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Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis. 艾滋病毒和性传播感染预防时代性传播感染控制的挑战和解决方案。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-10-01 Epub Date: 2023-09-26 DOI: 10.1007/s11904-023-00666-w
Felix Ong'era Mogaka, Jenell Stewart, Victor Omollo, Elizabeth Bukusi

Purpose of review: This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs.

Recent findings: The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.

综述目的:本文综述了目前在HIV暴露前预防(PrEP)使用者中控制细菌性传播感染(STIs)的努力,并概述了在HIV PrEP计划中控制STIs的机会和挑战。最近的发现:全球性传播感染的发病率持续上升,尤其是在艾滋病毒PrEP使用者中,估计每4名PrEP使用者就有1人患有可治愈的细菌性传播感染。性传播感染和艾滋病毒是一种需要双重干预的综合征。大多数性传播感染是无症状的,当可以进行检测时,许多性传播感染发生在生殖器外部位,而在依赖尿液检测或生殖器拭子时,这些部位被遗漏了。最佳检测和治疗,包括抗微生物耐药性检测,在高收入国家造成了困难,在大多数中低收入国家基本上不存在。新的STI初级预防策略,如用于预防STI的多西环素暴露后预防(PEP),已被证明在某些人群中非常有效。一些司法管辖区发布了多西环素PEP的规范性指南和立场声明;然而,实施的临床标准和关于公共卫生影响的数据是有限的。性行为活跃人群的性传播感染发病率很高,而且还在上升。性健康项目应利用扩大HIV PrEP提供服务,将STI检测、监测和新型STI预防服务结合起来。
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引用次数: 0
Integrated Care Models: HIV and Substance Use. 综合护理模式:艾滋病毒和药物使用。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-09-12 DOI: 10.1007/s11904-023-00667-9
Katherine Hill, Irene Kuo, Sheela V Shenoi, Mahalia S Desruisseaux, Sandra A Springer

Purpose of review: Behaviors and practices associated with substance use contribute to lack of HIV virologic suppression and onward transmission. In the USA, many recent HIV outbreaks have been connected with substance use. Evidence-based strategies for integrating care of those at risk for and living with HIV and who use substances continue to evolve. This review, based on scientific and medical literature through March 2023, provides an overview and evaluation of initiatives for integrated care aimed to serve patients at risk for and with HIV and a substance use disorder.

Recent findings: Integrated care services can improve health outcomes for patients at risk for and with HIV and a substance use disorder; for instance, treatment for an opioid use disorder can help improve HIV viral suppression. Brick-and-mortar facilities can provide successful care integration with appropriate clinic leadership to support multidisciplinary care teams, up-to-date provider training, and sufficient pharmacy stock for substance use treatment. Delivering healthcare services to communities (e.g., mobile healthcare clinics and pharmacies, telehealth) may prove to be an effective way to provide integrated services for those with or at risk of HIV and substance use disorders. Incorporating technology (e.g., mobile phone applications) may facilitate integrated care. Other venues, including harm reduction programs and carceral settings, should be targets for integrated services. Venues providing healthcare should invest in integrated care and support legislation that increases access to services related to HIV and substance use.

综述目的:与药物使用相关的行为和实践导致缺乏HIV病毒抑制和进一步传播。在美国,最近的许多艾滋病疫情都与药物使用有关。基于证据的综合护理艾滋病毒感染者和感染者以及使用药物者的战略仍在发展。这篇综述基于截至2023年3月的科学和医学文献,概述和评估了旨在为有艾滋病毒和药物使用障碍风险的患者提供服务的综合护理举措。最近的研究结果:综合护理服务可以改善有感染艾滋病毒和药物使用障碍风险的患者的健康状况;例如,阿片类药物使用障碍的治疗可以帮助改善HIV病毒的抑制。实体设施可以提供成功的护理整合,适当的诊所领导可以支持多学科护理团队、最新的提供者培训以及足够的药物使用治疗库存。向社区提供医疗服务(例如,移动医疗诊所和药店、远程医疗)可能被证明是为艾滋病毒和药物使用障碍患者或有风险的患者提供综合服务的有效方式。结合技术(例如,移动电话应用程序)可以促进综合护理。其他场所,包括减少伤害项目和尸体环境,应该成为综合服务的目标。提供医疗保健的场所应投资于综合护理和支持立法,以增加获得与艾滋病毒和药物使用有关的服务的机会。
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引用次数: 0
Intervention Approaches to Address Intimate Partner Violence and HIV: a Scoping Review of Recent Research. 应对亲密伴侣暴力和艾滋病毒的干预方法:最近研究的范围综述。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-09-28 DOI: 10.1007/s11904-023-00668-8
Kamila A Alexander, Gloria Mpundu, Brenice Duroseau, Nkemakolem Osian, Shadae Chambers, DaJaneil McCree, Karin E Tobin, Tiara C Willie

Purpose of review: Intimate partner violence (IPV) remains a critical challenge to HIV prevention and treatment efforts across the globe. We examined recently published (January 9, 2017-January 9, 2023) integrated behavioral interventions designed to address IPV and HIV across the care continuum.

Recent findings: Fifteen studies (involving n = 10,947 participants) met the inclusion criteria for this review. Majority (n = 13) of studies focused on IPV and HIV prevention whereas two studies addressed IPV and HIV care engagement among women living with HIV. Ten studies were conducted on the African continent representing 5 countries. Most interventions (n = 11) focused on individual-level outcomes among cisgender women although two involved male partners. About half of the interventions reviewed (n = 8) showed effectiveness on both IPV and HIV outcomes compared to control groups. Integrated HIV/IPV interventions are needed to address the synergistic nature of these epidemics among marginalized populations. Future studies should focus on developing and implementing strength-based interventions among people living with HIV, men, transgender people, and Black women in the USA. Additionally, researchers and program managers should consider addressing structural and internalized stigma as potential behavioral mechanisms for improving health among people simultaneously experiencing or at-risk for HIV and IPV.

审查目的:亲密伴侣暴力仍然是全球艾滋病毒预防和治疗工作面临的重大挑战。我们研究了最近发表的(2017年1月9日至2023年1月09日)综合行为干预措施,旨在解决整个护理过程中的IPV和HIV问题。最近的发现:15项研究(涉及10947名参与者)符合本综述的纳入标准。大多数(n=13)研究侧重于IPV和艾滋病毒预防,而两项研究涉及艾滋病毒感染妇女的IPV和艾滋病护理参与。代表5个国家在非洲大陆进行了10项研究。大多数干预措施(n=11)侧重于顺性别女性的个人层面结果,尽管有两项涉及男性伴侣。与对照组相比,大约一半的受访干预措施(n=8)对IPV和HIV结果均显示出有效性。需要采取综合的艾滋病毒/IPV干预措施,以解决这些流行病在边缘化人群中的协同作用。未来的研究应侧重于在美国的艾滋病毒感染者、男性、跨性别者和黑人女性中制定和实施基于力量的干预措施。此外,研究人员和项目经理应该考虑解决结构性和内化的污名,将其作为改善同时经历或面临艾滋病毒和IPV风险的人群健康的潜在行为机制。
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引用次数: 0
The New Era of Long-Acting Antiretroviral Therapy: When and Why to Make the Switch. 长效抗逆转录病毒疗法的新时代:何时以及为什么要做出改变。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-09-21 DOI: 10.1007/s11904-023-00665-x
Melanie C Goebel, Emmanuel Guajardo, Thomas P Giordano, Shital M Patel

Purpose of review: Despite the availability of safe and effective oral combination antiretroviral therapy, barriers to maintaining viral suppression remain a challenge to ending the HIV epidemic. Long-acting injectable antiretroviral therapy was developed as an alternative to daily oral therapy. This review summarizes the current literature on the efficacy of long-acting cabotegravir plus rilpivirine for the treatment of HIV-1, reasons to switch to injectable therapy, and barriers to switching.

Recent findings: Long-acting cabotegravir plus rilpivirine is safe and effective in maintaining HIV-1 virologic suppression. Ideal candidates for switching to long-acting cabotegravir plus rilpivirine are virologically suppressed on oral regimens with good adherence and no history of virologic failure or baseline resistance. Indications to switch to injectable therapy include patient preference, the potential for improved adherence, and avoidance of adverse effects. Implementation research is needed to assess and overcome system barriers. Long-acting cabotegravir plus rilpivirine is a novel alternative to oral antiretrovirals, with the potential to improve adherence and quality of life in people with HIV.

审查目的:尽管有安全有效的口服联合抗逆转录病毒疗法,但维持病毒抑制的障碍仍然是结束艾滋病毒流行的挑战。开发了长效注射抗逆转录病毒疗法,作为日常口服疗法的替代方案。这篇综述总结了目前关于长效卡博替拉韦联合利匹韦林治疗HIV-1的疗效、改用注射疗法的原因以及改用的障碍的文献。最近的发现:长效卡博韦加利匹韦林在维持HIV-1病毒抑制方面是安全有效的。改用长效卡博韦加利匹韦林的理想候选者在口服方案中受到病毒学抑制,具有良好的依从性,没有病毒学失败或基线耐药性史。转向注射治疗的适应症包括患者偏好、改善依从性的潜力以及避免不良反应。需要进行实施研究,以评估和克服系统障碍。长效卡博替拉韦加利匹韦林是口服抗逆转录病毒药物的一种新替代品,有可能改善艾滋病毒感染者的依从性和生活质量。
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引用次数: 0
Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory. 螺旋式风险:利用复杂系统理论可视化在同性恋、双性恋和其他男男性行为者中社会模式HIV风险的多层次因素。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-08-01 DOI: 10.1007/s11904-023-00664-y
K Stojanovski, E J King, S O'Connell, K S Gallagher, K P Theall, A T Geronimus

Purpose of review: Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV "risk."

Recent findings: We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.

综述目的:艾滋病毒感染的全球差异,特别是同性恋、双性恋和其他男男性行为者(GBMSM)之间的差异,表明探索影响艾滋病毒传播的多层次过程的重要性。我们使用复杂系统理论和PRISMA指南对63项全球综述进行了系统综述,以了解HIV在GBMSM中的社会模式。目的是对综述进行专题分析,以(1)综合艾滋病毒风险的多层次风险因素,(2)跨社会生态模型对风险进行分类,(3)建立一个概念性模型,将影响GBMSMS艾滋病毒风险的相关因素可视化。“最近的发现:我们纳入了49项高质量和中等质量的研究。结果表明,GBMSM的HIV风险来自社会生态模型的个体、人际和结构层面。我们确定了几个与生物医学预防方法有关的影响GBMSM感染艾滋病毒风险的主题;性和寻求性的行为;行为预防方法;个体水平特征与合并症感染;生活经历和人际关系;国家层面的收入;国家一级的艾滋病毒流行情况;以及结构性的病耻感。这些多层次的因素串联在一起,使gbsm在全球范围内感染艾滋病毒的风险持续存在。我们对综述的系统综述的主题分析的合并表明,艾滋病毒感染的风险在社会生态模型的多个层面上以一种紧急的、动态的和复杂的性质运作。运用复杂系统理论揭示了多重因素如何形成一个动态强化的GBMSM HIV风险系统。
{"title":"Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory.","authors":"K Stojanovski,&nbsp;E J King,&nbsp;S O'Connell,&nbsp;K S Gallagher,&nbsp;K P Theall,&nbsp;A T Geronimus","doi":"10.1007/s11904-023-00664-y","DOIUrl":"https://doi.org/10.1007/s11904-023-00664-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV \"risk.\"</p><p><strong>Recent findings: </strong>We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9971686","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
A Review of Serious Gaming as an Intervention for HIV Prevention. 将严肃游戏作为艾滋病预防干预措施的综述。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-08-01 Epub Date: 2023-05-22 DOI: 10.1007/s11904-023-00659-9
Ariel U Smith, Gabriella M Khawly, Janna Jann, Ana Paola Mata Zetina, Janeth Padilla, Rebecca Schnall

Purposeof review: Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes.

Recent findings: A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.

审查目的:在全球范围内,年轻人是新感染艾滋病毒人数最多的群体。随着智能手机的普及,严肃游戏被视为提高知识和行为结果的有效手段。本系统综述介绍了当前的艾滋病预防严肃游戏及其与艾滋病相关知识和行为结果之间的关系:我们使用 PubMed、CINAL、IEEE、Web of Science 和 Google Scholar 对艾滋病预防严肃游戏进行了检索。共发现了 31 篇论文,其中包括 20 项研究和 11 项协议。关于知识、态度、意向和行为的研究结果不一。有两项干预报告称,PrEP 的使用率和最佳剂量有所提高。游戏似乎是一种可行的、吸引人的方法,可以改善知识、态度和行为结果,从而促进全球不同青少年群体的艾滋病预防工作。然而,还需要开展更多的研究来了解如何有效地实施这种方式。
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引用次数: 0
Interventions to Improve Adolescent HIV Care Outcomes. 改善青少年艾滋病毒护理结果的干预措施。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-06-10 DOI: 10.1007/s11904-023-00663-z
Marta I Mulawa, Elizabeth T Knippler, Maryam Al-Mujtaba, T Harper Wilkinson, Venkata K Ravi, Leila S Ledbetter

Purpose of review: This review of recent studies evaluating interventions to improve HIV care outcomes among adolescents with HIV (AHIV) was conducted to provide a comprehensive overview of the recent evidence, highlight promising approaches, and suggest directions for future research.

Recent findings: Our scoping review revealed 65 studies evaluating a variety of interventions and using a range of study designs at various stages of research. Effective approaches included community-based, integrated service delivery models with case management, trained community adolescent treatment supporters, and consideration of social determinants of health. Recent evidence also supports the feasibility, acceptability, and preliminary efficacy of other innovative approaches, including mental health interventions as well as technology-delivered approaches; however, more research is needed to build the evidence base for these interventions. Our review's findings suggest that interventions providing comprehensive, individualized support are essential to improving HIV care outcomes among adolescents. More research is needed to build the evidence base for such interventions and ensure effective, equitable implementation to support the global target of ending the AIDS epidemic by 2030.

综述的目的:对最近评估干预措施以改善艾滋病毒感染青少年(AHIV)艾滋病毒护理结果的研究进行综述,以全面概述最近的证据,强调有前景的方法,并为未来的研究提出方向。最近的发现:我们的范围审查显示,65项研究评估了各种干预措施,并在不同的研究阶段使用了一系列研究设计。有效的方法包括以社区为基础的、具有病例管理的综合服务提供模式、经过培训的社区青少年治疗支持者以及考虑健康的社会决定因素。最近的证据也支持其他创新方法的可行性、可接受性和初步疗效,包括心理健康干预措施以及技术提供的方法;然而,还需要更多的研究来为这些干预措施建立证据基础。我们的综述结果表明,提供全面、个性化支持的干预措施对于改善青少年艾滋病毒护理结果至关重要。需要进行更多的研究,为此类干预措施建立证据基础,并确保有效、公平地实施,以支持到2030年结束艾滋病流行的全球目标。
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引用次数: 0
Mpox and HIV: a Narrative Review. Mpox 与 HIV:叙述性综述。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-05-13 DOI: 10.1007/s11904-023-00661-1
Carlos S Saldana, Colleen F Kelley, Bruce M Aldred, Valeria D Cantos

Purpose of review: We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH.

Recent findings: During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.

综述目的:我们回顾了有关艾滋病病毒感染者(PWH)水痘的现有文献。我们强调了感染天花的流行病学、临床表现、诊断和治疗注意事项、预防以及针对艾滋病感染者的公共卫生信息等方面的特殊考虑:在 2022 年麻风腮疫情爆发期间,全世界感染麻风腮疫情的威尔士和威尔士族人数不成比例。最新报告显示,这些患者(尤其是晚期艾滋病患者)的疾病表现、管理和预后可能与未患艾滋病相关免疫缺陷的患者大不相同。在病毒血症得到控制、CD4 细胞计数较高的感染者中,麻疹通常是轻微的,并可自行缓解。然而,它也可能很严重,出现皮肤坏死和长期愈合;肛门、直肠和其他粘膜病变;以及器官系统受累。公共卫生人员的医疗保健使用率较高。对于患有严重水痘的威斯康星人,通常采用支持性对症治疗和单一或联合水痘导向抗病毒药物。为了更好地指导临床决策,需要从随机临床对照试验中获得有关治疗和预防水痘工具在威尔士人中疗效的数据。
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引用次数: 0
Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections. 醋酸甲羟孕酮注射液对阴道黏膜终点的影响及与性传播感染的相关性的最新进展。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-06-21 DOI: 10.1007/s11904-023-00662-0
Smritee Dabee, Christina Balle, Maricianah Onono, Steve Innes, Gonasagrie Nair, Thesla Palanee-Phillips, Adam D Burgener, Steven E Bosinger, Jo-Ann S Passmore, Renee Heffron, Heather Jaspan, Anna-Ursula Happel

Purpose of review: The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial.

Recent findings: Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.

审查目的:醋酸甲羟孕酮长效可逆肌肉注射避孕药(DMPA-IM)被非洲的顺性别妇女广泛使用。虽然 DMPA-IM 能提供可靠的避孕效果,但它对女性生殖道(FGT)粘膜的潜在影响,包括感染 HIV 的风险,引起了人们的关注。本综述总结并比较了观察性队列研究和随机 "艾滋病结果中的避孕选择证据(ECHO)试验 "的证据:尽管之前的观察性研究发现,使用 DMPA-IM 的妇女体内与细菌性阴道病(BV)相关的细菌数量较多、炎症加剧、宫颈阴道 HIV 靶细胞密度增加以及上皮屏障受损,但 ECHO 试验的子研究发现,除了 Th17 样细胞增加外,阴道微生物组、炎症、蛋白质组、转录组以及病毒性和细菌性 STI 风险均未发生不利变化。随机数据表明,使用 DMPA-IM 不会对与感染相关的粘膜终点产生不利影响。这些研究结果支持在感染性传播疾病(包括艾滋病毒)的高风险妇女中安全使用 DMPA-IM。
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引用次数: 0
Interventions to Reduce Alcohol Use and HIV Risk among Sexual and Gender Minority Populations: a Systematic Review. 减少性少数群体和性别少数群体中饮酒和 HIV 风险的干预措施:系统综述。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-08-01 Epub Date: 2023-05-25 DOI: 10.1007/s11904-023-00660-2
Carolyn Lauckner, Kimberly Haney, Fidelis Sesenu, Trace Kershaw

Purpose of review: Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals.

Recent findings: Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.

审查目的:性与性别少数群体(SGM)被诊断出感染 HIV 的比例过高,而酗酒会增加他们感染 HIV 的风险。本综述评估了针对 SGM 人饮酒和 HIV 性风险行为的干预措施的文献现状:从 2012 年到 2022 年,共有 14 篇手稿测试了针对 SGM 群体中饮酒和 HIV 风险行为的干预措施,其中只有 7 项随机对照试验 (RCT)。几乎所有干预措施都针对男男性行为者,没有一项针对变性人群或顺性女性。虽然这些干预措施在减少饮酒和/或性风险方面显示出一定的有效性,但不同研究的结果差异很大。我们需要更多的研究来检验这一领域的干预措施,尤其是针对变性人的干预措施。需要对不同人群进行更大规模的 RCT 研究,并采用标准化的结果测量方法,以加强证据基础。
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Current HIV/AIDS Reports
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