Racial/Ethnic Disparities in Longitudinal Emotional–Behavioral Functioning Among Youth Born to Women Living With HIV

Bather, Jemar R.; Williams, Paige L.; Broadwell, Carly; Smith, Renee; Patel, Kunjal; Garvie, Patricia A.; Karalius, Brad; Kacanek, Deborah; Mellins, Claude A.; Malee, Kathleen

doi:10.1097/qai.0000000000002665

Cited by 4 publications

(5 citation statements)

References 41 publications

(86 reference statements)

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“…There were also psychosocial risk factors unique to AYAPHEU and AYALPHIV. Substance use was a risk factor for attempted suicide only among AYAPHEU, supporting prior studies that highlight AYAPHEU as a vulnerable group with unique risks that may require tailored interventions [ 41 , 123 , 124 ]. For AYALPHIV, HIV stigma was a risk factor for attempted suicide.…”

Section: Discussionsupporting

confidence: 76%

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

et al. 2022

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Introduction As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV‐exposed but uninfected (AYAPHEU). Methods Data come from an ongoing longitudinal New York City‐based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12–18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first‐reported suicide attempt. Generalized estimating equations were used to examine associations between first‐reported suicide attempt and socio‐demographic, contextual and psychosocial correlates measured concurrently across six timepoints. Results At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21–33%) compared to AYAPHEU (16%, CI 10–22%), with an OR of 1.74 (CI 1.04–2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46–4.85), mood (OR 3.62, CI 1.49–8.81) and behaviour disorders (OR 5.05, CI 2.15–11.87) and past‐year arrest (OR 3.05, CI 1.26–7.4), negative life events (OR 1.27, CI 1.11–1.46), city stress (OR 2.28, CI 1.46–3.57), pregnancy (OR 2.28, CI 1.08–4.81) and HIV stigma (OR 2.46, CI 1.27–4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14–0.52), higher personal (OR 0.45, CI 0.26–0.80) and family self‐concept (OR 0.36, CI 0.22–0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years. Conclusions AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

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Section: Discussionsupporting

confidence: 76%

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

et al. 2022

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“…[40][41][42] SMARTT is a prospective cohort study which evaluates the safety of in utero antiretroviral medication exposure and other maternal exposures on adverse child health outcomes, such as poor infant neurodevelopment. 10 To assess neurodevelopment at age 1 in SMARTT infants, licensed psychologists administered a validated assessment called the Bayley scales of infant development, which measures five areas of infant development: cognitive, language, motor, social-emotional, and adaptive behavior. 41 A composite score is calculated for each domain (reference population mean = 100, SD = 15).…”

Section: Study Backgroundmentioning

confidence: 99%

“…To illustrate an application of the MIM GEE and MIM IPW GEE, we analyzed data from the Surveillance Monitoring for ART Toxicities (SMARTT) study conducted by the Pediatric HIV/AIDS Cohort Study (PHACS) network 40‐42 . SMARTT is a prospective cohort study which evaluates the safety of in utero antiretroviral medication exposure and other maternal exposures on adverse child health outcomes, such as poor infant neurodevelopment 10 . To assess neurodevelopment at age 1 in SMARTT infants, licensed psychologists administered a validated assessment called the Bayley scales of infant development, which measures five areas of infant development: cognitive, language, motor, social‐emotional, and adaptive behavior 41 .…”

Section: Application To the Surveillance Monitoring For Art Toxicitie...mentioning

confidence: 99%

“…In particular, HIV researchers are increasingly interested in evaluating how maternal trimester-specific exposures affect child health outcomes. These exposures during pregnancy include unsuppressed viral load (VL), 9 social determinants of health, 10 substance use, 11 and insurance coverage, 12 which are often included in regression models as binary indicators. Although there is extensive research on evaluating continuous exposures across exposure windows, [1][2][3][4][13][14][15][16][17][18][19] much less is known about the statistical properties of models evaluating binary exposure measures across windows of exposure.…”

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confidence: 99%

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The impact of correlated exposures and missing data on multiple informant models used to identify critical exposure windows

Bather

Horton

Coull

et al. 2023

Statistics in Medicine

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There has been heightened interest in identifying critical windows of exposure for adverse health outcomes; that is, time points during which exposures have the greatest impact on a person's health. Multiple informant models implemented using generalized estimating equations (MIM GEEs) have been applied to address this research question because they enable statistical comparisons of differences in associations across exposure windows. As interest rises in using MIMs, the feasibility and appropriateness of their application under settings of correlated exposures and partially missing exposure measurements requires further examination. We evaluated the impact of correlation between exposure measurements and missing exposure data on the power and differences in association estimated by the MIM GEE and an inverse probability weighted extension to account for informatively missing exposures. We assessed these operating characteristics under a variety of correlation structures, sample sizes, and missing data mechanisms considering various exposure‐outcome scenarios. We showed that applying MIM GEEs maintains higher power when there is a single critical window of exposure and exposure measures are not highly correlated, but may result in low power and bias under other settings. We applied these methods to a study of pregnant women living with HIV to explore differences in association between trimester‐specific viral load and infant neurodevelopment.

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“…A second class of prevention strategies is through addressing the multiple other neurodevelopmental risks faced by children and adolescents with PHIV outlined above. These include structural change to reduce poverty, trauma and adversity, food insecurity, air pollution, systemic inequality and racism, educational and health inequity, and other risks to which children with PHIV are disproportionately exposed [103][104][105]. Comprehensive care to address mental health and substance use is important and behavioral interventions have been developed for this population [83,[106][107][108].…”

Section: Conclusion and Current Directionsmentioning

confidence: 99%

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

Nichols

2022

Curr HIV/AIDS Rep

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Purpose of Review Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life. Recent Findings Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated. Summary Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.

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Racial/Ethnic Disparities in Longitudinal Emotional–Behavioral Functioning Among Youth Born to Women Living With HIV

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 4 publications

References 41 publications

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

The impact of correlated exposures and missing data on multiple informant models used to identify critical exposure windows

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

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