| Records |
| Author |
Ross, I.; Mejia, C.; Melendez, J.; Chan, P.A.; Nunn, A.C.; Powderly, W.; Goodenberger, K.; Liu, J.; Mayer, K.H.; Patel, R.R. |
| Title |
Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation |
Type |
Journal Article |
| Year |
2017 |
Publication |
PloS one |
Abbreviated Journal |
PLoS One |
| Volume |
12 |
Issue |
3 |
Pages |
e0173057 |
| Keywords |
Adult; Anti-HIV Agents/therapeutic use; *Attitude of Health Personnel; Cross-Sectional Studies; Female; Guatemala; HIV Infections/*prevention & control; *Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Middle Aged; Physicians/psychology; Practice Patterns, Physicians'/*statistics & numerical data; Pre-Exposure Prophylaxis/*statistics & numerical data; Surveys and Questionnaires |
| Abstract |
INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS: We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS: Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS: Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala. |
| Address |
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America |
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1932-6203 |
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PMID:28257475 |
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no |
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ref @ user @ |
Serial |
97185 |
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| Author |
Del Brutto, O.H.; Mera, R.M.; Zambrano, M.; Del Brutto, V.J. |
| Title |
Severe edentulism is a major risk factor influencing stroke incidence in rural Ecuador (The Atahualpa Project) |
Type |
Journal Article |
| Year |
2017 |
Publication |
International Journal of Stroke : Official Journal of the International Stroke Society |
Abbreviated Journal |
Int J Stroke |
| Volume |
12 |
Issue |
2 |
Pages |
201-204 |
| Keywords |
Adult; Comorbidity; Ecuador/epidemiology; Female; Follow-Up Studies; Humans; Hypertension/complications/epidemiology; Incidence; Male; Middle Aged; Mouth, Edentulous/complications/*epidemiology; Prospective Studies; Risk Factors; Rural Population; Severity of Illness Index; Stroke/complications/*epidemiology; Ecuador; Stroke incidence; cohort study; edentulism; stroke risk factors |
| Abstract |
Background There is no information on stroke incidence in rural areas of Latin America, where living conditions and cardiovascular risk factors are different from urban centers. Aim Using a population-based prospective cohort study design, we aimed to assess risk factors influencing stroke incidence in community-dwelling adults living in rural Ecuador. Methods First-ever strokes occurring from 1 June 2012 to 31 May 2016, in Atahualpa residents aged >/=40 years, were identified from yearly door-to-door surveys and other overlapping sources. Poisson regression models adjusted for demographics, cardiovascular risk factors, edentulism and the length of observation time per subject were used to estimate stroke incidence rate ratio as well as factors influencing such incidence. Results Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48 +/- 0.95 years). Overall stroke incidence rate was 2.97 per 100 person-years of follow-up (95% CI: 1.73-4.2), which increased to 4.77 (95% CI: 1.61-14.1) when only persons aged >/=57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% CI: 2.55-7.93) and severe edentulism (IRR: 5.06; 95% CI: 2.28-7.85) were the factors independently increasing stroke incidence. Conclusions Stroke incidence in this rural setting is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes. Public awareness of the consequences of poor dental care might reduce stroke incidence in rural settings. |
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4 Department of Neurology, University of Chicago, Chicago, IL, USA |
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1747-4930 |
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PMID:27777377 |
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no |
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ref @ user @ |
Serial |
97187 |
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| Author |
Blot, S.; Bauer, G.; Fraser, M.; Nleya, M.; Wadham, M. |
| Title |
AIDS Service Organization Access Among African, Caribbean and Other Black Residents of an Average Canadian City |
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Journal Article |
| Year |
2017 |
Publication |
Journal of Immigrant and Minority Health |
Abbreviated Journal |
J Immigr Minor Health |
| Volume |
19 |
Issue |
4 |
Pages |
851-860 |
| Keywords |
African; Black people; Caribbean; Hiv/Aids; Health disparities; Health services research; Immigrant health; Minority health |
| Abstract |
Due to heightened vulnerability to HIV/AIDS, African, Caribbean and Black (ACB) communities are priority groups for prevention and intervention services in Canada. However, it is not clear which factors may affect ACB communities' access to these services. We evaluated access to the local AIDS service organization (ASO) in Middlesex-London by using data from the Black, African and Caribbean Canadian Health Study. Modified Poisson regression was used to obtain prevalence risk ratios for factors associated with three measures of access: familiarity with the ASO, willingness to access, and realized access. In adjusted analyses, older ACB community members were more likely to be familiar with the ASO, willing to access it, and have actually gone there. Canadian-born participants were less likely to have been to the ASO than recent immigrants. These results have implications for reaching specific segments of ACB communities for HIV/AIDS-related services in Canada. |
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Women and HIV/AIDS Initiative, Toronto, ON, Canada |
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English |
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1557-1912 |
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PMID:26895153 |
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no |
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ref @ user @ |
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97194 |
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| Author |
Godin, K.M.; Chacon, V.; Barnoya, J.; Leatherdale, S.T. |
| Title |
The school environment and sugar-sweetened beverage consumption among Guatemalan adolescents |
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Journal Article |
| Year |
2017 |
Publication |
Public Health Nutrition |
Abbreviated Journal |
Public Health Nutr |
| Volume |
20 |
Issue |
16 |
Pages |
2980-2987 |
| Keywords |
Latin America; Nutrition policy; School health; Sugar-sweetened beverages |
| Abstract |
OBJECTIVE: The current study sought to examine Guatemalan adolescents' consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students' SSB consumption. DESIGN: Within this observational pilot study, a questionnaire was used to assess students' consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample. SETTING: Guatemala City, Guatemala. SUBJECTS: Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools. RESULTS: Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property. CONCLUSIONS: Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies. |
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1School of Public Health and Health Systems,University of Waterloo, 200 University Avenue West,Waterloo,ON,Canada,N2L 3G1 |
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1368-9800 |
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PMID:28803573 |
Approved |
no |
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ref @ user @ |
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97261 |
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Derose, K.P.; Payan, D.D.; Fulcar, M.A.; Terrero, S.; Acevedo, R.; Farias, H.; Palar, K. |
| Title |
Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study |
Type |
Journal Article |
| Year |
2017 |
Publication |
PloS one |
Abbreviated Journal |
PLoS One |
| Volume |
12 |
Issue |
7 |
Pages |
e0181568 |
| Keywords |
Adolescent; Adult; Domestic Violence; Dominican Republic/epidemiology; Female; *Food Supply; HIV/isolation & purification; HIV Infections/*epidemiology; Humans; Middle Aged; Qualitative Research; Social Stigma; Social Support; Socioeconomic Factors; Young Adult |
| Abstract |
BACKGROUND: Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity. METHODS: We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes. RESULTS: Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress. CONCLUSIONS: Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality. |
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Division of HIV, ID and Global Medicine, School of Medicine, University of California – San Francisco, San Francisco, California, United States of America |
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English |
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1932-6203 |
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| Notes |
PMID:28742870 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
97262 |
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