Allen L Gifford
Datos Biográficos
| ID | 197241 |
|---|---|
| NOMBRE | Allen L Gifford |
| NOMBRES | Allen L |
| APELLIDO | Gifford |
| FIRMA | GIFFORD A L |
| AFILIACIONES | Boston University |
| ORCID | 0000-0001-6442-1128 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 42 |
| TOTAL DE CITAS | 21 |
| TOTAL COMO AUTOR | 42 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1964 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 2 |
Exploring HIV provider framings of living and aging with HIV
Complexity of Adherence Challenges
Negative clinic experiences as a barrier to care for people with HIV and their impact on patient preferences for intervention support
We conducted qualitative research among people with HIV (PWH) and care providers in Cape Town, South Africa to understand the impact of negative clinic experiences on adherence and support preferences. In-depth interviews were conducted with 41 patients with an unsuppressed viral load or a treatment gap, and focus group discussions with physicians, nurses, counselors, and community health workers. Questions addressed treatment history and adheren…
Patients’ and Providers’ Views on Optimal Evidence-Based and Scalable Interventions for Individuals at High Risk of HIV Treatment Failure
Real-time Feedback to Improve HIV Treatment Adherence in Pregnant and Postpartum Women in Uganda
We assessed an intervention aimed at improving adherence to antiretroviral therapy (ART) among pregnant and postpartum women living with HIV (PPWLH). We randomized 133 pregnant women initiating ART in Uganda to receive text reminders generated by real time-enabled electronic monitors and data-informed counseling through 3 months postpartum (PPM3) or standard care. Intention-to-treat analyses found low adherence levels and no intervention impact. …
Staff and Veteran Perspectives on Residential Treatment Programs’ Responses to Covid-19
Healthcare must rapidly and systematically learn from earlier COVID-19 responses to prepare for future crises. This is critical for VA's Mental Health Residential Rehabilitation and Treatment Programs (RRTPs), offering 24/7 care to Veterans for behavioral health and/or homelessness. We adapted the World Health Organization's After Action Review (AAR) to conduct semi-structured small-group discussions with staff from two RRTPs and Veterans who rec…
Provider Perceptions of Virtual Care During the Coronavirus Disease 2019 Pandemic
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC. OBJECTIVE: The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks. DESIGN: This was a voluntary survey. PARTICIPANTS: Mental health (MH), primary care, medical…
How Should We Organize Care for Patients With Human Immunodeficiency Virus and Comorbidities? A Multisite Qualitative Study of Human Immunodeficiency Virus Care in the United States Department of Vete…
BACKGROUND: With human immunodeficiency virus (HIV) now managed as a chronic disease, health care has had to change and expand to include management of other critical comorbidities. We sought to understand how variation in the organization, structure and processes of HIV and comorbidity care, based on patient-centered medical home (PCMH) principles, was related to care quality for Veterans with HIV. RESEARCH DESIGN: Qualitative site visits were c…
Retention in HIV Care Among HIV-Seropositive Pregnant and Postpartum Women in Uganda
The relationship between gastrointestinal symptom attribution, bothersomeness, and antiretroviral adherence among adults with HIV
Patients who attribute their symptoms to HIV medications, rather than disease, may be prone to switching antiretrovirals (ARVs) and experience poor retention/adherence to care. Gastrointestinal (GI) symptoms (e.g., nausea/vomiting) are often experienced as a side effect of ARVs, but little is known about the relationship of symptom attribution and bothersomeness to adherence. We hypothesized that attribution of a GI symptom to ARVs is associated …
Use of testosterone in men infected with human immunodeficiency virus in the veterans healthcare system
Testosterone supplementation has been widely used in those infected with human immunodeficiency virus (HIV) for hypogonadism, and wasting. But with effective antiretroviral therapy and increasing recognition of atherosclerotic disease and adults infected with HIV, the risks of inappropriate testosterone use in HIV-infected patients are far better recognized than previously. Testosterone use has expanded among U.S. males, but few studies have exam…
Improving VHA’s Approach to Community Care
Yakovchenko, Vera MPH, MS*; Gifford, Allen L. MD†,‡; Matthews, Kameron L. MD, JD§; Greenstone, Clinton L. MD§,∥,¶; Tsai, Jack PhD#,**; McInnes, D. Keith ScD, MSc*,† Author Information
The role of motivation in predicting antiretroviral therapy adherence in China
Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on impro…
“It is easier for me to shoot up”
Many HIV-positive people who inject drugs (PWID) globally are not receiving HIV care. This represents a major challenge among key populations to end the global HIV epidemic. This qualitative study explored the process and associated barriers of linking HIV-positive PWID who are in addiction treatment to HIV care in St. Petersburg, Russia. We conducted three focus groups and seven semi-structured interviews with participants in the LINC ("Linking …
HIV patient and provider feedback on a telehealth collaborative care for depression intervention
In the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care in Veterans Health Administration HIV clinics in the US. An offsite HIV depression care team including a psychiatrist, a depression care manager (DCM), and a clinical pharmacist provided collaborative care using a stepped-car…
Where’s My Choice?” An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program
BACKGROUND: The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA. OBJECTIVES: This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers. RESEARCH DESIGN: Qualitative study bas…
Resolute efforts to cure hepatitis C
Antiviral treatment for hepatitis C is usually difficult, demanding, and debilitating and has long offered modest prospects of successful cure. Most people who may need treatment have faced stigma of an illness associated with drug and alcohol misuse and thus may be deemed poor candidates for treatment, while completing a course of treatment typically calls for resolve and responsibility. Patients' efforts and their reasons for completing treatme…
Retaining Homeless Veterans in Outpatient Care
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated c…
Personal Health Record Use and Its Association with Antiretroviral Adherence
Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C
BACKGROUND: Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services. OBJECTIVES: To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience. RESEARCH DE…
Effectiveness of a Risk Screener in Identifying Hepatitis C Virus in a Primary Care Setting
Objectives. We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers. Methods. A clinical reminder sticker prompted physicians at 3 urban clinics to screen patients for 12 risk factors and order HCV testing if any risks were present. Risk factor data were collected from the sticker; demographic and testing data were extracted from electronic medical recor…
Development and implementation of collaborative care for depression in HIV clinics
We sought to develop and implement collaborative depression care in human immunodeficiency virus (HIV) clinics in a project called HIV Translating Initiatives for Depression into Effective Solutions (HITIDES). Here we describe: (i) the formative evaluation (FE) conducted prior to implementation; (ii) the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and (iii) the intervention itself. The …
Pilot study demonstrating effectiveness of targeted education to improve informed consent understanding in Aids clinical trials
Assessing and improving informed consent understanding is equally important as obtaining consent from participants in clinical trial research, but developing interventions to target gaps in participants' informed consent understanding remains a challenge. We used a randomized controlled study design to pilot test an educational intervention to improve actual informed consent understanding of new enrollees in the Adult AIDS Clinical Trial Group (A…
How Researchers Define Vulnerable Populations in HIV/Aids Clinical Trials
Cross-Cultural Considerations in the Recruitment of Latinos of Mexican Origin into HIV/Aids Clinical Trials in the U.S.-Mexico Border Region
Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV care providers serving HIV-positive Latinos and focus groups with HIV-positive Mexican-origin Latinos, we assessed cross-cultural barriers (e.g., stigma and linguistic) to HIV clinical trials in San Diego, Calif…
Behind the scenes in health care improvement
Retaining Homeless Veterans in Outpatient Care
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated c…
The role of motivation in predicting antiretroviral therapy adherence in China
Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on impro…
Resolute efforts to cure hepatitis C
Antiviral treatment for hepatitis C is usually difficult, demanding, and debilitating and has long offered modest prospects of successful cure. Most people who may need treatment have faced stigma of an illness associated with drug and alcohol misuse and thus may be deemed poor candidates for treatment, while completing a course of treatment typically calls for resolve and responsibility. Patients' efforts and their reasons for completing treatme…
Effectiveness of a Risk Screener in Identifying Hepatitis C Virus in a Primary Care Setting
Objectives. We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers. Methods. A clinical reminder sticker prompted physicians at 3 urban clinics to screen patients for 12 risk factors and order HCV testing if any risks were present. Risk factor data were collected from the sticker; demographic and testing data were extracted from electronic medical recor…
An Investigation into Differences in Respiratory Illness in Overseas and UK Students
It has been suggested that overseas students may have a worse experience of respiratory illness while in the United Kingdom than students from the United Kingdom itself. If this were so it might be due to infection of overseas students with viruses to which United Kingdom students are, by adult age, immune, or because of differences in living con- ditions between the two groups of students in the United Kingdom
Self-management health education for chronic HIV infection
This paper describes the design and implementation, and presents qualitative data on the Positive Self-Management Program (PSMP), a group health education programme to help patients actively participate in their HIV/AIDS disease and symptom management. PSMP design was guided by the needs and concerns of HIV patients and their caregivers, and by social cognitive theory. Programme participants meet weekly in interactive health education groups for …
Predictors of Self-Reported Adherence and Plasma HIV Concentrations in Patients on Multidrug Antiretroviral Regimens
BACKGROUND: Adherence to prescribed medications is a central feature of good clinical HIV care, but little is known about the factors associated with multidrug antiretroviral adherence, or about how such adherence is related to plasma HIV suppression. METHODS: We collected data from 133 HIV-infected adults receiving antiretroviral therapy. Study subjects completed customized adherence self-report instruments and provided blood samples to measure …
Self-reported adherence to antiretroviral medications among participants in HIV clinical trials
This paper describes the AACTG Adherence Instruments, which are comprised of two self-report questionnaires for use in clinical trials conducted by the Adult AIDS Clinical Trials Group (AACTG). The questionnaires were administered to 75 patients at ten AACTG sites in the USA. All patients were taking combination antiretroviral therapy (ART), including at least one protease inhibitor. Eleven per cent of patients reported missing at least one dose …
National Estimates of HIV-Related Symptom Prevalence From the HIV Cost and Services Utilization Study
OBJECTIVES: The objectives of this study were (1) to estimate the prevalence, bothersomeness, and variation of HIV-related symptoms in a nationally representative sample of HIV-infected adults receiving medical care and (2) to evaluate new aggregate measures of symptom frequency and bothersomeness. METHODS: Beginning in January 1996, 76% of a multistage national probability sample of 4,042 HIV-infected adults receiving medical care were interview…
Quality Enhancement Research Initiative for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
The Veterans Health Administration (VHA) sees ≈17,000 human immunodeficiency virus (HIV)-infected patients each year, which makes it the largest provider of HIV care in the United States. HIV causes chronic progressive disease that leads to early death. Newer combination antiretroviral treatments ar
Development and validation of a self-completed HIV symptom index
Evaluating Self-Efficacy for HIV Disease Management Skills
Measuring Medication
BACKGROUND: Medication measurement is crucial in assessing quality for chronic conditions yet agreement of alternate data sources remains uncertain. OBJECTIVES: To evaluate medication agreement between interviews, medical records, and pharmacy data; to assess data source contribution to attributing medication exposure; and to describe the impact of combining data sources on models that predict medication use. RESEARCH DESIGN: Prospective cohort s…
Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection
Balancing disfigurement and fear of disease progression
This study was conducted to identify and describe the perceived morphologic changes of body fat redistribution and related distress among persons taking combination antiretroviral therapy. Six focus group interviews were conducted in four different US cities with men and women (n = 58) who reported antiretroviral-related symptoms of body fat loss and/or gain. Interview data were audiotaped, transcribed verbatim and systematically analysed using i…
Retention in Care
BACKGROUND: Patients with human immunodeficiency virus (HIV) infection need lifelong medical care, but many do not remain in care. The effect of poor retention in care on survival is not known, and we sought to quantify that relationship. METHODS: We conducted a retrospective cohort study involving persons newly identified as having HIV infection during 1997-1998 at any United States Department of Veterans Affairs hospital or clinic who started a…
Quality indicators for depression care in HIV patients
HIV patients are at increased risk for depression. However, a comprehensive set of quality of care indicators for depression in the context of HIV does not exist. We report the results of a recent expert panel convened to develop a comprehensive set of HIV depression quality indicators. We systematically reviewed the depression and HIV depression literature to provide the evidence for the quality indicators. The HIV depression quality indicators …
Enhancing Organizational Change and Improvement Prospects
Most research on why health care quality improvement implementation succeeds or fails focuses on front-line or provider-based factors. However, background factors related to the structures and processes of projects themselves also pose challenges. Using a focused ethnographic assessment approach, we undertook a case study to characterize particularly challenging background factors in an ongoing implementation effort. We found that the organizatio…
Behind the scenes in health care improvement
A routine thing
Increasing HIV testing is a necessary step toward control of the disease. Many experts suggest routinely offering HIV testing to specific population segments. We explore provider discourse regarding an HIV test implementation project with the aim of illuminating a structurally emergent clinician strategy for promoting testing and the socio-cultural factors underlying it. Twenty US Veterans Affairs Healthcare System clinical care providers were in…
The Impact of Integrated HIV Care on Patient Health Outcomes
BACKGROUND: Control of viral replication through combination antiretroviral therapy (cART) improves patient health outcomes. Yet many HIV-infected patients have comorbidities that pose social and clinical barriers to achieving viral suppression. Integration of subspecialty services into HIV primary care may overcome such barriers. OBJECTIVE: To evaluate effect of integrated HIV care (IHC) on suppression of HIV replication. RESEARCH DESIGN: A retr…
How Researchers Define Vulnerable Populations in HIV/Aids Clinical Trials
Cross-Cultural Considerations in the Recruitment of Latinos of Mexican Origin into HIV/Aids Clinical Trials in the U.S.-Mexico Border Region
Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV care providers serving HIV-positive Latinos and focus groups with HIV-positive Mexican-origin Latinos, we assessed cross-cultural barriers (e.g., stigma and linguistic) to HIV clinical trials in San Diego, Calif…
Development and implementation of collaborative care for depression in HIV clinics
We sought to develop and implement collaborative depression care in human immunodeficiency virus (HIV) clinics in a project called HIV Translating Initiatives for Depression into Effective Solutions (HITIDES). Here we describe: (i) the formative evaluation (FE) conducted prior to implementation; (ii) the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and (iii) the intervention itself. The …
Pilot study demonstrating effectiveness of targeted education to improve informed consent understanding in Aids clinical trials
Assessing and improving informed consent understanding is equally important as obtaining consent from participants in clinical trial research, but developing interventions to target gaps in participants' informed consent understanding remains a challenge. We used a randomized controlled study design to pilot test an educational intervention to improve actual informed consent understanding of new enrollees in the Adult AIDS Clinical Trial Group (A…
Effectiveness of a Risk Screener in Identifying Hepatitis C Virus in a Primary Care Setting
Objectives. We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers. Methods. A clinical reminder sticker prompted physicians at 3 urban clinics to screen patients for 12 risk factors and order HCV testing if any risks were present. Risk factor data were collected from the sticker; demographic and testing data were extracted from electronic medical recor…
Personal Health Record Use and Its Association with Antiretroviral Adherence
Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C
BACKGROUND: Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services. OBJECTIVES: To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience. RESEARCH DE…
Retaining Homeless Veterans in Outpatient Care
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated c…
Medicine (40 obras) · Family medicine (28 obras) · HIV/AIDS Research and Interventions (26 obras) · Nursing (18 obras) · Internal Medicine (17 obras) · Psychiatry (16 obras) · Psychology (14 obras) · Health care (12 obras) · HIV-related health complications and treatments (12 obras) · Internal Medicine (10 obras)