David R Bangsberg
Biographic Data
| ID | 341856 |
|---|---|
| NAME | David R Bangsberg |
| GIVEN NAMES | David R |
| FAMILY NAME | Bangsberg |
| SIGNATURE | BANGSBERG D R |
| AFFILIATIONS | Harvard University |
| ORCID | 0000-0002-6352-8908 |
| VERIFIED | Yes |
| TOTAL WORKS | 148 |
| TOTAL CITATIONS | 183 |
| AUTHOR COUNT | 146 |
| EDITOR COUNT | 2 |
| FIRST PUBLICATION YEAR | 2000 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 7 |
‘We would look at the chickens as a source of security’
Background: Development interventions may promote sustainable livelihoods among participants via improved income generation, health, education, and quality of life. Within the development literature, microfinance institutions (MFIs) provide individuals with funds and/or start-up capital to develop small businesses. However, the evidence on whether MFIs are successful in ensuring sustainable livelihoods is mixed. In this study, we assessed partici…
Social networks and HIV treatment adherence among people with HIV initiating treatment in rural Uganda and peri-urban South Africa
Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have been linked with positive health outcomes, but less is known about the extent to which social network composition and structure are associated with improved ART adherence among people living with HIV (PLWH). We conducted an e…
Uptake and Persistence of Safer Conception Strategies Among South African Women Planning for Pregnancy
Safer conception strategies can minimize HIV acquisition during periconception periods among women living in HIV-endemic areas. We examined uptake and predictors of persistent use of the same safer conception strategy among a cohort of HIV-uninfected South African women ages 18-35 years planning for pregnancy with a partner living with HIV or of unknown HIV-serostatus. The safer conception strategies we evaluated included oral PrEP, condomless se…
The feasibility, acceptability, and preliminary impact of real-time monitors and SMS on tuberculosis medication adherence in southwestern Uganda
We conducted a pilot randomized controlled trial among patients initiating treatment for drug-sensitive tuberculosis (TB). Participants received real-time electronic adherence monitors and were randomized (1:1:1) to: (i) daily SMS (reminders to TB patients and notifications to social supporters sent daily for 3 months, then triggered by late or missed dosing for 3 months); (ii) weekly SMS (reminders to TB patients and notifications to social supp…
I still desire to have a child’
This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer concepti…
Adverse childhood experiences, alcohol consumption, and the modifying role of social participation
Background: Adverse childhood experiences (ACEs) include multiple forms of child maltreatment, including abuse and neglect, as well as other forms of household dysfunction. Studies from Uganda have revealed a high prevalence of child abuse, as well as one of the highest levels of alcohol consumption in Africa. Few population-based studies from Africa have estimated associations between ACEs and adult alcohol use, or assessed the potential bufferi…
A qualitative study of the acceptability of remote electronic bednet use monitoring in Uganda
Objective monitoring of bednet use with SmartNet appears acceptable to these households in Uganda. Use of SmartNet seems to be similar to behaviors around use of standard LLINs. Viewpoints on many aspects of SmartNet were generally favorable. Concerns around ethicality of bednet monitoring are present and indicate the need for continuing community education. The device will continue to be optimized to make it more acceptable to users and to accur…
Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda
Perceived and misperceived norms about khat and/or cannabis use among adults in southwest Uganda
Internalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy
Depression affects over 40% of people with HIV (PHIV) in low- and middle-income countries, and over half of PHIV report HIV-related internalized stigma. However, few longitudinal studies of PHIV have examined the relationship between HIV-related stigma and depression. Data were analyzed from the 2007-15 Uganda AIDS Rural Treatment Outcomes (UARTO) Study, a cohort of 454 antiretroviral therapy (ART)-naïve PHIV (68% women) starting ART. Our primary…
Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda
BACKGROUND: HIV stigma has well-documented negative impacts on HIV testing, transmission risk behavior, initiation of and adherence to antiretroviral therapy, and retention in care. We sought to assess the extent to which anticipated HIV stigma is based on misperceptions of normative attitudes toward persons with HIV, and to determine whether persons with HIV have stronger misperceptions compared with HIV-negative persons or persons of unknown se…
Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes
BACKGROUND: Cardiovascular diseases (CVD) pose a major threat to public health in sub-Saharan African communities, where the burden of these classes of illnesses is expected to double by 2030. Growing research suggests that past developmental experiences and early life conditions may also elevate CVD risk throughout the life course. Greater childhood stress and adversity are consistently associated with a range of adult CVDs and associated risk f…
“I did not plan … that is what hurts”
Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in Kwa…
Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research
Acceptability of an Intervention to Promote Viral Suppression and Serostatus Disclosure for Men Living with HIV in South Africa
Men living with HIV (MLWH) often have reproductive goals that can increase HIV-transmission risks to their pregnancy partners. We developed a safer conception intervention for MLWH in South Africa employing cognitive behavioral skills to promote serostatus disclosure, ART uptake, and viral suppression. MLWH were recruited from an HIV clinic near Durban, South Africa, and encouraged to include partners in follow-up visits. Exit in-depth interviews…
Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines
Cigarette smoking and misperceived norms among adults in rural Uganda
Most adults overestimated cigarette smoking frequency among village peers. Men who incorrectly believed that frequent smoking was the norm were more likely to engage in frequent smoking themselves. Applying a 'social norms approach' intervention by promoting existing healthy norms may prevent smoking initiation or motivate reductions in smoking among men in rural Uganda
Community-derived recommendations for healthcare systems and medical students to support people who are houseless in Portland, Oregon
Medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless
Influences on Adherence to Antiretroviral Therapy (ART) in Early-Stage HIV Disease
The Treatment Ambassador Program
Trajectories of initiation for the heroin-based drug whoonga – qualitative evidence from South Africa
When you have no water, it means you have no peace
Trajectories of HIV-related internalized stigma and disclosure concerns among art initiators and noninitiators in South Africa
Among ART-eligible South African PLHIV entering into HIV care, internalized stigma modestly declined over time but disclosure concerns persisted. PLHIV who initiated ART were more likely to have persistent disclosure concerns over time as compared with those who did not start ART
Relative wealth, subjective social status, and their associations with depression
Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southweste…
Breastfeeding Practices Among Women Living with HIV in KwaZulu-Natal, South Africa
Emergency Department Use Among the Homeless and Marginally Housed
Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons. Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models. Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% e…
Food insecurity, depression and the modifying role of social support among people living with HIV/Aids in rural Uganda
Revolving Doors
Objectives. We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. Methods. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Results. Almost one fourth of participants (23.1%) had a …
The social context of food insecurity among persons living with HIV/Aids in rural Uganda
HIV Seroprevalence Among Homeless and Marginally Housed Adults in San Francisco
Objectives. We report HIV seroprevalence and risk factors for urban indigent adults. Methods. A total of 2508 adults from shelters, meal programs, and low-cost hotels received interviews, blood tests, and tuberculosis screening. Results. Seroprevalence was 10.5% overall, 29.6% for men reporting sex with men (MSM), 7.7% for non-MSM injection drug users (IDUs), and 5.0% for residual non-MSM/non-IDUs. Risk factors were identified for MSM (sex trade …
When you have no water, it means you have no peace
Gender-specific Correlates of Sex Trade among Homeless and Marginally Housed Individuals in San Francisco
The social network context of HIV stigma
Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996–2003
Directly Observed Antidepressant Medication Treatment and HIV Outcomes Among Homeless and Marginally Housed HIV-Positive Adults
Objectives. We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. Methods. We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive diso…
Highly Active Antiretroviral Therapy and Increased Use of Contraceptives Among HIV-Positive Women During Expanding Access to Antiretroviral Therapy in Mbarara, Uganda
Objectives. We investigated whether the prevalence of contraceptive use among women who are HIV positive varied according to use of highly active antiretroviral therapy (HAART) in Mbarara, Uganda. Methods. We used data from a cross-sectional survey of 484 women who were HIV positive (18–50 years) and were attending Mbarara University's HIV clinic, 45% of whom were receiving HAART. Multivariate logistic regression was used to investigate the assoc…
Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population
OBJECTIVE: To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. DESIGN AND SETTING: A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. PARTICIPANTS: Thirty-four HIV-infected pe…
Combination antiretroviral therapy
Recent editorials, conferences and clinical practice articles have discussed providers' concerns and practices regarding prescribing antiretroviral combination therapy for HIV. We aimed to deepen our understanding of these largely anecdotal reports and of the challenges facing experienced HIV clinicians today using qualitative methodology. Eight focus groups using a structured discussion guide were conducted. Data were analyzed by constant compar…
Non-adherence to highly active antiretroviral therapy predicts progression to Aids
The introduction of highly active antiretroviral therapy (HAART) has produced a dramatic reduction in mortality among HIV-infected individuals [1–4]. Whereas the level of adherence to HAART is closely associated with suppression of the HIV viral load in plasma [5–14], a relationship between adherence and disease progression has not been established. Here we examine the relationship between pill-count adherence [10] and progression to AIDS, in a r…
Comparing Objective Measures of Adherence to HIV Antiretroviral Therapy
Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up
OBJECTIVE: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival. DESIGN, SETTING AND PARTICIPANTS: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number…
A computer-based assessment detects regimen misunderstandings and nonadherence for patients on HIV antiretroviral therapy
Accurately assessing nonadherence is a necessary first step toward improving adherence to highly active antiretroviral therapy (HAART). Patient self report is the most practical method for assessing adherence in clinical settings, but may produce unreliable and invalid results unless optimally performed. A computer-assisted, self-administered interview (CASI) may improve the disclosure of medication nonadherence by providing a neutral and seeming…
Emergency Department Use Among the Homeless and Marginally Housed
Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons. Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models. Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% e…
Barriers to Antiretroviral Adherence for Patients Living with HIV Infection and Aids in Botswana
BACKGROUND: Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, we conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence. METHODS: We used both qualitative and quantitative research methodologies, including questionnaires and interviews with patients receiving ARV treatment an…
Reliability and validity of the SF-36 in HIV-infected homeless and marginally housed individuals
Measuring Adherence to Antiretroviral Therapy in a Diverse Population Using a Visual Analogue Scale
PURPOSE: To examine the performance of an instrument to assess adherence based on a visual analogue scale, compared to an instrument based on 3-day recall, using unannounced pill counts in the place of residence as the gold standard. METHOD: We prospectively assessed adherence to antiretroviral therapy in 84 marginally housed indigent HIV-infected patients who were receiving stable antiretroviral therapy in San Francisco, California, with three a…
Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting
BACKGROUND: There are no validated measures of adherence to HIV antiretroviral therapy in resource-poor settings. Such measures are essential to understand the unique barriers to adherence as access to HIV antiretroviral therapy expands. METHODS: We assessed correspondence between multiple measures of adherence and viral load suppression in 34 patients purchasing generic Triomune antiretroviral therapy (coformulated stavudine, lamivudine, and nev…
HIV Seroprevalence Among Homeless and Marginally Housed Adults in San Francisco
Objectives. We report HIV seroprevalence and risk factors for urban indigent adults. Methods. A total of 2508 adults from shelters, meal programs, and low-cost hotels received interviews, blood tests, and tuberculosis screening. Results. Seroprevalence was 10.5% overall, 29.6% for men reporting sex with men (MSM), 7.7% for non-MSM injection drug users (IDUs), and 5.0% for residual non-MSM/non-IDUs. Risk factors were identified for MSM (sex trade …
Revolving Doors
Objectives. We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. Methods. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Results. Almost one fourth of participants (23.1%) had a …
Routine HIV Testing in Botswana
BACKGROUND: The Botswana government recently implemented a policy of routine or "opt-out" HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months af…
Adherence to Haart
Less Than 95% Adherence to Nonnucleoside Reverse‐Transcriptase Inhibitor Therapy Can Lead to Viral Suppression
For antiretroviral therapy, the 95% adherence "threshold" is based on nucloside-exposed patients who are receiving partially suppressive, unboosted protease inhibitor regimens. Using unannounced pill counts and electronic medication monitoring, viral suppression is common with a 54%-100% mean adherence level to nonnucleoside reverse-transcriptase-inhibitor regimens. Although perfect adherence is an important goal, viral suppression is possible wi…
Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America
CONTEXT: Adherence to antiretroviral therapy is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV) and AIDS. Concerns about incomplete adherence among patients living in poverty have been an important consideration in expanding the access to antiretroviral therapy in sub-Saharan Africa. OBJECTIVE: To evaluate estimates of antiretroviral therapy adherence in sub-Saharan Africa and North America. DATA SO…
Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana
Botswana, with its estimated HIV prevalence of 37%, instituted a policy of universal access to antiretroviral therapy (ART) in 2002. Initial enrolment lagged behind expectations, with a shortfall in voluntary testing that observers have attributed to HIV-related stigma - although there are no published data on stigma among HIV-positive individuals in Botswana. We interviewed 112 patients receiving ART in 2000, finding evidence of pervasive stigma…
The Impact of Chronic Hepatitis C on Health-Related Quality of Life in Homeless and Marginally Housed Individuals with HIV
HIV Counseling and Testing Practices at an Urban Hospital in Kampala, Uganda
Monitoring Adherence to HIV Antiretroviral Therapy in Routine Clinical Practice
The Price of Adherence
Gender-specific Correlates of Sex Trade among Homeless and Marginally Housed Individuals in San Francisco
The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating Haart
OBJECTIVE: To determine the impact of depressive symptoms on mortality among HIV/AIDS patients first initiating HAART and the potential role of patient adherence as a confounder and effect modifier in this association. METHODS: The study comprised HIV-positive individuals who were first prescribed HAART between August 1996 and June 2002. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Cox proportiona…
Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland
BACKGROUND: Both food insufficiency and HIV infection are major public health problems in sub-Saharan Africa, yet the impact of food insufficiency on HIV risk behavior has not been systematically investigated. We tested the hypothesis that food insufficiency is associated with HIV transmission behavior. METHODS AND FINDINGS: We studied the association between food insufficiency (not having enough food to eat over the previous 12 months) and incon…
Medicine (141 works) · HIV/AIDS Research and Interventions (115 works) · Environmental health (76 works) · Public health (70 works) · Family medicine (69 works) · Psychology (64 works) · Psychiatry (63 works) · Adolescent Sexual and Reproductive Health (58 works) · Population (56 works) · Demography (54 works)