Browsing by Author "Tsai, Alexander C."

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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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    Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations
    (Wiley, 2017-03-22) Haberer, Jessica E.; Sabin, Lora; Amico, K. Rivet; Orrell, Catherine; Galárraga, Omar; Tsai, Alexander C.; Vreeman, Rachel C.; Wilson, Ira; Sam-Agudu, Nadia A.; Blaschke, Terrence F.; Vrijens, Bernard; Mellins, Claude A.; Remien, Robert H.; Weiser, Sheri D.; Lowenthal, Elizabeth; Stirratt, Michael J.; Sow, Papa Salif; Thomas, Bruce; Ford, Nathan; Mills, Edward; Lester, Richard; Nachega, Jean B.; Bwana, Bosco Mwebesa; Ssewamala, Fred; Mbuagbaw, Lawrence; Munderi, Paula; Geng, Elvin; Bangsberg, David R.; Pediatrics, School of Medicine
    Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.
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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.