Browsing by Author "Duarte, Mariana"
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Item Correlates of depressive symptoms in transgender women initiating HIV treatment in Argentina(Wolters Kluwer Health, 2022) Aristegui, Ines; Radusky, Pablo; Zalazar, Virginia; Cardozo, Nadir; Fabian, Solange; Duarte, Mariana; Frola, Claudia; Cahn, Pedro; Sued, OmarObjective: To assess efficacy and safety of dolutegravir (DTG) + lamivudine (3TC) vs. DTG + tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in treatment-naive adults with HIV-1 in the prespecified 144-week secondary analyses of GEMINI-1 and GEMINI-2. Design: Identical, multicenter, phase III, randomized, non-inferiority studies (double-blind through 96 weeks). Methods: Participants with HIV-1 RNA ≤500 000 copies/ml and no major viral resistance mutations to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, or protease inhibitors were randomized 1:1 to once-daily DTG + 3TC or DTG + TDF/FTC. Results: At week 144, DTG + 3TC (N = 716) was noninferior to DTG + TDF/FTC (N = 717) in proportion of participants achieving HIV-1 RNA <50 copies/ml (Snapshot algorithm) in the pooled analysis (82% vs. 84%, respectively; adjusted treatment difference [95% confidence interval (CI)], −1.8% [−5.8, 2.1]), GEMINI-1 (−3.6% [−9.4, 2.1]), and GEMINI-2 (0.0% [−5.3, 5.3]). Twelve DTG + 3TC participants and nine DTG + TDF/FTC participants met protocol-defined confirmed virologic withdrawal (CVW) criteria; none developed treatment-emergent resistance. One DTG + 3TC participant who did not meet CVW criteria developed M184V at week 132 and R263R/K at week 144, conferring a 1.8-fold change in susceptibility to DTG; non-adherence to therapy was reported. Significantly fewer drug-related adverse events occurred with DTG + 3TC vs. DTG + TDF/FTC (20% vs. 27%; relative risk [95% CI], 0.76 [0.63–0.92]). Renal and bone biomarker changes favored DTG + 3TC. Conclusions: Three-year durable efficacy, long-term tolerability, and high barrier to resistance support first-line use of DTG + 3TC for HIV-1 treatment (see Supplemental Digital Content 1, https://links.lww.com/QAD/C297; video abstract).Item Mental health, substance use, experiences of violence, and access to health care among transgender and non-binary people during the COVID-19 lockdown in Argentina(2021-07) Radusky, Pablo; Cardozo, Nadir; Duarte, Mariana; Fabian, Solange; Frontini, Emilia; Sued, Omar; Aristegui, InesBackground: Lockdown measures are effective in controlling the spread of COVID-19; however, concerns have increased regarding their impact on transgender and non-binary people. Aims: This study describes self-reported changes in mental health, substance use, experiences of violence, and access to health care and basic services among transgender and non-binary populations from Argentina after two months of lockdown implementation. Methods: An online national survey was responded to by 182 participants (72 transfeminine [TF], 66 transmasculine [TM], 44 non-binary [NB] individuals) between May and June 2020. The questionnaire was informed by the results of focus groups, reviewed by activists, and disseminated through social media. Descriptive statistics were used to summarize the data. Results: The COVID-19 pandemic and the lockdown have had a generally negative impact on the participants. TF participants reported a greater proportion of negative changes in the socioeconomic aspect, such as a reduction in income and barriers to access basic services (housing, food, hygiene products, and financial assistance). TM and NB participants reported higher proportions of adverse psychological impact, with high frequencies of intense negative emotions and suicidal ideation. A general reduction in substance use was observed in all three groups. The most frequent source of violence in the three groups was from a family member, especially among NB participants. Half of the TF and TM individuals reported difficulties accessing or continuing their hormone therapy. TM and NB participants reported considerable barriers to accessing mental health care. Conclusion: The COVID-19 pandemic and the prolonged lockdown have had a negative impact on the transgender and NB population, exacerbating their preexisting vulnerability and exclusion. Furthermore, this impact affected each subgroup differently in a particular and specific way"¡Item Navegadores pares como “puentes” entre las personas trans y el sistema de salud: sistematización de roles y competencias(2021-11) Cardozo, Nadir; Fontini, Emilia; Duarte, Mariana; Fabian, Solange; Radusky, Pablo; Zalazar, Virginia; Cahn, Susana; Sued, Omar; Aristegui, Ines[RESUMEN]. El estigma y la discriminación llevan a la población trans a evitar acercarse a los servicios de salud. Les navegadores pares (NP) son personas de la comunidad insertas en el equipo de salud que construyen "puentes" entre ambos. Aunque los servicios reconocen cada vez más su importancia, no hay una guía específica y su rol no está bien definido. Este trabajo sistematiza la experiencia y competencias de tres NP en un servicio de atención de VIH en Buenos Aires, Argentina. Esta sistematización resalta la necesidad tanto de incrementar el número de NP con estas competencias específicas, asignando más recursos para incorporar NP con competencias específicas en salud y replicar su rol en otros sectores, como de promover su participación en la planificación e implementación de programas para poblaciónItem Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina(2024-02) Sciannameo, Sergio; Zalazar, Virginia; Spadaccini, Luciana; Duarte, Mariana; Cahn, Pedro; Aristegui, Ines; Sued, OmarBackground: Little is known about the preferences for antiretroviral therapy (ART) administration methods, such as oral daily pills or long-acting injectable (LAI) options, as well as preferences for pre-exposure prophylaxis (PrEP) administration methods among people without HIV in Latin America. Objectives: This study aimed to assess the preferences for ART administration methods among people with HIV and PrEP methods among those without HIV, as well as to examine the correlations and reasons for these preferences. Design: We conducted a cross-sectional web-based questionnaire between April and July 2021, using social media accounts of a HIV non-governmental organization. The questionnaire was open to all adults living in Argentina, irrespective of their sexual orientation or gender identity. Methods: The questionnaire included questions on substance use, depression, chronic treatment, previous experiences with injectable medication, and HIV status. Those with HIV answered questions about ART adherence and their preferences for ART methods, while those without HIV were asked about condom use, awareness of PrEP, and their preferences for PrEP methods. Results: Out of 1676 respondents, 804 had HIV, and 872 did not. Among those with HIV, 91.5% expressed a high preference for LAI-ART, with significantly higher preferences among participants with higher educational levels, cisgender gay, bisexual, and queer men, younger individuals, and those with prior injectable medication experience. Among those without HIV, 68% preferred LAI-PrEP, and this preference was positively associated with previous positive experiences with injectable medication. Conclusion: The strong preference for LAI-ART suggests the potential for improved adherence and well-being among people with HIV. Additionally, the preference for LAI-PrEP among those without HIV emphasizes the importance of considering this option for HIV prevention strategies. This study highlights the need to offer diverse methods for ART and prevention to accommodate different preferences and improve health care outcomes in Latin America.Item Prevalence and correlates of current cigarette smoking among transgender women in Argentina(University of Texas MD Anderson Cancer Center, United States, 2023-12) Cartujano-Barrera, Francisco; Mejia, Raul M.; Radusky, Pablo; Cardozo, Nadir; Duarte, Mariana; Fabian, Solange; Caballero, Romina; Zalazar, Virginia; Ramos-Pibernus, Alixida; Alpert, Ash B.; Cupertino, Ana Paula; Frola, Claudia; Aristegui, InesObjective: To assess the prevalence of current cigarette smoking among transgender women in Argentina, and to examine the unique associations of current cigarette smoking with demographic and psychosocial factors. Methods: This study is a secondary data analysis of the TransCITAR – a prospective cohort study of transgender individuals living in Buenos Aires, Argentina – baseline data. The baseline survey collected information on sociodemographic characteristics, perceived health status, depressive symptoms, suicide attempts, current cigarette smoking, alcohol use disorder, and substance use. Participants were also asked about lifetime experiences of physical and sexual violence perpetrated by partners, clients and/or the police, and experiences of gender identity stigma in the past year from healthcare workers and the police. Lastly, participants were asked if they had ever been arrested. Fisher’s exact test was used to compare proportions in categorical variables and student t-test was used for continuous variables. Significant associations with current cigarette smoking were tested in a logistic regression model adjusted for all significant associations. Results: A total of 41.7% of participants (n = 393) reported current cigarette smoking. Compared to their non-smoking counterparts, participants who reported current cigarette smoking (1) had completed less education, (2) were more likely to be born in Argentina, (3) more likely to had migrated to Buenos Aires from other parts of the country, (4) more likely to report a history of sex work, (5) more likely to perceive their health as excellent, (6) more likely to screen positive for hazardous alcohol drinking, (7) more likely to report any substance and cocaine use in the past year, (8) more likely to experience gender identity stigma from the police in the past year, and (9) more likely to being arrested in their lifetime (all p’s < 0.05). After controlling for all significant associations, education level of less than high school (AOR = 1.79, 95% CI 1.02–2.12), hazardous drinking (AOR = 2.65, 95% CI 1.30–5.37), and any substance use in the last year (AOR = 2.14, 95% CI 1.16–3.94) were positively and independently associated with current cigarette smoking. Conclusion: Among transgender women in Argentina, current cigarette smoking was more than double the rate for cisgender women. Current cigarette smoking was associated with education, hazardous drinking, and any drug use. These results will inform future smoking cessation interventions among transgender women in Argentina.Item Reduction of Gender Identity Stigma and Improvements in Mental Health Among Transgender Women Initiating HIV Treatment in a Trans-Sensitive Clinic in Argentina(2020-12) Radusky, Pablo; Zalazar, Virginia; Cardozo, Nadir; Fabian, Solange; Duarte, Mariana; Frola, Claudia; Cahn, Pedro; Sued, Omar; Aristegui, InesPurpose: Stigma toward transgender women (TGW) increases psychosocial vulnerability, leading to poor mental health and affecting access and retention in HIV care. Trans-sensitive health care (TSHC) has the potential to mitigate this adverse impact. This study aimed to describe baseline characteristics in gender identity stigma (GIS), mental health, and substance use among TGW living with HIV initiating antiretroviral treatment and to analyze changes after 6 months in HIV care in a TSHC clinic in Argentina. Methods: Sixty-one TGW living with HIV responded to the following questionnaires at baseline and after 6 months in TSHC: sociodemographic, experiences of GIS (in health care, police, etc.), Center for Epidemiologic Studies Depression Scale (CES-D) (depression), State Trait Anxiety Inventory (STAI) (anxiety), Drug Abuse Screening Test (DAST-10) (drug use), Alcohol Use Disorders Identification Test (AUDIT) (alcohol use), 8-item Personal Wellbeing Index-Adults (PWI-A) (quality of life [QOL]), Personality Inventory for DSM-5-Brief Form (PID-5-BF) (maladaptive personality traits), and Duke Index (social support). Analyses included Pearson correlations to analyze associations between variables; and paired sample t-tests, to explore changes between baseline and 6 months. Results: A significant proportion experienced episodes of GIS the last year in any context. At baseline, 50.8% showed significant depressive symptoms and 65.6% reported any drug use in the last year. At 6 months, participants experienced a significant reduction of GIS, both enacted and internalized, anxiety, drug, and alcohol use, and improvement in QOL. The remaining mental health indicators were not significantly modified. Conclusion: A TSHC service may have a gender-affirmative impact on TGW initiating HIV care that contributes to reduce GIS and substance use and improve mental health. This highlights the importance that HIV care programs for TGW comply with trans-sensitive essential components to enhance retention.