Browsing by Author "Greene, Meredith"

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    Correlates of Sleep Health among Older-Age People with and without HIV in Uganda
    (Springer, 2024) Yoo-Jeong, Moka; Ratnayake, Aneeka; Tong, Yao; Tsai, Alexander C.; Paul, Robert; Reynolds, Zahra; Ritchie, Christine S.; Seeley, Janet; Hoeppner, Susanne S.; Atwiine, Flavia; Okello, Samson; Nakasujja, Noeline; Saylor, Deanna; Greene, Meredith; Asiimwe, Stephen; Tindimwebwa, Edna; Tanner, Jeremy; Olivieri-Mui, Brianne; Siedner, Mark J.; Medicine, School of Medicine
    There is a growing population of older people with HIV (PWH) in Uganda. Sleep problems disproportionately affect older people and PWH. This study aimed to estimate correlates of sleep health among older Ugandans (aged ≥ 50 years) with and without HIV, using data from the Quality of Life and Aging with HIV in Rural Uganda Study. We used the Pittsburgh Sleep Quality Index to assess sleep quality, duration, and efficiency. We fitted multivariable linear and logistic regression models to estimate the associations between sleep outcomes and variables selected based on the Senescent Sleep Model: age, HIV serostatus, loneliness, urbanicity, symptoms of depression and anxiety, and perceived stress. Of 556 participants, 271 were PWH and 285 were people without HIV (PWoH). There were no statistically significant differences in sleep outcomes by HIV serostatus. Of the total sample, most reported very good (32.79%) or fairly good sleep quality (49.37%). The mean sleep duration was 6.46 h (SD = 1.74). The mean sleep efficiency was 73.98% (SD = 19.52%) with 36.69% having optimal (≥ 85%) sleep efficiency. A positive depression screen was associated with worse sleep quality (adjusted odds ratio [aOR] = 0.21; 95% CI [0.12, 0.36]), shorter sleep duration (b=-0.44; 95% CI [-0.60, -0.28]), and worse sleep efficiency (aOR = 0.51; 95% CI[0.31, 0.83]). Interventions targeting depression may improve sleep among older Ugandans, independent of HIV serostatus. Longitudinal studies are needed to determine the potential bidirectionality of this relationship and elucidate pathways to support sleep health among older Ugandans.
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    HIV, Social Networks, and Loneliness among Older Adults in Uganda
    (Springer, 2024) Quach, Lien T.; Ritchie, Christine S.; Reynolds, Zahra; Paul, Robert; Seeley, Janet; Tong, Yao; Hoeppner, Susanne; Okello, Samson; Nakasujja, Noeline; Olivieri-Mui, Brianne; Saylor, Deanna; Greene, Meredith; Asiimwe, Stephen; Tindimwebwa, Edna; Atwiine, Flavia; Sentongo, Ruth; Siedner, Mark J.; Tsai, Alexander C.; Medicine, School of Medicine
    Loneliness among older adults has been identified as a major public health problem. Yet little is known about loneliness, or the potential role of social networks in explaining loneliness, among older people with HIV (PWH) in sub-Saharan Africa, where 70% of PWH reside. To explore this issue, we analyzed data from 599 participants enrolled in the Quality of Life and Ageing with HIV in Rural Uganda study, including older adults with HIV in ambulatory care and a comparator group of people without HIV of similar age and gender. The 3-item UCLA Loneliness Scale was used to measure loneliness, and HIV status was the primary explanatory variable. The study found no statistically significant correlation between loneliness and HIV status. However, individuals with HIV had smaller households, less physical and financial support, and were less socially integrated compared to those without HIV. In multivariable logistic regressions, loneliness was more likely among individuals who lived alone (aOR:3.38, 95% CI:1.47-7.76) and less likely among those who were married (aOR:0.34, 95% CI:0.22-0.53) and had a higher level of social integration (aOR:0.86, 95% CI: 0.79-0.92). Despite having smaller social networks and less support, older adults with HIV had similar levels of loneliness as those without HIV, which may be attributed to resiliency and access to HIV-related health services among individuals with HIV. Nonetheless, further research is necessary to better understand the mechanisms involved.
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    Prevalence and Correlates of Frailty Among Older People With and Without HIV in Rural Uganda
    (Wolters Kluwer, 2024) Mbabazi, Phoebe; Chen, Geoffrey; Ritchie, Christine S.; Tsai, Alexander C.; Reynolds, Zahra; Paul, Robert; Seeley, Janet; Tong, Yao; Hoeppner, Susanne; Okello, Samson; Nakasujja, Noeline; Olivieri-Mui, Brianne; Tanner, Jeremy A.; Saylor, Deanna; Asiimwe, Stephen; Siedner, Mark J.; Greene, Meredith; Medicine, School of Medicine
    Background: The relationship between HIV and frailty, a predictor of poor outcomes in the face of stressors, remains unknown in older people in sub-Saharan Africa. Methods: We analyzed data from the Quality of Life and Ageing with HIV in Rural Uganda cohort study to estimate the prevalence and correlates of frailty among older people with HIV (PWH) on long-term antiretroviral therapy and among age- and sex-matched HIV-uninfected comparators. Frailty was defined as a self-report of 3 or 4 (and pre-frailty as 1 or 2) of the following phenotypic variables: weight loss, exhaustion, low activity, and slowness. We estimated the prevalence of frailty and prefrailty and fitted logistic regression models to estimate the association between HIV and frailty, adjusting for sociodemographic factors, depression, and other comorbidities. Results: We enrolled 599 participants (49% women) with a mean age of 58 years. PWH had a similar prevalence of frailty (8.1% vs. 10.9%, P = 0.24) but a lower prevalence of prefrailty (54.2% vs. 63.2%, P = 0.03) compared with their HIV-uninfected comparators. In multivariable regression models, people with depression [adjusted odds ratio (AOR) 7.52 (95% CI: 3.67 to 15.40), P < 0.001] and those with ≥1 comorbidities [AOR 3.15 (95% CI: 1.71 to 3.82), P < 0.001] were more likely to be frail. HIV serostatus was not significantly associated with frailty [AOR 0.71 (95% CI: 0.37 to 1.34), P = 0.29]. Conclusions: Older PWH had a similar prevalence of frailty as those without HIV. These findings call for additional study of the factors that contribute to the robustness of older PWH in sub-Saharan Africa.
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    Sex Differences in the Prevalence of Geriatric Syndromes Among Older People Living with HIV Attending an Urban Outpatient Clinic in Kampala, Uganda
    (Dove Press, 2024-11-26) Mbabazi, Phoebe; Banturaki, Grace; Naikoba, Suzan; Nasuuna, Esther M.; Manabe, Yukari C.; Greene, Meredith; Castelnuovo, Barbara; Medicine, School of Medicine
    Background: Older people living with HIV (PLHIV) are at high risk of developing geriatric syndromes. Data on geriatric syndromes among older PLHIV in sub-Saharan Africa are scarce. We examined sex differences in the prevalence and correlates of geriatric syndromes among PLHIV aged ≥60 years on antiretroviral therapy in Kampala, Uganda. Methods: This cross-sectional study analyzed data obtained during the enrollment of older PLHIV into a prospective observational cohort in Kampala. We used the Poisson regression model to explore the association between the number of geriatric syndromes and non-communicable diseases (NCDs), sociodemographic factors, and HIV-related factors. Results: We included 500 participants (48.8% women) with a median age of 64 years (interquartile range, IQR: 62.68). Almost all (94.4%) participants had at least one geriatric syndrome. More women were frail (13.1% vs 5.1%, P-value = 0.01) and had lower physical performance measured using the Short Physical Performance Battery (43.3% vs 26.6%, P-value < 0.01). Similarly, more women had cognitive impairment (83.2% vs 62.9%, P-value < 0.01) and reported falling (48.8% vs 34.0%, P-value < 0.01). Women (adjusted mean ratio, AMR 1.17, 95% CI 1.05-1.30, P-value < 0.01), older age (AMR 1.11, 95% CI 1.07-1.16, P-value < 0.01), no formal education (AMR 1.39, 95% CI 1.06-1.82, P-value = 0.01), underweight (AMR 1.49, 95% CI 1.26-1.76, P-value < 0.01), World Health Organization (WHO) stage 3 or 4 (AMR 1.11, 95% CI 0.01-1.22, P-value = 0.04) and having two or more NCDs (AMR 1.11, 95% CI 1.00-1.23, P-value = 0.04) were associated with a higher number of geriatric syndromes. Conclusion: The prevalence of geriatric syndromes was high among older PLHIV and was more common in women. There is a need to incorporate the screening and management of geriatric syndromes into the care of older PLHIV in sub-Saharan Africa, with a particular focus on women.
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    United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study
    (JMIR, 2024-10-08) Hill, Miranda; Greene, Meredith; Johnson, Julene K.; Tan, Judy Y.; Medicine, School of Medicine
    Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.