HIV Research & Clinical Practice最新文献

Background: Human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) can cause severe and fatal complications; knowledge about these diseases is essential for promoting safe sex practices and modifying behaviours that are harmful to one's health. This study investigates Syrian people's understanding, attitudes, and behaviors towards HIV/AIDS and STIs, aiming to identify factors promoting safe sex practices and modifying harmful behaviors.

Methods: This online cross-sectional study was conducted in Syria between 3 September and 23 November 2022, involving all 18+ individuals. The questionnaire was adapted from a previous study containing 74 questions from five sections: socio-demographic information, knowledge and practice regarding STIs, knowledge and practice regarding HIV/AIDS, attitude towards HIV/AIDS, and attitude regarding STIs and analyzed using descriptive and multivariate logistic regression.

Results: The study involved 1073 participants mostly aged between 18-30, with 55.3% females. Over half had good awareness of STIs and HIV/AIDS, with 55% and 63% respectively. Specifically, the overall knowledge level of STI type, signs/symptoms, risks of transmission, preventive methods, and complications for untreated STIs were (45.7%), (52.9%), (58.1%), (66.1%), and (59.6%), respectively. Medical field respondents had higher knowledge of HIV (P-value < 0.05, OR = 2).

Conclusion: Our results show that Syrian people have a knowledge level of STIs and HIV was moderate. However, the attitude toward STIs was negative, as less than half of the participants had a good attitude. It is essential to solve these knowledge gaps, especially in low-income countries such as Syria.

Background: Weight gain has been well-described with integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF). Doravirine (DOR) has been identified as a relatively "weight-neutral" drug; however, there is little data describing its effect on weight change in routine clinical practice.

Methods: We conducted a retrospective chart review of weight change among people with HIV changing from an INSTI- to a non-INSTI regimen with DOR.

Results: At the time of ART switch, among 49 people with HIV, the mean age was 47 years, 24% were female, and 75% had HIV-1 viral load <200 copies/mL. Most (55%) people with HIV were taking bictegravir/TAF/emtricitabine prior to the switch. Although 84% switched due to concerns about weight gain, only 16% had a weight gain of ≥10% in the year preceding, and 49% had no substantial change in weight. 86% switched to DOR/lamivudine/tenofovir disoproxil fumarate. A weight decrease (-2.6% [95% CI: -5.1, -0.1%, p = .041] was seen over the year following the ART switch. Weight change prior to switch was greatest in the year 2021 compared to 2019, 2020, and 2022.

Conclusions: Overall, modest changes in weight were seen following ART switch from INSTI-based regimen to a DOR-based, non-INSTI regimen. Further investigations with larger people with HIV cohorts will be helpful to guide clinical practice, while the impact of the COVID-19 pandemic on weight change should also be considered.

Background: COVID-19 profoundly and uniquely impacted people with HIV. People with HIV experienced significant psychosocial and socioeconomic impacts, yet a limited amount of research has explored potential differences across gender and racial/ethnic groups of people with HIV.

Objective: The objective of this study was to examine psychosocial and socioeconomic stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of stressors varied across gender and racial/ethnic groups.

Methods: We analyzed data from a cross-sectional survey with Miami-Dade County, Ryan White Program recipients. Outcomes included mental health, socioeconomic, drug/alcohol, and care responsibility/social support changes. Weighted descriptive analyses provided an overview of stressors by gender and racial/ethnic group and logistic regressions estimated associations between demographics and stressors.

Results: Among 291 participants, 39% were Non-Hispanic Black, 18% were Haitian, and 43% were Hispanic. Adjusting for age, sex, language, and foreign-born status, Hispanics were more likely to report several worsened mental health (i.e. increased loneliness, anxiety) and socioeconomic stressors (i.e. decreased income). Spanish speakers were more likely to report not getting the social support they needed. Women were more likely to report spending more time caring for children.

Conclusions: Findings highlight ways in which cultural and gender expectations impacted experiences across people with HIV and suggest strategies to inform interventions and resources during lingering and future public health emergencies. Results suggest that public health emergencies have different impacts on different communities. Without acknowledging and responding to differences, we risk losing strides towards progress in health equity.

Background: People living with HIV and non-communicable diseases (NCDs) are reported to experience challenges in accessing affordable and high-quality NCD care services. Consequently, the World Health Organization (WHO) recommends care integration of NCDs within the HIV services in resource-limited regions. The available opportunities and challenges need to be understood and addressed for an effective integration process. This study explored opportunities and challenges for integrating NCDs within HIV care and treatment services in Tanzania.

Methods: An exploratory qualitative case study was conducted in Tanzania between April and July 2022. A total of 22 key informants working at the ministerial level, supervising the provision of healthcare services in Tanzania, were recruited purposefully for in-depth interviews. Thematic analysis was employed during the study.

Results: Several opportunities were identified in the study for HIV/NCD services integration including the existence of an integration policy, the availability of regulations and guidelines, the existence of donor support, the presence of physical space and reliable information and communication systems, human resources adequacy, and political will to support the process. However, participants voiced concerns over the costs related to service integration, difficulties in reallocating donor funds, and hesitance of the healthcare providers as likely challenges to effective integration.

Conclusion: The findings of this study underscore that the effective and sustainable care integration of NCDs within HIV services relies on the availability of policy, funds, infrastructures, human resources, and stakeholders' willingness to support the process.

Background: Tuberculosis (TB) poses a significant risk to people with HIV (PWH), with heightened incidence and prevalence rates, especially in countries with a high TB burden. This study assesses the prevalence and incidence rates of TB among PWH during the COVID-19 pandemic, and on treatment outcomes in TB-HIV co-infections.

Methods: A retrospective study was conducted at Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand, from January 2020 to September 2023, involving newly diagnosed adult PWH. Data were collected on TB prevalence and incidence rates, with TB cases categorized as definite or possible. The primary outcomes were TB prevalence and incidence rates per 100,000 person-years of follow-up.

Results: Among 171 newly diagnosed PWH, the prevalence of TB was 5.85%, with an incidence rate of 4,568.71 per 100,000 person-years. All but one TB cases were diagnosed before antiretroviral therapy (ART) initiation. There was no incident TB during the follow-up period during ART. Nearly half of the TB cases required therapeutic trials without microbiological confirmation.

Conclusions: The study revealed a high prevalence and incidence rate of TB among PWH during the COVID-19 pandemic, comparable to pre-pandemic rates in Thailand. The findings highlight the necessity of comprehensive TB screening prior to ART initiation and the cautious implementation of universal TB preventive therapy. The use of molecular diagnostics, in addition to symptom screening, can enhance TB diagnosis among PWH, though accessibility remains an issue in many regions.

Background: Rapid Start ensures that persons with HIV initiate antiretroviral therapy in less than seven days after diagnosis. Benefits of Rapid Start include timely linkage to medical care, viral suppression in a shorter time and improved retention to medical care. Despite these benefits, there is a slow uptake of Rapid Start, in New Jersey.

Objective: Identify barriers to Rapid Start among New Jersey providers.

Methods: An electronic survey, consisting of 28 questions, with the following domains was administered to New Jersey providers, using Qualtrics: provider and practice characteristics (10), knowledge (1), barriers (8) and attitudes to diverse patient types (9). The results were analyzed using descriptive statistics due to small numbers over strata. Approval to conduct the survey was obtained from the William Paterson University Institutional Review Board.

Results: There were 69 responses to the survey. Providers were at least 45 years old (48%), female (44/60, 73%), nurse practitioners or physician assistants (41/59, 69%). Overall, 44/63 (70%) providers did not correctly identify that integrase inhibitors had the lowest prevalence of transmitted drug resistance. Newly diagnosed patients were referred for medical care in 37 (65%) of the medical sites. Only providers from Ryan White (federally funded clinics for persons with HIV) (64%) and non-Ryan White (73%) public sites reported co-located HIV testing sites. Seventy percent of medical sites offered same-day medical appointments. However, a lower proportion of private (62%), public Ryan White (55%), and other medical sites (36%) offered same-day appointments compared to public non-Ryan White sites (82%). Despite having staff available 40 h per week (91%), only 55% of Ryan White sites offered extended office hours in the early morning, evenings, or on Saturdays. When compared to providers in public non-Ryan White sites, a lower proportion of providers in Ryan White sites were comfortable doing Rapid Start either on the day of or within one week of diagnosis, 82% and 72%, respectively, or starting antiretroviral therapy before genotype results were available, 55% and 46%, respectively. Overall, providers were not comfortable with Rapid Start for persons engaging in condomless sex (60%).

Conclusions: Policy and administrative decisions are needed to eliminate barriers at the clinic level. An HIV clinical scholar program, to increase providers knowledge, may increase uptake of Rapid Start.

Background: Veterans Health Administration (VHA) has been at the forefront of offering integrated and patient-centered care to address the complex needs of more than 30,000 Veterans with HIV in the United States of America. These Veterans present with diverse cultural identities, personal values, and goals pertinent to their care, and they are often managing multiple comorbid chronic conditions, mental health diagnoses, and psychosocial stressors alongside HIV. The quality of their care has often been affected by stigma, minority stress, and the quality of the patient-provider relationship and associated collaborations over treatment approaches and goals, which has a direct effect on outcomes.

Objective: At San Francisco VA Health Care System, the Infectious Disease Care and Resilience (IDCaRe) team was established to improve outcomes for Veterans with acute needs or persistent difficulties in care delivery and efficacy.

Method: A five-step model to address complex needs in HIV care was adapted from existing literature and evidence base, combined with a culturally-aligned, interdisciplinary care orientation. This model was implemented with patients determined to be at high-risk for poor health engagement. A representative composite case study demonstrates the process.

Results: Three Veterans underwent the intervention with results presented. Lessons learned and future discussions are also discussed.

Conclusion: The IDCaRe model has promise as an integrated, patient-centered, behaviorally-grounded intervention for improving HIV-related care outcomes for Veterans with complex needs.

Background: Uptake of pre-exposure prophylaxis (PrEP) in the United States (US) remains below target, despite reported high efficacy in prevention of HIV infection and being considered as a strategy for ending new HIV transmissions. Here, we sought to investigate drivers for PrEP use and barriers to increased uptake using real-world data. Methods: Data were drawn from the Adelphi PrEP Disease Specific Programme^™, a cross-sectional survey of PrEP users and PrEP non-users at risk for HIV and their physicians in the US between August 2021 and March 2022. Physicians reported demographic data, clinical characteristics, and motivations for prescribing PrEP. PrEP users and non-users reported reasons for or against PrEP use, respectively. Bivariate analyses were performed to compare characteris tics of users and non-users. Results: In total, 61 physicians reported data on 480 PrEP users and 121 non-users. Mean ± standard deviation of age of users and non-users was 35.3 ± 10.8 and 32.5 ± 10.8 years, respectively. Majority were male and men who have sex with men. Overall, 90.0% of users were taking PrEP daily and reported fear of contracting HIV (79.0%) and having at-risk behaviors as the main drivers of PrEP usage. About half of non-users (49.0%) were reported by physicians as choosing not to start PrEP due to not wanting long-term medication. PrEP stigma was a concern for both users (50.0%) and non-users (65.0%). More than half felt that remembering to take PrEP (57.0%) and the required level of monitoring (63.0%) were burdensome. Conclusions: Almost half of people at risk for HIV were not taking PrEP due to not wanting long-term daily medication and about half of current PrEP users were not completely adherent. The most common reason for suboptimal adherence was forgetting to take medication. This study highlighted drivers for PrEP uptake from physician, PrEP user, and non-user perspectives as well as the attributes needed in PrEP products to aid increased PrEP uptake.