Browsing by Author "Meade, Christina S"

Objective: The prevalence of cognitive impairment in HIV-positive patients is estimated to be 39% in Uganda [1]. Despite the high prevalence of impairment, routine HIV management in Uganda does not include neuropsychological assessment. The objective of this study was to compare performance on the gold standard neuropsychological exam and on the CogState computerized exam. We hypothesized that there would be a high degree of correlation between performance on the two exams.

Methods: This cross-sectional survey was conducted from August to October 2011. Each participant completed the standard neuropsychological exam, which consisted of 10 tasks across 7 cognitive ability domains. Patients also completed CogState, which consisted of 4 tasks using playing cards. Performance for each exam was standardized using normative data from HIV seronegative controls to produce z-scores. The primary outcome measures were average z-scores of performance for each exam.

Results: Out of 181 patients tested, 130 (72%) were classified as impaired on the gold standard neuropsychological exam, while 104 (57%) were classified as impaired on CogState. The sensitivity of CogState compared to the gold standard was 65% (95% CI = 56% - 73%) and the specificity was 63% (95% CI = 48% - 73%). The Pearson's correlation of cumulative performance between the exams is 0.552, which is significant at the 0.01 level. Finally, those patients with normal cognition performed the best on CogState, while those with the most severe impairment performed the worst.

Conclusions: Our findings suggest that CogState is a feasible and useful tool to screen for and monitor impairment in HIV-positive patients, especially in resource-limited settings. Future studies are needed to examine how individual performance on CogState changes over time.

Introduction: South Africa has witnessed a tremendous rise in methamphetamine consumption since the year 2000. Sex trading is a phenomenon that has been observed in active drug users, globally and within South Africa, and has been associated with risks for HIV infection and violence. This paper is a secondary analysis examining sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Respondent driven sampling was used to recruit 360 active methamphetamine users in a peri-urban township in Cape Town. A structured clinical interview and computerized survey were used to assess history of sex trading, demographics, drug use, sexual risk behaviors, history of violence, and mental health. Logistic regression models were used to examine predictors of sex trading, separately for men and women. Results: In a total sample of 201 men and 159 women, 40% of men and 33% of women endorsed trading sex for tik or money in the past 3 months. Those who traded sex were more likely to meet the criteria for ICD-10 amphetamine dependence among both men (OR=4.59, 95% CI=1.31-16.13) and women (OR=8.00, 95% CI: 1.02-62.59). Men who were concurrent heroin users were also more likely to exchange sex (OR=2.58, 95% CI: 1.06-6.28). Sexual risk behaviors were significantly associated with sex trading. Notably, unprotected sex with a casual partner was correlated with sex trading in men (OR=3.57, 95% CI:1.66-7.69) and women (OR=3.68, 95% CI:1.63-8.29). Among women, those who experienced childhood sexual trauma (OR=3.79, 95% CI: 1.89-7.59) and had the symptoms of post-traumatic stress disorder (OR=2.95, 95% CI: 1.45-5.99) were also more likely to trade sex. Discussion: This study offers insight into the interventions needed for this high-risk population in a LMIC (low and/or middle income countries) context. The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. The risky sexual practices illustrate how targeted interventions geared toward safe sex practices may help this population. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior. In a context of high rates of trauma and violence, women need interventions that are attuned to their particular vulnerabilities and offer empowerment through counseling.

South Africa has a substantial HIV epidemic as well as a rising methamphetamine use problem, particularly in Cape Town. Respondent driven sampling (RDS) may be a useful tool for engaging vulnerable and hard-to-reach populations in HIV research, although its effectiveness has not yet been examined among South African methamphetamine users. The aim of the current study was to describe the effectiveness of RDS as a method for engaging methamphetamine users in Cape Town into a HIV behavioral research study. RDS procedures were used to screen 374 potential participants from a peri-urban township in Cape Town. Measures of homophily, equilibrium and RDS-1 estimators were computed for key demographic and social variables.

Beginning with 8 seeds, 345 methamphetamine users were enrolled over a 6 month period, with a coupon return rate of 67%. The sample included 197 men and 148 women who were ethnically diverse (73% Coloured, 27% Black African) and had a mean age of 28.8 years (SD=7.2). Social networks were adequate (mean network size >5) and mainly comprised of close social ties. Equilibrium on race was reached after 11 waves of recruitment, and after ≤3 waves for all other variables of interest. There was little to moderate preference for either in- or out-group recruiting in all subgroups.

Results suggest that RDS is an effective method for engaging methamphetamine users into HIV prevention research in South Africa. RDS may be a useful strategy for seeking high risk methamphetamine users for HIV testing and linkage to HIV care in this and other low resource settings. We also discuss future directions for RDS studies.

Introduction: Police brutality is a form of violence that negatively impacts health globally. Illegal drug use increases the likelihood that substance users will meet police globally. Methamphetamine use trends in South Africa have been increasing since the early 2000s. In this paper, secondary data analysis was done to examine predictors of methamphetamine users experiencing police brutality. Methods: Respondent driven sampling was used to recruit a sample of 360 active methamphetamine users in Delft, Cape Town, South Africa. Clinical interviews and computerized interviews were used to capture historical information about demographics, drug use, experiences of police violence, attitudes towards police, gang involvement, and arrest records. Logistic regression models were used to determine predictors of experiences of police brutality by sex. Results: The sample had a total of 202 males and 160 females, experiences of police violence were 53% and 14%, respectively by sex. 94% of participants reported prior arrests. Of those arrests, 48% and 39% were gang and drug related, respectively. Both male and female participants were more likely to experience police violence when reported weapon-related (OR 2.988, 95% CI=1.543-5.787) and drug-related (OR 1.796; 95% CI=1.140-2.829). Discussion: The analysis presented here adds to the current data about predictors of experiencing police violence. Further research should be conducted to determine if these results are generalizable to populations of substance users outside of the Delft township. The creation of policing policies based on research driven interventions need to be drafted and implemented to decrease the negative effects that abuses of police power have on public health.

The most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana use among this population is disproportionately common. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is virtually non-existent. The primary aim of this case-controlled study was to identify patterns of neurocognitive impairment among HIV patients who used marijuana compared to HIV patients who did not use drugs by comparing the groups on domain T-scores. Participants included 32 current marijuana users and 37 non-drug users. A comprehensive battery assessed substance use and neurocognitive functioning. Among the full sample, marijuana users performed significantly worse on verbal memory tasks compared to non-drug users and significantly better on attention/working memory tasks. A secondary aim of this study was to test whether the effect of marijuana use on memory was moderated by HIV disease progression, but these models were not significant. This study also examined whether the effect of marijuana use was differentially affected by marijuana use characteristics, finding that earlier age of initiation was associated with worse memory performance. These findings have important clinical implications, particularly given increased legalization of this drug to manage HIV infection.