are two attributes that
may affect caregiving. Little research has considered the
relationship between caregiver attributes and
caregiver-reported HIV-related stigma. In light of the
paucity of this literature, this paper will describe
HIV-related stigma among caregivers of OAC in five less
wealthy nations. METHODS: Baseline data were collected
between May 2006 through February 2008. The sample included
1,480 community-based and 192 institution-based caregivers.
Characteristics of the community-based and institution-based
caregivers are described using means and standard deviations
for continuous variables or counts and percentages for
categorical variables. We fit logistic regression models,
both for the full sample and separately for community-based
and institution-based caregivers, to explore predictors of
acceptance of HIV. RESULTS: Approximately 80% of both
community-based and institution-based caregivers were
female; and 84% of institution-based caregivers, compared to
66% of community-based caregivers, said that they would be
willing to care for a relative with HIV. Similar proportions
were reported when caregivers were asked if they were
willing to let their child play with an HIV-infected child.
In a multivariable model predicting willingness to care for
an HIV-infected relative, adjusted for site fixed effects,
being an institution-based caregiver was associated with
greater willingness (less stigma) than community-based
caregivers. Decreased willingness was reported by older
respondents, while willingness increased with greater formal
education. In the adjusted models predicting willingness to
allow one's child to play with an HIV-infected child, female
gender and older age was associated with less willingness.
However, willingness was positively associated with years of
formal education. CONCLUSIONS: The caregiver-child
relationship is central to a child's development. OAC
already face stigma as a result of their orphaned or
abandoned status; the addition of HIV-related stigma
represents a double burden for these children. Further
research on the prevalence of HIV-related acceptance and
stigma among caregivers and implications of such stigma for
child development will be critical as the policy community
responds to the global HIV/AIDS orphan crisis.},
Key = {fds301121}
}
@article{fds301122,
Author = {Whetten, K and Ostermann, J and Whetten, RA and Pence, BW and O'Donnell,
K and Messer, LC and Thielman, NM and Positive Outcomes for Orphans
(POFO) Research Team},
Title = {A comparison of the wellbeing of orphans and abandoned
children ages 6-12 in institutional and community-based care
settings in 5 less wealthy nations.},
Journal = {PLoS One},
Volume = {4},
Number = {12},
Pages = {e8169},
Year = {2009},
Month = {December},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20020037},
Abstract = {BACKGROUND: Leaders are struggling to care for the estimated
143,000,000 orphans and millions more abandoned children
worldwide. Global policy makers are advocating that
institution-living orphans and abandoned children (OAC) be
moved as quickly as possible to a residential family setting
and that institutional care be used as a last resort. This
analysis tests the hypothesis that institutional care for
OAC aged 6-12 is associated with worse health and wellbeing
than community residential care using conservative two-tail
tests. METHODOLOGY: The Positive Outcomes for Orphans (POFO)
study employed two-stage random sampling survey methodology
in 6 sites across 5 countries to identify 1,357
institution-living and 1,480 community-living OAC ages 6-12,
658 of whom were double-orphans or abandoned by both
biological parents. Survey analytic techniques were used to
compare cognitive functioning, emotion, behavior, physical
health, and growth. Linear mixed-effects models were used to
estimate the proportion of variability in child outcomes
attributable to the study site, care setting, and child
levels and institutional versus community care settings.
Conservative analyses limited the community living children
to double-orphans or abandoned children. PRINCIPAL FINDINGS:
Health, emotional and cognitive functioning, and physical
growth were no worse for institution-living than
community-living OAC, and generally better than for
community-living OAC cared for by persons other than a
biological parent. Differences between study sites explained
2-23% of the total variability in child outcomes, while
differences between care settings within sites explained
8-21%. Differences among children within care settings
explained 64-87%. After adjusting for sites, age, and
gender, institution vs. community-living explained only
0.3-7% of the variability in child outcomes. CONCLUSION:
This study does not support the hypothesis that
institutional care is systematically associated with poorer
wellbeing than community care for OAC aged 6-12 in those
countries facing the greatest OAC burden. Much greater
variability among children within care settings was observed
than among care settings type. Methodologically rigorous
studies must be conducted in those countries facing the new
OAC epidemic in order to understand which characteristics of
care promote child wellbeing. Such characteristics may
transcend the structural definitions of institutions or
family homes.},
Doi = {10.1371/journal.pone.0008169},
Key = {fds301122}
}
@article{fds301125,
Author = {Mugavero, MJ and Raper, JL and Reif, S and Whetten, K and Leserman, J and Thielman, NM and Pence, BW},
Title = {Overload: impact of incident stressful events on
antiretroviral medication adherence and virologic failure in
a longitudinal, multisite human immunodeficiency virus
cohort study.},
Journal = {Psychosom Med},
Volume = {71},
Number = {9},
Pages = {920-926},
Year = {2009},
Month = {November},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19875634},
Keywords = {HIV • AIDS • Trauma • Stress • Adherence
• Virologic failure • Disparities},
Abstract = {OBJECTIVE: To examine the influence of incident stressful
experiences on antiretroviral medication adherence and
treatment outcomes. Past trauma history predicts poorer
medication adherence and health outcomes. Human
immunodeficiency virus (HIV)-infected individuals experience
frequently traumatic and stressful events, such as sexual
and physical assault, housing instability, and major
financial, employment, and legal difficulties. METHODS: We
measured prospectively incident stressful and traumatic
events, medication adherence, and viral load over 27 months
in an eight-site, five-state study. Using multivariable
logistic and generalized estimating equation modeling, we
assessed the impact of incident stressful events on 27-month
changes in self-reported medication adherence and virologic
failure (viral load = >or=400 c/mL). RESULTS: Of 474
participants on antiretroviral therapy at baseline, 289
persons were interviewed and still received treatment at 27
months. Participants experiencing the median number of
incident stressful events (n = 9) had over twice the
predicted odds (odds ratio = 2.32) of antiretroviral
medication nonadherence at follow-up compared with those
with no events. Stressful events also predicted increased
odds of virologic failure during follow-up (odds ratio =
1.09 per event). CONCLUSIONS: Incident stressful events are
exceedingly common in the lives of HIV-infected individuals
and negatively affect antiretroviral medication adherence
and treatment outcomes. Interventions to address stress and
trauma are needed to improve HIV outcomes.},
Doi = {10.1097/PSY.0b013e3181bfe8d2},
Key = {fds301125}
}
@article{fds301124,
Author = {Messer, LC and O'Donnel, K and Parkash, S and Umar, E and Whetten,
K},
Title = {SOCIAL NETWORK ANALYSIS: MODIFYING A QUANTITATIVE INSTRUMENT
FOR A RESOURCE-POOR ENVIRONMENT},
Journal = {AMERICAN JOURNAL OF EPIDEMIOLOGY},
Volume = {169},
Number = {S11},
Pages = {S86-S86},
Publisher = {OXFORD UNIV PRESS INC},
Year = {2009},
Month = {June},
ISSN = {0002-9262},
url = {http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000266868300341&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=47d3190e77e5a3a53558812f597b0b92},
Key = {fds301124}
}
@article{fds317900,
Author = {Mugavero, MJ and Raper, JL and Reif, S and Whetten, K and Leserman, J and Thielman, NM and Pence, BW},
Title = {OVERLOAD: THE IMPACT OF INCIDENT STRESSFUL EVENTS ON
ANTIRETROVIRAL MEDICATION ADHERENCE AND VIROLOGIC FAILURE IN
A LONGITUDINAL, MULTI-SITE HIV COHORT STUDY.},
Journal = {AMERICAN JOURNAL OF EPIDEMIOLOGY},
Volume = {169},
Pages = {S55-S55},
Publisher = {OXFORD UNIV PRESS INC},
Year = {2009},
Month = {June},
Key = {fds317900}
}
@article{fds301096,
Author = {Ettner, SL and Conover, CJ and Proescholdbell, RJ and Weaver, MR and Ang, A and Arno, PS and HIV/AIDS Treatment Adherence and Health
Outcomes and Cost Study Group},
Title = {Triply-diagnosed patients in the HIV/AIDS Treatment
Adherence, Health Outcomes and Cost Study: patterns of home
care use.},
Journal = {AIDS care},
Volume = {20},
Number = {10},
Pages = {1177-1189},
Year = {2008},
Month = {November},
ISSN = {0954-0121},
url = {http://dx.doi.org/10.1080/09540120801918644},
Abstract = {Although AIDS is a chronic illness, little is known about
the patterns and correlates of long-term care use among
triply diagnosed HIV patients. We examined nursing and home
care use among 1,045 participants in the HIV/AIDS Treatment
Adherence, Health Outcomes and Cost Study, a multi-site
study of HIV-positive patients with at least one mental
health and one substance disorder. Patient interviews and
medical record review data were used to examine the average
monthly cost of nursing home, formal home and informal home
care. Multinomial logit and two-part regression models were
used to identify correlates of the use of formal and
informal home care and the number of informal home care
hours used. During the three months prior to baseline, 2, 7
and 23% of participants used nursing home, formal home and
informal home care, respectively. Patients who were
better-educated, had higher incomes, had Medicaid insurance
(with or without Medicare coverage) and whose transmission
mode was homosexual sex had higher regression-adjusted
probabilities of receiving any formal home care; Latinos and
physically healthier patients had lower probabilities. Women
and patients who abused drugs or alcohol (but not both) were
more likely to receive informal care only. Overall, patients
who were female, better-educated, physically or mentally
sicker or single-substance abusers were more likely to
receive any home care (either formal or informal), while
those contracting HIV through heterosexual sex were less
likely. Women received 28 more monthly hours of informal
care than men and married patients received 31 more hours
than unmarried patients. We conclude that at least one
mutable policy factor (Medicaid insurance) is strongly
associated with formal home care use among triply diagnosed
patients. Further research is needed to explore possible
implications for access among this vulnerable
subpopulation.},
Doi = {10.1080/09540120801918644},
Key = {fds301096}
}
@article{fds301106,
Author = {Whetten, K and Whetten, RA and Ostermann, J and Itemba,
D},
Title = {Trauma, anxiety and reported health among HIV-positive
persons in Tanzania and the US Deep South.},
Journal = {AIDS care},
Volume = {20},
Number = {10},
Pages = {1233-1241},
Year = {2008},
Month = {November},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18608062},
Abstract = {Little research has been conducted in less wealthy nations
to evaluate the prevalence of severe life traumas in general
population groups and the impact of such traumas. Previous
studies in wealthy nations have found that experiencing
severe traumas can cause elevated levels of anxiety, but few
studies have examined this association in non-disaster
situations in less wealthy nations. Trauma and
trauma-related anxiety are associated with greater sexual
risk taking behaviours, lower HIV medication adherence
levels and poorer health outcomes in wealthy nations. The
objectives of this manuscript are: (1) to compare rates of
trauma in two HIV-positive samples from areas that have not
experienced disaster situations that are recognized by the
international community as traumatic events; and (2) to
examine whether the reported traumatic experiences are
similarly associated with self-reported mental and physical
health. The samples come from a region of a wealthy nation
that consistently experiences large increases in incident
AIDS cases and where the epidemic is largely transmitted
heterosexually (Deep South, United States; n =611) and a
region in a less wealthy nation with relatively high HIV
prevalence and incidence rates and where transmission is
also primarily heterosexual (Moshi, Tanzania; n =72).
Compared to the US sample, the Tanzanian sample reported
significantly higher rates of trauma in the areas of
illness, injury, accidents and "other" significant traumas,
a higher prevalence of anxiety and poorer physical health.
The experience of trauma was similarly associated with
greater mental health symptomatology and poorer physical
health in both samples. Further investigation into the area
of trauma and its sequelae is warranted, particularly in
relation to risk behaviours and HIV medication adherence. At
a time of increasing anti-retroviral therapy (ART)
availability in less wealthy nations, additional focus on
trauma care could improve ART adherence rates and reduce
risk behaviors, thereby assisting in stemming the further
spread of the epidemic.},
Doi = {10.1080/09540120801918636},
Key = {fds301106}
}
@article{fds301126,
Author = {Pence, BW and Thielman, NM and Whetten, K and Ostermann, J and Kumar, V and Mugavero, MJ},
Title = {Coping strategies and patterns of alcohol and drug use among
HIV-infected patients in the United States
Southeast.},
Journal = {AIDS Patient Care STDS},
Volume = {22},
Number = {11},
Pages = {869-877},
Year = {2008},
Month = {November},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19025481},
Abstract = {Alcohol and drug use are common among HIV-infected patients
and are important determinants of secondary transmission
risk and medication adherence. As part of the Coping with
HIV/AIDS in the Southeast (CHASE) Study, 611 HIV-infected
patients were consecutively recruited from eight clinical
care sites in five southeastern U.S. states in 2001-2002. We
examined the distribution and predictors of alcohol and drug
use in this sample with an emphasis on psychosocial
predictors of use. In the prior 9 months, 27% of
participants drank alcohol and 7% drank to intoxication at
least weekly. The most common drugs used at least weekly
were marijuana (12%) and crack (5%); 11% used a
non-marijuana drug. 7% reported polysubstance use (use of
multiple substances at one time) at least weekly. Injection
drug use was rare (2% injected at least once in the past 9
months). There were few differences in alcohol and drug use
across sociodemographic characteristics. Stronger adaptive
coping strategies were the most consistent predictor of less
frequent alcohol and drug use, in particular coping through
action and coping through relying on religion. Stronger
maladaptive coping strategies predicted greater frequency of
drinking to intoxication but not other measures of alcohol
and drug use. Those with more lifetime traumatic experiences
also reported higher substance use. Interventions that teach
adaptive coping strategies may be effective in reducing
alcohol and substance use among HIV-positive
persons.},
Doi = {10.1089/apc.2008.0022},
Key = {fds301126}
}
@article{fds301127,
Author = {Whetten, K and Reif, S and Whetten, R and Murphy-McMillan,
LK},
Title = {Trauma, mental health, distrust, and stigma among
HIV-positive persons: implications for effective
care.},
Journal = {Psychosomatic medicine},
Volume = {70},
Number = {5},
Pages = {531-538},
Year = {2008},
Month = {June},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18541904},
Abstract = {Individuals living with HIV often have complicated
histories, including negative experiences such as traumatic
events, mental illness, and stigma. As the medical community
in the United States adapts to managing HIV as a chronic
disease, understanding factors such as these negative
experiences that may be associated with poorer adherence to
treatment regimens, greater HIV risk behavior, and lower
patient quality of life becomes critical to HIV care and
prevention. In less wealthy nations, these issues are also
critical for addressing quality of life as well as
medication adherence in the areas where antiretroviral
therapies are being made available. This article presents a
review of the literature regarding the following
psychosocial factors as they relate to HIV/AIDS in the US
and globally: traumatic events; mental illness, including
depression, anxiety, and posttraumatic stress disorder; lack
of trust in the healthcare system and government; and
experiences of stigma among individuals with HIV disease.
These factors have been found to be prevalent among
individuals with HIV/AIDS, regardless of gender or
race/ethnicity. Traumatic events, mental illness, distrust,
and stigma have also been linked with poorer adherence to
medication regimens and HIV risk behavior.},
Doi = {10.1097/psy.0b013e31817749dc},
Key = {fds301127}
}
@article{fds301123,
Author = {Hanisch, LJ and Ostermann, J and Palmer, SC and Reif, SS and Thielman,
N and Whetten, K},
Title = {Victimization and clinical outcomes among HIV-infected
individuals with co-occurring mental and substance use
disorders},
Journal = {ANNALS OF BEHAVIORAL MEDICINE},
Volume = {35},
Number = {S1},
Pages = {S45-S45},
Publisher = {SPRINGER},
Year = {2008},
Month = {March},
ISSN = {0883-6612},
url = {http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000259245500171&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=47d3190e77e5a3a53558812f597b0b92},
Key = {fds301123}
}
@article{fds301128,
Author = {Pence, BW and Ostermann, J and Kumar, V and Whetten, K and Thielman, N and Mugavero, MJ},
Title = {The influence of psychosocial characteristics and
race/ethnicity on the use, duration, and success of
antiretroviral therapy.},
Journal = {J Acquir Immune Defic Syndr},
Volume = {47},
Number = {2},
Pages = {194-201},
Year = {2008},
Month = {February},
ISSN = {1525-4135},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17971712},
Abstract = {BACKGROUND: Expanded access to antiretroviral therapy (ART)
has produced dramatic reductions in HIV-associated morbidity
and mortality. Disparities in access to and benefit from ART
have been observed by race, gender, and mental health
status, however. METHODS: From 2001 to 2002, 611
HIV-positive patients were consecutively recruited from 5
southeastern US states and followed for 3 years. We
evaluated demographic and psychosocial predictors of
probability of receiving ART among all those eligible for
ART (on ART, CD4 <350 cells/mm3 or viral load [VL] >55,000
copies/mL in the year preceding enrollment), time to first
ART discontinuation among those on ART, and time to VL >400
copies/mL among those on ART with VL <400 copies/mL at
enrollment. RESULTS: Of 611 participants, 474 consented to
medical record abstraction and had known ART status at
enrollment; 81% (385 of 474) of all participants and 89%
(385 of 435) of ART-eligible participants were receiving ART
at enrollment. In multivariable analyses, ART receipt was
associated with greater age (adjusted odds ratio = 1.92 per
10 years, 95% confidence interval: 1.23 to 3.01), fewer
recent stressful life events (odds ratio = 0.68, 95%
confidence interval: 0.51 to 0.92), less alcohol use (odds
ratio = 0.64, 95% confidence interval: 0.46 to 0.90), and
greater perceived self-efficacy (OR = 2.82, 95% confidence
interval: 1.41 to 5.62). No psychosocial characteristics
were associated with ART discontinuation or virologic
failure. No racial/ethnic or gender disparities were
observed in ART receipt; however, minority racial/ethnic
groups were faster to discontinue ART (adjusted hazard ratio
= 2.44, 95% confidence interval: 1.33 to 4.49) and
experience virologic failure (adjusted hazard ratio = 2.01,
95% confidence interval: 1.09 to 3.71). CONCLUSIONS:
Patients with unfavorable psychosocial profiles were less
likely to be on ART, perhaps attributable to providers' or
patients' expectations of readiness. Psychosocial
characteristics were not associated with ART discontinuation
or virologic failure, however, possibly reflecting the
selection process involved in who initiates ART. Racial
disparities in ART discontinuation and virologic failure
merit further attention.},
Doi = {10.1097/QAI.0b013e31815ace7e},
Key = {fds301128}
}
@article{fds301129,
Author = {Bouis, S and Reif, S and Whetten, K and Scovil, J and Murray, A and Swartz,
M},
Title = {An integrated, multidimensional treatment model for
individuals living with HIV, mental illness, and substance
abuse.},
Journal = {Health Soc Work},
Volume = {32},
Number = {4},
Pages = {268-278},
Year = {2007},
Month = {November},
ISSN = {0360-7283},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18038728},
Abstract = {The challenge of providing effective treatment services for
the growing population of HIV-positive individuals who are
also dually diagnosed with substance use and mental
disorders has only recently been recognized as an important
public health concern affecting both HIV treatment and
prevention. This article describes a treatment model that
was created for a study of integrated treatment for
HIV-positive individuals with substance use and mental
disorders. The treatment model was based on the
transtheoretical model of behavior change as well as
evidence-based practices that are widely used in the
treatment of individuals dually diagnosed with substance use
and mental disorders. The model involved collaboration
between medical and behavioral health care professionals and
emphasized the importance of goal reinforcement across
disciplines. Furthermore, it included the development and
enhancement of client motivation to modify medical and
behavioral health-risk behaviors using individual readiness
for change and offered comprehensive care addressing a
continuum of client needs that may influence treatment
outcomes. Treatment modalities included individual therapy,
group therapy, and psychiatric medication management. This
treatment intervention was associated with positive outcomes
in the integrated treatment study and can be adapted for use
in a variety of psychiatric or medical treatment
settings.},
Doi = {10.1093/hsw/32.4.268},
Key = {fds301129}
}
@article{fds301131,
Author = {Pence, BW and Reif, S and Whetten, K and Leserman, J and Stangl, D and Swartz, M and Thielman, N and Mugavero, MJ},
Title = {Minorities, the poor, and survivors of abuse: HIV-infected
patients in the US deep South.},
Journal = {South Med J},
Volume = {100},
Number = {11},
Pages = {1114-1122},
Year = {2007},
Month = {November},
ISSN = {0038-4348},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17984744},
Abstract = {BACKGROUND: The HIV/AIDS epidemic in the U.S. South is
undergoing a marked shift toward a greater proportion of new
HIV/AIDS cases in women, African-Americans, and through
heterosexual transmission. METHODS: Using consecutive
sampling, 611 participants were interviewed from eight
Infectious Diseases clinics in five southeastern states in
2001 to 2002. RESULTS: Sixty four percent of participants
were African-American, 31% were female, and 43% acquired HIV
through heterosexual sex; 25% had private health insurance.
Eighty-one percent were on antiretroviral therapy, and 46%
had HIV RNA viral loads (VL) <400. Women and racial/ethnic
minorities were less likely to be on antiretrovirals and to
have VL <400. Probable psychiatric disorders (54%) and
history of childhood sexual (30%) and physical abuse (21%)
were common. CONCLUSIONS: Prevention and care systems need
to address the HIV epidemic's shift into poor, minority, and
female populations. High levels of trauma and probable
psychiatric disorders indicate a need to assess for and
address these conditions in HIV clinical
care.},
Doi = {10.1097/01.smj.0000286756.54607.9f},
Key = {fds301131}
}
@article{fds304237,
Author = {Leserman, J and Pence, BW and Whetten, K and Mugavero, MJ and Thielman,
NM and Swartz, MS and Stangl, D},
Title = {Relation of lifetime trauma and depressive symptoms to
mortality in HIV.},
Journal = {Am J Psychiatry},
Volume = {164},
Number = {11},
Pages = {1707-1713},
Year = {2007},
Month = {November},
ISSN = {0002-953X},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17974936},
Abstract = {OBJECTIVE: In an era of highly active antiretroviral
therapies, the authors needed to confirm previous findings
showing that stress and depression have an impact on HIV
disease progression. The goal of the current study was to
examine the effects of lifetime trauma, recent stressful
events, and depression on all-cause and AIDS-related
mortality among HIV-infected men and women. The authors
hypothesized that these psychosocial variables would predict
significantly faster HIV-specific and all-cause mortality.
METHOD: The authors consecutively sampled HIV-infected men
and women who received care at one of eight infectious
diseases clinics in five Southeastern states. The sample
included 490 patients who were followed by interview for 27
months and followed with their medical records for up to 41
months. RESULTS: There were 29 deaths; 16 were AIDS-related.
More lifetime trauma and antigenic marker on helper/inducer
T cells (CD4)<200 significantly predicted faster all-cause
and AIDS-related mortality. For those at or above the median
in trauma, the all-cause death rate was 3.54 per 100
person-years, compared to 1.72 for those below the median.
For those at or above the median in trauma, the AIDS-related
death rate was 2.13 per 100 person-years, compared to 0.77
for those below the median. Depressive symptoms and higher
baseline viral load were significantly related to greater
risk of AIDS-related mortality. CONCLUSIONS: Further
research is needed to determine if interventions to address
trauma and depression can modify these detrimental effects
on HIV.},
Doi = {10.1176/appi.ajp.2007.06111775},
Key = {fds304237}
}
@article{fds301130,
Author = {Ostermann, J and Kumar, V and Pence, BW and Whetten,
K},
Title = {Trends in HIV testing and differences between planned and
actual testing in the United States, 2000-2005.},
Journal = {Arch Intern Med},
Volume = {167},
Number = {19},
Pages = {2128-2135},
Year = {2007},
Month = {October},
ISSN = {0003-9926},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17954809},
Abstract = {BACKGROUND: Increasing the rates of human immunodeficiency
virus (HIV) testing among groups not traditionally perceived
as being at high risk has been advanced as a primary
strategy in the effort to combat the HIV epidemic. METHODS:
We conducted a pooled cross-sectional analysis of data from
146 868 participants aged 18 to 64 years in the 2000-2005
National Health Interview Surveys to describe longitudinal
trends in HIV testing rates in the US population and
differences between planned and actual testing across
demographic and risk groups. Multivariable logistic models
were estimated to assess correlates of perceived risk for
HIV infection and planned and actual HIV testing.
Difference-in-differences models examine how differences
between planned and actual testing varied with demographic
characteristics, perceived risk, alcohol consumption,
depression, and health behaviors and access. RESULTS: Rates
of HIV testing remained relatively unchanged from 2000 to
2005 (mean rates for lifetime and past year, 37% and 10%,
respectively) and varied substantially by sex and race, with
female and minority (nonwhite) populations more likely to
get tested. Rates were higher in individuals reporting
greater risks of HIV infection. However, even among
respondents reporting medium or high risks of contracting
HIV, less than 25% reported an HIV test in the previous
year. Those with a higher perceived risk, more alcohol
consumption, and more depressive symptoms had higher rates
of both planned and actual testing but also demonstrated the
greatest deficit of actual relative to planned testing.
CONCLUSIONS: In the United States, HIV testing rates remain
low, nationally and in high-risk populations; low rates are
likely contributing to a substantial number of undiagnosed
cases of HIV. Despite above-average testing rates,
populations considered to be at increased risk for HIV
infection still demonstrate the need for improved access to
and utilization of testing.},
Doi = {10.1001/archinte.167.19.2128},
Key = {fds301130}
}
@article{fds304236,
Author = {Mugavero, MJ and Pence, BW and Whetten, K and Leserman, J and Swartz, M and Stangl, D and Thielman, NM},
Title = {Childhood abuse and initial presentation for HIV care: an
opportunity for early intervention.},
Journal = {AIDS Care},
Volume = {19},
Number = {9},
Pages = {1083-1087},
Year = {2007},
Month = {October},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18058391},
Abstract = {An alarmingly high prevalence of childhood sexual and
physical abuse has been observed in HIV-infected men and
women, with rates several times higher than observed in the
general population. Childhood abuse history has been
associated with worse antiretroviral adherence and negative
health behaviours in HIV-infected patients. This study
evaluates the relationship between childhood abuse and the
timing of presentation for HIV care. Participants in a
multi-center prospective cohort study, who established
initial HIV care after January 1996 and had a CD4 count
available within six months of initial presentation, were
included in this analysis. Bivariate contingency tables and
multivariate logistic regression were used to evaluate the
association of childhood abuse with early presentation for
HIV care (initial CD4 count > or =200/mm3). Among the 186
subjects included in this analysis, 33% had childhood abuse
histories and 58% had an initial CD4 count > or =200/mm3.
Participants with a history of childhood abuse were more
likely to present early for HIV care (AOR=2.12; p=0.03),
perhaps because survivors of abuse tend to have higher
utilization of health services. Because HIV-infected
patients with childhood abuse histories have worse
antiretroviral medication adherence and are more likely to
engage in high-risk sexual and injection drug use
behaviours, early presentation affords clinicians the
opportunity for timely institution of interventions that may
improve patient outcomes and prevent secondary HIV
infections.},
Doi = {10.1080/09540120701351896},
Key = {fds304236}
}
@article{fds301134,
Author = {Mugavero, MJ and Pence, BW and Whetten, K and Leserman, J and Swartz, M and Stangl, D and Thielman, NM},
Title = {Predictors of AIDS-related morbidity and mortality in a
southern U.S. Cohort.},
Journal = {AIDS Patient Care STDS},
Volume = {21},
Number = {9},
Pages = {681-690},
Year = {2007},
Month = {September},
ISSN = {1087-2914},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17919095},
Abstract = {Advances in the treatment of HIV and associated
opportunistic infections (OIs) have led to dramatic
reductions in HIV-related morbidity and mortality in the
United States, but not all patients have benefited equally.
A longitudinal analysis of the Coping with HIV/AIDS in the
Southeast (CHASE) cohort evaluated sociodemographic,
psychosocial, and clinical factors associated with
HIV-related events (incident category C OI or AIDS-related
death) among southern HIV-infected patients engaged in
clinical care. Participants were followed for a median of 30
months (interquartile range, 17-34 months) after study
enrollment (enrollment period December 2001 to April 2002).
Ten percent of study participants (50/489) experienced an
HIV-related event (incident category C OI and/or
AIDS-related deaths) during study follow-up. The rate of
HIV-related events was 4.8 per 100 patient-years of
observation, and the rate of AIDS-related death was 1.5 per
100 patient-years of observation. In unadjusted survival
analyses, younger age, lacking private health insurance,
psychosocial trauma, depressive symptoms, lower baseline CD4
count, and less time on antiretroviral therapy during
follow-up were associated with HIV-related events. In Cox
proportional hazards analysis adjusting for covariates,
patients who had suffered more psychosocial trauma (hazard
ratio [HR] = 1.97, p = 0.04), who had lower baseline CD4
counts (HR = 0.48 per 100 cells/mm(3), p < 0.01), and who
spent less time on antiretroviral therapy during follow-up
(HR = 0.47, p = 0.02) were more likely to experience an
HIV-related event.},
Doi = {10.1089/apc.2006.0167},
Key = {fds301134}
}
@article{fds301135,
Author = {Reif, S and Whetten, K and Thielman, N},
Title = {Association of race and gender with use of antiretroviral
therapy among HIV-infected individuals in the Southeastern
United States.},
Journal = {South Med J},
Volume = {100},
Number = {8},
Pages = {775-781},
Year = {2007},
Month = {August},
ISSN = {0038-4348},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17713302},
Abstract = {BACKGROUND: Women and minorities continue to account for a
higher proportion of AIDS incidence and mortality than their
male and white counterparts. This study examined whether
race and gender were associated with antiretroviral use
among HIV-infected individuals in the southeastern US.
METHODS: Multivariate regression analyses were used to
identify whether race and gender predicted use of a protease
inhibitor (PI) or non-nucleoside reverse transcriptase
inhibitor (NNRTI) from 1996 to 2000 among individuals
receiving HIV primary care. RESULTS: Female gender and
nonwhite race were significantly associated with a lower
likelihood of being prescribed a PI or NNRTI at baseline. At
the follow-up measure three years later, fewer individuals
of minority race and female gender were prescribed a PI or
NNRTI; however, these differences had declined and were no
longer statistically significant. CONCLUSIONS: Efforts are
needed to improve prompt access to advances in HIV
therapeutics for women and minorities and to address
continued disparities in HIV care by race and
gender.},
Doi = {10.1097/SMJ.0b013e3180f626b4},
Key = {fds301135}
}
@article{fds301097,
Author = {Reif, S and Geonnotti, KL and Whetten, K and Pence,
BW},
Title = {Reif et al. respond [2]},
Journal = {American Journal of Public Health},
Volume = {97},
Number = {3},
Pages = {391-392},
Publisher = {American Public Health Association},
Year = {2007},
Month = {March},
ISSN = {0090-0036},
url = {http://dx.doi.org/10.2105/AJPH.2006.104307},
Doi = {10.2105/AJPH.2006.104307},
Key = {fds301097}
}
@article{fds301119,
Author = {Ford, CL and Whetten, KD and Hall, SA and Kaufman, JS and Thrasher,
AD},
Title = {Black sexuality, social construction, and research targeting
'The Down Low' ('The DL').},
Journal = {Annals of epidemiology},
Volume = {17},
Number = {3},
Pages = {209-216},
Year = {2007},
Month = {March},
ISSN = {1047-2797},
url = {http://dx.doi.org/10.1016/j.annepidem.2006.09.006},
Abstract = {<h4>Purpose</h4>The purpose of this commentary is to explain
how social constructions of black sexuality are relevant to
research targeting black sexual behavior and the ostensibly
new and race-specific phenomenon known as "the Down Low"
(the DL). The term "the DL" is widely used to refer to black
men publicly presenting as heterosexual while secretly
having sex with other men and presumably spreading human
immunodeficiency virus and acquired immune deficiency
syndrome (HIV/AIDS) to unsuspecting women.<h4>Methods</h4>We
briefly review lay and public health literature from 1998 to
2004 about the DL, describe existing social constructions of
black sexuality, discuss two implications for epidemiologic
research, and offer recommendations to guide future
research.<h4>Results</h4>The lifestyle referenced by the
term the DL is neither new nor limited to blacks, and
sufficient data linking it to HIV/AIDS disparities currently
are lacking. Common perceptions about the DL reflect social
constructions of black sexuality as generally excessive,
deviant, diseased, and predatory. Research targeting black
sexual behavior that ignores these constructions may
unwittingly reinforce them.<h4>Conclusions</h4>Unaddressed
social constructions of black sexuality have implications
for epidemiologic research targeting black sexual behavior.
Explicit examination of these concerns is necessary to
eliminate fundamental causes of health disparities.},
Doi = {10.1016/j.annepidem.2006.09.006},
Key = {fds301119}
}
@article{fds301132,
Author = {Leserman, J and Pence, BW and Whetten, K and Mugavero, MJ and Thielman,
NM and Swartz, MS and Stangl, D},
Title = {Lifetime Trauma and Depressive Symptoms Predict Mortality in
HIV},
Journal = {American Journal of Psychiatry},
Volume = {164},
Number = {11},
Pages = {1707-1713},
Year = {2007},
ISSN = {0002-953X},
url = {http://www.ncbi.nlm.nih.gov/pubmed/17974936},
Abstract = {OBJECTIVE: In an era of highly active antiretroviral
therapies, the authors needed to confirm previous findings
showing that stress and depression have an impact on HIV
disease progression. The goal of the current study was to
examine the effects of lifetime trauma, recent stressful
events, and depression on all-cause and AIDS-related
mortality among HIV-infected men and women. The authors
hypothesized that these psychosocial variables would predict
significantly faster HIV-specific and all-cause mortality.
METHOD: The authors consecutively sampled HIV-infected men
and women who received care at one of eight infectious
diseases clinics in five Southeastern states. The sample
included 490 patients who were followed by interview for 27
months and followed with their medical records for up to 41
months. RESULTS: There were 29 deaths; 16 were AIDS-related.
More lifetime trauma and antigenic marker on helper/inducer
T cells (CD4)<200 significantly predicted faster all-cause
and AIDS-related mortality. For those at or above the median
in trauma, the all-cause death rate was 3.54 per 100
person-years, compared to 1.72 for those below the median.
For those at or above the median in trauma, the AIDS-related
death rate was 2.13 per 100 person-years, compared to 0.77
for those below the median. Depressive symptoms and higher
baseline viral load were significantly related to greater
risk of AIDS-related mortality. CONCLUSIONS: Further
research is needed to determine if interventions to address
trauma and depression can modify these detrimental effects
on HIV.},
Doi = {10.1176/appi.ajp.2007.06111775},
Key = {fds301132}
}
@article{fds301133,
Author = {Mugavero, MJ and Pence, BW and Whetten, K and Leserman, J and Swartz, M and Stangl, D and Thielman, N},
Title = {Childhood sexual abuse or physical trauma and initial
presentation for HIV care: An opportunity for early
intervention},
Journal = {AIDS Care},
Volume = {19},
Number = {9},
Pages = {1083-1087},
Year = {2007},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18058391},
Abstract = {An alarmingly high prevalence of childhood sexual and
physical abuse has been observed in HIV-infected men and
women, with rates several times higher than observed in the
general population. Childhood abuse history has been
associated with worse antiretroviral adherence and negative
health behaviours in HIV-infected patients. This study
evaluates the relationship between childhood abuse and the
timing of presentation for HIV care. Participants in a
multi-center prospective cohort study, who established
initial HIV care after January 1996 and had a CD4 count
available within six months of initial presentation, were
included in this analysis. Bivariate contingency tables and
multivariate logistic regression were used to evaluate the
association of childhood abuse with early presentation for
HIV care (initial CD4 count > or =200/mm3). Among the 186
subjects included in this analysis, 33% had childhood abuse
histories and 58% had an initial CD4 count > or =200/mm3.
Participants with a history of childhood abuse were more
likely to present early for HIV care (AOR=2.12; p=0.03),
perhaps because survivors of abuse tend to have higher
utilization of health services. Because HIV-infected
patients with childhood abuse histories have worse
antiretroviral medication adherence and are more likely to
engage in high-risk sexual and injection drug use
behaviours, early presentation affords clinicians the
opportunity for timely institution of interventions that may
improve patient outcomes and prevent secondary HIV
infections.},
Doi = {10.1080/09540120701351896},
Key = {fds301133}
}
@article{fds301142,
Author = {Pence, BW and Miller, WC and Whetten, K and Eron, JJ and Gaynes,
BN},
Title = {Prevalence of DSM-IV-defined mood, anxiety, and substance
use disorders in an HIV clinic in the Southeastern United
States.},
Journal = {J Acquir Immune Defic Syndr},
Volume = {42},
Number = {3},
Pages = {298-306},
Year = {2006},
Month = {July},
ISSN = {1525-4135},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16639343},
Abstract = {BACKGROUND: Mood and anxiety disorders, particularly
depression, and substance abuse (SA) commonly co-occur with
HIV infection. Appropriate policy and program planning
require accurate prevalence estimates. Yet most estimates
are based on screening instruments, which are likely to
overstate true prevalence. SETTING: Large academic medical
center in Southeast. PARTICIPANTS: A total of 1,125
patients, representing 80% of HIV-positive patients seen
over a 2.5-year period, completed the Substance Abuse-Mental
Illness Symptoms Screener, a brief screening instrument for
probable mood, anxiety, and SA disorders. Separately, 148
participants in a validation study completed the Substance
Abuse-Mental Illness Symptoms Screener and a reference
standard diagnostic tool, the Structured Clinical Interview
for DSM-IV. METHODS: Using the validation study sample, we
developed logistic regression models to predict any
Structured Clinical Interview for DSM-IV mood/anxiety
disorder, any SA, and certain specific diagnoses.
Explanatory variables included sociodemographic and clinical
information and responses to Substance Abuse-Mental Illness
Symptoms Screener questions. We applied coefficients from
these models to the full clinic sample to obtain 12-month
clinic-wide diagnosis prevalence estimates. RESULTS: We
estimate that in the preceding year, 39% of clinic patients
had a mood/anxiety diagnosis and 21% had an SA diagnosis,
including 8% with both. Of patients with a mood/anxiety
diagnosis, 76% had clinically relevant depression and 11%
had posttraumatic stress disorder. CONCLUSIONS: The burden
of psychiatric disorders in this mixed urban and rural
clinic population in the southeastern United States is
comparable to that reported from other HIV-positive
populations and significantly exceeds general population
estimates. Because psychiatric disorders have important
implications for clinical management of HIV/AIDS, these
results suggest the potential benefit of routine integration
of mental health identification and treatment into HIV
service sites.},
Doi = {10.1097/01.qai.0000219773.82055.aa},
Key = {fds301142}
}
@article{fds301086,
Author = {Reif, S and Geonnotti, KL and Whetten, K},
Title = {HIV Infection and AIDS in the Deep South.},
Journal = {American journal of public health},
Volume = {96},
Number = {6},
Pages = {970-973},
Year = {2006},
Month = {June},
ISSN = {0090-0036},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16670228},
Abstract = {We examine epidemiological and demographic data documenting
the HIV/AIDS epidemic in the Deep South region of the United
States. These data document substantial increases in AIDS
cases in the Deep South from 2000 to 2003. In contrast,
other US regions are experiencing stable rates or small
increases in new AIDS cases. Furthermore, the AIDS epidemic
in the Deep South is more concentrated than in other regions
among African Americans, women, and rural residents. The
Deep South also has some of the highest levels of poverty
and uninsured individuals, factors that complicate the
prevention and treatment of HIV infection. Further research
is needed to determine the cause of the disproportionate
rise in AIDS incidence and to develop effective means of
preventing HIV infection and providing care of those
infected in this region.},
Doi = {10.2105/ajph.2005.063149},
Key = {fds301086}
}
@article{fds301087,
Author = {Whetten, K and Leserman, J and Lowe, K and Stangl, D and Thielman, N and Swartz, M and Hanisch, L and Van Scoyoc and L},
Title = {Prevalence of childhood sexual abuse and physical trauma in
an HIV-positive sample from the deep south.},
Journal = {Am J Public Health},
Volume = {96},
Number = {6},
Pages = {1028-1030},
Year = {2006},
Month = {June},
ISSN = {0090-0036},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16670226},
Abstract = {We examined prevalence and predictors of trauma among
HIV-infected persons in the Deep South using data from the
Coping with HIV/AIDS in the Southeast (CHASE) study. Over
50% of CHASE participants were abused during their lives,
with approximately 30% experiencing abuse before age 13,
regardless of gender. Caregiver characteristics were
associated with childhood abuse. Abuse is related to
increases in high-HIV-risk activities. The findings help
explain why people engage in such high-risk activities and
can provide guidance in designing improved care and
prevention messages.},
Doi = {10.2105/AJPH.2005.063263},
Key = {fds301087}
}
@article{fds301136,
Author = {Mugavero, M and Ostermann, J and Whetten, K and Leserman, J and Swartz,
M and Stangl, D and Thielman, N},
Title = {Barriers to antiretroviral adherence: the importance of
depression, abuse, and other traumatic events.},
Journal = {AIDS Patient Care STDS},
Volume = {20},
Number = {6},
Pages = {418-428},
Year = {2006},
Month = {June},
ISSN = {1087-2914},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16789855},
Abstract = {Among HIV-infected persons, high-level adherence to
antiretroviral medications (>90%-95%) is associated with
improved immunologic, virologic, and clinical outcomes, and
is necessary to prevent the emergence of viral resistance.
This study examines whether lifetime traumatic events
including physical and sexual abuse, are associated with
antiretroviral nonadherence. We present a cross-sectional
analysis of the Coping with HIV/AIDS in the Southeast
(CHASE) Study, analyzing data from the enrollment interview
and medical records of study subjects. The CHASE Study is a
prospective cohort study of consecutively sampled
HIV-infected subjects from infectious diseases clinics in
five southern states; Alabama, Georgia, Louisiana, North
Carolina, and South Carolina. Four hundred seventy-four
(78%) of the 611 CHASE study subjects reported being treated
with antiretroviral medications at enrollment and are
included in this analysis. Nonadherence was defined as the
patient's self-report of missing any doses of their
antiretroviral medications over the previous 7 days. Among
study subjects, 54% reported a history of physical and/or
sexual abuse, 91% reported at least one lifetime traumatic
event, and 24% reported nonadherence with their
antiretrovirals. In multivariable logistic regression
analysis, the number of categories of lifetime traumatic
events (p = 0.03), the Addiction Severity Index (ASI)
alcohol score (p = 0.02), and being uninsured (p = 0.04)
were associated with antiretroviral nonadherence. The
finding that lifetime traumatic events are associated with
antiretroviral nonadherence, particularly among those who
have been traumatized in multiple ways, highlights the
complex and often persisting manifestations of such trauma
and calls for further investigation.},
Doi = {10.1089/apc.2006.20.418},
Key = {fds301136}
}
@article{fds301141,
Author = {Reif, S and Whetten, K and Lowe, K and Ostermann,
J},
Title = {Association of unmet needs for support services with
medication use and adherence among HIV-infected individuals
in the southeastern United States.},
Journal = {AIDS care},
Volume = {18},
Number = {4},
Pages = {277-283},
Year = {2006},
Month = {May},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16809104},
Abstract = {Unmet needs for services, such as housing and psychiatric
treatment, are relatively common among HIV-infected
individuals; however, the effects of different types of
unmet needs on health-care outcomes are not well understood.
This study describes unmet psychosocial needs and their
relationship with health-care outcomes among individuals
receiving HIV care in the southeastern US (n=526). We used
multivariate logistic regression to examine the association
of seven categories of unmet needs with HIV medication use
and adherence. Most participants (84.5%) reported at least
one service need in the past year. Nearly half (47%) of
participants with service needs reported that at least one
need was not met. Participants with one or more unmet needs
were less likely to be taking any HIV medications (p =
0.007) and reported poorer medication adherence (p=0.013).
The specific unmet needs for benefits (including Social
Security, health insurance and prescription coverage) (p =
0.006) and a support group (p=0.040) were associated with
being less likely to be taking any HIV medications. Unmet
need for mental health-related counseling was associated
with poorer medication adherence (p=0.003). Study findings
regarding the high level of unmet need and the association
of unmet need with poorer outcomes illustrate the importance
of interventions to address these needs.},
Doi = {10.1080/09540120500161868},
Key = {fds301141}
}
@article{fds301144,
Author = {Whetten, K and Leserman, J and Whetten, R and Ostermann, J and Thielman,
N and Swartz, M and Stangl, D},
Title = {Exploring lack of trust in care providers and the government
as a barrier to health service use.},
Journal = {Am J Public Health},
Volume = {96},
Number = {4},
Pages = {716-721},
Year = {2006},
Month = {April},
ISSN = {0090-0036},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16507725},
Abstract = {OBJECTIVES: We examined associations between trust of health
care providers and the government and health service use and
outcomes. METHODS: Interviews with a sample of 611
HIV-positive individuals included an attitudinal assessment
measuring beliefs concerning the creation of AIDS,
information being withheld about the disease, and trust of
care providers. RESULTS: Trust in care providers was
associated with increased HIV-related out-patient clinic
visits, fewer emergency room visits, increased use of
antiretroviral medications, and improved reported physical
and mental health. Trusting the government was associated
with fewer emergency room visits and better mental and
physical health. More than one quarter of the respondents
believed that the government created AIDS to kill
minorities, and more than half believed that a significant
amount of information about AIDS is withheld from the
public. Ten percent did not trust their provider to give
them the best care possible. CONCLUSIONS: Distrust may be a
barrier to service use and therefore to optimal health.
Distrust is not isolated in minority communities but also
exists among members of nonminority communities and equally
interferes with their use of services and health
outcomes.},
Doi = {10.2105/AJPH.2005.063255},
Key = {fds301144}
}
@article{fds301140,
Author = {Reif, S and Whetten, K and Ostermann, J and Raper,
JL},
Title = {Characteristics of HIV-infected adults in the Deep South and
their utilization of mental health services: A rural vs.
urban comparison.},
Journal = {AIDS care},
Volume = {18 Suppl 1},
Pages = {S10-S17},
Year = {2006},
Month = {January},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16938670},
Abstract = {Insufficient utilization of mental health services has been
described among HIV-infected individuals in urban areas;
however, little is known about utilization of mental health
services among rural-living HIV-infected individuals. This
article examines use of mental health services by
HIV-infected adults in the Southern U.S., where
approximately two-thirds of rural HIV cases reside, and
compares mental health services use between those in rural
and urban areas. Data were obtained from surveys of
HIV-infected individuals receiving care at tertiary
Infectious Diseases clinics in the Southern U.S. (n = 474).
Study findings indicated that participants living in areas
with a higher proportion of rural-living individuals were
less likely to report seeing a mental health provider (p <
.001) in the last year even though there were no differences
in level of psychological distress by degree of rurality.
Participants living in more rural areas also reported
significantly fewer mental health visits in the previous
month (p = .025). Furthermore, rural living was
significantly associated with being African-American,
heterosexual, less educated, and having minor children in
the home. Due to differences in characteristics and mental
health services use by degree of rurality, efforts are
needed to assess and address the specific mental health and
other needs of HIV-infected individuals in rural
areas.},
Doi = {10.1080/09540120600838738},
Key = {fds301140}
}
@article{fds200014,
Author = {Reif S.S. and K. Whetten and K. Lowe and J. Ostermann},
Title = {Association of unmet needs for support services with
medication use and adherence among HIV-infected individuals
in the Southeastern United States},
Journal = {AIDS Care},
Volume = {18},
Number = {4},
Pages = {277-283},
Year = {2006},
Abstract = {Unmet needs for services, such as housing and psychiatric
treatment, are relatively common among HIV-infected
individuals; however, the effects of different types of
unmet needs on health care outcomes are not well understood.
This study describes unmet psychosocial needs and their
relationship with health care outcomes among individuals
receiving HIV care in the Southeastern U.S. (N=526). We used
multivariate logistic regression to examine the relationship
of seven categories of unmet needs with HIV medication use
and adherence. Most participants (84.5%) reported at least
one service need in the past year. Nearly half (47%) of
participants with service needs reported that at least one
need was not met. Participants with one or more unmet needs
were less likely to be taking any HIV medications (p=.007)
and reported poorer medication adherence (p=.013). The
specific unmet needs for benefits (including Social
Security, health insurance, and prescription coverage)
(p=.006) and a support group (p=.040) were associated with
being less likely to be taking any HIV medications. Unmet
need for mental health-related counseling was associated
with poorer medication adherence (p=.003). Study findings
regarding the high level of unmet need and the association
of unmet need with poorer outcomes illustrate the importance
of interventions to address these needs.},
Key = {fds200014}
}
@article{fds301114,
Author = {Whetten, K and Leserman, J and Lowe, K and Stangl, D and Thielman, N and Swartz, M and Hanisch, L and Van Scoyoc and L},
Title = {Prevalence of Childhood Sexual Abuse in a Southern
HIV-Positive Cohort},
Journal = {American Journal of Public Health},
Volume = {96},
Number = {6},
Pages = {970-973},
Year = {2006},
Abstract = {Objective: This study describes the prevalence and
predictors of sexual and physical trauma among HIV-infected
persons in the Deep South. Methods: Prevalence of sexual and
physical abuse was evaluated in a sample of 611 HIV-positive
individuals. Interviews included a behavioral assessment to
measure abuse and questions about the behaviors and
attributes of primary caretakers during childhood. Results:
Over half of this sample was sexually or physically abused
during their lives. Approximately 30% of respondents
reported either sexual or severe physical abuse before age
13. Nearly one quarter of both men and women reported
experiencing childhood sexual abuse. Parent characteristics
are associated with childhood abuse, but not lifetime abuse.
Conclusions: This is the largest study of a clinic
population, using standard sexual abuse measures, to find
such high rates of childhood abuse. Sexual abuse and
physical abuse are related to higher rates of activities
that put individuals at risk for contracting and
transmitting HIV and other STDs. These findings may help
explain why people engage in high-HIV-risk activities and
may assist health educators and clinicians in designing more
appropriate prevention messages and care},
Key = {fds301114}
}
@article{fds301115,
Author = {Whetten, K and Leserman, J and Whetten, R and Ostermann, J and Thielman,
N and Swartz, M and Stangl, D},
Title = {Exploring Trust as a Barrier to Health Service
Use},
Journal = {American Journal of Public Health},
Volume = {96},
Number = {4},
Pages = {716-721},
Year = {2006},
Abstract = {Objective: This study examines the association between trust
of health care providers and government with health services
utilization and outcomes. Methods: Associations were
evaluated in a sample of 611 HIV-positive individuals from
the Deep South. Interviews included an attitudinal
assessment to measure beliefs concerning who created AIDS
and why, whether information is being withheld about the
disease and whether the respondents trust their care
providers. Results: Trust in care providers was associated
with: 3 or more HIV-related outpatient clinic visits over 9
months; fewer emergency room visits; taking antiretroviral
medications; and improved reported physical health and
mental health. Trusting the government was associated with:
fewer emergency room visits; greater mental health and
physical health. More than one-quarter of the respondents
believed that the government created AIDS to kill minorities
and more than half believed that a lot of information about
AIDS is being withheld from the public. One in ten did not
trust their provider to give them the best care possible.
Conclusions: This study indicates that distrust may be a
barrier to health services utilization and therefore to
optimal health. The study also demonstrates that distrust is
not isolated in minority communities, but also exists among
non-minorities and equally interferes with use of services
and health outcomes.},
Key = {fds301115}
}
@article{fds301137,
Author = {Whetten, K and Reif, S},
Title = {Overview: HIV/AIDS in the deep south region of the United
States.},
Journal = {AIDS Care},
Volume = {18 Suppl 1},
Pages = {S1-S5},
Year = {2006},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16938668},
Doi = {10.1080/09540120600838480},
Key = {fds301137}
}
@article{fds301138,
Author = {Whetten, K and Reif, S and Ostermann, J and Pence, BW and Swartz, M and Whetten, R and Conover, C and Bouis, S and Thielman, N and Eron,
J},
Title = {Improving health outcomes among individuals with HIV, mental
illness, and substance use disorders in the
Southeast.},
Journal = {AIDS Care},
Volume = {18 Suppl 1},
Pages = {S18-S26},
Year = {2006},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16938671},
Abstract = {Providing behavioral treatment for mental health and
substance use disorders among HIV-infected individuals is
critical because these disorders have been associated with
negative outcomes such as poorer medication adherence. This
study examines the effectiveness of an integrated treatment
model for HIV-infected individuals who have both substance
use and mental disorders. Study participants (n = 141) were
recruited through routine mental health and substance abuse
screening at tertiary Infectious Disease clinics in North
Carolina. The study participants received integrated mental
health and substance abuse treatment for one year and were
interviewed at three-month intervals. Using linear
regression analyses, we detected statistically significant
decreases in participants' psychiatric symptomatology,
illicit substance use, alcohol use, and inpatient hospital
days. Participants also reported fewer emergency room visits
and were more likely to be receiving antiretroviral
medications and adequate psychotropic medication regimens at
follow-up. No changes in sexual risk, physical health, or
medical adherence were detected after treatment
participation. This integrated treatment model offers an
option for treating HIV-infected individuals with mental
health and substance use disorders that can be adapted for
use in a variety of psychiatric and medical treatment
settings.},
Doi = {10.1080/09540120600839330},
Key = {fds301138}
}
@article{fds301139,
Author = {Whetten, R and Whetten, K and Pence, BW and Reif, S and Conover, C and Bouis, S},
Title = {Does distance affect utilization of substance abuse and
mental health services in the presence of transportation
services?},
Journal = {AIDS Care},
Volume = {18 Suppl 1},
Pages = {S27-S34},
Year = {2006},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16938672},
Abstract = {Long travel times have been identified as a significant
barrier to accessing mental health and other critical
services. This study examines whether distance to treatment
was a barrier to receiving outpatient mental health and
substance abuse care for HIV-positive persons when
transportation was provided. Data from a cohort of
HIV-positive persons who participated in a year-long
substance abuse and mental health treatment programme were
examined longitudinally. Transportation, which included
buses, taxis, and mileage reimbursement for private
transportation, was provided free of charge for participants
who needed this assistance. Nearly three-quarters (74%) of
participants utilized the transportation services. No
statistically significant differences in retention in, or
utilization of, the mental health and substance abuse
treatment programme were identified by distance to the
treatment site. This analysis demonstrated that increased
distance to care did not decrease utilization of the
treatment programme when transportation was provided to the
client when necessary. These results provide preliminary
evidence that distance to substance abuse and mental health
services need not be a barrier to care for HIV-positive
individuals when transportation is provided. Such options
may need to be considered when trying to treat
geographically dispersed individuals so that efficiencies in
treatment can be attained.},
Doi = {10.1080/09540120600839397},
Key = {fds301139}
}
@article{fds301143,
Author = {Reif, SS and Lowe, K and Whetten, K},
Title = {HIV and AIDS in the Deep South},
Journal = {American Journal of Public Health},
Volume = {96},
Number = {6},
Pages = {970-973},
Year = {2006},
Key = {fds301143}
}
@article{fds301146,
Author = {Pence, BW and Gaynes, BN and Whetten, K and Eron, JJ and Ryder, RW and Miller, WC},
Title = {Validation of a brief screening instrument for substance
abuse and mental illness in HIV-positive
patients.},
Journal = {J Acquir Immune Defic Syndr},
Volume = {40},
Number = {4},
Pages = {434-444},
Year = {2005},
Month = {December},
ISSN = {1525-4135},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16280698},
Abstract = {BACKGROUND: Substance abuse (SA) and mental illness (MI)
commonly co-occur with HIV infection in the United States
and have important implications for clinical management of
HIV/AIDS. Yet SA/MI often go untreated due in part to a lack
of practical, validated screening tools. SETTING: HIV clinic
in academic medical center. METHODS: The 16-item SA/MI
Symptoms Screener (SAMISS) targets SA/MI in HIV-positive
patients. Consecutive consenting HIV-positive patients
completed the SAMISS and then a reference standard
diagnostic tool, SCID, the Structured Clinical Interview for
DSM-IV (Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition). RESULTS: Twenty percent of
participants (29/148) had an SA diagnosis and 41% (59/143)
had an MI diagnosis in the past year on the SCID; 48%
(68/143) had 1 or both. Thirty-seven percent (55/148)
screened positive for SA and 69% (99/143) screened positive
for MI on the SAMISS. The SAMISS had 86% (95% CI: 68%-96%)
sensitivity and 75% (66%-82%) specificity for SA and 95%
(86%-99%) sensitivity and 49% (38%-60%) specificity for MI.
Patients with SA were likely to show up as false positives
for MI and vice versa. CONCLUSION: The SAMISS functioned
well as a first-line screening tool for SA/MI in this HIV
clinic population. It missed few cases and was easily
incorporated into a busy clinical setting. Persons screening
positive require a more rigorous confirmatory psychiatric
evaluation.},
Doi = {10.1097/01.qai.0000177512.30576.9c},
Key = {fds301146}
}
@article{fds301105,
Author = {Whetten, K and Reif, S and Swartz, M and Stevens, R and Ostermann, J and Hanisch, L and Eron, JJ},
Title = {A brief mental health and substance abuse screener for
persons with HIV.},
Journal = {AIDS Patient Care STDS},
Volume = {19},
Number = {2},
Pages = {89-99},
Year = {2005},
Month = {February},
ISSN = {1087-2914},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15716640},
Abstract = {Mental illness and substance abuse are common among
HIV-infected individuals and are associated with negative
outcomes, including poor medication adherence. Therefore,
quick and effective methods for detecting these co-occurring
disorders are necessary for health care practitioners. This
article reports on the creation and preliminary testing of a
brief screening tool, the Substance Abuse and Mental Illness
Symptoms Screener (SAMISS). The 13-item screener was
developed primarily from existing scales and administered to
HIV-infected individuals receiving care at infectious
diseases clinics in the Southeast. To assess the validity of
the SAMISS, a subset of those who screened positive for both
mental illness symptoms and substance use problems (n = 207)
were administered the Structured Clinical Interview for
DSMIV Disorders (SCID). The positive predictive value of the
screener in comparison to the SCID was 98.6% for mental
disorders and 98.6% for substance use disorders. The
agreement between specific screener symptoms and their
corresponding SCID diagnoses was relatively high for alcohol
dependence (kappa = 0.50, p < 0.001), drug dependence (kappa
= 0.30, p < 0.001), and drug abuse (kappa = 0.42, p <0.001).
The finding that the screener is highly predictive of having
a general mental disorder and substance use disorder among
those screening positive for mental illness symptoms and
substance use problems, as well as its brevity and ease of
administration, make it a useful tool to detect symptoms of
co-occurring disorders so that patients can be referred to
mental health and substance abuse specialists. The screener
is not a diagnostic instrument and has limited value in
predicting specific psychiatric diagnoses.},
Doi = {10.1089/apc.2005.19.89},
Key = {fds301105}
}
@article{fds301147,
Author = {Whetten, K and Reif, SS and Napravnik, S and Swartz, MS and Thielman,
NM and Eron, JJ and Lowe, K and Soto, T},
Title = {Substance abuse and symptoms of mental illness among
HIV-positive persons in the Southeast.},
Journal = {South Med J},
Volume = {98},
Number = {1},
Pages = {9-14},
Year = {2005},
Month = {January},
ISSN = {0038-4348},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15678633},
Abstract = {OBJECTIVES: Mental illness and substance abuse have been
consistently associated with poor HIV-medication adherence
and other negative health outcomes. METHODS: A brief mental
health and substance use screening instrument was
administered to 1,362 HIV-infected individuals receiving
care at two academic medical center Infectious Diseases
Clinics in North Carolina. RESULTS: Study results indicated
high frequencies of symptoms of mental illness (60%),
substance abuse (32%), and co-occurring symptoms of mental
illness and substance abuse (23%). Younger age (P = 0.03),
male sex (P < 0.001), and higher viral load (P < 0.001) were
associated with substance use problems. White race (P =
0.001), younger age (P = 0.023), and higher viral load (P =
0.042) were associated with symptoms of mental illness.
CONCLUSIONS: In the Southeast, mental health and substance
abuse services are sparse and stigma is high; thus,
innovative treatment strategies are needed to address the
high levels of co-occurring mental illness and substance
abuse. Antiretroviral therapies will not reach their
potential for slowing the HIV/AIDS epidemic and prolonging
survival if comorbidities that influence patient behavior
are not addressed.},
Doi = {10.1097/01.SMJ.0000149371.37294.66},
Key = {fds301147}
}
@article{fds304234,
Author = {Lombard, F and Whetten, K and Forry, N and Despard,
M},
Title = {Utilizing the clinical social work model to foster
collaboration among HIV providers in North
Carolina},
Journal = {Journal of HIV/AIDS and Social Services},
Volume = {4},
Number = {1},
Pages = {39-56},
Publisher = {Informa UK Limited},
Year = {2005},
Month = {January},
url = {http://dx.doi.org/10.1300/J187v04n01_04},
Abstract = {This article demonstrates one effort to examine the
applicability of client behavioral change models to medical
provider and case manager behavioral change. The clinical
social work model is used to explain the behavioral change
process when providers were asked to utilize a voluntary and
complex data management system to manage clients' HIV care.
Through intense psychosocial support and training
initiatives, providers were able to alter their behaviors so
that they could successfully integrate new strategies and
technologies into their practice while providing better
quality care to their clients. © 2005 by The Haworth Press,
Inc. All rights reserved.},
Doi = {10.1300/J187v04n01_04},
Key = {fds304234}
}
@article{fds301145,
Author = {Lombard, F and DeSanctis, N and Whetten, K and Despard,
M},
Title = {Utilizing the Clinical Social Work Model to Foster
Collaboration among HIV-Providers in North
Carolina},
Journal = {Journal of HIV/AIDS and Social Services: Practice, Policy
and Research},
Volume = {4},
Number = {1},
Pages = {57-70},
Year = {2005},
url = {http://dx.doi.org/10.1300/J187v04n01_04},
Abstract = {This article demonstrates one effort to examine the
applicability of client behavioral change models to medical
provider and case manager behavioral change. The clinical
social work model is used to explain the behavioral change
process when providers were asked to utilize a voluntary and
complex data management system to manage clients’ HIV
care. Through intense psychosocial support and training
initiatives, providers were able to alter their behaviors so
that they could successfully integrate new strategies and
technologies into their practice while providing better
quality care to their clients.},
Doi = {10.1300/J187v04n01_04},
Key = {fds301145}
}
@article{fds301148,
Author = {Leserman, J and Whetten, K and Lowe, K and Stangl, D and Swartz, MS and Thielman, NM},
Title = {How trauma, recent stressful events, and PTSD affect
functional health status and health utilization in
HIV-infected patients in the south.},
Journal = {Psychosom Med},
Volume = {67},
Number = {3},
Pages = {500-507},
Year = {2005},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15911916},
Abstract = {OBJECTIVE: In addition to biological markers of human
immunodeficiency virus (HIV) disease progression, physical
functioning, and utilization of health care may also be
important indicators of health status in HIV-infected
patients. There is insufficient understanding of the
psychosocial predictors of health-related physical
functioning and use of health services among those with this
chronic disease. Therefore, the current study examines how
trauma, severe stressful events, posttraumatic stress
disorder (PTSD), and depressive symptoms are related to
physical functioning and health utilization in HIV-infected
men and women living in rural areas of the South. METHODS:
We consecutively sampled patients from 8 rural HIV clinics
in 5 southern states, obtaining 611 completed interviews.
RESULTS: We found that patients with more lifetime trauma,
stressful events, and PTSD symptoms reported more bodily
pain, and poorer physical, role, and cognitive functioning.
Trauma, recent stressful events, and PTSD explained from 12%
to 27% of the variance in health-related functioning, over
and above that explained by demographic variables. In
addition, patients with more trauma, including sexual and
physical abuse, and PTSD symptoms were at greater risk for
having bed disability, an overnight hospitalization, an
emergency room visit, and four or more HIV outpatient clinic
visits in the previous 9 months. Patients with a history of
abuse had about twice the risk of spending 5 or more days in
bed, having an overnight hospital stay, and visiting the
emergency room, compared with those without abuse. The
effects of trauma and stress were not explained by CD4
lymphocyte count or HIV viral load; however, these effects
appear to be largely accounted for by increases in current
PTSD symptoms. CONCLUSION: These findings highlight the
importance of addressing past trauma, stress, and current
PTSD within clinical HIV care.},
Doi = {10.1097/01.psy.0000160459.78182.d9},
Key = {fds301148}
}
@article{fds304232,
Author = {Whetten, K and Zhu, CW},
Title = {Do United States-based Medicaid spend-down programmes make
public sense for persons with HIV/AIDS?},
Journal = {AIDS care},
Volume = {16},
Number = {6},
Pages = {781-785},
Year = {2004},
Month = {August},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15370065},
Abstract = {Medicaid is a US government insurance programme designed
primarily for poor individuals, with expenditures that rose
more than 13% in 2002. Thirty-five states have programmes
allowing individuals to incur medical expenses at a rate
that would make them poor enough to meet Medicaid
eligibility criteria. This paper examines the cost of
providing care to those spending-down to Medicaid compared
to those eligible without spending-down. This longitudinal
cohort study compiled inpatient, outpatient and Medicaid
data from three academic Infectious Diseases clinics serving
approximately 40% of the reported HIV-positive population in
North Carolina. Participants included all HIV-positive
patients who received care in one of three clinics and
received Medicaid coverage at any time from 1996 to 2000
(1,495 individuals). Overall, those who needed to spend-down
to Medicaid incurred higher medical costs, following a
distinctive pattern of high costs when initially qualified
and when ending coverage, and low costs while on spend-down.
US states may wish to consider expanding Medicaid's
categorically eligible criteria or significantly reducing
the frequency with which persons must spend-down to become
eligible for Medicaid.},
Doi = {10.1080/09540120412331269611},
Key = {fds304232}
}
@article{fds301151,
Author = {Whetten, K and Reif, S and Lowe, K and Eldred, L},
Title = {Gender differences in knowledge and perceptions of HIV
resources among individuals living with HIV in the
Southeast.},
Journal = {Southern medical journal},
Volume = {97},
Number = {4},
Pages = {342-349},
Year = {2004},
Month = {April},
ISSN = {0038-4348},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15108826},
Abstract = {<h4>Objectives</h4>Ancillary services have been associated
with beneficial health utilization outcomes among
individuals infected with the human immunodeficiency virus
(HIV), including greater retention in medical care and
greater likelihood of antiretroviral use. Our primary
objectives were to examine gender differences in barriers to
ancillary services among people living with HIV in the
Southeastern United States.<h4>Methods</h4>Survey and chart
abstraction data were collected from six tertiary infectious
diseases clinics in the Southeast. Using multivariate
analyses, we examined the relationship between gender and 1)
knowledge of how to access HIV and acquired immunodeficiency
syndrome (AIDS) resource information and 2) opinions about
the helpfulness of local services for people with
HIV/AIDS.<h4>Results</h4>Women were less knowledgeable about
HIV/AIDS resources and rated local services less favorably
than men. Middle-aged and older African-American women rated
local services as less helpful than other survey
participants did.<h4>Conclusions</h4>These findings indicate
a need for outreach services that are designed to address
the specific needs of older African-American women, and
women in general.},
Doi = {10.1097/01.smj.0000118902.64603.a5},
Key = {fds301151}
}
@article{fds301152,
Author = {Uldall, KK and Palmer, NB and Whetten, K and Mellins, C and HIV/AIDS
Treatment Adherence and Health Outcomes and Cost Study
Group},
Title = {Adherence in people living with HIV/AIDS, mental illness,
and chemical dependency: a review of the
literature.},
Journal = {AIDS care},
Volume = {16 Suppl 1},
Number = {SUPPL. 1},
Pages = {S71-S96},
Year = {2004},
Month = {January},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15736823},
Abstract = {Adherence to antiretroviral medications is central to
reducing morbidity and mortality among people living with
HIV/AIDS. Relatively few studies published to date address
HIV adherence among special populations. The purpose of this
article is to review the existing literature on HIV
antiretroviral adherence, with an emphasis on studies among
the triply diagnosed population of people living with
HIV/AIDS, mental illness, and chemical dependency. In order
to reflect the most current information available, data from
conference proceedings, federally funded studies in
progress, and the academic literature are presented for
consideration.},
Doi = {10.1080/09540120412331315277},
Key = {fds301152}
}
@article{fds304233,
Author = {Aidala, A and Havens, J and Mellins, CA and Dodds, S and Whetten, K and Martin, D and Gillis, L and Ko, P},
Title = {Development and validation of the Client Diagnostic
Questionnaire (CDQ): A mental health screening tool for use
in HIV/AIDS service settings},
Journal = {Psychology, Health and Medicine},
Volume = {9},
Number = {3},
Pages = {362-380},
Publisher = {Informa UK Limited},
Year = {2004},
Month = {January},
ISSN = {1354-8506},
url = {http://dx.doi.org/10.1080/13548500410001721927},
Abstract = {This study examines the validity, feasibility, and utility
of the Client Diagnostic Questionnaire (CDQ), a brief
diagnostic screening tool designed for use by non-mental
health professionals and designed specifically to assess the
range of psychiatric disorders known to be prevalent among
persons infected with HIV or at high risk of infection:
depression, anxiety, PTSD, substance abuse. Non-clinically
trained personnel administered the CDQ to a diverse sample
of 260 HIV infected individuals at six primary care or
social service agencies; a second interview was conducted by
an experienced mental health clinician. There was good
agreement between positive screen on the CDQ and diagnosis
made by an independent mental health professional. For the
diagnosis of any disorder, sensitivity = 91%, specificity =
78%, and overall accuracy = 85%. Clients who screened
positive for disorder based on the CDQ interview had
significantly impaired mental health functioning compared to
individuals without CDQ screening diagnosis. CDQ was well
received by both clients and agency staff. Findings support
the feasibility and utility of the CDQ. The CDQ can be used
by providers in a range of service settings to identify
persons in need of formal mental health assessment and
treatment, to more effectively target scarce mental health
resources, and to reduce the negative impact of unrecognized
disorder on the health and well-being of individuals in
their care.},
Doi = {10.1080/13548500410001721927},
Key = {fds304233}
}
@article{fds44954,
Author = {Scott, K.A. and T.Q. Nguyen and K. Whetten},
Title = {If There’s a Will, Is There a Way?: Integrating HIV and
Mental Health Services in Rural Areas},
Journal = {AIDS and Public Policy Journal},
Volume = {17},
Number = {4},
Pages = {130-137},
Year = {2004},
Key = {fds44954}
}
@article{fds301149,
Author = {Whetten, K and Reif, S and Swartz, M and Stevens, R and Ostermann, J and Hanisch, L and Eron, J},
Title = {A Brief Mental Health and Substance Abuse Screener For
Persons with HIV},
Journal = {AIDS Patient Care and STDS},
Volume = {19},
Number = {2},
Pages = {23-29},
Year = {2004},
Key = {fds301149}
}
@article{fds301150,
Author = {Whetten, K and with, THIVAIDSTA and Health, O and Cost,
SG},
Title = {The HIV/AIDS Treatment Adherence, Health Outcomes and Cost
Study: Conceptual Foundations and Overview},
Journal = {AIDS Care},
Volume = {16},
Number = {Supplement 1},
Pages = {S6-S21},
Year = {2004},
Key = {fds301150}
}
@article{fds301153,
Author = {Whetten, K and Zhu, CW},
Title = {Do Medicaid Medically Needy Programs Make Public Sense? The
Case of HIV/AIDS},
Journal = {AIDS Care},
Volume = {16},
Number = {6},
Pages = {781-785},
Year = {2004},
ISSN = {0954-0121},
url = {http://www.ncbi.nlm.nih.gov/pubmed/15370065},
Abstract = {Medicaid is a US government insurance programme designed
primarily for poor individuals, with expenditures that rose
more than 13% in 2002. Thirty-five states have programmes
allowing individuals to incur medical expenses at a rate
that would make them poor enough to meet Medicaid
eligibility criteria. This paper examines the cost of
providing care to those spending-down to Medicaid compared
to those eligible without spending-down. This longitudinal
cohort study compiled inpatient, outpatient and Medicaid
data from three academic Infectious Diseases clinics serving
approximately 40% of the reported HIV-positive population in
North Carolina. Participants included all HIV-positive
patients who received care in one of three clinics and
received Medicaid coverage at any time from 1996 to 2000
(1,495 individuals). Overall, those who needed to spend-down
to Medicaid incurred higher medical costs, following a
distinctive pattern of high costs when initially qualified
and when ending coverage, and low costs while on spend-down.
US states may wish to consider expanding Medicaid's
categorically eligible criteria or significantly reducing
the frequency with which persons must spend-down to become
eligible for Medicaid.},
Doi = {10.1080/09540120412331269611},
Key = {fds301153}
}
@article{fds301154,
Author = {Aidala, A and Havens, J and Mellins, CA and Dodds, S and Whetten, K and Martin, D and Gillis, L},
Title = {Development and Validation of the Client Diagnostic
Questionnaire (CDQ): A Mental Health Screening Tool for Use
in HIV/AIDS Service Settings},
Journal = {Psychology, Health and Medicine},
Volume = {9},
Number = {3},
Pages = {371-388},
Year = {2004},
ISSN = {1354-8506},
url = {http://dx.doi.org/10.1080/13548500410001721927},
Abstract = {This study examines the validity, feasibility, and utility
of the Client Diagnostic Questionnaire (CDQ), a brief
diagnostic screening tool designed for use by non-mental
health professionals and designed specifically to assess the
range of psychiatric disorders known to be prevalent among
persons infected with HIV or at high risk of infection:
depression, anxiety, PTSD, substance abuse. Non-clinically
trained personnel administered the CDQ to a diverse sample
of 260 HIV infected individuals at six primary care or
social service agencies; a second interview was conducted by
an experienced mental health clinician. There was good
agreement between positive screen on the CDQ and diagnosis
made by an independent mental health professional. For the
diagnosis of any disorder, sensitivity = 91%, specificity =
78%, and overall accuracy = 85%. Clients who screened
positive for disorder based on the CDQ interview had
significantly impaired mental health functioning compared to
individuals without CDQ screening diagnosis. CDQ was well
received by both clients and agency staff. Findings support
the feasibility and utility of the CDQ. The CDQ can be used
by providers in a range of service settings to identify
persons in need of formal mental health assessment and
treatment, to more effectively target scarce mental health
resources, and to reduce the negative impact of unrecognized
disorder on the health and well-being of individuals in
their care.},
Doi = {10.1080/13548500410001721927},
Key = {fds301154}
}
@article{fds301155,
Author = {Whetten, K and Reif, S and Lowe, K and Eldred, L},
Title = {Knowledge and Perceptions of HIV Resources among
Women},
Journal = {Southern Medical Journal},
Volume = {97},
Number = {4},
Pages = {342-349},
Year = {2004},
Key = {fds301155}
}
@article{fds301156,
Author = {Stevens, RA and Melvin, L and Whetten, K},
Title = {Is there One Best Model of Care for Children Orphaned by
AIDS: A Multinational Perspective},
Journal = {Chance},
Volume = {17},
Number = {1},
Pages = {39-43},
Year = {2004},
Key = {fds301156}
}
@article{fds301166,
Author = {Nguyen, TQ and Whetten, K},
Title = {Is anybody out there? Integrating HIV services in rural
regions.},
Journal = {Public health reports (Washington, D.C. :
1974)},
Volume = {118},
Number = {1},
Pages = {3-9},
Year = {2003},
Month = {January},
ISSN = {0033-3549},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12604759},
Abstract = {As the HIV epidemic has changed nationally, the parallel
change in the Southern states has been a disproportionate
increase in HIV infection among people of color and among
women. Due to the limited and disjointed health care and
social service resources in rural Southern regions, already
marginalized groups have difficulty in accessing appropriate
care and services to address their HIV infection seamlessly
and with continuity. To ameliorate the limitations in the
health care infrastructure, the North Carolina Services
Integration Project collaborated with North Carolina medical
and social service providers and state agencies to create a
sustainable and replicable model of integrated care for
HIV-positive, geographically dispersed residents.},
Doi = {10.1093/phr/118.1.3},
Key = {fds301166}
}
@article{fds301167,
Author = {Messeri, P and Kim, S and Whetten, K},
Title = {Measuring HIV services integration activities},
Journal = {Journal of HIV/AIDS and Social Services},
Volume = {2},
Number = {1},
Pages = {19-44},
Publisher = {Informa UK Limited},
Year = {2003},
Month = {January},
url = {http://dx.doi.org/10.1300/J187v02n01_03},
Abstract = {Despite efforts for more than four decades to better
integrate the delivery of health and human services,
particularly for individuals with problems that cross
service sectors, such as HIV, our understanding remains
limited as to what successful services integration (SI)
strategies look like and whether they translate into
improved client health and well being. One obstacle to
expanding our knowledge of SI is the absence of a conceptual
vocabulary and corresponding measures that delineate the
salient features that allow us to compare and contrast the
many concrete forms of SI initiatives. Drawing on past
research literature, this article presents a conceptual
taxonomy for classifying different components of SI
initiatives. We present operational measures for the
concepts in the taxonomy and illustrate their application
for a comparative analysis of services integration
activities implemented by 34 HIV service demonstration
projects. © 2003 by The Haworth Press, Inc. All rights
reserved.},
Doi = {10.1300/J187v02n01_03},
Key = {fds301167}
}
@article{fds12779,
Author = {Scott, K.A. and T.Q. Nguyen},
Title = {"If There's a Will, Is There a Way?": Integrating HIV and
Mental Health Services in Rural Areas"},
Journal = {AIDS and Public Policy Journal},
Year = {2003},
Key = {fds12779}
}
@article{fds301157,
Author = {Scott, K and Ngayen, TQ and Whetten, K},
Title = {If there's a will, is there a way? Integrating HIV and
mental health services in rural areas},
Journal = {AIDS and Public Policy Journal},
Volume = {17},
Number = {4},
Pages = {127-134},
Year = {2002},
Month = {December},
ISSN = {0887-3852},
Abstract = {In North Carolina, more than 50,000 of the 84,000 people
with serious mental illness who need services from the
community-based health system or the public mental health
system are not served. In the 1990s, federal authorities
investigated the state's Medicaid mental health funding
after reports of multi-million dollar mismanagement. By
2001, North Carolina faced its worst fiscal crisis in more
than a decade with a deficit of nearly $900 million.
Concurrently, HIV/AIDS in the southeastern United States
became a serious public health problem. Many people living
with HIV/AIDS have multidimensional problems, yet few
professionals are trained to deal with all of them, and
services funding is limited. Psychiatric disorders increase
the chance of acquiring HIV because they may provoke
high-risk behaviors; thus, mental health treatment in
HIV-care settings can help to reduce the spread of HIV.
Public health initiatives to prevent transmission of new
infections must make multiply diagnosed patients a priority
population for care through the recognition and treatment of
psychiatric disorders. In this article, we describe the
efforts of the Health Inequalities Program (HIP), which
focused on integrating services for adults who were multiply
diagnosed with HIV disease, a mental disorder, and/or a
substance related disorder who lived in the eastern half of
North Carolina, a primarily rural area. Integration targeted
the continuum of ambulatory care by educating various
providers, creating local and regional provider networks
with links to fiscal resources and existing care networks,
and creating awareness of the systemic unavailability of
care for multiply diagnosed patients.},
Key = {fds301157}
}
@article{fds301168,
Author = {Schenkman, M and Cutson, TM and Zhu, CW and Whetten-Goldstein,
K},
Title = {A longitudinal evaluation of patients' perceptions of
Parkinson's disease.},
Journal = {Gerontologist},
Volume = {42},
Number = {6},
Pages = {790-798},
Year = {2002},
Month = {December},
ISSN = {0016-9013},
url = {http://www.ncbi.nlm.nih.gov/pubmed/12451160},
Abstract = {PURPOSE: Parkinson's disease (PD) is a chronic progressive
neurological disorder that frequently results in nearly
total disability. This study examined changes over 3 years
in patients' experiences living with PD, and explored how
participants' health perceptions and predicted mortality at
baseline related to their actual death by Year 3. DESIGN AND
METHODS: Data were obtained from a local sample of 109
participants by in-home interviews. RESULTS: The collected
results (1) suggested a disconnection between the
participants' responses to open-ended questions about the
disorder, compared with their responses to questions
structured by the investigators; (2) demonstrated changes in
responses to structured and open-ended questions; and (3)
demonstrated that respondents who declined to predict
whether they would be living in 10 years were three times
more likely to die by Year 3 than those who answered the
question. IMPLICATIONS: Results demonstrate the importance
of identifying the most important issues for the individual
with PD and suggest that these issues may change over time.
Results also raise issues surrounding how patients'
perceptions influence the course of their
disease.},
Doi = {10.1093/geront/42.6.790},
Key = {fds301168}
}
@article{fds301081,
Author = {Conover, CJ and Whetten-Goldstein, K},
Title = {The impact of ancillary services on primary care use and
outcomes for HIV/AIDS patients with public insurance
coverage.},
Journal = {AIDS care},
Volume = {14 Suppl 1},
Series = {Supplement 1},
Number = {SUPPL. 1},
Pages = {S59-S71},
Year = {2002},
Month = {August},
url = {http://dx.doi.org/10.1080/09540120220149957},
Abstract = {To better understand the impact of ancillary services on
access to primary care, utilization of health services,
costs and health status of HIV/AIDS patients, we studied
adult HIV/AIDS patients eligible for public insurance for
low-income people (Medicaid) in eastern North Carolina.
Using primary data from a 1997 survey of such patients
linked to Medicaid claims, multivariate logit analysis was
used to estimate the effect of receiving housing, legal
services and substance abuse treatment and of self-reported
failure to obtain transportation and child care services on:
(a) adequacy and use of primary care; (b) CD-4 counts; (c)
viral load; and (d) self-rated health status. Between
two-thirds and four-fifths of patients needing ancillary
services obtain them. Receipt of housing and legal services
were found to have a positive relationship with access to
primary care. Difficulties in obtaining transportation and
receipt of substance abuse services had a negative
relationship with receipt of adequate primary care. On
balance, these findings provide some support for continued
public funding for various ancillary services to improve
patient access to needed primary care. At current funding
levels, not all patients needing help appear able to obtain
such services.},
Doi = {10.1080/09540120220149957},
Key = {fds301081}
}
@article{fds301163,
Author = {Schenkman, M and Wei Zhu and C and Cutson, TM and Whetten-Goldstein,
K},
Title = {Longitudinal evaluation of economic and physical impact of
Parkinson's disease.},
Journal = {Parkinsonism Relat Disord},
Volume = {8},
Number = {1},
Pages = {41-50},
Year = {2001},
Month = {September},
ISSN = {1353-8020},
url = {http://www.ncbi.nlm.nih.gov/pubmed/11472879},
Abstract = {The cost of parkinsonism and Parkinson's disease (PD) is
largely unknown although clinical experience suggests that
the impact of this disease is substantial. Longitudinal data
is presented for health status, disease symptoms, functional
status, and financial costs for 70 participants with PD or
parkinsonism. The sample was dichotomized into those rating
their health as excellent, good, or very good ('good
health') and those rating their health as fair or poor
('poor health'). The 'poor health' group were significantly
more disabled at baseline. Symptoms increased between year 1
and 3 with greatest increases in fatigue, pain, and
depression for the 'good health' group. At year 1, total
direct cost/capita was about dollars 5000/year for both
groups; indirect costs were dollars 5000 for the 'good
health' group and dollars 15,000/year for the 'poor health'
group. By year 3, total expenditures increased over 25% for
the 'good health' group and nearly doubled for the 'poor
health' group, while percent costs that were compensated
declined for groups. Out of pocket, expenses were as high as
dollars 3000/year for the 'poor health' group by year 3.
Through analysis of the broad impact of PD, including
non-neurological symptoms and economic ramifications, it is
possible to better appreciate the impact of this chronic
condition on overall quality of life.},
Doi = {10.1016/s1353-8020(00)00079-1},
Key = {fds301163}
}
@article{fds301161,
Author = {Whetten Goldstein and K and Nguyen, TQ},
Title = {"Characteristics of Individuals Infected with the Human
Immunodeficiency Virus and Provider Interaction inthe
Predominantly Rural Southeast"},
Journal = {Southern Medical Journal},
Volume = {94},
Number = {2},
Pages = {212-222},
Year = {2001},
Abstract = {<h4>Background</h4>This detailed study describes the
demographic characteristics, behavioral characteristics,
care-seeking behavior, and barriers to health care and
social services for patients infected with the human
immunodeficiency virus (HIV) in the Southeast.<h4>Methods</h4>We
conducted a cross-sectional study of Medicaid-eligible
HIV-positive individuals (chart abstractions [N = 679],
patient surveys [N = 487]) and care providers (N = 101) in
North Carolina. Relative risks compare blacks, women, and
respondents reporting substance abuse with their reference
groups. Results are compared with those of a larger sample
including persons from Alabama and South
Carolina.<h4>Results</h4>Forty-one percent of respondents
did not receive care locally, and 69% of female respondents
had young children at home. In the 12 months before the
survey, 66% reported substance abuse; 49% reported multiple
living situations; 11% had entered drug treatment; and 10%
had difficulty with the law. The findings in North Carolina
did not differ from those in Alabama and South Carolina.
Mean indices from care provider surveys revealed low
interagency knowledge and referrals.<h4>Conclusions</h4>Patients
have complex needs for both social services and health care.
However, providers are not working together.},
Key = {fds301161}
}
@article{fds301162,
Author = {Whetten Goldstein and K and Nguyen, TQ and Sugarman,
J},
Title = {"So Much for Keeping Secrets: the Importance of Considering
Patients' Perspectives on Maintaining Confidentiality"},
Journal = {AIDS Care},
Volume = {13},
Number = {4},
Pages = {457-466},
Year = {2001},
ISSN = {0954-0121},
url = {http://dx.doi.org/10.1080/09540120120057987},
Abstract = {Little data are available from patients' perspectives
regarding the maintenance of confidentiality by care
providers. Such data may be useful in determining the
importance of confidentiality to patients and in developing
appropriate policies and procedures regarding
confidentiality. Three focus groups were conducted with
support groups of rural HIV-positive patients. Text was
coded inductively and analyzed with software designed for
qualitative analysis. Participants perceived breaches of
confidentiality in hospitals, clinics and health departments
that occurred by word of mouth, computers, facsimile and
written materials. Patients included sharing stigmatizing
medical information among medical providers without prior
consent as a breach. They made decisions about where to seek
care based on the degree of professionalism of medical staff
(which included respecting confidentiality), clinic location
or the level of security of the organization's computer
network since they believed that computers increase
information access. Finally, participants believed that
medical personnel should be taught the importance of
maintaining confidentiality and that those who violated
confidentiality should be punished. Patients would like
confidentiality policies that require providers to: (1)
explain procedures for sharing information, (2) request
patients' specific consent for access to their medical
records, even among other providers, and (3) punish those
who breach confidentiality.},
Doi = {10.1080/09540120120057987},
Key = {fds301162}
}
@article{fds304235,
Author = {Sloan, FA and Stout, EM and Liang, L and Whetten-Goldstein,
K},
Title = {Liability, risk perceptions, and precautions at
bars},
Journal = {Journal of Law and Economics},
Volume = {43},
Number = {2},
Pages = {473-501},
Publisher = {University of Chicago Press},
Year = {2000},
Month = {January},
url = {http://hdl.handle.net/10161/2584 Duke open
access},
Abstract = {Are state laws, regulatory practices, and allocation of
public resources for enforcement reflected in perceptions by
bar owners/managers that they will be cited or sued if they
fail to exercise care? Among policies, which ones have the
greatest impact on risk perceptions and, in turn, on such
behaviors? We used data on laws, law enforcement, and
regulations in the same areas as the bars to determine risk
perceptions of bar owners/managers of threats of being sued
or cited if they were to serve minors or obviously
intoxicated adults. We found that many of the laws and
regulations related systematically to risk perceptions of
bar owners/managers. This was particularly true of tort.
Precautionary measures were more likely to be taken by
owners/managers when the risk was perceived to be
high.},
Doi = {10.1086/467463},
Key = {fds304235}
}
@article{fds301158,
Author = {Sloan, FA and Liang, L and Stout, EM and Whetten Goldstein,
K},
Title = {"Liability, Risk Perceptions, and Precautions at
Bars"},
Journal = {The Journal of Law and Economics},
Volume = {XLIII},
Number = {2},
Pages = {473-501},
Year = {2000},
url = {http://hdl.handle.net/10161/2584},
Abstract = {Are state laws, regulatory practices, and allocation of
public resources for enforcement reflected in perceptions by
bar owners/managers that they will be cited or sued if they
fail to exercise care? Among policies, which ones have the
greatest impact on risk perceptions and, in turn, on such
behaviors? We used data on laws, law enforcement, and
regulations in the same areas as the bars to determine risk
perceptions of bar owners/managers of threats of being sued
or cited if they were to serve minors or obviously
intoxicated adults. We found that many of the laws and
regulations related systematically to risk perceptions of
bar owners/managers. This was particularly true of tort.
Precautionary measures were more likely to be taken by
owners/managers when the risk was perceived to be
high.},
Key = {fds301158}
}
@article{fds301164,
Author = {Whetten Goldstein and K and Cutson, T and Zhu, W and Schenkman,
M},
Title = {"Financial Burden of Chronic Neurological Disorders to
Patients and Their Families: What Providers Need to
Know"},
Journal = {Neurology Report. Special Topic Issue: Quality of
Life},
Volume = {24},
Number = {4},
Pages = {140-144},
Publisher = {Ovid Technologies (Wolters Kluwer Health)},
Year = {2000},
url = {http://dx.doi.org/10.1097/01253086-200024040-00005},
Abstract = {Access to financial resources influences the quality of life
that individuals are able to lead. An important aspect of
quality of life for persons with chronic neurological
disorders and their families is the financial burden placed
on the family due to the illness. Health care providers may
assume that most illness related expenses are covered by
insurance. While many studies examine the cost of illnesses
to society, research is only beginning to explore the
financial burden that such disorders place on the family.
This manuscript describes several recent studies that
evaluate the financial burden that 2 chronic neurological
disorders, Multiple Sclerosis and Parkinson's Disease, place
on persons with the disorders and their families. A better
understanding of the financial burden of disorders may help
health care providers to better meet the need of their
patients either through improved counseling or through
referral of patients to appropriately trained individuals.
© 2000 Lippincott Williams & Wilkins, Inc.},
Doi = {10.1097/01253086-200024040-00005},
Key = {fds301164}
}
@article{fds301165,
Author = {Whetten Goldstein and K and Sloan, FA and Stout, EM and Liang,
L},
Title = {"Civil Liability, Criminal Law, and Other Policies and
Alcohol-related Motor Vehicle Fatalities in the United
States 1984-1995"},
Journal = {Accident Analysis and Prevention},
Volume = {32},
Number = {6},
Pages = {723-733},
Year = {2000},
ISSN = {0001-4575},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10994599},
Abstract = {This study examines the associations between alcohol
policies and motor vehicle fatality rates from 1984 to 1995
in the United States. State policies and state
characteristics variables were merged with motor vehicle
fatality rates over an 11 year period and analyzed using
minimum logit chi-square method and fixed effects to create
a quasi time-series analysis. Laws allowing individuals to
sue bars for the drunken behavior of their patrons were the
policies most strongly associated with lower minor and adult
fatality rates. The mandatory first offense fine was
associated with lower minor fatality rates but not adult
fatality rates, while minor and adult rates fell after
administrative per se license suspension and
anti-consumption laws for all vehicle occupants. Many other
public policies evaluated were not associated with lower
fatality rates.},
Doi = {10.1016/s0001-4575(99)00122-0},
Key = {fds301165}
}
@article{fds301159,
Author = {Dreher, T and Whetten Goldstein and K},
Title = {"A Survey of Beliefs about Managed Care"},
Journal = {North Carolina Medical Journal},
Volume = {60},
Number = {1},
Pages = {30-33},
Year = {1999},
ISSN = {0029-2559},
Key = {fds301159}
}
@article{fds301160,
Author = {Whetten Goldstein and K and Kulas, E and Sloan, F and Hickson, G and Entman, S},
Title = {"Compensation for Birth-Related Injury: No-Fault Programs
Compared With Tort System"},
Journal = {Archives of Pediatrics and Adolescent Medicine},
Volume = {153},
Number = {1},
Pages = {41-48},
Year = {1999},
ISSN = {1072-4710},
url = {http://dx.doi.org/10.1001/archpedi.153.1.41},
Abstract = {<h4>Objective</h4>To compare compensation systems for
birth-related injuries.<h4>Design</h4>Retrospective cohort
study.<h4>Setting</h4>Florida.<h4>Participants</h4>Parents
of children with birth-related injuries who filed claims
that closed before August 1, 1995, with Florida's no-fault
program (Neurological Injury Compensation Act [NICA]) or who
filed tort claims that closed from January 1, 1986, to
August 1, 1995.<h4>Main outcome measures</h4>Compensation
for medical and income losses due to birth-related
injuries.<h4>Results</h4>Families who received tort
settlements were overcompensated for the injury, considering
all sources of compensation. By contrast, NICA recipients
broke even. Those who did not receive tort or NICA
compensation lost nearly $75000 in the first 5 years
following the birth. In the subsample of families of
children with cerebral palsy, overcompensation by tort claim
was even greater, whereas NICA recipients were
undercompensated. The cost of care for cerebral palsy in
both groups was the same. The difference between tort and
NICA compensation levels was attributable to payment for
income loss. Overall, NICA recipients were satisfied with
compensation received.<h4>Conclusions</h4>Medical expenses
were adequately covered under NICA, but not income loss. A
universal health insurance program for children would not
cover income losses. Similar costs incurred in NICA and tort
systems suggests no rationing of care by NICA. Finally,
absent some sort of targeted compensation, the losses
experienced by families of children with birth-related
injuries were substantial.},
Doi = {10.1001/archpedi.153.1.41},
Key = {fds301160}
}
@article{fds301112,
Author = {Whetten-Goldstein, K and Sloan, FA and Goldstein, LB and Kulas,
ED},
Title = {A comprehensive assessment of the cost of multiple sclerosis
in the United States.},
Journal = {Mult Scler},
Volume = {4},
Number = {5},
Pages = {419-425},
Year = {1998},
Month = {October},
ISSN = {1352-4585},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9839302},
Abstract = {Comprehensive data on the costs of multiple sclerosis is
sparse. We conducted a survey of 606 persons with MS who
were members of the National Multiple Sclerosis Society to
obtain data on their cost of personal health services, other
services, equipment, and earnings. Compensation of such cost
in the form of health insurance, income support, and other
subsidies was measured. Survey data and data from several
secondary sources was used to measure costs incurred by
comparable persons without MS. Based on the 1994 data, the
annual cost of MS was estimated at over $34,000 per person,
translating into a conservative estimate of national annual
cost of $6.8 billion, and a total lifetime cost per case of
$2.2 million. Major components of cost were earnings loss
and informal care. Virtually all persons with MS had health
insurance, mostly Medicare/Medicaid. Health insurance
covered 51 per cent of costs for services, excluding
informal care. On average, compensation for earnings loss
was 27 per cent. MS is very costly to the individual, health
care system, and society. Much of the cost (57 per cent) is
in the form of burdens other than personal health care,
including earnings loss, equipment and alternations, and
formal and informal care. These costs often are not
calculated.},
Doi = {10.1177/135245859800400504},
Key = {fds301112}
}
@article{fds301093,
Author = {Sloan, FA and Whetten-Goldstein, K and Hickson,
GB},
Title = {The influence of obstetric no-fault compensation on
obstetricians' practice patterns.},
Journal = {American journal of obstetrics and gynecology},
Volume = {179},
Number = {3 Pt 1},
Pages = {671-676},
Year = {1998},
Month = {September},
ISSN = {0002-9378},
url = {http://dx.doi.org/10.1016/s0002-9378(98)70062-6},
Abstract = {<h4>Objectives</h4>The objectives were to determine level of
satisfaction among obstetricians with the no-fault insurance
programs in Florida and Virginia and to study any reported
practice patterns attributable to implementation of no-fault
compensation.<h4>Study design</h4>Structured surveys were
conducted with 119 obstetricians in Florida and
Virginia.<h4>Results</h4>More than 90% of obstetricians were
enrolled in no-fault insurance programs, but only 13%
reported having had a patient compensated by a no-fault
program. Only 14% knew of a colleague with a patient who had
been compensated. Despite no-fault compensation, threat of
lawsuits was a factor in 39% of cases of physicians who quit
practicing obstetrics. The no-fault programs did not cause
obstetricians to report increases in their obstetric
caseloads or in their fraction of patients at high risk.
Overall, obstetricians were far more satisfied with the
no-fault system than with the tort system. Still, more than
half of the respondents expressed dissatisfaction with
premiums assessed by no-fault insurance.<h4>Conclusion</h4>Obstetricians
who knew about the no-fault programs were generally
satisfied with their performance. However, the no-fault
programs have not built a constituency with physicians, and
the programs are relatively small in their scope of
coverage. No-fault compensation thus has had minor impact on
reported obstetric practice. To be effective in improving
patient access, no-fault compensation must be broader in
scope.},
Doi = {10.1016/s0002-9378(98)70062-6},
Key = {fds301093}
}
@article{fds301080,
Author = {Sloan, FA and Whetten-Goldstein, K and Stout, EM and Entman, SS and Hickson, GB},
Title = {No-fault system of compensation for obstetric injury:
winners and losers.},
Journal = {Obstetrics and gynecology},
Volume = {91},
Number = {3},
Pages = {437-443},
Year = {1998},
Month = {March},
ISSN = {0029-7844},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9491874},
Abstract = {<h4>Objective</h4>To determine whether Florida's
implementation of a no-fault system for birth-related
neurologic injuries reduced lawsuits and total spending
associated with such injuries, and whether no-fault was more
efficient than tort in distributing compensation.<h4>Methods</h4>We
compared claims and payments before and after implementation
of a no-fault system in 1989. Data came from the Department
of Insurance's medical malpractice closed claim files and
no-fault records. Descriptive statistics were compiled for
tort claims before 1989 and for tort and no-fault claims for
1989-1991. We developed two projection approaches to
estimate claims and payments after 1989, with and without
no-fault. We assessed the program's performance on the basis
of comparisons of actual and projected values for
1989-1991.<h4>Results</h4>The number of tort claims for
permanent labor-delivery injury and death fell 16-32%.
However, when no-fault claims were added to tort claims,
total claims frequency rose by 11-38%. Annually, an
estimated 479 children suffered birth-related injuries;
however, only 13 were compensated under no-fault. Total
combined payments to patients and all lawyers did not
decrease, but of the total, a much larger portion went to
patients. Compensation of patients after plaintiff lawyers'
fees rose 4% or 44%, depending on the projection method
used. Less than 3% of total payments went to lawyers under
no-fault versus 39% under tort.<h4>Conclusion</h4>Some
claimants with birth-related injuries were winners, taking
home a larger percentage of their awards than their tort
counterparts. Lawyers clearly lost under no-fault. Because
of the narrow statutory definition, many children with
birth-related neurologic injuries did not qualify for
coverage.},
Doi = {10.1016/s0029-7844(97)00705-9},
Key = {fds301080}
}
@article{fds301094,
Author = {Sloan, FA and Viscusi, WK and Chesson, HW and Conover, CJ and Whetten
Goldstein, K},
Title = {Alternative Approaches to Valuing Intangible Health Losses:
The Evidence for Multiple Sclerosis},
Journal = {Journal of Health Economics},
Volume = {17},
Number = {4},
Pages = {475-497},
Year = {1998},
ISSN = {0167-6296},
url = {http://www.ncbi.nlm.nih.gov/pubmed/10180927},
Abstract = {This study uses both risk-risk and risk-dollar approaches to
assess intangible health losses associated with multiple
sclerosis (MS). Using an estimation approach that adjusts
for potential perceptional biases that may effect the
expressed risk tradeoffs, we estimated parameters of the
utility function of persons with and without MS as well as
the degree of subjects" overestimation of the probability of
obtaining MS. The sample included subjects from the general
population and persons with MS. We found that marginal
utility of income is lower in the state with MS than without
it. However, the difference in marginal in two states was
greater for persons without MS than for those with the
disease. Persons with MS overestimated the probability of
acquiring MS to a greater extent than did persons within MS.
Correcting for overestimation of this probability, the value
of intangible loss of a statistical case of MS derived from
responses of the general population was US$350,000 to
US$500.000. Persons with MS were willing to pay somewhat
more than this (D80,118,J17).},
Doi = {10.1016/s0167-6296(97)00025-8},
Key = {fds301094}
}
@article{fds301092,
Author = {Sloan, FA and Whetten-Goldstein, K and Wilson,
A},
Title = {Hospital pharmacy decisions, cost containment, and the use
of cost-effectiveness analysis.},
Journal = {Social science & medicine (1982)},
Volume = {45},
Number = {4},
Pages = {523-533},
Year = {1997},
Month = {August},
ISSN = {0277-9536},
url = {http://www.ncbi.nlm.nih.gov/pubmed/9226778},
Abstract = {The key hypothesis of the study was that hospital pharmacies
under the pressure of managed care would be more likely to
adopt process innovations to assure less costly and more
cost-effective provision of care. We conducted a survey of
103 hospitals and analyzed secondary data on cost and
staffing. Compared to the size of the reduction in length of
stay, changes in the way that a day of care is delivered
appear to be minor, even in areas with substantial managed
care share. The vast majority of hospitals surveyed had
implemented some form of therapeutic interchange and generic
substitution. Most hospitals used some drug utilization
guidelines, but as of mid 1995 these were not yet important
management tools for hospital pharmacies. To our knowledge,
ours was the first survey to investigate the link between
hospital formularies and use of cost-effectiveness analysis.
At most cost-effectiveness was a minor tool in
pharmaceutical decision making in hospitals at present. We
could determine no differences in use of such analyses by
managed care market share in the hospital's market share.
One impediment to the use of cost-effectiveness studies was
the lack of timeliness of studies. Other stated reasons for
not using cost-effectiveness analysis more often were: lack
of information on hospitalized patients and hence on the
potential cost offsets accruing to the hospital: lack of
independent sponsorship, and inadequate expertise in
economic evaluation.},
Doi = {10.1016/s0277-9536(96)00393-0},
Key = {fds301092}
}
@article{fds301113,
Author = {Whetten-Goldstein, K and Sloan, F and Kulas, E and Cutson, T and Schenkman, M},
Title = {The burden of Parkinson's disease on society, family, and
the individual.},
Journal = {J Am Geriatr Soc},
Volume = {45},
Number = {7},
Pages = {844-849},
Year = {1997},
Month = {July},
ISSN = {0002-8614},
url = {http://dx.doi.org/10.1111/j.1532-5415.1997.tb01512.x},
Abstract = {OBJECTIVE: To examine the burden of Parkinson's Disease (PD)
on society, family, and the individual. SETTING: In-home
interviews in Central North Carolina. DESIGN: A
cross-sectional, descriptive study. PARTICIPANTS: A total of
109 people with PD. MEASURES: Standard instruments used to
assess income, health status, health-related costs, and
household activities. SAMPLE: The sample was weighted toward
individuals who were within the first 5 years of post-PD
diagnosis. RESULTS: The total per capita societal burden was
approximately $6000 per year, the greatest single element of
which was compensation for earnings loss for those less than
age 65. Government insurance covered 85% of our sample. The
largest components of family burden were the burden of
providing informal caregiving and that of earnings loss.
Spouses providing informal care did so a mean of 22 hours
per week. Compared with a random sample of older people, our
respondents spent much less time on house and yard work.
CONCLUSION: The direct costs of the disease reflect a small
portion of the burden. The hidden costs, in the form of lost
wages, informal care, and changing roles are substantial.
Their magnitude is even more important when we consider that
the family generally lives on a fixed income, and the
caregiver is an older aged spouse. Medical practitioners
will best be able to intervene if they look holistically at
the patient with this disease. When treating symptoms
themselves, practitioners need to be aware of the high level
of pain, fatigue, and depression associated with PD, even in
the early stages. The results demonstrate clearly that
family relationships are affected early, indicating the
importance of providing early referrals to services such as
home health, social workers/counseling, and well as PD
support groups.},
Doi = {10.1111/j.1532-5415.1997.tb01512.x},
Key = {fds301113}
}
@article{fds301091,
Author = {Sloan, FA and Whetten-Goldstein, K and Githens, PB and Entman,
SS},
Title = {Effects of the threat of medical malpractice litigation and
other factors on birth outcomes.},
Journal = {Medical care},
Volume = {33},
Number = {7},
Pages = {700-714},
Year = {1995},
Month = {July},
ISSN = {0025-7079},
url = {http://www.ncbi.nlm.nih.gov/pubmed/7596209},
Abstract = {Most major health reform proposals include reform of medical
malpractice. A major objective of the current medical
malpractice system is to improve quality of care. The
authors examine the effect of variations in the threat of
medical malpractice, measured by claims frequency and
payments per exposure year, on various indicators of birth
outcomes, fetal deaths, low Apgar score, death within 5 days
of birth, infant death, and death or permanent impairment at
5 years of age. Data came from 2 sources: a Survey of
Obstetrical Care of 963 women in Florida in 1992 who
delivered 5 years previously; and a fetal death and a linked
birth-death file obtained from Florida Vital Statistics for
1987. Among the outcomes considered, only fetal deaths
decreased in response to an increased threat of being sued,
and this relationship was only obtained from one of the data
sets. Overall, no systematic improvement in birth outcomes
in response to an increased threat of medical malpractice
litigation was obtained.},
Doi = {10.1097/00005650-199507000-00006},
Key = {fds301091}
}
@article{fds337183,
Author = {Hickson, GB and Clayton, EW and Entman, SS and Miller, CS and Githens,
PB and Whetten-Goldstein, K and Sloan, FA},
Title = {Obstetricians’ prior malpractice experience and patients'
satisfaction with care},
Journal = {Obstetrical and Gynecological Survey},
Volume = {50},
Number = {5},
Pages = {351-353},
Publisher = {Ovid Technologies (Wolters Kluwer Health)},
Year = {1995},
Month = {January},
url = {http://dx.doi.org/10.1097/00006254-199505000-00013},
Doi = {10.1097/00006254-199505000-00013},
Key = {fds337183}
}
@article{fds301090,
Author = {Peskin, T and Micklitsch, C and Quirk, M and Sims, H and Primack, W and Weyrauch, KF and Hickson, GB and Clayton, EW and Entman, SS and Miller,
CS and Githens, PB and Whetten-Goldstein, K and Sloan, F and Levinson,
W},
Title = {Malpractice, patient satisfaction, and physician-patient
communication [1]},
Journal = {Journal of the American Medical Association},
Volume = {274},
Number = {1},
Pages = {22-23},
Year = {1995},
Key = {fds301090}
}
@article{fds301088,
Author = {Hickson, GB and Clayton, EW and Entman, SS and Miller, CS and Githens,
PB and Whetten-Goldstein, K and Sloan, FA},
Title = {Obstetricians' prior malpractice experience and patients'
satisfaction with care.},
Journal = {JAMA},
Volume = {272},
Number = {20},
Pages = {1583-1587},
Year = {1994},
Month = {November},
ISSN = {0098-7484},
url = {http://dx.doi.org/10.1001/jama.1994.03520200039032},
Abstract = {<h4>Objective</h4>To examine the relationship between prior
physician malpractice experience and patients' satisfaction
with care.<h4>Design</h4>Women were interviewed using a
questionnaire that contained structured and open-ended
questions.<h4>Participants</h4>Mothers of all stillborn
infants, infant deaths, and a random sampling of viable
infants drawn from 1987 Florida Vital Statistics were sorted
into four groups based on the malpractice claims experience
of their obstetricians between 1983 and 1986. Interviews
were completed with 963 of 1536 women, most by telephone, 53
by in-person interview.<h4>Main outcome measures</h4>Mothers'
responses to closed-ended and open-ended questions about
their perceptions of the care they received during their
pregnancy, labor, and delivery.<h4>Results</h4>Even though
none of the women actually filed a claim, a consistent
pattern of differences emerged when comparing women's
perceptions of care received. Patients seeing physicians
with the most frequent numbers of claims but without high
payments were significantly more likely to complain that
they felt rushed, never received explanations for tests, and
were ignored. In response to the open-ended question, "What
part of your care were you least satisfied with?" women
seeing physicians in the High Frequency malpractice risk
group offered twice as many complaints as those seeing
physicians who had never been sued. Problems with
physician-patient communication were the most commonly
offered complaints.<h4>Conclusion</h4>Physicians who have
been sued frequently are more often the objects of
complaints about the interpersonal care they provide even by
their patients who do not sue.},
Doi = {10.1001/jama.1994.03520200039032},
Key = {fds301088}
}
@article{fds301089,
Author = {Entman, SS and Glass, CA and Hickson, GB and Githens, PB and Whetten-Goldstein, K and Sloan, FA},
Title = {The relationship between malpractice claims history and
subsequent obstetric care.},
Journal = {JAMA},
Volume = {272},
Number = {20},
Pages = {1588-1591},
Year = {1994},
Month = {November},
ISSN = {0098-7484},
url = {http://dx.doi.org/10.1001/jama.1994.03520200044033},
Abstract = {<h4>Objective</h4>To determine the relationship between
prior malpractice claims experience and the quality of
clinical obstetric care.<h4>Design</h4>Historical cohort
study of obstetricians, classified by their prior
malpractice claims experience, with blinded review of
medical records from their practices 5 to 10 years
later.<h4>Setting</h4>Florida obstetricians who lost,
settled, or defended malpractice claims between 1977 and
1983 and who were still practicing obstetrics in
1987.<h4>Main outcome measures</h4>Objective and subjective
assessment of quality of clinical care of patients attended
by obstetricians with different histories of malpractice
claims.<h4>Results</h4>No differences were found in any of
the objective or subjective measures of the quality of
clinical care provided to patients of obstetricians who were
classified into one of four groups according to their prior
claims history.<h4>Conclusions</h4>No relationship was found
between prior malpractice claims experience and the
technical quality of practice by Florida obstetricians.
Strategies that attempt to identify physicians at risk for
future clinical errors by using data on prior malpractice
claims (such as the National Practitioner Data Bank) may be
misjudging the likelihood that substandard clinical care
will be provided by physicians with prior
claims.},
Doi = {10.1001/jama.1994.03520200044033},
Key = {fds301089}
}
%% Chapters in Books
@misc{fds331195,
Author = {Gray, CL and Ariely, S and Pence, BW and Whetten,
K},
Title = {Why institutions matter: Empirical data from five low- and
middle-income countries indicate the critical role of
institutions for orphans},
Pages = {379-400},
Booktitle = {Child Maltreatment in Residential Care: History, Research,
and Current Practice},
Publisher = {Springer International Publishing},
Year = {2017},
Month = {August},
ISBN = {9783319579894},
url = {http://dx.doi.org/10.1007/978-3-319-57990-0_18},
Doi = {10.1007/978-3-319-57990-0_18},
Key = {fds331195}
}
@misc{fds338446,
Author = {Escueta, M and Whetten, K and Ostermann, J and O’Donnell,
K},
Title = {Adverse childhood experiences, psychosocial well-being, and
cognitive development among orphans and abandoned children
in five low income countries},
Pages = {241-267},
Booktitle = {Childhood Adversity and Developmental Effects: International
and Cross-Disciplinary Perspectives},
Publisher = {Apple Academic Press},
Year = {2015},
Month = {January},
ISBN = {9781771881104},
url = {http://dx.doi.org/10.1201/b18372},
Abstract = {The plight of orphansa and abandoned children (OAC) is an
increasing global problem that is particularly pervasive in
Southeast Asia and sub-Saharan Africa [1]. Improving the
educational attainment of the 153 million orphans and other
vulnerable children worldwide is a key goal for development
policymakers and practitioners. International declarations
such as the Millennium Development Goals and the Education
for All Movement indicate that the educational attainment of
vulnerable children has become a global priority. Most
recently, the 2011 Political Declaration on HIV/AIDS
targeted increases in school attendance of orphans as an
important and measureable indicator of progress
[2].},
Doi = {10.1201/b18372},
Key = {fds338446}
}
@misc{fds349761,
Author = {Messer, LC and Whetten, K and Ostermann, J and Pence, BW and Ariely, S and O'Donnell, K and Whetten, R and Wasonga, A and Vann, V and Eticha, M and Madan, I},
Title = {Three-year Change in the Wellbeing of Orphaned and Abandoned
Children in Institutional and Family-Based Care Settings in
Five Low and Middle Income Countries},
Journal = {INTERNATIONAL JOURNAL OF EPIDEMIOLOGY},
Volume = {44},
Pages = {216-217},
Publisher = {OXFORD UNIV PRESS},
Year = {2015},
Month = {January},
Key = {fds349761}
}
@misc{fds301059,
Author = {Reisinger, D and Clifford, and Deardorff, and Whetten},
Title = {Cultures and Languages Across the Curriculum in Global
Health: New Curricular Pathways toward Internationalization},
Pages = {261-274},
Booktitle = {Internationalising the curriculum in disciplines: Stories
from business, education and health},
Publisher = {Sense Publishing},
Editor = {Green, and Whitsed},
Year = {2015},
ISBN = {9789463000840},
url = {http://dx.doi.org/10.1007/978-94-6300-085-7_20},
Abstract = {Institutions of higher education have placed increasing
importance on internationalising their curricula over the
past 10 years. At Duke University, a private university in
the southern United States, these efforts have led to a
unique partnership between the Romance Studies Department
and the Duke Global Health Institute (DGHI) that focuses on
a curriculum design based on the Cultures and Languages
Across the Curriculum (CLAC) model. Our partnership began in
2012 when Deborah Reisinger, Lecturer in French, and Joan
Clifford, Lecturer in Spanish, teamed up with Kathryn
Whetten, Director of the Center for Health Policy and
Inequalities Research, to create a series of courses that
explore global health issues in multiple target languages.
At the end of the pilot’s first semester, we reached out
to our colleague Darla Deardorff, a research scholar in
Duke’s Program in Education, who consulted with our team
to help integrate intercultural competency into the
curriculum.},
Doi = {10.1007/978-94-6300-085-7_20},
Key = {fds301059}
}
@misc{fds317901,
Author = {Pence, W and Reif, S and Whetten, K and Leserman, J and Stang, D and Swartz, M and Thielman, N and Mugavero, MJ},
Title = {Clinical and psychosocial characteristics of HIV-11-infected
patients in the US deep south.},
Journal = {AMERICAN JOURNAL OF EPIDEMIOLOGY},
Volume = {165},
Number = {11},
Pages = {S119-S119},
Publisher = {OXFORD UNIV PRESS INC},
Year = {2007},
Month = {June},
Key = {fds317901}
}
@misc{fds153271,
Author = {Murphy, R.A. and KJ O'Donnell and K Whetten and J
Adnopoz},
Title = {Pyschosocial Aspects of HIV/AIDS},
Booktitle = {Lewis' Child and Adolescent Psychiatry: A Comprehensive
Textbook, Fourth Edition},
Publisher = {Lippincott Williams & Wilkins, a Wolters Kluwer
buisness},
Address = {Philadelphia, PA},
Editor = {A. Martin and F. Volkmar},
Year = {2007},
Key = {fds153271}
}
@misc{fds14478,
Author = {Kulas, E.D. and Whetten-Goldstein K.},
Title = {"Use of Cost Analyses to Improve our Understanding of the
Therapeutic Trade-offs for Multiple Sclerosis"},
Series = {Second},
Booktitle = {Multiple Sclerosis: Experimental and Applied
Therapeutics},
Publisher = {London: Martin Dunitz Ltd.},
Editor = {J.A. Cohen and R.A. Rudnick},
Year = {2003},
Key = {fds14478}
}
@misc{fds14477,
Author = {K. Whetten-Goldstein},
Title = {"The Use of Cost Analyses to Improve our Understanding of
the Threrapeutic Trade-offs for Multiple
Sclerosis"},
Booktitle = {Multiple Sclerosis: Experimental and Applied
Therapeutics},
Publisher = {London: Martin Dunitz Ltd.},
Editor = {R.A. Rudick and D.E. Goodkin},
Year = {1999},
Key = {fds14477}
}