2012 MPH graduates recently presented their community-based masters projects,some of which included a focus on care for HIV patients in local health centers, pregnancy as a predictor for perinatal depression in HIV-positive women, postpartum depression in HIV-positive and HIV-negative women, and enteric disease susceptibility among HIV-positive individuals. Below is a list of HIV-focused abstracts from our students:
Pregnancy Intent and Perinatal Depression in HIV-Positive and HIV-Negative Women
Alice Chen, MPH
Marcia Polansky, ScD(1), Erika Aaron(2)
(1)Drexel University School of Public Health, (2)Drexel University College of Medicine
Background & Objectives: Depression during the perinatal period (during pregnancy and 12 months post-partum) has been linked to poor prenatal behavior and adverse developmental outcomes for the child. Co-occurrence of HIV and depression is a health concern for pregnant HIV-positive women. Pregnancy intent has been identified as a potential risk factor for perinatal depression. This study examined pregnancy planning, timing, wantedness, and feelings about the pregnancy as predictors for depressive symptoms.
Methods: A prospective cohort study was conducted using a structured interview questionnaire administered to pregnant women seeking care at the Women’s Care Center at the Drexel University College of Medicine; data on HIV status, social support and pregnancy intent was collected. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms.
Results: Pregnancy intent was associated with potential depressive symptoms in pregnant women. Women were more likely to score higher on the CES-D if they reported that their pregnancy came too soon, wanted to avoid getting pregnant, and/or felt unhappy about their pregnancy. HIV-positive women wanted to avoid getting pregnant more than HIV-negative women. Prenatal HIV status may predict for postpartum CES-D score; prenatal wantedness of the pregnancy may predict for post-partum CES-D score before adjusting for emotional and instrumental support from the woman’s partner.
Conclusion: Prenatal care clinics should continue to offer mental health services for HIV-positive women with unintended pregnancies. Clinics should identify all women with depressive symptoms in the prenatal period and encourage them to return to the clinic for perinatal care.
Examining the Retention of HIV Positive Patients who attend the Drexel Partnership Comprehensive Care Practice
Darryl Fields, MPH, Sara Allen, RN, CRNP, MSN
HIV positive individuals who remain in care are shown to be healthier and live longer than those who do not. It is estimated 50% of known HIVinfected individuals in the United States are not engaged in regular HIV care. In order to effectively reduce the prevalence of HIV/AIDS in the United States, there is a need for the development of better retention methods. The purpose of this study is to identify characteristics of patients, which attend the Partnership Comprehensive Care Practice, who have the highest risk of being lost to care. It was hypothesized those who are lost to care will have detectable viral loads; CD4 levels less than 500 cells/mm3, and not have private insurance. Results suggested there were significant associations between viral loads and retention status (p<0.0001), between CD4 cell counts and retention status ((p=0.0009); and retention status and whether or not a patient was prescribed ART medication. Results from this study suggest there are populations in the clinic who are in need of targeted inventions in order to enroll them back in to care. Further research should investigate the reasons why patients belonging to these populations are less likely to be retained in care.
Using the Fetal Infant Mortality Review to Assess Availability and Impact of Contraceptives on the Prevention of Perinatal HIV Transmission in Philadelphia
Michelle Holliday, MPH
Kathleen Brady, MD(2), Debra D’Alessandro, MPH(3), Renee Turchi, MD, MPH(1)
(1)Drexel University School of Public Health, (2)Philadelphia Department of Public Health, (3)Health Federation of Philadelphia
Background: Family planning services and preconception care have been identified as essential to preventing perinatal HIV transmission. Data from the Philadelphia Fetal Infant Mortality Review/HIV (FIMR/HIV) project and the Preconception Counseling and Contraception Provider Survey suggest underutilization of contraception and infrequent discussions of preconception counseling by providers with their patients.
Objectives: This project investigates the relationship between provider knowledge and the discussion of pregnancy planning and contraception and explores the impact of this relationship on perinatal HIV transmission in Philadelphia.
Methods: 21 cases of perinatal exposure from the FIMR/HIV project were reviewed and 10 Ryan White Care physicians, nurse practitioners and nurses were interviewed using semi-structured interviews. Interviews were transcribed, coded using theme identification and analyzed for commonalities and differences across themes.
Results: Cases indicated that 52.4% of women did not use contraception and 38.1% of pregnancies were unplanned. Providers reported both facilitating and inhibiting factors such as family planning on site and social chaos/stigma influencing access to care for women of childbearing age with HIV in Philadelphia. Aspects such as time and competing elements in the patient-provider discussion are barriers to consistent discussion. In addition, respondents reported that discussions occur annually, at varied rates and/or when initiated by the patient. Providers reported no knowledge of formal preconception counseling guidelines.
Conclusion: Results illuminate the need to examine perinatal HIV prevention in the context of psychosocial factors experienced by women of childbearing age with HIV in addition to improved coordination of care, enhanced referral systems and development of rigid guidelines for preconception counseling content.
How does Trauma Influence Post-Partum Depression Rates in HIV+/ HIV- Women?
Janay S. Jeter, MPH
Marcia Polansky, ScD, MS, MSW, Brian K. Lee, PhD
Background: Not much is known regarding depression in HIV+ pregnant women or the influence of trauma on HIV status. There is an extreme disparity considering that depression is one of the most common complications in pregnancy. Despite ACOG recommendations, routine screening for depression is not part of the standard of care in all OB practices, and 85% of pregnant women who suffer from depression are not diagnosed. Higher rates of depression were found in Black and Hispanic women, 28% and 35% respectively. Moderate to severe depression alone affects 42% of HIV infected women. Therefore, it’s important to identify and understand the relationship among psychosocial factors that affect depression and health in women living with HIV.
Objective: To determine whether in women who experienced trauma suffer from higher rates of PPD that women who have not, and to see if this pattern applies when comparing HIV+ and HIV- women. Additionally, investigate whether HIV+ women utilize more mental health services for depression, and if the CESD depression scale is a good measure for determining PPD in this study sample.
Methods: A prospective cohort study was performed involving in-person interviews of women age 18-45 that were at least 24 weeks pregnant, and had at least two prenatal care visits and/or 1 postpartum visit. This study conducted a total of 231 completed prenatal interviews, with an outcome of total CES-D score. Descriptive analyses were done, and unpaired t-tests were used to assess the general differences between women who may or may not have experienced trauma, in addition to differences in HIV+ and HIV- women experiencing trauma. The independent relationship between trauma & depression-related factors, and CES-D score was evaluated using ANOVA, chi-square, and multiple linear and logistic regression analyses.
Results: About 25% of women responded yes to experiencing each for of trauma used, experiencing higher CES-D scores that are at least 7 points higher than their counterparts that did not report trauma.
Regardless of completing the study, HIV+ women reported experiencing about 50% yes or no for each trauma category. HIV- women who did not complete the postpartum survey had higher mean CES-D scores for trauma, each having a mean score of least 21.
Conclusions: Women who experienced any form of trauma have higher average CES-D scores when compared to women who didn't. HIV+ women who completed both the prenatal and postpartum survey are experiencing trauma at higher rates and have higher average CES-D scores than HIV- women, but of the women who did not complete the postpartum survey those with HIV+ have higher rates of trauma, but the HIV- women have higher CES-D scores. When adjusting for all other variables previous depression and pregnancy feelings are significant in linear & logistic models.
Assessing Cultural Competence of Providers within a Network of HIV/AIDS Care Providers
Adedipupo King B.Pharm, MPH
Rashidah Abdul-Khabeer, RN, MHS, PhDc(2), Nathalie Bartle, EdD(1)
(1)Drexel University School of Public Health, (2)Family Planning Council, Circle of Care
For organizations that serve culturally diverse populations, the importance of knowing the diversity within their clientele and establishing procedures to ensure the provision of culturally competent services cannot be overemphasized. This is vital to whether or not clients access care and adhere to their treatment regimen. These outcomes are particularly desirable for HIV/AIDS-infected individuals. The cultural competence of providers within a network of HIV/AIDS healthcare service providers in Philadelphia was assessed.
This project aims to: 1) Determine key elements of a culturally competent service delivery system; 2) Identify standards used in various healthcare organizations particularly among STD/HIV care providers; 3) Identify major constraints of providers to providing culturally appropriate services; 4) Determine major population groups that make up the clientele of the Circle of Care and identify their major concerns and needs to receiving culturally appropriate services; and 5) Determine key steps to enhance delivery of culturally appropriate services.
Qualitative methods including key informant interviews with care providers and focus group sessions of clients were conducted. Culturally and Linguistically Appropriate Standards (CLAS) published by the Office of Minority Health was used to develop the interview guides. Results from key informant interviews show that all organizations interviewed have no detailed procedural descriptions for measuring cultural competence. Results from clients signify that experiences of some clients differ from what organizations believe. For example, some clients believe the information collected by organizations during their first meeting is collected as mere formality because such information is not acknowledged in their subsequent encounters with staff.
Enteric Disease Susceptibility Among HIV Positive Individuals<
Jason Mehr, MPH, Ami Patel, PhD, MPH(2),(3), Kathleen Brady, MD(2), Michael Eberhart, MPH(2), Issa Zakeri, PhD(1)
1Drexel University, 2Philadelphia Department of Public Health, 3Centers for Disease Control and Prevention
Background: HIV positive individuals have compromised immune systems, leading to an increased morbidity of disease. Enteric pathogens are the most common form of communicable disease the Philadelphia Department of Public Health (PDPH) investigates. This presents a serious risk to the HIV positive population of Philadelphia.
Objective: Conduct a cross-sectional analysis of the susceptibility of HIV positive individuals to enteric pathogens from 2006-2010.
Methods: Cases were defined as being co-infected with HIV and one of the following mandatory reportable enteric pathogens from between 2006-2010: Salmonella (non-Typhoidal), Shigella, Giardia, Campylobacter, Cryptosporidium, shiga-toxin producing E.coli. Comparison populations consisted of the general HIV and enteric disease population of Philadelphia.
Results: From 2006-2010 18 (8%) campylobacteriosis, 64 (30%) salmonellosis (non-Typhoidal), 31 (15%) shigellosis, 47 (22%) cryptosporidiosis, 1 (<1%) shiga-toxin producing E. coli and 51 (24%) giardiasis cases of co-infection were reported. Of the 212 co-infected cases, 76% were male, 77% reported having diarrhea, and 41% listed as having homosexual contact only. Cases had a mean CD4 count of 242 as opposed to a mean CD4 count of 356 for the HIV-only group. Regression showed that Male-Male sexual contact could be associated with enteric disease status (OR 1.7, 95% CI 1.17, 2.53).
Conclusion: Comparison of CD4 counts and viral loads between coinfected cases and the HIV positive only comparison group depict more severe HIV infection among the co-infected. Results suggest men who have sex with men may not only risk infecting partners with HIV during sexual activity, but enteric diseases as well.