Browsing by Author "Rodriguez, Violeta J."

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    A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care
    (2022-06) Sued, Omar; Cecchini, Diego; Rolón, María José; Calanni, Liliana; David, Daniel; Lupo, Sergio; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen M.; Alcaide, Maria Luisa; Rodriguez, Violeta J.; Mantero, Alejandro; Jones, Deborah L.
    Background Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, p = 0·027), and self-efficacy (B = 0·063, p = 0·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted.
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    Differential Item Functioning by HIV Status and Sexual Orientation of the Center for Epidemiological Studies– Depression Scale: An Item Response Theory Analysis
    (2021-1) Radusky, Pablo; Rodriguez, Violeta J.; Kumar, Mahendra; Jones, Deborah L.
    The Center for Epidemiological Studies-Depression Scale (CES-D) is the most widely used instrument to assess depressive symptoms in people living with HIV. However, its differential item functioning (DIF) by HIV status and sexual orientation has yet to be explored. This study examined DIF and measurement invariance of the CES-D using an item response theory (IRT) framework, and a more traditional factor analytic approach. Data from 841 HIV-infected and HIV-uninfected individuals, from Miami, Florida, were analyzed. Uniform DIF by HIV status was detected in Items 4, 12, and 16 from the Positive Affect factor. Nonuniform DIF was detected in Items 13 and 17. Uniform DIF by sexual orientation was detected in Items 2, 15, and 19, two of them from the Interpersonal factor. Nonuniform DIF was detected in Item 2. Using a factor analytic approach, the CES-D was invariant at the configural and metric levels by HIV and sexual orientation. These findings indicate that overall, however, using IRT, the magnitudes of DIF were negligible, the CED-D was somewhat invariant using factor analytic methods; the CES-D may be reliably used to compare by HIV status or sexual orientation.