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Browsing by Author "Metsch, Lisa R."

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    Effectiveness of a Culturally Tailored HIV and Sexually Transmitted Infection Prevention Intervention for Black Women in Community Supervision Programs A Randomized Clinical Trial
    (American Medical Association, 2021) Gilbert, Louisa; Goddard-Eckrich, Dawn; Chang, Mingway; Hunt, Timothy; Wu, Elwin; Johnson, Karen; Richards, Stanley; Goodwin, Sharun; Tibbetts, Richard; Metsch, Lisa R.; El-Bassel, Nabila; Columbia University; University of Alabama Tuscaloosa
    IMPORTANCE Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs. OBJECTIVE To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-AmericanWomen on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach. INTERVENTION E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information. MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12month period. RESULTS A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P =.01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P =.04). CONCLUSIONS AND RELEVANCE The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women.
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    Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care
    (Elsevier, 2018) Wilson, Tracey E.; Kay, Emma Sophia; Turan, Bulent; Johnson, Mallory O.; Kempf, Mirjam-Colette; Turan, Janet M.; Cohen, Mardge H.; Adimora, Adaora A.; Pereyra, Margaret; Golub, Elizabeth T.; Goparaju, Lakshmi; Murchison, Lynn; Wingood, Gina M.; Metsch, Lisa R.; State University of New York (SUNY) Downstate Medical Center; University of Alabama Tuscaloosa; University of Alabama Birmingham; University of California San Francisco; University of North Carolina School of Medicine; University of North Carolina; University of North Carolina Chapel Hill; Columbia University; Johns Hopkins University; Johns Hopkins Bloomberg School of Public Health; Georgetown University; Montefiore Medical Center; Yeshiva University; Albert Einstein College of Medicine
    Introduction: This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV. Methods: From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of >= 95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017. Results: Adherence of >= 95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the Informed Collaboration Committed Engagement subscale and viral control, controlling for model covariates (AOR = 1.08, p = 0.04), but not for the Tolerance for Uncertainty subscale and viral control (AOR = 0.99, p = 0.68). In separate mediation analyses, the indirect effect of Informed Collaboration Committed Engagement on viral control through adherence (beta = 0.04, SE = 0.02, 95% CI = 0.02, 0.08), and the indirect effect of Informed Collaboration Committed Engagement on viral control through retention (beta = 0.01, SE = 0.008, 95% CI = 0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects. Conclusions: The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV. (C) 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.