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Promises and challenges: cabotegravir for preexposure prophylaxis. 前景与挑战:卡波特韦用于暴露前预防。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-07-01 DOI: 10.1097/COH.0000000000000733
Matthew A Spinelli, Beatriz Grinsztejn, Raphael J Landovitz

Purpose of review: Tenofovir-based oral PrEP has been effective in reducing population-level HIV incidence in multiple settings, although disparities remain. Injectable cabotegravir-based PrEP is an alternative that may be attractive to individuals with adherence challenges or who do not desire to take a daily medication. We review promises and challenges of cabotegravir-based PrEP.

Recent findings: Cabotegravir has demonstrated higher effectiveness than oral PrEP in two randomized trials, with a hazard ratio of 0.31 for HIV incidence among MSM and transgender women across multiple settings [95% confidence interval (CI) 0.18-0.62] and 0.11 for cisgender women in sub-Saharan Africa (95% CI 0.040.32). Cabotegravir was also highly effective among populations with disproportionate HIV incidence. Although cabotegravir breakthrough was rare, diagnosis was delayed with use of antigen/antibody-based HIV tests, and resistance occurred with breakthrough infections. Implementation will need to overcome several challenges, including HIV RNA laboratory monitoring not being widely available, requirement for additional staff time and clinic space, and need to provide oral medication during interruptions in dosing.

Summary: Cabotegravir-based PrEP is a highly effective additional PrEP option that will expand HIV prevention options. For successful roll-out, strategies for streamlined and accessible delivery of cabotegravir in real-world settings will need to be developed.

综述目的:以替诺福韦为基础的口服PrEP在多种环境下有效降低人群水平的HIV发病率,尽管差距仍然存在。可注射的以卡波特韦为基础的PrEP是一种替代方案,可能对那些有依从性挑战或不想每天服药的人有吸引力。最近的研究发现:在两项随机试验中,Cabotegravir显示出比口服PrEP更高的有效性,在多种环境下,MSM和跨性别女性的艾滋病毒感染率的风险比为0.31[95%置信区间(CI) 0.18-0.62],在撒哈拉以南非洲的无性别女性的风险比为0.11 (95% CI 0.040.32)。卡波特韦在艾滋病毒发病率不成比例的人群中也非常有效。虽然卡博特韦的突破很少,但使用基于抗原/抗体的艾滋病毒检测延迟了诊断,并且突破感染发生耐药性。实施工作将需要克服若干挑战,包括艾滋病毒RNA实验室监测不能广泛提供,需要额外的工作人员时间和诊所空间,以及需要在给药中断期间提供口服药物。总结:以卡波特韦为基础的PrEP是一种非常有效的额外PrEP选择,将扩大艾滋病毒预防选择。为了成功推广,需要制定在现实环境中简化和方便地提供卡波特韦的战略。
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引用次数: 5
Long-acting preexposure prophylaxis in low- and middle-income countries: key considerations for implementation. 低收入和中等收入国家的长效暴露前预防:实施的关键考虑因素。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000729
Quanhathai Kaewpoowat, Suwat Chariyalertsak, Nittaya Phanuphak, Reshmie A Ramautarsing

Purpose of review: HIV preexposure prophylaxis (PrEP) is a key tool in ending the HIV epidemic. Long-acting cabotegravir (LA- CAB) phase II/III studies revealed promising efficacy in preventing HIV acquisition. Here, we discuss key considerations for implementing LA-CAB in low- and middle-income countries (LMIC).

Recent findings: PrEP roll out in LMIC is still far from ideal, and contextual factors within LMIC vary widely. Implementation science studies are urgently needed to optimize the implementation of LA-CAB in different settings, consider effective service delivery models, and ensure program sustainability. Preferences and concerns regarding LA-CAB among potential users are unknown but likely specific to local context. Demedicalized and simplified PrEP service delivery increases uptake, and ways to safely and effectively do the same for LA- CAB need to be explored. Although ideally LA-CAB should be an additional choice of HIV prevention method, its cost will be the major determinant in deciding its position as a first line choice or restricted second-line option.

Summary: LA-CAB has the potential to enhance PrEP uptake. However, several implementation challenges need to be explored and addressed to ensure it can be accessed and utilized in different settings by those who need it the most.

审查目的:艾滋病毒暴露前预防(PrEP)是结束艾滋病毒流行的关键工具。长效卡博特韦(LA- CAB) II/III期研究显示,在预防HIV获得方面有希望的疗效。在这里,我们讨论了在低收入和中等收入国家(LMIC)实施LA-CAB的关键考虑因素。最近的发现:PrEP在低收入和中等收入国家的推广还远远不够理想,低收入和中等收入国家的背景因素差异很大。迫切需要实施科学研究来优化LA-CAB在不同环境下的实施,考虑有效的服务提供模式,并确保项目的可持续性。潜在用户对LA-CAB的偏好和关注尚不清楚,但可能具体到当地情况。非医疗化和简化的PrEP服务提供增加了使用率,需要探索安全有效地为LA- CAB提供同样服务的方法。虽然理想情况下LA-CAB应该是艾滋病毒预防方法的一种额外选择,但其成本将是决定其作为一线选择还是限制性二线选择的主要决定因素。总结:LA-CAB具有增强PrEP摄取的潜力。然而,需要探索和解决若干实施方面的挑战,以确保最需要它的人能够在不同的环境中访问和利用它。
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引用次数: 2
Implementation of long-acting antiretroviral therapy in low-income and middle-income countries. 在低收入和中等收入国家实施长效抗逆转录病毒治疗。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000732
Fiona V Cresswell, Mohammed Lamorde

Purpose of review: With oral antiretroviral therapy, HIV has become a manageable chronic illness. However, UNAIDS targets for virologic suppression have not yet been attained in many low-income and middle-income countries (LMICs). Long-acting drug formulations hold promise to improve treatment outcomes. In this rapidly evolving area of research, we aim to review recent literature on the treatment of HIV with long-acting agents and identify implementation considerations for LMICs.

Recent findings: Randomized controlled trials have shown that monthly long-acting injectable cabotegravir (CAB) and rilpivirine (RPV) is noninferior to oral ART, and 2-monthly CAB/RPV is noninferior to monthly injections. However, few people from LMICs were included. A modelling study predicts that in sub-Saharan Africa, injectable CAB/RPV is best targeted to those with poor adherence (HIV viral load >1000 copies/ml) in whom cost-effectiveness is greatest and risk of contributing to further resistance is no greater than continuation of oral ART. Other promising agents, such as lenacapavir are under investigation and may prove particularly useful in heavily treatment-experienced adults.

Summary: Long-acting regimens are a promising advance in HIV treatment. By extending the dosing interval, increasing convenience and being discreet these regimens may reduce HIV treatment challenges. However, there are multiple implementation considerations in LMICs including the need for exclusion of hepatitis B, cold chain, oral bridging in case of missed dosing and switching during tuberculosis therapy. Efficacy and safety data are also awaited for settings without routine access to baseline resistance testing or regular viral load monitoring and for special populations, such as pregnancy, children and the elderly.

综述目的:通过口服抗逆转录病毒治疗,艾滋病毒已成为一种可控的慢性疾病。然而,在许多低收入和中等收入国家,艾滋病规划署的病毒学抑制目标尚未实现。长效药物制剂有望改善治疗效果。在这个快速发展的研究领域,我们的目标是回顾最近关于长效药物治疗艾滋病毒的文献,并确定中低收入国家的实施考虑因素。最近的发现:随机对照试验表明,每月长效注射卡博特韦(CAB)和利匹韦林(RPV)不逊色于口服抗逆转录病毒治疗,每月2个月的CAB/RPV不逊色于每月注射。然而,来自中低收入国家的人很少被包括在内。一项模拟研究预测,在撒哈拉以南非洲,可注射的CAB/RPV最适合那些依从性差的患者(艾滋病毒载量>1000拷贝/毫升),这些患者的成本效益最高,导致进一步耐药的风险不大于继续口服抗逆转录病毒治疗。其他有希望的药物,如lenacapavir正在研究中,可能对有大量治疗经验的成年人特别有用。摘要:长效治疗方案是HIV治疗的一个有希望的进展。通过延长给药间隔,增加便利性和谨慎,这些方案可以减少艾滋病毒治疗的挑战。然而,在低收入和中等收入国家实施时需要考虑多种因素,包括需要排除乙型肝炎、冷链、在错过给药情况下的口服桥接以及在结核病治疗期间的转换。对于没有常规基线耐药检测或定期病毒载量监测的环境以及特殊人群(如孕妇、儿童和老年人),也等待有效性和安全性数据。
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引用次数: 3
An exploration of how broadly neutralizing antibodies might induce HIV remission: the 'vaccinal' effect. 如何广泛中和抗体可能诱导HIV缓解的探索:“疫苗”效应。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-05-01 Epub Date: 2022-04-18 DOI: 10.1097/COH.0000000000000731
Timothy Tipoe, Sarah Fidler, John Frater

Purpose of review: Broadly neutralizing antibodies (bNAbs) are a potential new therapeutic strategy to treat HIV infection. This review explores possible mechanisms of action of bNAbs and summarizes the current evidence supporting their immunomodulatory properties, which might lead to sustained virological remission - the 'vaccinal effect'.

Recent findings: Antiretroviral therapy (ART) is required to confer lasting HIV suppression; stopping ART almost invariably leads to HIV recrudescence from a persistent pool of virally infected cells - the HIV reservoir. HIV-specific broadly neutralizing antibodies (bNAbs) may confer viral control after ART cessation predominantly through blockade of viral entry into uninfected target cells. In some human and animal studies, HIV bNAbs also conferred lasting viral suppression after therapeutic bNAb plasma levels had declined. Immune-modulatory mechanisms have been postulated to underlie this observation - the 'vaccinal effect'. Hypothesized mechanisms include the formation of immune complexes between bNAbs and HIV envelope protein, thereby enhancing antigen presentation and uptake by immune cells, with boosted adaptive immune responses subsequently controlling the HIV reservoir.

Summary: There is emerging evidence for potent antiviral efficacy of bNAb therapy. Whether bNAbs can induce sustained viral suppression after dropping below therapeutic levels remains controversial. Mechanistic data from on-going and future clinical trials will help answer these questions.

综述目的:广泛中和抗体(bNAbs)是治疗HIV感染的一种潜在的新治疗策略。这篇综述探讨了bNAbs的可能作用机制,并总结了目前支持其免疫调节特性的证据,这可能会导致持续的病毒学缓解,即“疫苗效应”;停止抗逆转录病毒疗法几乎总是会导致艾滋病毒从一个持续的病毒感染细胞库——艾滋病毒库——中复发。HIV特异性广泛中和抗体(bNAbs)可以在ART停止后主要通过阻断病毒进入未感染的靶细胞来提供病毒控制。在一些人类和动物研究中,在治疗性bNAb血浆水平下降后,HIV bNAb也具有持久的病毒抑制作用。免疫调节机制被认为是这一观察结果的基础——“疫苗效应”。假设的机制包括bNAb和HIV包膜蛋白之间形成免疫复合物,从而增强免疫细胞的抗原呈递和摄取,增强的适应性免疫反应随后控制HIV库。综述:有新的证据表明bNAb疗法具有强大的抗病毒功效。bNAbs在降至治疗水平以下后是否能诱导持续的病毒抑制仍存在争议。来自正在进行和未来临床试验的机制数据将有助于回答这些问题。
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引用次数: 4
Editorial: Is it time to implement injectable antiretroviral treatments globally? 社论:现在是在全球实施可注射抗逆转录病毒治疗的时候了吗?
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000736
M. Boffito, Kimberley K. Scarsi, C. Orkin
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引用次数: 0
Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review. 主要人群对长效抗逆转录病毒药物预防和治疗的看法和意见:范围审查。
IF 4.5 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-05-01 Epub Date: 2022-04-18 DOI: 10.1097/COH.0000000000000734
Omar Sued, Norma Nardi, Luciana Spadaccini

Purpose of review: Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.

Recent findings: According to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues.

Summary: Knowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.

审查目的:重点人群受到人类免疫缺陷病毒(HIV)的不成比例的影响。在这些人群中,获取、保留和坚持是暴露前预防(PrEP)和艾滋病毒治疗效果的重要障碍。长效(LA)抗逆转录病毒药物有望解决其中一些问题。当前审查的目的是更新关键人群和PLWH对LA的看法,基于他们的意见,可接受性和使用它的意愿。最近的研究发现:根据综述,对LA的偏好因研究人群而异。关于艾滋病毒感染者(PLWH),与男性发生性关系的男性对拥有不同的选择感兴趣,青少年对LA(植入物的强烈偏好)感兴趣,但也认为使用生物医学预防存在重大障碍;跨性别女性的目标是不可见的小型植入物,具有持久的效果,或者LA注射可以应用于臀部以外的其他部位,而有过医疗注射史的女性可能会增加对LA的偏好(注射吸毒者的历史除外[IDU])。女性性工作者和IDU都对LA-PrEP感兴趣。在抗逆转录病毒治疗方面,LA提高了治疗满意度和接受度,主要是在每2个月接受一次注射的患者中。洛杉矶帮助克服了药物疲劳、耻辱和依从性问题。摘要:了解对生物医学干预措施的偏好将有助于更好地了解和制定针对这些人群的有效策略。
{"title":"Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review.","authors":"Omar Sued, Norma Nardi, Luciana Spadaccini","doi":"10.1097/COH.0000000000000734","DOIUrl":"10.1097/COH.0000000000000734","url":null,"abstract":"<p><strong>Purpose of review: </strong>Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.</p><p><strong>Recent findings: </strong>According to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues.</p><p><strong>Summary: </strong>Knowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.</p>","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 3","pages":"145-161"},"PeriodicalIF":4.5,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Clinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantages 高收入国家长效抗逆转录病毒治疗的临床实施:挑战与优势
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-04-18 DOI: 10.1097/COH.0000000000000730
L. Waters, Alex Sparrowhawk
Purpose of review Long-acting antiretroviral therapy (LA-ART) brings a paradigm shift to HIV care with injectable cabotegravir/rilpivirine (IM-CAB/RPV) in current or imminent use in several countries. This brings the usual opportunities and challenges of a new therapy, plus requirements to adapt services to reliably deliver injections and ensure patients understand advantages and limitations. We summarise key considerations for implementation in high-income countries. Recent findings Monthly IM-CAB/RPV is noninferior to oral ART and monthly IM-CAB/RPV to 1-monthly in carefully selected virally suppressed people. The numerically higher virological failure rate on two-monthly IM-CAB/RPV warrants close attention and careful monitoring. Implementation projects report positive experiences for patients and staff, but also barriers. Data is needed in younger people, pregnancy/breastfeeding, and in those with detectable viraemia secondary to suboptimal adherence. Summary We highlight a paucity of real-world data and key unanswered questions. Existing data on injection techniques may have implications for training; monitoring of outcomes is crucial to ensure clinical trial results are replicated in real-life. Better understanding of treatment failure, and individualised therapy, is crucial, and it is important to repeat patient preference surveys as new data emerges to ensure decisions are based on the most recent evidence of benefit vs risk.
长效抗逆转录病毒疗法(LA-ART)在一些国家目前或即将使用的可注射卡波特韦/利比韦林(IM-CAB/RPV)带来了艾滋病毒治疗的范式转变。这给新疗法带来了通常的机遇和挑战,此外还需要调整服务,以可靠地提供注射,并确保患者了解优势和局限性。我们总结了在高收入国家实施的关键考虑因素。在精心挑选的病毒抑制人群中,每月IM-CAB/RPV不低于口服ART,每月IM-CAB/RPV低于1个月。两个月的IM-CAB/RPV的病毒学失败率较高,值得密切关注和仔细监测。实施项目报告了患者和工作人员的积极经验,但也存在障碍。需要在年轻人、怀孕/母乳喂养者以及继发于次优依从性的可检测到的病毒血症患者中提供数据。我们强调缺乏真实世界的数据和关键的未解问题。关于注射技术的现有数据可能对培训有影响;监测结果对于确保临床试验结果在现实生活中得到复制至关重要。更好地了解治疗失败和个性化治疗是至关重要的,随着新数据的出现,重复患者偏好调查以确保决策基于最新的获益与风险证据是很重要的。
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引用次数: 2
Editorial introductions. 编辑介绍。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000719
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引用次数: 0
Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research. 适应不断变化的艾滋病毒形势的数字卫生干预措施:支持预防和治疗研究的实例。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000721
Henna Budhwani, B Matthew Kiszla, Lisa B Hightow-Weidman
Purpose of review Although many HIV prevention and/or treatment digital health interventions (DHIs) have shown feasibility and acceptability, fewer have indicated efficacy, and only a subset have been adapted for new contexts. Adaptation is a key element of pragmatic implementation science research. Adaptation is cost effective and time efficient compared with new development. Leveraging adaptation can lead to accelerated scale-up and enhanced public health impact. Considering the value of adaptation, the purpose of this piece is to present examples of DHI to DHI adaptation sequences to inform future HIV prevention and/or treatment research. Recent findings From an examination of recent academic articles (01 November 2016 to 31 October 2021), we identified adaptation sequences that included an original DHI with at least two adaptations. Four models are presented herein; examples consist of adapted DHIs for new population, health outcome, geography, or a combination thereof. Summary Adaptation is a promising scientific approach to expeditiously respond to the evolving HIV landscape. We present examples of DHI adaptations alongside considerations for each type of adaptation; we also present adaptation challenges with responsive strategies. We suggest when conducted with attention to rigor (leveraging adaptation frameworks, community engagement, and tailoring content), adaptation is a powerful tool to pragmatically address the HIV epidemic.
审查目的:尽管许多艾滋病毒预防和/或治疗数字健康干预措施(DHIs)已显示出可行性和可接受性,但显示出有效性的较少,并且只有一小部分已适应新的情况。适应是语用实施科学研究的重要内容。与新开发相比,适应具有成本效益和时间效率。利用适应能力可以加速扩大规模并增强公共卫生影响。考虑到适应的价值,这篇文章的目的是提出DHI到DHI适应序列的例子,为未来的艾滋病毒预防和/或治疗研究提供信息。最近的发现:从最近的学术文章(2016年11月1日至2021年10月31日)的检查中,我们确定了适应序列,其中包括具有至少两个适应的原始DHI。本文提出了四种模型;例子包括针对新人群、健康结果、地理位置或其组合而调整的DHIs。摘要:适应是一种有前途的科学方法,可以迅速应对不断变化的艾滋病毒形势。我们提出了DHI适应的例子以及对每种适应类型的考虑;我们还提出了相应的适应战略。我们建议,在严格执行(利用适应框架、社区参与和定制内容)的情况下,适应是务实应对艾滋病毒流行的有力工具。
{"title":"Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research.","authors":"Henna Budhwani,&nbsp;B Matthew Kiszla,&nbsp;Lisa B Hightow-Weidman","doi":"10.1097/COH.0000000000000721","DOIUrl":"https://doi.org/10.1097/COH.0000000000000721","url":null,"abstract":"Purpose of review Although many HIV prevention and/or treatment digital health interventions (DHIs) have shown feasibility and acceptability, fewer have indicated efficacy, and only a subset have been adapted for new contexts. Adaptation is a key element of pragmatic implementation science research. Adaptation is cost effective and time efficient compared with new development. Leveraging adaptation can lead to accelerated scale-up and enhanced public health impact. Considering the value of adaptation, the purpose of this piece is to present examples of DHI to DHI adaptation sequences to inform future HIV prevention and/or treatment research. Recent findings From an examination of recent academic articles (01 November 2016 to 31 October 2021), we identified adaptation sequences that included an original DHI with at least two adaptations. Four models are presented herein; examples consist of adapted DHIs for new population, health outcome, geography, or a combination thereof. Summary Adaptation is a promising scientific approach to expeditiously respond to the evolving HIV landscape. We present examples of DHI adaptations alongside considerations for each type of adaptation; we also present adaptation challenges with responsive strategies. We suggest when conducted with attention to rigor (leveraging adaptation frameworks, community engagement, and tailoring content), adaptation is a powerful tool to pragmatically address the HIV epidemic.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 2","pages":"112-118"},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833493/pdf/nihms-1859688.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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: 11
Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research. 背景、COVID-19 和合并症:探索综合症和艾滋病研究的新方向。
IF 4.1 3区 医学 Q2 IMMUNOLOGY Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000722
Carmen H Logie, Madelaine Coelho, Brandon Kohrt, Alexander C Tsai, Emily Mendenhall

Purpose of review: The purpose of this review is to identify themes across articles that aimed to explore HIV-related syndemics in 2020 and 2021 and to discuss their implications for research on syndemics.

Recent findings: We identified 189 articles on syndemics between 2020 and 2021. Key themes across studies included COVID-19; mental health and psychosocial challenges; substance use; socio-structural factors; protective factors; and methodological approaches. COVID-19's implications for HIV syndemic research were discussed. Mental health and substance use research largely examined linkages with sexual practices or reduced HIV care retention. Researchers examined associations between socio-structural variables (e.g. poverty) and elevated HIV exposure, reduced HIV testing and poorer health. Concepts of water insecurity and 'ecosyndemics' were also raised, as was the importance of attending to noncommunicable diseases and comorbidities. Most studies did not assess interactions between health conditions, signalling the need for methodological grounding in the foundational concepts of syndemic theory.

Summary: Most studies recommended that HIV prevention and care research attend to the interplay between poor mental health, substance use and multidimensional violence. Increased attention to structural factors, particularly exacerbated poverty in the COVID-19 pandemic, is required. Research can identify protective factors to harness to advance HIV prevention and care.

综述的目的:本综述旨在确定 2020 年和 2021 年旨在探讨艾滋病毒相关综合征的文章的主题,并讨论其对综合征研究的影响:我们确定了 2020 年至 2021 年间有关综合征的 189 篇文章。各项研究的关键主题包括 COVID-19、心理健康和社会心理挑战、药物使用、社会结构因素、保护因素和方法学方法。讨论了 COVID-19 对艾滋病毒综合征研究的影响。心理健康和药物使用方面的研究主要探讨了与性行为的联系或艾滋病毒护理保留率降低的问题。研究人员审查了社会结构变量(如贫困)与艾滋病毒接触率升高、艾滋病毒检测减少和健康状况不佳之间的联系。还提出了水不安全和 "生态疾病 "的概念,以及关注非传染性疾病和合并症的重要性。小结:大多数研究建议,艾滋病毒预防和护理研究应关注不良心理健康、药物使用和多层面暴 力之间的相互作用。需要更多地关注结构性因素,尤其是在 COVID-19 大流行中加剧的贫困问题。研究可以确定保护性因素,利用这些因素推进艾滋病毒预防和护理工作。
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引用次数: 0
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Current Opinion in HIV and AIDS
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