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Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States. 提高 PrEP 的水平:在系统和结构层面扩大 PrEP 在美国的使用的实施策略》(Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States)。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-01 Epub Date: 2024-03-22 DOI: 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.

审查目的:尽管艾滋病暴露前预防(PrEP)的生物医学方案非常有效,但在美利坚合众国(USA),PrEP 的采用率却不尽如人意,这阻碍了在终结艾滋病流行方面取得进展。实施科学将我们在受控临床试验环境中获知的有效方法与预期部署有效工具的背景和环境联系起来。在本综述中,我们将重点关注针对系统或结构层面的 PrEP 使用障碍的策略,探讨在美国医疗保健系统分散的背景下的影响和机遇:任务转移可以增加 PrEP 的处方者,但在美国,有效性的证据很少,而且一般都集中在城市环境中。将 PrEP 整合到现有的医疗保健基础设施中可以集中相关资源,但示范项目很少介绍人员调整对资源的影响。通过扩大远程医疗服务范围来改变服务地点可以改善更多农村人口的就医条件,但对于美国一些负担最重的社区来说,互联网连接、技术接入以及与确定生物医学资格相关的挑战仍然是后勤方面的障碍。最后,量身定制的护理导航和协调方法已成为 PrEP 服务的一个非常有效的组成部分,它试图直接改变个人使用 PrEP 的系统级决定因素。我们重点介绍了任务转移、整合、服务提供和量身定制方面的最新进展和证据。除量身定制的护理导航外,其他证据参差不齐,任务转移和护理整合的下游影响和可持续性需要进一步关注。为了最大限度地提高 PrEP 的效果,研究工作需要继续考察个人、诊所、医疗保健系统和相关政策之间的相互作用。
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引用次数: 0
Central Nervous System Complications of HIV in Children. 儿童艾滋病的中枢神经系统并发症。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-01 Epub Date: 2024-01-22 DOI: 10.1007/s11904-024-00689-x
Hanalise V Huff, Kristen Sportiello, David R Bearden
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引用次数: 0
“Your Package Could Not Be Delivered”: The State of Digital HIV Intervention Implementation in the US "您的包裹无法送达":美国艾滋病数字化干预措施的实施现状
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-03-19 DOI: 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。
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引用次数: 0
Antiretroviral Therapy in Pregnancy: A 2023 Review of the Literature. 妊娠期抗逆转录病毒疗法:2023 年文献综述》。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-02-01 Epub Date: 2024-01-26 DOI: 10.1007/s11904-024-00688-y
Alison N Goulding, Kasey Meeks, Lena Shay, Sarah Casey, Colton Applegarth, Jennifer McKinney

Purpose of review: Selection of antiretroviral therapy during pregnancy must consider maternal physiology and resulting pharmacokinetic changes in pregnancy, resistance and efficacy profiles, tolerability and frequency of adverse effects, teratogenicity, and maternal, neonatal, and pregnancy outcomes. The objective of this review is to summarize the underlying data that informs the current clinical perinatal guidelines in the USA.

Recent findings: Data now supports the use of dolutegravir at all stages of pregnancy with no significant increase in neural tube defects. Safety and pharmacokinetic data on newer antiretroviral medications in pregnancy continue to lag behind the general population. While there are multiple safety and tolerability concerns with older regimens, there are now multiple options of regimens that are highly efficacious and have good safety data in pregnancy. Most pregnant patients who are virally suppressed on a well-tolerated regimen are able to safely continue those medications during pregnancy.

审查目的:妊娠期抗逆转录病毒疗法的选择必须考虑妊娠期母体的生理学和由此产生的药代动力学变化、耐药性和疗效概况、耐受性和不良反应频率、致畸性以及母体、新生儿和妊娠结局。本综述旨在总结美国现行围产期临床指南的基础数据:目前的数据支持在妊娠的各个阶段使用多鲁曲韦,神经管畸形的发生率没有明显增加。新型抗逆转录病毒药物在妊娠期的安全性和药代动力学数据仍然落后于普通人群。虽然旧的治疗方案存在多种安全性和耐受性问题,但现在有多种治疗方案可供选择,这些方案在妊娠期具有很高的疗效和良好的安全性数据。大多数采用耐受性良好的治疗方案且病毒已被抑制的妊娠期患者都可以在妊娠期间安全地继续服用这些药物。
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引用次数: 0
More than the Infinite Monkey Theorem: NHP Models in the Development of a Pediatric HIV Cure. 超越无限猴子定理:开发小儿艾滋病治疗方法中的NHP模型。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-02-01 Epub Date: 2024-01-16 DOI: 10.1007/s11904-023-00686-6
Jairo A Fonseca, Alexis C King, Ann Chahroudi

Purpose of review: An HIV cure that eliminates the viral reservoir or provides viral control without antiretroviral therapy (ART) is an urgent need in children as they face unique challenges, including lifelong ART adherence and the deleterious effects of chronic immune activation. This review highlights the importance of nonhuman primate (NHP) models in developing an HIV cure for children as these models recapitulate the viral pathogenesis and persistence.

Recent findings: Several cure approaches have been explored in infant NHPs, although knowledge gaps remain. Broadly neutralizing antibodies (bNAbs) show promise for controlling viremia and delaying viral rebound after ART interruption but face administration challenges. Adeno-associated virus (AAV) vectors hold the potential for sustained bNAb expression. Therapeutic vaccination induces immune responses against simian retroviruses but has yet to impact the viral reservoir. Combining immunotherapies with latency reversal agents (LRAs) that enhance viral antigen expression should be explored. Current and future cure approaches will require adaptation for the pediatric immune system and unique features of virus persistence, for which NHP models are fundamental to assess their efficacy.

综述的目的:儿童面临着独特的挑战,包括终生坚持抗逆转录病毒疗法和慢性免疫激活的有害影响,因此迫切需要一种能够消除病毒库或无需抗逆转录病毒疗法(ART)即可控制病毒的艾滋病治疗方法。本综述强调了非人灵长类动物(NHP)模型在开发儿童艾滋病治疗方法中的重要性,因为这些模型再现了病毒的发病机制和持续性:最近的研究结果:在婴儿非人灵长类动物中探索了几种治疗方法,但仍存在知识空白。广谱中和抗体(bNAbs)有望控制病毒血症并延缓抗逆转录病毒疗法中断后的病毒反弹,但面临着管理方面的挑战。腺相关病毒(AAV)载体具有持续表达 bNAb 的潜力。治疗性疫苗接种可诱导针对猿类逆转录病毒的免疫反应,但尚未对病毒库产生影响。应探索将免疫疗法与可增强病毒抗原表达的潜伏期逆转剂(LRAs)相结合。目前和未来的治疗方法需要适应儿科免疫系统和病毒持续存在的独特特征,而非濒危动物模型是评估其疗效的基础。
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引用次数: 0
Major Drug Resistance Mutations on Reverse Transcriptase Gene in Human Immunodeficiency Virus Type-1 in Indonesia: A Systematic Review 印度尼西亚 1 型人类免疫缺陷病毒逆转录酶基因的主要耐药性突变:系统综述
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-01-20 DOI: 10.1007/s11904-023-00687-5
Nurjannah, Sri Jayanti, Francisca Srioetami Tanoerahardjo, Ummu Syauqah Al Musyahadah, Caecilia Hapsari Ceriapuri Sukowati, Muhammad Nasrum Massi

Purpose of Review

The prevalence of HIV-1 in Indonesia is on a concerning upward trajectory, with a concurrent rise in the development of drug-resistant strains, challenging the efficacy of antiretroviral therapy (ART). Many mutations have been found in the pol gene that makes HIV resistant to ART. We aim to review the major drug resistance mutations (DRMs) of reverse transcriptase (RT) of pol gene in HIV-1 cases in Indonesia.

Recent Findings

A total of eleven articles reporting DRMs in HIV-1 subjects from various regions between 2015–2020 in Indonesia are included. The prevalence of major DRMs on the RT gene in studies included varies from 3.4% to 34%. The CRF01_AE subtype stands out as the predominant variant. Notably, the prevalence of major DRMs in ART-experienced individuals is 22.1%, while ART-naïve individuals show a lower rate of 4.4%. Among the RT gene mutations, M184I/V emerges as the most prevalent (10.5%) within the nucleos(t)ide reverse transcriptase inhibitors (NRTI) group, while K103N leads among the non-NRTI (NNRTI) group, with a frequency of 6.4%. Regionally, North Sulawesi records the highest prevalence of major DRMs in the RT gene at 21.1%, whereas Riau and Central Papua exhibit the lowest rates at 3.4%.

Summary

Significant variations in drug resistance mutations within the RT gene across Indonesian regions highlight the importance of closely monitoring and evaluating the effectiveness of current antiretroviral therapy (ART) regimens. Considerably, more studies are needed to understand better and overcome the emergence of DRMs on HIV-1 patients in Indonesia.

综述目的印度尼西亚的 HIV-1 感染率呈上升趋势,同时耐药株的发展也在上升,对抗逆转录病毒疗法(ART)的疗效提出了挑战。目前已发现许多使艾滋病病毒对抗逆转录病毒疗法产生耐药性的 pol 基因突变。我们旨在回顾印度尼西亚HIV-1病例中pol基因逆转录酶(RT)的主要耐药性突变(DRMs)。在纳入的研究中,RT 基因上主要 DRMs 的流行率从 3.4% 到 34% 不等。CRF01_AE 亚型是最主要的变异。值得注意的是,主要 DRMs 在有抗逆转录病毒疗法经验的个体中的流行率为 22.1%,而抗逆转录病毒疗法未接受者的流行率较低,仅为 4.4%。在 RT 基因突变中,M184I/V 突变在核苷(t)ide 逆转录酶抑制剂(NRTI)组中最常见(10.5%),而 K103N 突变在非 NRTI(NNRTI)组中最常见,频率为 6.4%。从地区来看,北苏拉威西省的 RT 基因中主要 DRMs 的发生率最高,为 21.1%,而廖内省和巴布亚省中部的发生率最低,仅为 3.4%。摘要印尼各地区 RT 基因中耐药性突变的显著差异凸显了密切监测和评估当前抗逆转录病毒疗法(ART)疗效的重要性。为了更好地了解和克服印尼 HIV-1 患者中出现的 DRMs,我们需要进行更多的研究。
{"title":"Major Drug Resistance Mutations on Reverse Transcriptase Gene in Human Immunodeficiency Virus Type-1 in Indonesia: A Systematic Review","authors":"Nurjannah, Sri Jayanti, Francisca Srioetami Tanoerahardjo, Ummu Syauqah Al Musyahadah, Caecilia Hapsari Ceriapuri Sukowati, Muhammad Nasrum Massi","doi":"10.1007/s11904-023-00687-5","DOIUrl":"https://doi.org/10.1007/s11904-023-00687-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>The prevalence of HIV-1 in Indonesia is on a concerning upward trajectory, with a concurrent rise in the development of drug-resistant strains, challenging the efficacy of antiretroviral therapy (ART). Many mutations have been found in the pol gene that makes HIV resistant to ART. We aim to review the major drug resistance mutations (DRMs) of reverse transcriptase (RT) of pol gene in HIV-1 cases in Indonesia.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>A total of eleven articles reporting DRMs in HIV-1 subjects from various regions between 2015–2020 in Indonesia are included. The prevalence of major DRMs on the RT gene in studies included varies from 3.4% to 34%. The CRF01_AE subtype stands out as the predominant variant. Notably, the prevalence of major DRMs in ART-experienced individuals is 22.1%, while ART-naïve individuals show a lower rate of 4.4%. Among the RT gene mutations, M184I/V emerges as the most prevalent (10.5%) within the nucleos(t)ide reverse transcriptase inhibitors (NRTI) group, while K103N leads among the non-NRTI (NNRTI) group, with a frequency of 6.4%. Regionally, North Sulawesi records the highest prevalence of major DRMs in the RT gene at 21.1%, whereas Riau and Central Papua exhibit the lowest rates at 3.4%.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Significant variations in drug resistance mutations within the RT gene across Indonesian regions highlight the importance of closely monitoring and evaluating the effectiveness of current antiretroviral therapy (ART) regimens. Considerably, more studies are needed to understand better and overcome the emergence of DRMs on HIV-1 patients in Indonesia.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"26 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508780","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}
引用次数: 0
Digital Adaptive Behavioral Interventions to Improve HIV Prevention and Care: Innovations in Intervention Approach and Experimental Design. 改进艾滋病毒预防和护理的数字自适应行为干预:干预方法和实验设计的创新。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-12-01 Epub Date: 2023-11-04 DOI: 10.1007/s11904-023-00671-z
Inbal Nahum-Shani, Sylvie Naar

Purpose of review: Recent advances in digital technologies can be leveraged to adapt HIV prevention and treatment services to the rapidly changing needs of individuals in everyday life. However, to fully take advantage of these technologies, it is critical to effectively integrate them with human-delivered components. Here, we introduce a new experimental approach for optimizing the integration and adaptation of digital and human-delivered behavioral intervention components for HIV prevention and treatment.

Recent findings: Typically, human-delivered components can be adapted on a relatively slow timescale (e.g., every few months or weeks), while digital components can be adapted much faster (e.g., every few days or hours). Thus, the systematic integration of these components requires an experimental approach that involves sequential randomizations on multiple timescales. Selecting an experimental approach should be motivated by the type of adaptive intervention investigators would like to develop, and the scientific questions they have about its construction.

审查目的:可以利用数字技术的最新进展,使艾滋病毒预防和治疗服务适应个人日常生活中快速变化的需求。然而,要充分利用这些技术,关键是要将它们与人工交付的组件有效集成。在这里,我们介绍了一种新的实验方法,用于优化数字和人类提供的行为干预组件的集成和适应,以预防和治疗艾滋病毒。最近的发现:通常,人工交付的组件可以在相对较慢的时间范围内进行调整(例如,每隔几个月或几周),而数字组件的调整速度可以更快(例如,每几天或几小时)。因此,这些组件的系统集成需要一种实验方法,该方法涉及在多个时间尺度上的顺序随机化。选择实验方法的动机应该是研究人员想要开发的适应性干预类型,以及他们对其构建的科学问题。
{"title":"Digital Adaptive Behavioral Interventions to Improve HIV Prevention and Care: Innovations in Intervention Approach and Experimental Design.","authors":"Inbal Nahum-Shani, Sylvie Naar","doi":"10.1007/s11904-023-00671-z","DOIUrl":"10.1007/s11904-023-00671-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent advances in digital technologies can be leveraged to adapt HIV prevention and treatment services to the rapidly changing needs of individuals in everyday life. However, to fully take advantage of these technologies, it is critical to effectively integrate them with human-delivered components. Here, we introduce a new experimental approach for optimizing the integration and adaptation of digital and human-delivered behavioral intervention components for HIV prevention and treatment.</p><p><strong>Recent findings: </strong>Typically, human-delivered components can be adapted on a relatively slow timescale (e.g., every few months or weeks), while digital components can be adapted much faster (e.g., every few days or hours). Thus, the systematic integration of these components requires an experimental approach that involves sequential randomizations on multiple timescales. Selecting an experimental approach should be motivated by the type of adaptive intervention investigators would like to develop, and the scientific questions they have about its construction.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":" ","pages":"502-512"},"PeriodicalIF":4.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479218","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}
引用次数: 0
Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction. 通过减少耻辱感来提高PrEP的接受和坚持的数字干预措施。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-12-01 Epub Date: 2023-12-07 DOI: 10.1007/s11904-023-00685-7
Jane J Lee, Juliann Li Verdugo, Anna Y Xiao, Katie Vo

Purpose of review: Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes.

Recent findings: Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.

综述目的:尽管暴露前预防(PrEP)对降低艾滋病毒传播风险有效,但耻辱感仍然是艾滋病毒预防的障碍。数字技术为难以接触到的人群提供了机会,并提高了现有干预措施的效率。本综述审查了目前解决病耻感的数字干预措施,以改善prep相关的结果。最近的发现:数字技术越来越多地用于艾滋病毒预防,包括各种各样的格式。最近的干预措施侧重于污名化和预防措施,往往涉及与移动电话相关的技术,并将重点放在年轻人群上,特别关注男男性行为者和变性女性。解决耻辱感问题的数字干预措施有望改善预科相关成果。目前还没有一种技术显示出一贯的优势。在资源不足的国家,获得预防措施的机会有限和污名化加剧,为支持不同社区的干预措施带来了挑战。进一步的研究应检查数字干预如何能够在个人层面之外减少耻辱感,以提高PrEP的使用,并探索改进和整合耻辱感测量方法的机会。
{"title":"Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction.","authors":"Jane J Lee, Juliann Li Verdugo, Anna Y Xiao, Katie Vo","doi":"10.1007/s11904-023-00685-7","DOIUrl":"10.1007/s11904-023-00685-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes.</p><p><strong>Recent findings: </strong>Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":" ","pages":"458-469"},"PeriodicalIF":4.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138498054","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}
引用次数: 0
Chatbots for HIV Prevention and Care: a Narrative Review. 艾滋病预防和护理的聊天机器人:叙述回顾。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-12-01 Epub Date: 2023-11-27 DOI: 10.1007/s11904-023-00681-x
Alastair van Heerden, Shannon Bosman, Dallas Swendeman, Warren Scott Comulada

Purpose of review: To explore the intersection of chatbots and HIV prevention and care. Current applications of chatbots in HIV services, the challenges faced, recent advancements, and future research directions are presented and discussed.

Recent findings: Chatbots facilitate sensitive discussions about HIV thereby promoting prevention and care strategies. Trustworthiness and accuracy of information were identified as primary factors influencing user engagement with chatbots. Additionally, the integration of AI-driven models that process and generate human-like text into chatbots poses both breakthroughs and challenges in terms of privacy, bias, resources, and ethical issues. Chatbots in HIV prevention and care show potential; however, significant work remains in addressing associated ethical and practical concerns. The integration of large language models into chatbots is a promising future direction for their effective deployment in HIV services. Encouraging future research, collaboration among stakeholders, and bold innovative thinking will be pivotal in harnessing the full potential of chatbot interventions.

综述目的:探讨聊天机器人与艾滋病预防和护理的交集。介绍和讨论了聊天机器人在艾滋病服务中的应用现状、面临的挑战、最新进展和未来的研究方向。最近的发现:聊天机器人促进了关于艾滋病毒的敏感讨论,从而促进了预防和护理策略。信息的可信度和准确性被认为是影响用户与聊天机器人互动的主要因素。此外,将处理和生成类人文本的人工智能驱动模型集成到聊天机器人中,在隐私、偏见、资源和道德问题方面带来了突破和挑战。聊天机器人在艾滋病预防和护理方面显示出潜力;然而,在解决相关的伦理和实际问题方面仍有大量工作要做。将大型语言模型集成到聊天机器人中是一个有希望的未来方向,可以有效地部署在艾滋病毒服务中。鼓励未来的研究、利益相关者之间的合作以及大胆的创新思维,对于充分利用聊天机器人干预的潜力至关重要。
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引用次数: 0
The Role of p53 in HIV Infection. p53在HIV感染中的作用。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-12-01 Epub Date: 2023-11-27 DOI: 10.1007/s11904-023-00684-8
Mahmoud Mohammad Yaseen, Nizar Mohammad Abuharfeil, Homa Darmani

Purpose of review: This review aims to elucidate the multifaceted role of the tumor suppressor protein p53 in the context of HIV infection. We explore how p53, a pivotal regulator of cellular processes, interacts with various facets of the HIV life cycle. Understanding these interactions could provide valuable insights into potential therapeutic interventions and the broader implications of p53 in viral infections.

Recent findings: Recent research has unveiled a complex interplay between p53 and HIV. Several reports have highlighted the involvement of p53 in restricting the replication of HIV within both immune and nonimmune cells. Various mechanisms have been suggested to unveil how p53 enforces this restriction on HIV replication. However, HIV has developed strategies to manipulate p53, benefiting its replication and evading host defenses. In summary, p53 plays a multifaceted role in HIV infection, impacting viral replication and disease progression. Recent findings underscore the importance of understanding the intricate interactions between p53 and HIV for the development of innovative therapeutic approaches. Manipulating p53 pathways may offer potential avenues to suppress viral replication and ameliorate immune dysfunction, ultimately contributing to the management of HIV/AIDS. Further research is warranted to fully exploit the therapeutic potential of p53 in the context of HIV infection.

综述目的:本文旨在阐明肿瘤抑制蛋白p53在HIV感染中的多方面作用。我们探讨了细胞过程的关键调节因子p53如何与HIV生命周期的各个方面相互作用。了解这些相互作用可以为潜在的治疗干预和p53在病毒感染中的更广泛意义提供有价值的见解。最近的发现:最近的研究揭示了p53和HIV之间复杂的相互作用。一些报告强调了p53在限制HIV在免疫细胞和非免疫细胞内复制中的作用。人们提出了多种机制来揭示p53如何对HIV复制施加这种限制。然而,HIV已经开发出了操纵p53的策略,有利于其复制并逃避宿主防御。总之,p53在HIV感染中起着多方面的作用,影响病毒复制和疾病进展。最近的研究结果强调了了解p53和HIV之间复杂的相互作用对于开发创新治疗方法的重要性。操纵p53通路可能提供抑制病毒复制和改善免疫功能障碍的潜在途径,最终有助于艾滋病毒/艾滋病的管理。为了充分挖掘p53在HIV感染中的治疗潜力,需要进一步的研究。
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引用次数: 0
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Current HIV/AIDS Reports
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