Patient motivation is important in managing medication regimens such as antiretroviral treatment ... more Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on improving adherence; however, we did not find evidence that self-determination theory predicts adherence in this population of HIV-positive patients. Autonomous motivation was strongly associated with perceived competence; among low adherers, external regulation was negatively correlated with adherence.
International Journal of Maternal and Child Health and AIDS (IJMA), 2020
Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother... more Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing. Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data. Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been rando...
IntroductionIn the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) ... more IntroductionIn the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, including in sub-Saharan Africa, to prevent and control SARS-CoV-2 transmission. This mixed-methods study examines adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of laboratory-confirmed COVID-19 in each country. Additionally, we aim to evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths.MethodsThis mixed-methods analysis utilized semi-structured interviews and a quantitative dataset constructed using multiple open data sources, including the Oxford COVID-19 Government Response Tracker. To understand potential barriers and facilitators in implementing and enforcing NPIs qualitative data were collected from those involved in the COVID-19 response and analyzed using NVivo. Quantitative results were analyzed using descripti...
Purpose of Review The complexity of HIV care and its expanding clinical workforce has created a n... more Purpose of Review The complexity of HIV care and its expanding clinical workforce has created a need for new distance learning models to deliver medical education. We conducted a narrative review to assess the acceptability and effectiveness of recent eHealth HIV education interventions supporting HIV healthcare providers. Recent Findings Evidence from 24 articles revealed that synchronous (real time), asynchronous (any time), and hybrid (combination) models of eHealth education are feasible and acceptable. Only two interventions (one asynchronous, one hybrid) of 19 included in the review utilized a randomized controlled design. Some studies showed improvement in confidence and perceived quality of case management, but few studies were designed to demonstrate impact. Summary Successful eHealth education interventions require a thorough understanding of the target community’s capacity and needs. Both synchronous and asynchronous strategies appear acceptable and potentially effective, but more studies are needed to assess impact on knowledge and practices to determine the most effective delivery models.
Journal of Acquired Immune Deficiency Syndromes, Sep 1, 2011
To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulne... more To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulnerabilities of orphaned and vulnerable children, including those infected and affected by HIV/AIDS. Two age-specific instruments, comprised of previously validated tools and indicators commonly considered best practice, were administered to 102 children aged 5-10 years and 100 children aged 11-17 years in Mchinji, Malawi. Respondents were randomly sampled from a roster of children recently scored with the CSI. For each of the CSI's 12 subdomains, we assessed construct validity using Spearman Rank correlation coefficients. We also calculated cross tabulations to explain the resulting correlation coefficients. Analyses were conducted separately for the 2 age groups. No relationships exceeded the standard for high construct validity (≥0.7). Only 2 were moderate (0.3-0.7), both for the younger age group: food security (0.4) and wellness (0.36). All other relationships were weak or negative. In most subcategories, a substantial proportion of surveyed children indicated distress that was not evident from CSI scores. In the abuse and exploitation subdomain, all children were rated as "good" or "fair" by the CSI, but among surveyed children aged 11-17, 20% or more reported being beaten, kicked, locked out of the house, threatened with abandonment, cursed, and made to feel ashamed. In this rural Malawi population, we were not able to validate the CSI as a tool for assessing the vulnerabilities of orphaned and vulnerable children. We recommend caution in interpreting CSI scores and revisions to the tool before global scale-up in its use.
Patient motivation is important in managing medication regimens such as antiretroviral treatment ... more Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on improving adherence; however, we did not find evidence that self-determination theory predicts adherence in this population of HIV-positive patients. Autonomous motivation was strongly associated with perceived competence; among low adherers, external regulation was negatively correlated with adherence.
International Journal of Maternal and Child Health and AIDS (IJMA), 2020
Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother... more Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing. Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data. Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been rando...
IntroductionIn the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) ... more IntroductionIn the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, including in sub-Saharan Africa, to prevent and control SARS-CoV-2 transmission. This mixed-methods study examines adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of laboratory-confirmed COVID-19 in each country. Additionally, we aim to evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths.MethodsThis mixed-methods analysis utilized semi-structured interviews and a quantitative dataset constructed using multiple open data sources, including the Oxford COVID-19 Government Response Tracker. To understand potential barriers and facilitators in implementing and enforcing NPIs qualitative data were collected from those involved in the COVID-19 response and analyzed using NVivo. Quantitative results were analyzed using descripti...
Purpose of Review The complexity of HIV care and its expanding clinical workforce has created a n... more Purpose of Review The complexity of HIV care and its expanding clinical workforce has created a need for new distance learning models to deliver medical education. We conducted a narrative review to assess the acceptability and effectiveness of recent eHealth HIV education interventions supporting HIV healthcare providers. Recent Findings Evidence from 24 articles revealed that synchronous (real time), asynchronous (any time), and hybrid (combination) models of eHealth education are feasible and acceptable. Only two interventions (one asynchronous, one hybrid) of 19 included in the review utilized a randomized controlled design. Some studies showed improvement in confidence and perceived quality of case management, but few studies were designed to demonstrate impact. Summary Successful eHealth education interventions require a thorough understanding of the target community’s capacity and needs. Both synchronous and asynchronous strategies appear acceptable and potentially effective, but more studies are needed to assess impact on knowledge and practices to determine the most effective delivery models.
Journal of Acquired Immune Deficiency Syndromes, Sep 1, 2011
To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulne... more To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulnerabilities of orphaned and vulnerable children, including those infected and affected by HIV/AIDS. Two age-specific instruments, comprised of previously validated tools and indicators commonly considered best practice, were administered to 102 children aged 5-10 years and 100 children aged 11-17 years in Mchinji, Malawi. Respondents were randomly sampled from a roster of children recently scored with the CSI. For each of the CSI's 12 subdomains, we assessed construct validity using Spearman Rank correlation coefficients. We also calculated cross tabulations to explain the resulting correlation coefficients. Analyses were conducted separately for the 2 age groups. No relationships exceeded the standard for high construct validity (≥0.7). Only 2 were moderate (0.3-0.7), both for the younger age group: food security (0.4) and wellness (0.36). All other relationships were weak or negative. In most subcategories, a substantial proportion of surveyed children indicated distress that was not evident from CSI scores. In the abuse and exploitation subdomain, all children were rated as "good" or "fair" by the CSI, but among surveyed children aged 11-17, 20% or more reported being beaten, kicked, locked out of the house, threatened with abandonment, cursed, and made to feel ashamed. In this rural Malawi population, we were not able to validate the CSI as a tool for assessing the vulnerabilities of orphaned and vulnerable children. We recommend caution in interpreting CSI scores and revisions to the tool before global scale-up in its use.
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