Papers by Serena Rajabiun
Background: Many people living with HIV (PLWHA) experience oral manifestations of HIV disease tha... more Background: Many people living with HIV (PLWHA) experience oral manifestations of HIV disease that can lead to poor health status. Yet, studies have shown that unmet need for dental care for PLWHA is greater than medical care. We examined the factors associated with unmet need for dental care among underserved, hard to reach PLWHA enrolled in interventions to engage them in HIV care. Methods: A longitudinal survey was conducted among PLWHA at risk for not engaging in HIV medical care from ten urban community and clinic-based sites. Measures included socio-demographics, drug use, mental health status, health care utilization, and unmet needs for dental care and support services. Bivariate and multivariate analyses were conducted to examine the factors associated with unmet need for dental care. McNemar chi-square test was conducted to assess the changes in unmet need for dental care. Results: Dental care (70%) was the most frequently reported service need compared to transportation, ...
Background: The effectiveness of outreach programs to retain hard-to-reach patients with HIV in p... more Background: The effectiveness of outreach programs to retain hard-to-reach patients with HIV in primary care has yet to be comprehensively evaluated. We will present information on the design and implementation of a data collection instrument to track outreach and non-clinical staff program encounters with out-of-care patients that was developed as part of a multi-site evaluation. Methods: We systematically collected information on 1066 patients at 10 sites for over 33,000 program contacts during 12-18 months of follow-up. The purpose of the instrument was to allow for the classification and dose of the intervention provided for each patient. The information collected included the time and place of the contact, the reason for the contact, and the duration of the contact. Results: We will discuss how these data were summarized for analysis and linked longitudinally to patient interview and medical chart review data. We will present the results of an analysis relating program contact ...
Background: The Peer Education Training Initiative funded by the Health Resources & Service Admin... more Background: The Peer Education Training Initiative funded by the Health Resources & Service Administration provides training to people living with HIV/AIDS from communities of color to serve as peer educators. Three centers, located in California, Missouri, and New York, have developed peer training programs tailored to their target populations. The training sites all address key peer educator competencies including treatment adherence and communication with health care providers. Methods: The training curricula for peers will be presented. A Peer educator will discuss the successes and challenges encountered with training and strategies for sustaining the peer programs as part of HIV care. Techniques for evaluating the emerging role of peers in HIV care and preliminary results of a multisite evaluation exploring the impact of the peer training on participants' knowledge and skills will be shared. Results: To date 423 peers have been trained. At the time of the 6-month interview...
The HRSA SPNS Oral Health Care Initiative funds 15 innovative models across the United States to ... more The HRSA SPNS Oral Health Care Initiative funds 15 innovative models across the United States to expand access to oral health care services for people living with HIV/AIDS (PLWHA). These program models target underserved populations in both rural and urban areas where there is high unmet need for oral health care. We developed a program typology to highlight key program characteristics such as host agency (AIDS service organizations, community heath centers, and university based medical centers); program models (mobile vans and mobile equipment, , locating services in dental hygiene schools, and establishing satellite clinics); service delivery strategies (level of oral health care, dental care coordination) as well as other program characteristics (linkages with medical providers, the provision of ancillary services, transportation and provider education). All programs emphasize strategies to outreach, engage and retain PLWHA in oral health care services. Our typology can assist pr...
Oral health care is an essential yet often unmet need for underserved and underinsured population... more Oral health care is an essential yet often unmet need for underserved and underinsured populations in the US. This is a social justice issue that requires national attention from not only policy makers, but oral health providers, public health workers and the general public. This unmet need is extensive in the HIV population and has been widely documented. This session will provide information about how social justice can be promoted by increasing access to oral health care for persons living with HIV and share the results from the multisite evaluation identifying the structural and personal barriers to oral health care that lead to poor dental care utilization, lower literacy about oral hygiene and health, and higher unmet needs. Strategies will be presented for promoting greater access that can reduce the disparity within this population. The 3 panelists will present the following topics: 1. A lack of access to oral health care leading to dissatisfaction with a patients' appea...
Access to oral health care for vulnerable populations is one of the concerns addressed by the U.S... more Access to oral health care for vulnerable populations is one of the concerns addressed by the U.S. Health Resources and Services Administration HIV/AIDS Bureau's Community-Based Dental Partnership Program (CBDPP). The program introduces dental students and residents at several dental schools to care for vulnerable patients through didactic and clinical work in community-based dental settings. This study of the dental students and residents in this program answered three questions: 1) What are their HIV knowledge, attitudes, and behaviors? 2) How has participation in the CBDPP impacted their knowledge, attitudes, and behaviors? 3) Has the intervention affected their work placement decisions and attitudes after graduation, particularly with respect to treating people living with HIV and other underserved populations? A total of 305 first- through fourth-year dental students and first- and second-year residents at five dental schools across the United States completed surveys befor...
Background Latinos in the US South are disproportionately impacted by HIV/AIDS. Structural barrie... more Background Latinos in the US South are disproportionately impacted by HIV/AIDS. Structural barriers, service practices, and anti-immigration laws contribute to limited access to HIV services and poor health outcomes. Using CBPR approach, the Latino Southern REACH project facilitated the formation of a community coalition to document Latino's HIV needs and advocacy efforts in nine US Southern states. Methods A transdisciplinary research team and 20 community members from Alabama, Arkansas, Northern Florida, Georgia, Louisiana, North Carolina, Mississippi, South Carolina, and, Tennessee, engaged in a partnership to carry out the research which resulted in a multi-state coalition. Through consensus, the coalition developed the research agenda, conducted in-depth interviews, and participated in data analyses on factors impacting HIV testing, care, and treatment in 9 communities. The coalition members received training via webinars focused on 1) human rights framework and 2) research...
Public health reports (Washington, D.C. : 1974), 2012
We provide an overview of the Health Resources and Services Administration HIV/AIDS Bureau's ... more We provide an overview of the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative, describe the models developed by the 15 demonstration sites and associated evaluation center, and present initial descriptive data about the characteristics of the multisite evaluation study sample. Baseline data were collected from May 2007-August 2009 for 2,469 adults living with HIV/AIDS who had been without dental care, except for emergency care, for 12 months or longer. Variables included sociodemographic characteristics, HIV status, medical care, history of dental care and oral health symptoms, oral health practices, and physical and mental health quality of life. Descriptive statistics of baseline variables were calculated. The study sample included 2,469 adults who had been HIV-positive for a decade; most were engaged in HIV care. The majority (52.4%) of patients had not seen a dentist in more t...
Ethnicity & disease, 2008
US Latino adults are disproportionately affected by the HIV epidemic and experience disparities i... more US Latino adults are disproportionately affected by the HIV epidemic and experience disparities in access to HIV care. However, relatively little is known about how acculturation affects perceived barriers to engagement in care among Latinos. This article examines factors that may be associated with engaging HIV-infected persons in primary care by using interview data from 651 Latino and non-Latino adults presenting for services at five agencies that participated in a multisite demonstration project Latinos (n=219) were more likely than non-Latino Whites (n=117) to be male, recently diagnosed with HIV, less educated, without health insurance, not on Medicaid, taking HIV medications, and in better physical health. In addition, Latinos were more likely to report facing numerous structural barriers, stigma-related worries/concerns, and belief barriers than were non-Latino Whites. Upon closer examination of the Latino subsample, acculturation (based on language) was associated with repo...
Public health reports (Washington, D.C. : 1974), 2012
This qualitative study explored the impact on oral health-care knowledge, attitudes, and practice... more This qualitative study explored the impact on oral health-care knowledge, attitudes, and practices among 39 people living with HIV/AIDS (PLWHA) participating in a national initiative aimed at increasing access to oral health care. Personal values and childhood dental experiences, beliefs about the importance of oral health in relation to HIV health, and concerns for appearance and self-esteem were found to be determinants of oral health knowledge and practice. Program participation resulted in better hygiene practices, improved self-esteem and appearance, relief of pain, and better physical and emotional health. In-depth exploration of the causes for these changes revealed a desire to continue with dental care due to the dental staff and environmental setting, and a desire to maintain overall HIV health, including oral health. Our findings emphasize the importance of addressing both personal values and contextual factors in providing oral health-care services to PLWHA.
Journal of Public Health Dentistry, 2011
This article describes a typology of program models for expanding access to dental services for p... more This article describes a typology of program models for expanding access to dental services for people living with HIV/AIDS (PLWHA). These programs serve communities with limited access and high unmet need for oral health care, such as rural areas, low-income and racial/ethnic minorities. Interviews and site visits with dental and program directors were conducted at participating sites, including AIDS service organizations, community health centers, and university-affiliated medical centers or hospitals. Despite the differences across organizational structure, similar models and approaches were developed to engage and retain PLWHA in dental care. These approaches included: using mobile dental units; expanding the type and availability of previous dental services provided; providing training opportunities for dental residents and hygienists; establishing linkages with medical providers; providing transportation and other ancillary services; using dental case managers and peer navigators to coordinate care; and patient education. This typology can assist program planners, medical and dental care providers with service delivery strategies for addressing the unmet need for oral health care in their area.
Journal of HIV/AIDS & Social Services, 2005
ABSTRACT. The substance abuse treatment and HIV health care sys-tems have different treatment app... more ABSTRACT. The substance abuse treatment and HIV health care sys-tems have different treatment approaches, and many HIV-infected sub-stance users fall through the cracks between systems. Providers are often challenged by the difficulty of engaging and retaining HIV-...
Journal of HIV/AIDS & Social Services, 2011
Engaging and retaining persons living with HIV/AIDS (PLWHA) in medical care is essential to ensur... more Engaging and retaining persons living with HIV/AIDS (PLWHA) in medical care is essential to ensure disease management and successful health outcomes. This article summarizes the results of a qualitative study of 21 staff members from seven programs aimed to engage and retain at-risk PLWHA in HIV medical care. The data revealed five domains of services provided and skills delivered: 1.
Journal of Health Communication, 2008
This article examines health literacy among a group a HIV-positive persons at risk for receiving ... more This article examines health literacy among a group a HIV-positive persons at risk for receiving suboptimal health care due to histories of substance abuse, mental illness, incarceration, and unstable housing or homelessness. Participants receiving services from three outreach programs funded as part of a multisite demonstration project were screened for health literacy using the Test of Functional Health Literacy in Adults (TOFHLA) at program enrollment. The goal of this analysis was to identify demographics, risk factors, and health indicators associated with different levels of health literacy. Results indicated that although fewer than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, health professionals can use other potential venues for health literacy assessment and intervention including substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers also must become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.
Journal of Community Health, 2010
People living with HIV (PLWHIV) have been involved in the continuum of HIV care since the early d... more People living with HIV (PLWHIV) have been involved in the continuum of HIV care since the early days of the epidemic providing education and prevention services. There is a growing interest in utilizing HIV positive peers to support access to care and treatment, but little is known about the range of roles these peers perform and what they need to know to do this work. This study of 186 HIV-positive peers currently providing community health services in eight states found that peers perform a wide range of roles, including assistance with care and treatment, emotional support, and service referrals. Over 80% discussed medications with clients. On average, experienced peers provided correct responses to 73% of questions about HIV and AIDS, and 65% of questions about the appropriate role of a peer. Peers living with HIV for more than 5 years, in paid employment with more than a high school education had higher HIV knowledge scores than volunteers. Higher education, length of time living with HIV, age and speaking English as the primary language were associated with higher peer knowledge scores. This study suggests that we cannot assume that peers already working in the field are fully knowledgeable about HIV care and treatment or peer roles. It is important to address gaps in knowledge through continuing education and to create common standards for the training and skills that peers who work in community health settings need to have.
Tufts University …, 2002
Discussion papers provide a means for researchers, students and professionals to share thoughts a... more Discussion papers provide a means for researchers, students and professionals to share thoughts and findings on a wide range of topics relating to food, hunger, agriculture and nutrition. They contain preliminary material and are circulated prior to a formal peer review in order to stimulate discussion and critical comment. Some working papers will eventually be published and their content may be revised based on feedback received.
AIDS Patient Care and STDs, 2007
This qualitative study investigated the process of engagement in HIV medical care from the perspe... more This qualitative study investigated the process of engagement in HIV medical care from the perspective of people living with HIV/AIDS (PLWHA). In-depth interviews were conducted with 76 participants in six cities. All participants were considered underserved because of histories of substance use, mental illness, incarceration, homelessness, or cultural barriers to the traditional health care system. A semistructured interview guide elicited narratives related to health care and the role of program interventions in facilitating access to care. Data analysis revealed that participants cycled in and out of care, a process that was influenced by (1) their level of acceptance of being diagnosed with HIV, (2) their ability to cope with substance use, mental illness, and stigma, (3) their health care provider relationships, (4) the presence of external support systems, and (5) their ability to overcome practical barriers to care. Outreach interventions played a role in connecting participants to care by dispelling myths and improving knowledge about HIV, facilitating access to HIV care and treatment, providing support, and reducing the barriers to care. The findings suggest that outreach programs can interrupt this cyclical process and foster sustained, regular HIV care for underserved PLWHA by conducting client-centered risk assessments to identify and reduce sources of instability and improve the quality of provider relationships; implementing strategies that promote healthy practices; creating a network of support services in the community; and supporting adherence through frequent follow-ups for medication and appointment keeping.
AIDS Patient Care and STDs, 2011
Literature describing the roles and activities of peers working in HIV care is limited. Evaluatio... more Literature describing the roles and activities of peers working in HIV care is limited. Evaluations of the impact of peer-based behavior-change interventions reveal mixed results, due in part to varied program aims, structure, evaluation mechanisms, and training. Peers themselves are important resources to address these concerns and lay the groundwork for developing improved programs and evaluation strategies. This qualitative article describes peer support in HIV care and treatment from the perspective of 23 HIV-positive peers across the United States. Peers reported that peer characteristics (HIV-status, common experiences, and self-care) enable them to engage clients. Peers also required flexibility to respond to client needs, and their activities spanned four types of social support: informational, emotional, instrumental, and affiliational. We recommend peer programs and evaluations accommodate the broad scope of peer work by acknowledging the need for flexibility and activities that are not always directly related to clients' HIV care and treatment.
AIDS Patient Care and STDs, 2007
This paper examines factors associated with engaging socially marginalized HIV-positive persons i... more This paper examines factors associated with engaging socially marginalized HIV-positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12-month follow-up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV-positive persons in HIV primary care.
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Papers by Serena Rajabiun