Pub Date : 2024-06-01Epub Date: 2024-03-22DOI: 10.1007/s11904-024-00696-y
Stephanie D Roche, Daniel Were, Natalie D Crawford, Angela Tembo, Jillian Pintye, Elizabeth Bukusi, Kenneth Ngure, Katrina F Ortblad
Purpose of review: To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions.
Recent findings: Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.
{"title":"Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions.","authors":"Stephanie D Roche, Daniel Were, Natalie D Crawford, Angela Tembo, Jillian Pintye, Elizabeth Bukusi, Kenneth Ngure, Katrina F Ortblad","doi":"10.1007/s11904-024-00696-y","DOIUrl":"10.1007/s11904-024-00696-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions.</p><p><strong>Recent findings: </strong>Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140189580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-05-11DOI: 10.1007/s11904-024-00699-9
Zhuoheng Yin, Yumeng Du, Weibin Cheng, Weiming Tang
Purpose of review: This review captured how digital strategies support social network approaches to promote HIV testing.
Recent finding: Overall, 29 studies were identified by searching PubMed and Embase for studies published up to June 2023. Existing studies revealed three types of digital strategies (social media (n = 28), online information channels (n = 4), and multifunctional digital platforms (n = 4)) split into four major modes of digital strategy-supported social-network-based HIV testing promotion: 1) Online outreach and recruiting, 2) gathering and identifying key populations for HIV testing, 3) communicating and disseminating online HIV testing health interventions, and 4) assisting and facilitating HIV testing uptake and distribution. Social network approaches supported by digital strategies yielded advantages in HIV testing education and distribution, which increases HIV testing coverage among key populations. Studies are needed on how to facilitate the use of digital strategies for social network-based HIV testing, as well as how to integrate them with existing HIV testing approaches.
综述目的:本综述记录了数字策略如何支持社交网络方法来促进艾滋病检测:通过搜索 PubMed 和 Embase 上截至 2023 年 6 月发表的研究,共发现了 29 项研究。现有研究揭示了三种类型的数字策略(社交媒体(n = 28)、在线信息渠道(n = 4)和多功能数字平台(n = 4)),分为基于社交网络的艾滋病检测推广的四种主要数字策略支持模式:1) 在线推广和招募,2) 收集和确定 HIV 检测的关键人群,3) 在线交流和传播 HIV 检测健康干预措施,4) 协助和促进 HIV 检测的接受和传播。在数字战略支持下的社会网络方法在艾滋病病毒检测教育和分发方面产生了优势,从而提高了艾滋病病毒检测在重点人群中的覆盖率。需要研究如何促进数字策略在基于社会网络的艾滋病毒检测中的应用,以及如何将其与现有的艾滋病毒检测方法相结合。
{"title":"Digital Strategies Supporting Social Network Approaches to HIV Testing: A Scoping Review.","authors":"Zhuoheng Yin, Yumeng Du, Weibin Cheng, Weiming Tang","doi":"10.1007/s11904-024-00699-9","DOIUrl":"10.1007/s11904-024-00699-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review captured how digital strategies support social network approaches to promote HIV testing.</p><p><strong>Recent finding: </strong>Overall, 29 studies were identified by searching PubMed and Embase for studies published up to June 2023. Existing studies revealed three types of digital strategies (social media (n = 28), online information channels (n = 4), and multifunctional digital platforms (n = 4)) split into four major modes of digital strategy-supported social-network-based HIV testing promotion: 1) Online outreach and recruiting, 2) gathering and identifying key populations for HIV testing, 3) communicating and disseminating online HIV testing health interventions, and 4) assisting and facilitating HIV testing uptake and distribution. Social network approaches supported by digital strategies yielded advantages in HIV testing education and distribution, which increases HIV testing coverage among key populations. Studies are needed on how to facilitate the use of digital strategies for social network-based HIV testing, as well as how to integrate them with existing HIV testing approaches.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-03-13DOI: 10.1007/s11904-024-00695-z
Sara Wallach, Suzue Saito, Harriet Nuwagaba-Biribonwoha, Lenhle Dube, Matthew R Lamb
Purpose of review: HIV service delivery programs are some of the largest funded public health programs in the world. Timely, efficient evaluation of these programs can be enhanced with methodologies designed to estimate the effects of policy. We propose using the synthetic control method (SCM) as an implementation science tool to evaluate these HIV programs.
Recent findings: SCM, introduced in econometrics, shows increasing utility across fields. Key benefits of this methodology over traditional design-based approaches for evaluation stem from directly approximating pre-intervention trends by weighting of candidate non-intervention units. We demonstrate SCM to evaluate the effectiveness of a public health intervention targeting HIV health facilities with high numbers of recent infections on trends in pre-exposure prophylaxis (PrEP) enrollment. This test case demonstrates SCM's feasibility for effectiveness evaluations of site-level HIV interventions. HIV programs collecting longitudinal, routine service delivery data for many facilities, with only some receiving a time-specified intervention, are well-suited for evaluation using SCM.
审查目的:艾滋病服务项目是世界上资金投入最大的公共卫生项目之一。对这些项目进行及时、高效的评估,可以通过旨在估算政策效果的方法得到加强。我们建议使用合成控制法(SCM)作为实施科学工具来评估这些艾滋病项目:最近的研究结果:SCM 是在计量经济学中引入的,在各个领域的实用性日益增强。与传统的基于设计的评估方法相比,该方法的主要优势在于通过对候选的非干预单位进行加权,直接逼近干预前的趋势。我们将 SCM 用于评估一项公共卫生干预措施的有效性,该干预措施针对的是近期感染人数较多的艾滋病医疗机构,评估的是暴露前预防疗法(PrEP)的注册趋势。该测试案例证明了 SCM 在现场级 HIV 干预有效性评估中的可行性。艾滋病项目收集了许多机构的纵向、常规服务提供数据,其中只有部分机构接受了规定时间的干预措施,因此非常适合使用 SCM 进行评估。
{"title":"Synthetic Controls for Implementation Science: Opportunities for HIV Program Evaluation Using Routinely Collected Data.","authors":"Sara Wallach, Suzue Saito, Harriet Nuwagaba-Biribonwoha, Lenhle Dube, Matthew R Lamb","doi":"10.1007/s11904-024-00695-z","DOIUrl":"10.1007/s11904-024-00695-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>HIV service delivery programs are some of the largest funded public health programs in the world. Timely, efficient evaluation of these programs can be enhanced with methodologies designed to estimate the effects of policy. We propose using the synthetic control method (SCM) as an implementation science tool to evaluate these HIV programs.</p><p><strong>Recent findings: </strong>SCM, introduced in econometrics, shows increasing utility across fields. Key benefits of this methodology over traditional design-based approaches for evaluation stem from directly approximating pre-intervention trends by weighting of candidate non-intervention units. We demonstrate SCM to evaluate the effectiveness of a public health intervention targeting HIV health facilities with high numbers of recent infections on trends in pre-exposure prophylaxis (PrEP) enrollment. This test case demonstrates SCM's feasibility for effectiveness evaluations of site-level HIV interventions. HIV programs collecting longitudinal, routine service delivery data for many facilities, with only some receiving a time-specified intervention, are well-suited for evaluation using SCM.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-11DOI: 10.1007/s11904-024-00698-w
Samantha M. Ayoub, Breanna M. Holloway, Alannah H. Miranda, Benjamin Z. Roberts, Jared W. Young, Arpi Minassian, Ronald J. Ellis
Purpose of Review
Cannabis may have beneficial anti-inflammatory effects in people with HIV (PWH); however, given this population’s high burden of persisting neurocognitive impairment (NCI), clinicians are concerned they may be particularly vulnerable to the deleterious effects of cannabis on cognition. Here, we present a systematic scoping review of clinical and preclinical studies evaluating the effects of cannabinoid exposure on cognition in HIV.
Recent Findings
Results revealed little evidence to support a harmful impact of cannabis use on cognition in HIV, with few eligible preclinical data existing. Furthermore, the beneficial/harmful effects of cannabis use observed on cognition were function-dependent and confounded by several factors (e.g., age, frequency of use).
Summary
Results are discussed alongside potential mechanisms of cannabis effects on cognition in HIV (e.g., anti-inflammatory), and considerations are outlined for screening PWH that may benefit from cannabis interventions. We further highlight the value of accelerating research discoveries in this area by utilizing translatable cross-species tasks to facilitate comparisons across human and animal work.
综述目的大麻可能对艾滋病病毒感染者(PWH)具有有益的抗炎作用;然而,鉴于这一人群的持续神经认知障碍(NCI)负担较高,临床医生担心他们可能特别容易受到大麻对认知的有害影响。在此,我们对评估大麻素暴露对 HIV 认知影响的临床和临床前研究进行了系统的范围界定综述。最新研究结果研究结果显示,几乎没有证据支持使用大麻会对 HIV 的认知产生有害影响,符合条件的临床前数据也很少。此外,所观察到的使用大麻对认知的有益/有害影响与功能有关,并受多种因素(如年龄、使用频率)的影响。摘要研究结果与大麻对艾滋病认知的潜在影响机制(如抗炎)一起进行了讨论,并概述了筛选可能受益于大麻干预的艾滋病感染者的注意事项。我们进一步强调了通过利用可转化的跨物种任务来促进人类和动物工作之间的比较,从而加快该领域研究发现的价值。
{"title":"The Impact of Cannabis Use on Cognition in People with HIV: Evidence of Function-Dependent Effects and Mechanisms from Clinical and Preclinical Studies","authors":"Samantha M. Ayoub, Breanna M. Holloway, Alannah H. Miranda, Benjamin Z. Roberts, Jared W. Young, Arpi Minassian, Ronald J. Ellis","doi":"10.1007/s11904-024-00698-w","DOIUrl":"https://doi.org/10.1007/s11904-024-00698-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Cannabis may have beneficial anti-inflammatory effects in people with HIV (PWH); however, given this population’s high burden of persisting neurocognitive impairment (NCI), clinicians are concerned they may be particularly vulnerable to the deleterious effects of cannabis on cognition. Here, we present a systematic scoping review of clinical and preclinical studies evaluating the effects of cannabinoid exposure on cognition in HIV.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Results revealed little evidence to support a harmful impact of cannabis use on cognition in HIV, with few eligible preclinical data existing. Furthermore, the beneficial/harmful effects of cannabis use observed on cognition were function-dependent and confounded by several factors (e.g., age, frequency of use).</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Results are discussed alongside potential mechanisms of cannabis effects on cognition in HIV (e.g., anti-inflammatory), and considerations are outlined for screening PWH that may benefit from cannabis interventions. We further highlight the value of accelerating research discoveries in this area by utilizing translatable cross-species tasks to facilitate comparisons across human and animal work.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140571942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1007/s11904-024-00694-0
Abstract
Purpose of review
Lottery incentives are an innovative approach to encouraging HIV prevention, treatment initiation, and adherence behaviours. This paper reviews the latest research on lottery incentives’ impact on HIV-related services, and their effectiveness for motivating behaviours to improve HIV service engagement and HIV health outcomes.
Recent findings
Our review of ten articles, related to lottery incentives, published between 2018 and 2023 (inclusive) shows that lottery incentives have promise for promoting HIV-related target behaviours. The review highlights that lottery incentives may be better for affecting simpler behaviours, rather than more complex ones, such as voluntary medical male circumcision. This review recommends tailoring lottery incentives, ensuring contextual-relevance, to improve the impact on HIV-related services.
Summary
Lottery incentives offer tools for improving uptake of HIV-related services. The success of lottery incentives appears to be mediated by context, the value and nature of the incentives, and the complexity of the target behaviour.
{"title":"A 5-Year Review of the Impact of Lottery Incentives on HIV-Related Services","authors":"","doi":"10.1007/s11904-024-00694-0","DOIUrl":"https://doi.org/10.1007/s11904-024-00694-0","url":null,"abstract":"<h3>Abstract</h3> <span> <h3>Purpose of review</h3> <p>Lottery incentives are an innovative approach to encouraging HIV prevention, treatment initiation, and adherence behaviours. This paper reviews the latest research on lottery incentives’ impact on HIV-related services, and their effectiveness for motivating behaviours to improve HIV service engagement and HIV health outcomes.</p> </span> <span> <h3>Recent findings</h3> <p>Our review of ten articles, related to lottery incentives, published between 2018 and 2023 (inclusive) shows that lottery incentives have promise for promoting HIV-related target behaviours. The review highlights that lottery incentives may be better for affecting simpler behaviours, rather than more complex ones, such as voluntary medical male circumcision. This review recommends tailoring lottery incentives, ensuring contextual-relevance, to improve the impact on HIV-related services.</p> </span> <span> <h3>Summary</h3> <p>Lottery incentives offer tools for improving uptake of HIV-related services. The success of lottery incentives appears to be mediated by context, the value and nature of the incentives, and the complexity of the target behaviour.</p> </span>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140571933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-24DOI: 10.1007/s11904-024-00691-3
Abdu Musubire, Enock Kagimu, Timothy Mugabi, David B Meya, David R Boulware, Nathan C Bahr
Purpose of review: This review highlights the difficulties in diagnosing and treating persons with a prior history of cryptococcal meningitis who improve but suffer from a recurrence of symptoms. This scenario is well known to those who frequently care for patients with cryptococcal meningitis but is not well understood. We highlight major gaps in knowledge.
Recent findings: We recently summarized our experience with 28 persons with paradoxical immune reconstitution inflammatory syndrome (IRIS) and 81 persons with microbiological relapse. CD4 count and cerebrospinal fluid white blood cell count were higher in IRIS than relapse but neither was reliable enough to routinely differentiate these conditions. Second-episode cryptococcal meningitis remains a difficult clinical scenario as cryptococcal antigen, while excellent for initial diagnosis has no value in differentiating relapse of infection from other causes of recurrent symptoms. Updated research definitions are proposed and rapid, accurate diagnostic tests are urgently needed.
{"title":"Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis.","authors":"Abdu Musubire, Enock Kagimu, Timothy Mugabi, David B Meya, David R Boulware, Nathan C Bahr","doi":"10.1007/s11904-024-00691-3","DOIUrl":"10.1007/s11904-024-00691-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review highlights the difficulties in diagnosing and treating persons with a prior history of cryptococcal meningitis who improve but suffer from a recurrence of symptoms. This scenario is well known to those who frequently care for patients with cryptococcal meningitis but is not well understood. We highlight major gaps in knowledge.</p><p><strong>Recent findings: </strong>We recently summarized our experience with 28 persons with paradoxical immune reconstitution inflammatory syndrome (IRIS) and 81 persons with microbiological relapse. CD4 count and cerebrospinal fluid white blood cell count were higher in IRIS than relapse but neither was reliable enough to routinely differentiate these conditions. Second-episode cryptococcal meningitis remains a difficult clinical scenario as cryptococcal antigen, while excellent for initial diagnosis has no value in differentiating relapse of infection from other causes of recurrent symptoms. Updated research definitions are proposed and rapid, accurate diagnostic tests are urgently needed.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11016006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139944019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-27DOI: 10.1007/s11904-024-00692-2
Edna A Ferreira, Janice E Clements, Rebecca T Veenhuis
Purpose of review: HIV reservoirs are the main barrier to cure. CD4+ T cells have been extensively studied as the primary HIV-1 reservoir. However, there is substantial evidence that HIV-1-infected myeloid cells (monocytes/macrophages) also contribute to viral persistence and pathogenesis.
Recent findings: Recent studies in animal models and people with HIV-1 demonstrate that myeloid cells are cellular reservoirs of HIV-1. HIV-1 genomes and viral RNA have been reported in circulating monocytes and tissue-resident macrophages from the brain, urethra, gut, liver, and spleen. Importantly, viral outgrowth assays have quantified persistent infectious virus from monocyte-derived macrophages and tissue-resident macrophages. The myeloid cell compartment represents an important target of HIV-1 infection. While myeloid reservoirs may be more difficult to measure than CD4+ T cell reservoirs, they are long-lived, contribute to viral persistence, and, unless specifically targeted, will prevent an HIV-1 cure.
{"title":"HIV-1 Myeloid Reservoirs - Contributors to Viral Persistence and Pathogenesis.","authors":"Edna A Ferreira, Janice E Clements, Rebecca T Veenhuis","doi":"10.1007/s11904-024-00692-2","DOIUrl":"10.1007/s11904-024-00692-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>HIV reservoirs are the main barrier to cure. CD4+ T cells have been extensively studied as the primary HIV-1 reservoir. However, there is substantial evidence that HIV-1-infected myeloid cells (monocytes/macrophages) also contribute to viral persistence and pathogenesis.</p><p><strong>Recent findings: </strong>Recent studies in animal models and people with HIV-1 demonstrate that myeloid cells are cellular reservoirs of HIV-1. HIV-1 genomes and viral RNA have been reported in circulating monocytes and tissue-resident macrophages from the brain, urethra, gut, liver, and spleen. Importantly, viral outgrowth assays have quantified persistent infectious virus from monocyte-derived macrophages and tissue-resident macrophages. The myeloid cell compartment represents an important target of HIV-1 infection. While myeloid reservoirs may be more difficult to measure than CD4+ T cell reservoirs, they are long-lived, contribute to viral persistence, and, unless specifically targeted, will prevent an HIV-1 cure.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-03-22DOI: 10.1007/s11904-024-00697-x
Sarah E Rutstein, Kathryn E Muessig
Purpose of review: Despite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system.
Recent findings: Task shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings. Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff. Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, a tailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual. We highlight recent advances and evidence surrounding task shifting, integration, service delivery, and tailoring. With the exception of tailored care navigation, evidence is mixed, and the downstream impact and sustainability of task shifting and care integration require further attention. To maximize PrEP outcomes, research will need to continue to examine the interplay between individuals, clinics, and the healthcare system and associated policies within which they operate.
{"title":"Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States.","authors":"Sarah E Rutstein, Kathryn E Muessig","doi":"10.1007/s11904-024-00697-x","DOIUrl":"10.1007/s11904-024-00697-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system.</p><p><strong>Recent findings: </strong>Task shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings. Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff. Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, a tailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual. We highlight recent advances and evidence surrounding task shifting, integration, service delivery, and tailoring. With the exception of tailored care navigation, evidence is mixed, and the downstream impact and sustainability of task shifting and care integration require further attention. To maximize PrEP outcomes, research will need to continue to examine the interplay between individuals, clinics, and the healthcare system and associated policies within which they operate.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140189581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-01-22DOI: 10.1007/s11904-024-00689-x
Hanalise V Huff, Kristen Sportiello, David R Bearden
{"title":"Central Nervous System Complications of HIV in Children.","authors":"Hanalise V Huff, Kristen Sportiello, David R Bearden","doi":"10.1007/s11904-024-00689-x","DOIUrl":"10.1007/s11904-024-00689-x","url":null,"abstract":"","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139511471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.1007/s11904-024-00693-1
Dennis H. Li, Kathryn Macapagal, Melissa Mongrella, Rana Saber, Brian Mustanski
Purpose of Review
Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions.
Recent Findings
We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement.
Summary
Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain “on the shelf” absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
综述目的尽管不断进行创新和联邦投资,以创建解决艾滋病预防和护理连续性问题的数字化干预措施,但这些干预措施尚未大规模惠及美国民众。本文回顾了美国实施数字化 HIV 干预措施的情况,并提出了跨越此类干预措施从研究到实践的鸿沟的策略。最近的研究结果我们对美国实施数字化 HIV 干预措施的原始研究进行了叙述性回顾,发现很少有研究报告实施的决定因素、策略、过程或结果,尤其是在有效性试验之外。为了对文献进行补充,2023 年,我们调查了代表 64 项独特干预措施的 47 位调查者,了解他们在研究试验后的实施经验。受访者高度重视干预措施的实施,但主要障碍包括缺乏资金和明确的实施模式、技术成本以及难以找到具备实施数字干预措施能力的合作伙伴。他们认为,干预措施的实施责任应由干预措施开发者、实施者(如诊所)和政府实体共同承担。如果有一个实施中心,大多数受访者都希望该中心能够提供指导或技术援助,但大部分受访者都希望该中心的参与程度较低。然而,这些干预措施仍被 "束之高阁",缺乏具体、可持续的实际传播和实施模式。根据我们的研究结果,我们呼吁建立国家实施中心,类似于其他卫生系统的实施中心,以促进艾滋病数字化干预措施的实施,并加快终结美国艾滋病流行的进程。
{"title":"“Your Package Could Not Be Delivered”: The State of Digital HIV Intervention Implementation in the US","authors":"Dennis H. Li, Kathryn Macapagal, Melissa Mongrella, Rana Saber, Brian Mustanski","doi":"10.1007/s11904-024-00693-1","DOIUrl":"https://doi.org/10.1007/s11904-024-00693-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain “on the shelf” absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}