vanessa cooper

The effectiveness of antiretroviral therapy (ART) depends on prompt uptake of treatment and a high level of adherence over the long-term, yet these behaviors are suboptimal. Previous interventions have significantly improved adherence but effect sizes are generally small. The aim of this article is to describe the design and content of an intervention to support uptake and adherence to treatment in HIV positive patients (SUPA intervention), utilizing cognitive behavioral and motivational interviewing (MI) techniques. The intervention was developed in line with Medical Research Council (MRC) guidance for the development of complex interventions and informed by the NICE (National Institute for Health and Care Excellence) Guidelines for adherence, empirical evidence and focus groups. Behavior change techniques were mapped to perceptual and practical barriers to uptake and adherence to ART, identified in previous research. Intervention materials were designed and later discussed within ...

Despite a decline in the number of new HIV infections in the UK overall, the number and proportion of new HIV diagnoses in people aged ≥50 years continues to increase. People aged ≥50 years are disproportionately affected by late diagnosis, which is associated with poorer health outcomes, increased treatment complexity and increased healthcare costs. Late HIV diagnosis also has significant public health implications in terms of onward HIV transmission. It is not fully understood what factors affect the decision of an older person to test for HIV. The aim of this study was to identify factors associated with testing for HIV in people aged ≥50 years who tested late for HIV. We interviewed 20 people aged ≥50 years diagnosed late with HIV to identify factors associated with HIV testing. Interviews were audio recorded, transcribed verbatim and thematically analysed. Seven themes associated with HIV testing in people aged ≥50 years were identified: experience of early HIV/AIDS campaigns, ...

BACKGROUND Asthma is a chronic disease requiring effective self-management to control it and prevent mortality. The use of theory-informed digital interventions promoting asthma self-management is increasing. However, there is limited knowledge concerning how and to what extent psychological theory has been applied to the development of digital interventions, or how using theory impacts outcomes. OBJECTIVE The study aimed to examine the use and application of theory in the development of digital interventions to enhance asthma self-management and to evaluate the effectiveness of theory-based interventions in improving adherence, self-management, and clinical outcomes. METHODS Electronic databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched systematically using predetermined terms. Additional studies were identified by scanning references within relevant studies. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepan...

A systematic review of reviews was conducted to identify and appraise brief measures of health-related quality of life (HRQoL) that have been used in peer-reviewed research with people living with HIV. The review was conducted in two stages: 1) search of electronic databases to identify systematic reviews of tools used to measure HRQoL in adults living with HIV, published since the year 2000; 2) selection of HRQol scales from those identified in the reviews. Inclusion criteria included scales that could be self-administered in 10 min or less, covering at least 3 domains of quality of life (physical function, social/role function and mental/emotional function). For generic scales, inclusion criteria included the availability of normative data while for HIV-specific scales, patient input into the development of the scale was required. Ten reviews met the inclusion criteria. Nine generic scales met the inclusion criteria: the EuroQol five dimensions questionnaire (EQ-5D); Health Utilit...

The number of HIV-positive people aged ≥50 years is rising each year. We measured the prevalence of non-infectious illnesses and their risk factors and described healthcare use in this UK population. A cross-sectional, observational study conducted at an outpatient HIV specialist clinic in south east England. Patients age ≥50 years were invited to complete questionnaires measuring demographics, non-infectious illnesses, medication use, lifestyle and healthcare utilisation. The response rate was 67%. Of 299 participants, 84% reported ≥1 comorbid condition and 61% reported ≥2 (multimorbidity). Most commonly reported were high cholesterol, sexual dysfunction, hypertension and depression. In multivariate analyses, age, number of years HIV positive and duration of antiretroviral therapy remained significant predictors of comorbidity when controlling for lifestyle factors (exercise, smoking and use of recreational drugs and alcohol). Use of non-HIV healthcare services was associated with ...

To assess the effects of expressive writing on health care utilization, clinical variables and subjective quality of life following first myocardial infarction (MI). One-hundred and seventy-nine first MI patients were randomized to Intervention (N = 88) or Control (N = 91) groups. The intervention group wrote about their thoughts and feelings in relation to having had an MI. Controls wrote in a neutral way about daily activities. The main outcome measures were health care utilization, physical status and subjective quality of life (QOL), assessed after one, two, and five months. One-hundred and fifty-six (87%) completed the study. Five months post-intervention, the intervention group had significantly fewer recorded medical appointments compared to controls. The number of prescribed medicines decreased over time within the intervention group but increased within the control group. The intervention group attended significantly more rehabilitation sessions, reported fewer cardiac related symptoms and had lower diastolic blood pressure five months post-intervention. There was no significant group by time interaction on reported physical health. The group by time interaction on reported mental health approached significance, those in the intervention group reporting greater improvement. Expressive writing may be a beneficial strategy which could be incorporated into rehabilitation interventions to help individuals adjust after first MI.

Increasing numbers of older people with HIV are under treatment and care, which is due to both the availability of effective highly active antiretroviral therapy (HAART) and increasing numbers of new transmissions and diagnoses in older adults. Mortality due to AIDS-related malignancies and infections has fallen dramatically in treated patients, but overall mortality remains higher than in the general population [1], and life expectancy is shorter [2 & ]. Mortality due to non-AIDS events (including non-AIDS defining cancers, pancreatitis, liver disease, serious cardiovascular events and endstage kidney disease) is now more common than mortality resulting from AIDS-related events [3 & ]. These diseases are associated with old age in the general population, and because relatively few people living with HIV can be considered old, this has led to speculation that normal ageing is accelerated [4].

BackgroundDepression in childhood or adolescence often has morbidity implications continuing into adulthood, generating needs for specialist services and support.AimsTo estimate the patterns of service use and costs in adulthood of former patients.MethodService use and other cost-related data were collected from former patients. Comparisons were made between those people with and without comorbid conduct disorder in childhood and with data for the general population.ResultsData on 91 people with depression (only) and 49 with comorbid conduct disorder revealed high adulthood service utilisation rates and costs. Inpatient care and criminal justice services were used more frequently by the comorbid group and total costs were significantly higher. There were also indications of higher service use by the comorbid group than the general adult population.ConclusionsThe high and enduring long-term costs associated with childhood depression and conduct disorder give further reason for early ...