Browsing by Author "Gardiner JC"

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Evaluating layered stigma from comorbid HIV and epilepsy among Zambian adults.
(2018-Dec) Elafros MA; Gardiner JC; Sikazwe I; Okulicz JF; Paneth N; Chomba E; Birbeck GL; University Teaching Hospital, Department of Paediatrics and Child Health, Nationalist Way, Lusaka, Zambia.; Infectious Disease Service, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA.; Epilepsy Care Team, Chikankata Hospital, Private Bag S2, Mazabuka, Zambia.; Centre for Infectious Disease Research in Zambia, 532 Great North Road, PO Box 24681, Lusaka, Zambia.; Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B629, East Lansing, MI 48824, USA.; Strong Epilepsy Center, Department of Neurology, University of Rochester, 265 Crittenden Blvd, CU420694, Rochester, NY 14642, USA.; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, 909 Fee Road, Room 324, East Lansing, MI 48824, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND AND PURPOSE: Stigma hinders care for patients with neurologic illness. Layered stigma due to comorbid disease is common yet poorly characterized due to lack of instruments. Epilepsy and HIV are prototypical stigmatized conditions widespread in sub-Saharan Africa. METHODS: We assessed layered stigma among people with HIV and epilepsy (n = 21), epilepsy only (n = 88), and HIV only (n = 40) in Zambia. Epilepsy-associated stigma was assessed using the Stigma Scale of Epilepsy and Jacoby's Stigma Scale. HIV-related stigma was assessed using the HIV/AIDS Stigma Instrument-People Living with HIV/AIDS and Jacoby's Stigma Scale. Stigma was compared across groups using RESULTS: 55% (60/109) with epilepsy reported some epilepsy-associated stigma and 20% (12/61) with HIV reported HIV self-stigmatization. Those with HIV and epilepsy were more likely to associate seizures with fear (OR 6.1 [95% CI: 1.3-27.9]) and epilepsy with dependence (OR 4.6 [1.1-19.6]), controlling for age, gender, marital status, and employment. Those with comorbid disease were more likely to report they were "no longer a person" and felt "blamed" for their HIV. Controlling for age and gender, the difference in depersonalization remained (OR: 6.4 [1.1-36.1]). CONCLUSION: Individuals carrying the burden of one stigmatized condition may be more vulnerable to stigma from a comorbid disease.
Patient-Reported Adverse Effects Associated with Combination Antiretroviral Therapy and Coadministered Enzyme-Inducing Antiepileptic Drugs.
(2017-Jun) Elafros MA; Birbeck GL; Gardiner JC; Siddiqi OK; Sikazwe I; Paneth N; Bositis CM; Okulicz JF; Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas.; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.; Global Neurology Program, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.; Department of Neurology, University of Rochester, Rochester, New York.; Greater Lawrence Family Health Center, Lawrence, Massachusetts.; Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.; Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
AbstractConcurrent treatment with combination antiretroviral therapy (cART) and an enzyme-inducing antiepileptic drug (EI-AED) is common in resource-limited settings; however, the incidence and impact of adverse effects in cotreated patients is largely unknown. Symptoms of adverse effects were assessed by both spontaneous report and checklist for 145 human immunodeficiency virus (HIV)-infected Zambian adults initiating various treatment combinations, such as cART with an EI-AED (