Pence ADEPT IAPAC 2013

Pence Fidelity IAPAC 2013

Where: Keck Center (100) • 500 Fifth St. NW, Washington, DC 20001

Topics: Diseases, Global Health, Children, Youth and Families

Activity: The Outcome and Impact Evaluation of Global HIV/AIDS Programs

Boards: Board on Global Health, Board on Children, Youth, and Families

The Institute of Medicine will host a public dialogue session on the Evaluation of PEPFAR report authored by the Committee for the Outcome and Impact Evaluation of Global HIV/AIDS Programs Implemented under the Lantos/Hyde Act of 2008. The session will be held on April 1^st from 10:00 a.m. to 5:30 p.m. at the Institute of Medicine Keck Building at 500 5^th Street NW, Washington DC. The morning will include presentations by representatives of the evaluation committee and other stakeholders involved in the global response to HIV/AIDS, as well as a participant and panelist discussion. In the afternoon, participants will break out into small groups to explore specific report topics in greater depth.

This event is open to the public, however registration is limited based on space availability. For those unable to attend person, webcasting will be available on this website. To attend this event in person or watch the webcast please RSVP with the registration link provided on this page. More details regarding panelists,discussants, and breakout sessions will also be available on this website within the next few weeks.

For more information, please visit the Institute of Medicine’s Webpage on the event using this link: http://www.iom.edu/Activities/Global/PEPFAR2/2013-APR-01.aspx

The second edition of “‘You’re the First One I’ve Told’: The New Faces of HIV in the South” by authors Kathryn Whetten and Brian Pence, which is now available for order, provides new details on the HIV/AIDS epidemic in the South while bringing to life the stories and voices of people infected with the disease.

As HIV is explained within the context of individuals’ life histories, beliefs, attitudes and current life situations, the book’s latest edition incorporates new HIV research that gets to a deeper issue. In a recent Duke study, Whetten and Pence found that many people living with HIV in the South have experienced sexual abuse, physical abuse, family violence, early loss or other traumatic experiences. Those who experienced more traumatic events in their lifetime tended to have worse overall physical health and cognitive functioning.

“We found that HIV was simply one more event in a long history of traumatic life experiences,” write the authors in the book. “We believe it is critical to develop HIV medical care models that acknowledge, ask about, and respond to patients’ life histories in order to best promote patients’ health.”

The most Southern states of the U.S., including Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and east Texas, accounted for 36 percent of new AIDS diagnoses in 2009, while only containing 22 percent of the US population. Many of the underlying reasons for the spread of the disease in the region have yet to be been addressed by policy makers. Those issues include ignorance about HIV, reluctance to get tested, non-adherence to treatment protocols, and resistance to behavioral changes.

“The South has been the epicenter of the U.S. HIV epidemic for the last decade, and the authors have used a balanced set of information from both surveys and personal observations to present a poignant and accessible portrait of the complexities of human health and disease,” John Bartlett, professor of medicine and global health at the Duke Global Health Institute.

“Expertly linking patients’ pasts to their current struggles to obtain health care and support, the stories related here contextualize AIDS within the lived experiences of the poor and marginalized communities that bear the greatest burden of HIV in the American South,” said Paul Farmer, professor at Harvard University, and board member at the Duke Global Health Institute. “This book offers indispensable insight into the ways that large-scale social forces shape the lives of those facing AIDS.”
The book was first published in 2002.

From: February 27, 2013 at 12:00pm to: 1:00pm

In 2012, the POFO team completed Round 8 data collection at four of the six POFO study sites (the two Indian sites were awaiting official approval from the Indian Council of Medical Research, which was granted in May 2012, delaying the data collection).

In April 2012, an NIH grant was awarded to Dr. Lynne Messer called “Pathways to Health and Wellbeing”; this grant will conduct additional interviews with the child POFO participants to assess their social and sexual networks.

In June 2012 the sixth paper utilizing POFO data was published by Dr. Thielman (DGHI faculty) in PLoS ONE, called ”Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: the Importance of Caregiver Health.” As of November 2012, all six study-sites began administering the Round 9 surveys.

Publications

• O’Donnell K, Murphy R, Ostermann J, Masnick M, Whetten RA, Madden E, Thielman NM, Whetten K, The Positive Outcomes for Orphans (POFO) Research Team. A brief assessment of learning for orphaned and abandoned Children in low and middle-income countries. AIDS Behav 16(2): 480-90, 2012.
  • ABSTRACT: Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes.
• Thielman N, Ostermann J, Whetten K, Whetten R, O’Donnell K (2012) Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health. PLoS ONE 7(6): e38109. doi:10.1371/journal.pone.0038109
  • ABSTRACT: Poor caregiver health is a strong signal for poor health of Orphans and Abandoned Children. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.

In 2012, CHPIR obtained a R21 grant supplement, Pathways to Health and Wellbeing: social networks of orphans and abandoned youth, which further analyzes the cohort from the POFO study in relation to various social networks. The primary goal of this study is to determine key factors that may put youth at a disadvantage as they transition from structured care settings into their adult lives and those that support positive transitions. In order to accomplish this task, researchers will study existing education and employment support networks as well as sexual communities. Researchers will then be able to determine how certain characteristics of these networks are associated with OAC health outcomes, including poor education, ability to generate income, and HIV risk-taking behaviors. Based on prior OAC-related research, this study expects to find that OAC networks are small and lack variability, leading to reduced access to education, fewer positive employment opportunities, and increased sexual-risk behavior. Findings will be used to construct potential interventions to promote OAC health and well-being.

• Round 7 interviews were completed and the last Round of interviews (Round 8) began.

• Two stakeholder meetings were held in Moshi, Tanzania, in February 2012 and November 2012, and were attended by members of the community as well as local clinical staff and policymakers.
• In April 2012, Kristin Johnson (Economics doctoral student) presented CHAT data from her doctoral dissertation called “Subjective Expectations and Adherence to Antiretroviral Treatment: Evidence from Tanzania” at the annual Society of Behavioral Medicine meeting in New Orleans.
• In May 2012, Dr. Pence (DGHI faculty) published a paper describing CHAT data in PLoS ONE, titled “Prevalence of Psychological Trauma and Association with Current Health and Functioning in a Sample of HIV-infected and HIV-uninfected Tanzanian Adults”
• Elizabeth Reddy (DGHI faculty) presented a poster titled, “The Loliondo phenomenon: Reduced adherence to antiretroviral therapy following mass visits to ‘Babu wa Loliondo’ in Tanzania” at the International AIDS Conference in Washington, DC, in June 2012
• A one-year supplemental grant was awarded in September 2012 to conduct a pilot study in St. Petersburg, Russia, with 500 HIV-positive patients to explore the psychosocial determinants of HIV medication adherence, retention in care, transmission risk behaviors, and disease progression. This grant will collect similar data to those being collected in Tanzania for CHAT.
• In December 2012, Nadya Belenky (UNC Master’s student, epidemiology) presented her Master’s thesis describing CHAT data on depression, stigma, and adherence to ART to faculty at UNC.

The CHAR Study – Coping with HIV and AIDS in Russia one-year supplemental grant was awarded in September 2012 to conduct a pilot study in St. Petersburg, Russia, with 500 HIV-positive patients to explore the psychosocial determinants of HIV medication adherence, retention in care, transmission risk behaviors, and disease progression. This grant will collect similar data to those being collected in the Coping and Health in Tanzania (CHAT) study.  CHAT is a four-year longitudinal study following a cohort of 1,200 HIV-negative and HIV-positive adults in Moshi, Tanzania, to assess various factors influencing adherence to antiretroviral therapy (ART).  Elizabeth Reddy (DGHI faculty) presented a poster titled, “The Loliondo phenomenon: Reduced adherence to antiretroviral therapy following mass visits to ‘Babu wa Loliondo’ in Tanzania” at the International AIDS Conference in Washington, DC, in June 2012.

Publications & Presentations

• In May 2012, Brian Pence (DGHI faculty) published a paper describing CHAT data in PLoS ONE, titled “Prevalence of Psychological Trauma and Association with Current Health and Functioning in a Sample of HIV-infected and HIV-uninfected Tanzanian Adults”
  • ABSTRACT: This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
• There are several other manuscripts in preparation or under review

With this in mind, we looked for ways to reach people who do not have HIV, but who could be in a position to support those living with the virus. This led to our speaking with faith leaders of Durham churches, and we learned that most churches no longer have an HIV/AIDS ministry, although their pastors are open to HIV education and to welcoming people with HIV into their congregations. Pastors suggested that we create an HIV training that provides HIV information aligned with their teachings on living a Christian life. They also shared that their congregants would like to learn about chronic diseases other than HIV, and they believe that HIV training attendance would increase if the training also includes information on cancer and diabetes.

We have launched the development of this curriculum, with an expected completion in early December, 2012. The curriculum is entitled, “Health Talk: Tackling Health Topics that Affect Our Congregations and Communities.” It includes three modules that can be offered together or separately:

• Health Talk: Diabetes
• Health Talk: HIV
• Health Talk: Cancer

To access the curriculum described above, use this link: Health Talk: HIV Resource Tool (January 2013)