Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Craw JA[original query] |
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Progress toward achieving national HIV/AIDS strategy goals for quality of life among persons aged ≥50 years with diagnosed HIV - medical monitoring project, United States, 2017-2023
Beer L , Tie Y , Crim SM , Weiser J , Taussig J , Craw JA , Buchacz KA , Dobbs A , Collins CB Jr , Johnston ME , De Los Reyes A , Gelaude D , Hughes K , Desamu-Thorpe R , Prejean J . MMWR Morb Mortal Wkly Rep 2024 73 (36) 781-787 Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH. |
The capacity of HIV care facilities to implement strategies recommended by the Ending the HIV Epidemic-The Medical Monitoring Project Facility Survey
Beer L , Williams D , Tie Y , McManus T , Yuan AX , Crim SM , Demeke HB , Creel D , Blackwell AD , Craw JA , Weiser J . J Acquir Immune Defic Syndr 2023 94 (4) 290-300 BACKGROUND: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING: US HIV care facilities. METHODS: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION: Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports. |
Viral rebound among persons with diagnosed HIV who achieved viral suppression, United States
Craw JA , Beer L , Tie Y , Jaenicke T , Shouse RL , Prejean J . J Acquir Immune Defic Syndr 2020 84 (2) 133-140 BACKGROUND: Some persons who achieve viral suppression may later experience viral rebound, potentially putting them at risk for transmitting HIV. We estimate the prevalence of, and describe factors associated with, viral rebound among adults with diagnosed HIV in the United States who had >/=2 viral load tests in a 12-month period. SETTING: The Medical Monitoring Project (MMP) is an annual cross-sectional survey about the experiences and needs of adults with diagnosed HIV sampled from the National HIV Surveillance System (NHSS). METHODS: We analyzed interview and medical record data from three MMP cycles spanning June 2015-May 2018. We analyzed viral load results from the 12-month period before the interview among persons with >/=2 viral load tests who achieved viral suppression. Data were weighted based on known probabilities of selection, adjusted for patient nonresponse, and post-stratified to known population totals from NHSS. RESULTS: Among those with >/=2 viral load tests who achieved viral suppression, 7.5% demonstrated viral rebound. In multivariable analyses, viral rebound was higher among non-Hispanic blacks, persons ages 18-39, persons with public insurance, persons recently experiencing homelessness, persons with higher numbers of viral load tests, persons who missed HIV care appointments, and persons with sub-optimal adherence to antiretroviral therapy. CONCLUSIONS: Viral rebound varied by sociodemographic and clinical characteristics. HIV providers can monitor persons at greatest risk for viral rebound and link patients with ancillary services or evidence-based interventions to help them remain virally suppressed. Our findings can inform strategies and interventions implemented under the Ending the HIV Epidemic initiative. |
A national behavioral and clinical surveillance system of adults with diagnosed HIV (The Medical Monitoring Project): Protocol for an annual cross-sectional interview and medical record abstraction survey
Beer L , Johnson CH , Fagan JL , Frazier EL , Nyaku M , Craw JA , Sanders CC , Luna-Gierke RE , Shouse RL . JMIR Res Protoc 2019 8 (11) e15453 BACKGROUND: The Medical Monitoring Project (MMP) is a national population-based behavioral and clinical surveillance system of adults with diagnosed HIV in the United States, and it is sponsored by the Centers for Disease Control and Prevention (CDC). Its purpose is to provide locally and nationally representative estimates of factors affecting HIV transmission risk and clinical outcomes. OBJECTIVE: This study aimed to describe the rationale for and methodology of the MMP, in addition to its contribution to evaluating and monitoring HIV prevention, care, and treatment efforts in the United States. METHODS: MMP employs a stratified 2-stage sample design to select annual samples of persons living with diagnosed HIV from the National HIV Surveillance System and conducts interviews and medical record abstractions with participating persons. RESULTS: MMP data are published routinely via annual reports, conference presentations, and scientific publications. Data may be accessed upon request from the CDC, contingent on the guidelines established for the security and confidentiality of HIV surveillance data. CONCLUSIONS: MMP is the only source of annual population-based data on the behaviors and clinical care of persons with diagnosed HIV in the United States. It provides essential information for monitoring progress toward national treatment and prevention goals and guiding efforts to improve the health of persons with diagnosed HIV and prevent HIV transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/15453. |
Retention in care services reported by HIV care providers in the United States, 2013 to 2014
Craw JA , Bradley H , Gremel G , West BT , Duke CC , Beer L , Weiser J . J Int Assoc Provid AIDS Care 2017 16 (5) 2325957417724204 OBJECTIVES: Evidence-based guidelines recommend that HIV care providers offer retention-in-care services, but data are needed to assess service provision. METHODS: We surveyed a probability sample of 1234 HIV care providers to estimate the percentage of providers whose practices offered 5 recommended retention services and describe providers' perceptions of barriers to care among patients. RESULTS: An estimated 21% of providers' practices offered all 5 retention services. Providers at smaller (<50 versus >400 patients), private, and non-Ryan White HIV/AIDS Program (RWHAP)-funded practices, and practices without on-site case management were significantly less likely to provide patient navigation services or do systematic monitoring of retention. Providers' most commonly perceived barriers to care among patients were mental health (40%), substance abuse (36%), and transportation (34%) issues. CONCLUSION: Deficiencies in the provision of key retention services are substantial. New strategies may be needed to increase the delivery of recommended retention services, especially among private, non-RWHAP-funded, and smaller facilities. |
Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in six U.S. HIV clinics
Gardner LI , Giordano TP , Marks G , Wilson TE , Craw JA , Drainoni ML , Keruly JC , Rodriguez AE , Malitz F , Moore RD , Bradley-Springer LA , Holman S , Rose CE , Girde S , Sullivan M , Metsch LR , Saag M , Mugavero MJ . Clin Infect Dis 2014 59 (5) 725-34 BACKGROUND: To determine whether enhanced personal contact with HIV-infected patients across time improves retention in care compared with existing standard of care (SOC) practices, and whether brief skills training improves retention beyond enhanced contact. METHODS: The study, conducted at 6 US HIV clinics, included 1,838 patients with a recent history of inconsistent clinic attendance, and new patients. Each clinic randomized participants to one of three arms and continued to provide SOC practices to all enrollees: Enhanced contact with interventionist (EC; brief face-to-face meeting upon returning for care visit, interim visit call, appointment reminder calls, missed visit call); EC+skills (organization, problem solving, and communication skills); or SOC-only. The intervention was delivered by project staff for 12 months following randomization. The outcomes during that 12-month period were (1) percentage of participants attending at least one primary care visit in three consecutive 4-month intervals (visit constancy), and (2) proportion of kept/scheduled primary care visits (visit adherence). RESULTS: Log-binomial risk ratios comparing intervention arms against the SOC arm demonstrated better outcomes in both the EC and EC+skills arms (visit constancy: RRs=1.22 (1.09-1.36) and 1.22 (1.09-1.36); visit adherence: RR=1.08 (1.05-1.11) and 1.06 (1.02-1.09), all ps<0.01). Intervention effects were observed in numerous patient subgroups, although lower in patients reporting unmet needs or illicit drug use. CONCLUSION: Enhanced contact with patients improved retention in HIV primary care compared to existing SOC practices. A brief patient skill-building component did not improve retention further. Additional intervention elements may be needed for patients reporting illicit drug use or who have unmet needs. |
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