Elsevier

Drug and Alcohol Dependence

Volume 187, 1 June 2018, Pages 236-241
Drug and Alcohol Dependence

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Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV

https://doi.org/10.1016/j.drugalcdep.2018.03.005Get rights and content

Highlights

  • GPS data may reveal differences in community exposure to risk environments.

  • Exposure to alcohol and crime environments was greater in activity spaces.

  • Activity space exposures were associated with behavioral outcomes.

  • GPS and daily diary data collection approaches were feasible among people living with HIV (PLWH).

Abstract

Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation’s highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects’ behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.

Section snippets

Background

Although antiretroviral therapy (ART) has greatly reduced HIV-related morbidity and mortality (Palella et al., 2006), benefits of therapy require strict adherence, tolerance of side effects, and regular access to primary care (Celum et al., 2013; Lima et al., 2007). Retention in care among PLWH is low in the U.S. (Marks et al., 2010), and 30% or less achieve successful viral suppression (CDC, 2011; Gardner et al., 2011). There is also substantial geographic variability and potential regional

Methods

A parent study was underway in an urban metropolitan region in the Southeast to examine the impact of early life and adult stress on biological and clinical outcomes of PLWH over 2.5 years (N = 350). The goal of the parent cohort is to examine the impact of early life and adult stress on biological and clinical outcomes of PLWH over 2.5 years. From October 2015 to October 2017, a small random sample of participants who consented to the parent study were invited to participate in this additional

Results

Almost half (45%) of participants in this small pilot study (N = 11) were female, and 90% identified as Black. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Participants traversed an average of 23 census tracts over this period. They were exposed to neighborhood violent crime rates that varied from 1 to 28 per 1,000 population and off-site alcohol density rates of 0–22 per 1,000 depending on the census tract. The average

Discussion

This study fits within a broader effort in the study of health and place to document the multiple contexts that individuals inhabit and the ways they move across contexts throughout the day. Results demonstrate the feasibility of this methodology (GPS coupled with a daily diary captured via SMS messaging) among PLWH. Furthermore, as demonstrated in previous studies (Byrnes et al., 2015), there were meaningful differences in exposure context comparing activity space to residential contexts.

Conflict of interest

There are no conflicts of interest to report.

Contributors

KPT and DJW conceptualized the study. EFK and XZ conducted data collection. Data analysis was conducted by EFK, MW, CM, and KPT. KPT wrote the manuscript with feedback provided by all co-authors. All authors have contributed to and approved the final manuscript

Role of funding source

No form of payment was given to anyone to produce the manuscript.

Acknowledgments

This study was supported by the National Institutes on Alcohol Abuse and Alcoholism(NIAAA) (P60AA009803). This study was approved by two university Institutional Review Boards. The authors thank all of the participants who agreed to take part in this study.

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