2025
Pilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®
Earnshaw V, Collier Z, Wong P, Saifi R, Chong N, Ng R, Azwa I, Basri S, Hassan A, Mousavi M, Omar S, Walters S, Haddad M, Kamarulzaman A, Altice F. Pilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®. AIDS Care 2025, 37: 1313-1331. PMID: 40736373, DOI: 10.1080/09540121.2025.2534539.Peer-Reviewed Original ResearchConceptsHIV-related stigmaClinical-related outcomesClinical Trial Registration:Scalable interventionsPilot randomized controlled trialQualitative focus groupsFocus group resultsQuantitative survey resultsSubgroup of participantsStigma reductionProject ECHOHIV testingIndividual healthcare facilitiesHIV preventionTrial Registration:Structural stigmaFocus groupsIntervention conditionHealthcare facilitiesStigmaGlobal disparitiesPotential benefitsRegistration:InterventionCliniciansUsing nominal group technique to identify and prioritize barriers to decentralizing HIV care to primary health centers in Lima, Peru
Oliveros D, Konda K, Madden L, Montenegro-Idrogo J, Tafur Quintanilla K, Sosa Barbarán K, Nikitin B, Ponticiello M, Benites C, Sánchez J, Altice F. Using nominal group technique to identify and prioritize barriers to decentralizing HIV care to primary health centers in Lima, Peru. BMC Health Services Research 2025, 25: 466. PMID: 40156011, PMCID: PMC11954239, DOI: 10.1186/s12913-025-12618-8.Peer-Reviewed Original ResearchConceptsPrimary health centersNominal group techniqueDecentralized HIV careHIV careHealth centersHIV servicesGroup of healthcare providersDecentralization of HIV careNominal group technique groupsPatient's continuity of careContinuity of carePeruvian Ministry of HealthGroup techniqueEvidence-based strategiesMinistry of HealthHIV stigmaLack of confidenceHealthcare accessPerceived BarriersProvider groupsHealth outcomesHealthcare providersPatient continuityIdentified barriersEducational meetings
2024
Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine
Machavariani E, Bromberg D, Dumchev K, Esserman D, Earnshaw V, Pykalo I, Filippovich M, Ivasiy R, Ahmad B, Long J, Haddad M, Madden L, Oliveros D, Dvoriak S, Altice F. Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine. International Journal Of Drug Policy 2024, 136: 104682. PMID: 39705875, PMCID: PMC11821433, DOI: 10.1016/j.drugpo.2024.104682.Peer-Reviewed Original ResearchConceptsPrimary care centersQuality health indicatorsProvider stigmaEvidence-based practiceGuideline-concordantPatient outcomesHealth indicatorsReduce provider stigmaCare centerInfluence healthcare utilizationSpecialty health servicesPatient-level outcomesTele-educationImprove patient outcomesProvider fearsImplementation trialHealthcare utilizationPreventive careHealth servicesPoor healthLinear mixed-effects modelsImprove attitudesStigmaIncrease accessMixed-effects modelsHigh rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine
Ottesen T, Wickersham J, Lawrence J, Antoniak S, Zezuilin O, Polonsky M, Antonyak S, Rozanova J, Dvoriak S, Pykalo I, Filippovych M, Altice F. High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine. PLOS ONE 2024, 19: e0305086. PMID: 39028735, PMCID: PMC11259278, DOI: 10.1371/journal.pone.0305086.Peer-Reviewed Original ResearchConceptsAntiretroviral therapy prescriptionAntiretroviral therapyCD4 countSubstance use disordersIncreased levels of stigmaNational sampleLevel of stigmaIndependent of risk groupSuboptimal antiretroviral therapyInitiate antiretroviral therapyPopulation of peopleHIV expertsHIV incidenceHIV physiciansHIV treatmentKey populationsTransgender womenAntiretroviral treatmentFeeling thermometerDrinking alcoholSex workersPhysiciansSex partnersPWHRisk groupsInfluence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru
Oliveros Gómez D, Machavariani E, Altice F, Gálvez de León S, Earnshaw V, Montenegro-Idrogo J, Sánchez J, Seminario A. Influence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru. AIDS And Behavior 2024, 28: 2755-2768. PMID: 38878137, DOI: 10.1007/s10461-024-04401-3.Peer-Reviewed Original ResearchConceptsAdherence to antiretroviral therapyART adherenceTransgender womenHIV careSocial determinants of healthDeterminants of healthMultiple health outcomesInfluence of stigmaHIV-related outcomesViral suppression levelsGender minoritiesStigma subscaleAntiretroviral therapyHIV stigmaHealthcare engagementSocial determinantsHealth outcomesHIV clinicHIV epidemicStigmaVulnerable populationsCareOutcome variablesAssess factorsAdherenceHIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician’s Propensity Towards HIV Activism in Malaysia
Chong N, Azwa I, Hassan A, Mousavi M, Wong P, Ng R, Saifi R, Basri S, Omar S, Walters S, Collier Z, Haddad M, Altice F, Kamarulzaman A, Earnshaw V. HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician’s Propensity Towards HIV Activism in Malaysia. AIDS And Behavior 2024, 28: 2780-2792. PMID: 38806844, PMCID: PMC11827331, DOI: 10.1007/s10461-024-04381-4.Peer-Reviewed Original ResearchConceptsExploratory factor analysisHIV-related stigmaIntra-class correlation coefficientPrimary care physiciansTest-retest reliabilityCronbach's alpha valuesOrientation ScaleCare physiciansStigma-relatedPsychometric evaluationHIV treatmentHIV activityAlpha valuesPsychometric qualitiesActivist identitiesHIVClinical practiceFactor analysisCliniciansCorrelation coefficientDay-to-dayStructured activitiesCronbachStigmaPhysicians
2022
Exploring Malaysian Physicians' Intention to Discriminate Against Gay, Bisexual, and Other Men Who Have Sex with Men Patients
Ni Z, Shrestha R, Earnshaw VA, Tee YC, Altice FL, Azwa I, Kamarulzaman A, Zhou X, Wickersham JA. Exploring Malaysian Physicians' Intention to Discriminate Against Gay, Bisexual, and Other Men Who Have Sex with Men Patients. LGBT Health 2022, 10: 169-175. PMID: 36251945, PMCID: PMC9986015, DOI: 10.1089/lgbt.2021.0452.Peer-Reviewed Original ResearchBarriers and Facilitators to Implementing Project ECHO in Malaysia During the COVID-19 Pandemic
Walters SM, Li WP, Saifi R, Azwa I, Omar S, Collier ZK, Hassan A, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. Barriers and Facilitators to Implementing Project ECHO in Malaysia During the COVID-19 Pandemic. Journal Of The International Association Of Providers Of AIDS Care (JIAPAC) 2022, 21: 23259582221128512. PMID: 36177542, PMCID: PMC9528038, DOI: 10.1177/23259582221128512.Peer-Reviewed Original Research
2021
The opioid crisis and HIV in the USA: deadly synergies
Hodder SL, Feinberg J, Strathdee SA, Shoptaw S, Altice FL, Ortenzio L, Beyrer C. The opioid crisis and HIV in the USA: deadly synergies. The Lancet 2021, 397: 1139-1150. PMID: 33617769, DOI: 10.1016/s0140-6736(21)00391-3.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAnalgesics, OpioidBlack or African AmericanCase-Control StudiesDisease OutbreaksEvidence-Based MedicineFemaleFentanylHealth Services AccessibilityHispanic or LatinoHIV InfectionsHumansMaleNeedle SharingOpiate OverdoseOpioid EpidemicOpioid-Related DisordersSocial StigmaUnited StatesWhite PeopleYoung AdultConceptsNew HIV diagnosesHIV diagnosisOpioid epidemicHIV preventionMultiple evidence-based interventionsGreat public health problemRecent HIV outbreaksOpioid overdose death ratesOpioid use disorderLarge central metropolitan areasPublic health problemOverdose death ratesComprehensive health careEvidence-based interventionsDeadly synergyHIV acquisitionSynthetic opioid fentanylSyringe sharingHIV outbreakUse disordersOpioid fentanylTreatment servicesHealth problemsOpioid crisisDeath rate
2019
HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients
Shrestha R, Altice FL, Copenhaver MM. HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. JAIDS Journal Of Acquired Immune Deficiency Syndromes 2019, 80: 166-173. PMID: 30383588, PMCID: PMC6331231, DOI: 10.1097/qai.0000000000001891.Peer-Reviewed Original ResearchConceptsOptimal ART adherenceAntiretroviral therapyMethadone-maintained patientsMethadone maintenance treatmentART adherenceMaintenance treatmentHIV treatment outcomesHIV-positive patientsOpioid agonist therapyMultivariable logistic regressionHIV risk behaviorsExplanatory pathwaysAgonist therapySuboptimal adherenceMedication adherenceHIV treatmentTreatment outcomesHIV stigmaPatientsLogistic regressionHIVPrevention initiativesTherapyAdherenceSignificant correlates
2018
Evaluating Physicians’ Intention to Discriminate Against Patients Living with HIV in Malaysia
Tee YC, Earnshaw VA, Altice FL, Jin H, Kamarulzaman A, Wickersham JA. Evaluating Physicians’ Intention to Discriminate Against Patients Living with HIV in Malaysia. AIDS And Behavior 2018, 23: 1039-1047. PMID: 30560483, PMCID: PMC6459712, DOI: 10.1007/s10461-018-2362-4.Peer-Reviewed Original ResearchConceptsStigma-related constructsMajor university hospitalClasses of patientsCross-sectional online surveyNon-surgical specialtiesMore HIVSocio-demographic characteristicsUniversity HospitalHIV preventionTreatment strategiesPWHClinical experienceHIVBetter carePhysiciansMultivariate linear regressionMedical settingsInternational HIV preventionMost participantsLinear regressionPatientsCarePresent studyParticipantsStigmaStigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study
Dubov A, Galbo P, Altice FL, Fraenkel L. Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study. American Journal Of Men's Health 2018, 12: 1843-1854. PMID: 30160195, PMCID: PMC6199453, DOI: 10.1177/1557988318797437.Peer-Reviewed Original ResearchConceptsPrEP stigmaPre-exposure prophylaxis uptakeExperiences of MSMHIV-negative menPrEP-related stigmaHealth care professionalsPrEP useHIV preventionHIV stigmaMSM communityExperiences of stigmaCondom usePrEP programConstant comparison techniquesPrEPSemistructured interviewsMSMStigmaLack of literatureMenQualitative studyMedicationsChemsexHIV Sero-Status Non-disclosure Among HIV-Infected Opioid-Dependent Individuals: The Roles of HIV-Related Stigma, Risk Behavior, and Social Support
Shrestha R, Altice FL, Sibilio B, Copenhaver MM. HIV Sero-Status Non-disclosure Among HIV-Infected Opioid-Dependent Individuals: The Roles of HIV-Related Stigma, Risk Behavior, and Social Support. Journal Of Community Health 2018, 44: 112-120. PMID: 30043195, PMCID: PMC6330145, DOI: 10.1007/s10900-018-0560-7.Peer-Reviewed Original ResearchConceptsOpioid-dependent individualsOpioid-dependent patientsHIV statusFamily/friendsSexual partnersHIV disclosureHIV sero-status disclosureRisk behaviorsHIV sero statusAntiretroviral therapy adherenceHigh-risk HIVRole of HIVMultivariable logistic regressionSubstance abuse treatment settingsHIV risk behaviorsInconsistent condom useMultiple sex partnersSocial supportHigh HIVSero statusHIV transmissionTherapy adherenceIndependent correlatesHIV riskHIV stigmaAssessment of barrier severity and willingness to enter opioid agonist treatment among people who inject drugs in Ukraine
Zelenev A, Shea P, Mazhnaya A, Rozanova J, Madden L, Marcus R, Altice FL. Assessment of barrier severity and willingness to enter opioid agonist treatment among people who inject drugs in Ukraine. Drug And Alcohol Dependence 2018, 190: 82-88. PMID: 29990648, PMCID: PMC6292439, DOI: 10.1016/j.drugalcdep.2018.05.027.Peer-Reviewed Original ResearchConceptsOpioid agonist therapyOpioid agonist treatmentOpioid-dependent peopleSubstance abuse treatment programsCross-sectional surveyAgonist therapyAgonist treatmentHIV preventionTreatment perceptionsTreatment efficacyOAT expansionStudy participantsTreatment programAddiction treatmentComposite measureSeveritySocial stigmaDrugsTreatmentStructural barriersBarrier severityParticipants
2017
Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia
Vijay A, Earnshaw VA, Tee YC, Pillai V, Hughto J, Clark K, Kamarulzaman A, Altice FL, Wickersham JA. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia. LGBT Health 2017, 5: 61-68. PMID: 29227183, PMCID: PMC5770086, DOI: 10.1089/lgbt.2017.0092.Peer-Reviewed Original ResearchConceptsDiscrimination intentTransgender patientsSociodemographic characteristicsMedical doctors' knowledgeStigma-related constructsUniversity Medical CenterPoor health outcomesMajor university medical centerDevelopment of interventionsMedical CenterTransgender peopleHealth outcomesDoctors' knowledgeDoctors' intentionsHealth disparitiesBetter careIndependent covariatesTransgender stigmaHealthcare settingsKuala LumpurPatientsMedical doctorsPersonal shameDoctorsFrequent targetA Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence
Shrestha R, Copenhaver M, Bazazi AR, Huedo-Medina TB, Krishnan A, Altice FL. A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence. AIDS And Behavior 2017, 21: 1059-1069. PMID: 28108877, PMCID: PMC5344717, DOI: 10.1007/s10461-017-1693-x.Peer-Reviewed Original Research
2015
The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons
Culbert GJ, Bazazi AR, Waluyo A, Murni A, Muchransyah AP, Iriyanti M, Finnahari, Polonsky M, Levy J, Altice FL. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons. AIDS And Behavior 2015, 20: 1026-1038. PMID: 26400080, PMCID: PMC4805506, DOI: 10.1007/s10461-015-1198-4.Peer-Reviewed Original ResearchConceptsAntiretroviral therapyART utilizationIndonesian prisonersMedication attitudesIndonesian prisonsHalf of participantsHIV medicationsHIV stigmaART efficacyMultivariate analysisEligibility guidelinesHIVAdverse effectsMixed-method studyTherapyART attitudesMale prisonersParticipantsMedicationsSocial marketingStructured surveyNegative attitudesStigma Toward Men Who Have Sex with Men Among Future Healthcare Providers in Malaysia: Would More Interpersonal Contact Reduce Prejudice?
Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, Altice FL. Stigma Toward Men Who Have Sex with Men Among Future Healthcare Providers in Malaysia: Would More Interpersonal Contact Reduce Prejudice? AIDS And Behavior 2015, 20: 98-106. PMID: 26324078, PMCID: PMC4718796, DOI: 10.1007/s10461-015-1168-x.Peer-Reviewed Original ResearchCorrelates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis
Culbert GJ, Earnshaw VA, Wulanyani NM, Wegman MP, Waluyo A, Altice FL. Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis. Journal Of The Association Of Nurses In AIDS Care 2015, 26: 743-757. PMID: 26304049, PMCID: PMC4600662, DOI: 10.1016/j.jana.2015.07.006.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnti-Retroviral AgentsAntiretroviral Therapy, Highly ActiveHIV InfectionsHumansIndonesiaInterviews as TopicMaleMiddle AgedPrincipal Component AnalysisPrisonersPrisonsPsychiatric Status Rating ScalesQualitative ResearchSelf DisclosureSexual PartnersSocial DiscriminationSocial StigmaSurveys and QuestionnairesTruth DisclosureConceptsHIV stigmaExperiences of stigmaDrug-related offensesMixed-methods analysisDepth interviewsSyndemic natureLargest prisonFamily membersPrisonersHIV statusIndonesiaDrug useStigmaIncarcerationCurrent incarcerationGroup of HIVMale HIVStigma SurveyHIV treatmentExperienceHIVPrisonOffensesPrevention goalsStigma levels
2014
An assessment of health-care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency
Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, Altice FL. An assessment of health-care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency. AIDS Care 2014, 26: 1223-1228. PMID: 24625279, PMCID: PMC4089975, DOI: 10.1080/09540121.2014.894616.Peer-Reviewed Original ResearchConceptsHealth care studentsMSM patientsVulnerable populationsFuture HIV preventionHealth care providersProfessional health-care studentsMultiple clinical contextsHealth care students' attitudesPatient groupGeneral patientsHIV preventionInternet-based surveyHigh riskHIVPatientsPWIDEffective interventionsTreatment effortsClinical contextGroup comparisonsDental studentsGroup differencesMean scoreSignificant differencesSurvey invitation
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