Judy Y. Tan

Introduction: Older adults with HIV experience increasing loneliness and social isolation as they age with the stigma of HIV. Group singing is a promising social identity approach but remains largely understudied among people with stigmatizing health conditions. Based on our conceptual model, we developed United Voices (UV), a group-singing intervention for older adults with HIV to mitigate the impacts of stigma on loneliness and social isolation. Methods: We conducted a randomized, waitlist-controlled pilot trial of UV to evaluate its feasibility and acceptability. A total of 23 people with HIV ages 50 years and older were randomized into immediate- (n=13) or delayed-start (n=10) group of 12 weekly 90-minute group-singing sessions via Zoom during COVID-19. Psychosocial and behavioral measures were administered at baseline, 6- and 12-weeks, and semi-structured exit interviews were conducted. Results: Of four a priori feasibility thresholds, only enrollment was met (6.8 per week vs. 6). Of 27 enrolled participants, 23 (85%) were randomized (threshold 100%). Of 13 randomized to the immediate-start arm, 9 (69.2%) completed baseline (threshold 80%); of these, 7 (77.8%) attended at least 10 of 12 rehearsals and 7 (77.8%) completed both follow-up assessments (thresholds 80%). Among the 7 participants who completed the acceptability survey, the 80% benchmark was met for staff support (100%), information provided, the study website, rehearsal structure, and confidence in ability to participate (86% each), but not for overall satisfaction with the choir (71%) or the research study (57%). Exit interviews from 4 of the 13 participants randomized to the immediate-start arm indicated that while participants were at first skeptical regarding online group-singing, the experience was enjoyable, providing a social outlet during shelter-in-place. Discussion: Participants appreciated getting to know and supporting each other over time. The professionally rendered concert recording was a source of pride. Interviewed participants described pride, belonging, and mutual support, consistent with the social identity processes UV is designed to engage; whether these processes reduce loneliness and social isolation remains to be tested. Findings identify the procedural changes needed before a full-scale randomized controlled trial to test the efficacy of UV among older adults with HIV.

Background: Scalable, low-cost strategies for monitoring antiretroviral therapy adherence are increasingly important, particularly in decentralized and telehealth-based care settings. This study assessed both the feasibility and performance of at-home, point-of-care (POC) urine tenofovir (TFV) testing for adherence monitoring, using tenofovir diphosphate (TFV-DP) levels in dried blood spots (DBS) as a pharmacological standard of adherence. Setting: This study was conducted within the LetSync cohort of people with HIV in primary romantic relationships, primarily Black men who have sex with men, across the U.S. Methods: Participants self-collected POC urine TFV testing and DBS samples over five timepoints across eight months. Adequate adherence was defined as TFV-DP ≥4 doses/week in DBS. Generalized estimating equation models evaluated associations between urine TFV results and DBS-based adherence, as well as the probability of sample return over time. Results: Among 86 participants and 341 paired samples, detectable urine TFV was strongly associated with adequate adherence in DBS (aRR = 2.86; 95% CI: 1.37–5.99). The urine POC test demonstrated high sensitivity (97%) and positive predictive value (85%), with lower specificity (31%). Across timepoints, urine samples showed higher return rates compared to DBS (aRR = 1.04; 95% CI: 1.01–1.08). Participants with detectable viral load had lower return rates for DBS compared to urine. Conclusions: At-home POC urine TFV testing is a sensitive and feasible approach for monitoring adherence. Its simplicity and consistently high return rates support its potential as a practical adherence monitoring tool, particularly in settings where VL testing is infrequent or logistically limited.

Background: Older people with HIV experience increasing loneliness and social isolation as they age with the stigma of HIV. Group singing is a promising social identity approach but remains largely understudied among people with stigmatizing health conditions. Based on our conceptual model, we developed United Voices (UV), a group-singing intervention for older people with HIV to mitigate the impacts of stigma on loneliness and social isolation. Methods: We conducted a randomized, waitlist-controlled pilot trial of UV to evaluate its feasibility and acceptability. A total of 23 people with HIV ages 50 years and older were randomized into immediate- (n=13) or delayed-start (n=10) group of 12 weekly 90-minute group-singing sessions via Zoom during COVID-19. Psychosocial and behavioral measures were administered at baseline, 6- and 12-weeks, and semi-structured exit interviews were conducted. Results: Enrollment (M=6.8/week) was on par with a priori feasibility threshold, proportion randomized was 85%, lower than threshold (100%). In the immediate-start group, proportion attending at least 10 of the 12 weekly sessions was 77.8%, lower than threshold (80%). Most participants gave moderately high to high ratings for experience with study and group singing program. Conclusions: Most of the a priori feasibility thresholds were met, and satisfaction with the intervention content and implementation procedures was moderately high to high. Group singing affords social opportunities for stigmatized people to reclaim a “spoiled identity” in positive terms through group pride, personal control, belongingness, and social bonding, thereby mitigating loneliness and social isolation. Findings support a subsequent full-scale randomized controlled trial.

Background: Physicians often fail to communicate important details about key risks and benefits of treatment in prostate cancer consultations, an information gap that may inhibit effective patient participation in care decisions. We developed a framework to assess detail and personalization of physician communication of key concepts, derived from observations of treatment consultations. Methods: We recorded and transcribed treatment consultations of 50 men with newly diagnosed prostate cancer across 10 multidisciplinary providers. Using open coding, analysts identified statements related to guideline-endorsed SDM concepts and categorized the level of detail for each topic. Concept-specific hierarchies indicating increasing detail were integrated into a unified framework. We reported the highest observed level for each concept across consultations. Results: Across 19,388 statements, sentences addressing cancer severity (1,016; 5.2%), baseline function (186; 1.0%), oncologic endpoints (343; 1.8%), cancer prognosis (318; 1.6%), life expectancy (111; 0.57%), and treatment-related side effects (952; 4.9%) were extracted. Empirically derived frameworks for evaluating the level of detail and personalization for each concept consistently displayed parallel levels of detail. We created a unified framework, with each level providing more precise, patient-specific risk communication: (0) omission, (1) no quantification, (2) binary assessment, (3) imprecise quantification, (4) specific quantification, and (5) patient-specific estimate. The prevalence of the highest observed level of detail and personalization conveyed varied by concept, ranging from 4% to 84%, 0% to 47%, 0% to 42%, 2% to 8%, 0% to 48%, and 0% to 66% for levels 0 to 5, respectively. Conclusions: Our framework introduces an empirically derived, structured foundation for characterizing the level of detail and personalization of physician risk communication of key concepts in prostate cancer consultations.

Group singing has been shown to have positive effects on health and well-being. These interventions have been shown to generally be helpful in enhancing health outcomes in people with stigmatising conditions. However, the effect of these interventions on biological markers of health is less understood. This scoping review will map the existing evidence on the effect of group singing interventions on biomarkers in people with stigmatising health conditions, such as HIV. This scoping review aims to explore the relationship between group singing interventions and biomarkers in people with stigmatising health conditions. This review will follow the Joanna Briggs Institute methodology for scoping reviews. We will search the following databases: PubMed, CINAHL, PsycINFO, EMBASE, and Cochrane Library. We will also search grey literature sources, such as conference proceedings and dissertations. Two reviewers will independently screen titles and abstracts, and full-text articles for inclusion. Data will be extracted using a standardised form (PRISMA-SCR), and a narrative synthesis will be conducted. This review will consider studies that include adults with stigmatising health conditions who have participated in group singing interventions. Studies must also include biomarkers as outcome measures. Our research will provide a significant contribution by taking a more specific approach to understanding how group singing interventions affect health biomarkers in populations that have been historically excluded due to stigma. Our focus on objective outcomes of this social intervention may inform future research on the best ways to use group singing interventions, including who is most affected, what specific health benefits can be derived from group singing, and the strength of evidence of group singing in general. This review was pre-registered on OSF at https://osf.io/qbg7x/ .

LGB (lesbian, gay, and bisexual) individuals have higher rates of tobacco and alcohol use than the general population. While protective social policies have been found to reduce these disparities, their long-term impact remains largely unknown. In this study, we used data from waves 3 (2001–2002) and 4 (2008–2009) of the National Longitudinal Study of Adolescent to Adult Health to assess the impact of exposure to LGB state policy protections during emerging adulthood on substance use in young adulthood. Using multivariable Poisson models, we evaluated whether emerging adulthood was a critical period of exposure and quantified the relative reduction in substance use disparities between LGB and heterosexual individuals living in more protective states. Findings suggest that LGB individuals living in states with more policy protections during emerging adulthood had a significantly lower prevalence of tobacco use and binge drinking in young adulthood compared with those in less protective states. These findings were not observed among heterosexual individuals, indicating that policy effects were specific to LGB individuals. Furthermore, these protections appeared to reduce overall substance use disparities, especially among female participants. It is critical to continue evaluating policy protections to safeguard the health of the LGB community, especially considering the potential erosion of these vital protections.

Background: Disparities persist in testing and treatment for hepatitis C virus (HCV), leaving socially marginalized populations, including people who inject drugs (PWID), less likely to benefit from curative treatment. Linkage services are often insufficient to overcome barriers to navigating the medical system and contextual factors. Methods: The You’re Empowered for Treatment Initiation (YETI) Partner trial is a single-site randomized controlled trial evaluating the efficacy of a two-session behavioral intervention that engages injecting partners as peer navigators for HCV treatment. We aim to recruit 250 PWID and their primary injecting partners in San Francisco, California, randomizing them 1:1 to either a control or intervention group. The primary outcome is the initiation of HCV treatment, with secondary outcomes including treatment completion and sustained virologic response 12 weeks post-treatment. Data will be collected through questionnaires and electronic health records and analyzed using intention-to-treat and mixed-effects models. Discussion: This trial will provide evidence of a new HCV treatment linkage intervention leveraging the support of primary injecting partners to initiate HCV treatment. If successful, the intervention could inform public health strategies and policies to address HCV in marginalized populations. Trial registration: ClinicalTrials.gov NCT06179498. Registered on December 22, 2023.

Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.

Background: Dietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics. Methods: Data were from a 2013–2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation. Results: Three dietary patterns were identified: “Asian,” “Western,” and a distinct “Multicultural” factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy. Conclusions: The finding of a distinct “Multicultural” factor beyond the typical “Asian” and “Western” factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.