International Journal of STD & AIDS最新文献

BackgroundMen who have sex with men (MSM) in China are at risk of HIV, and a low pre-exposure prophylaxis (PrEP) uptake. This study examined HIV testing and PrEP-related behaviors by sexual behavior profiles amongst MSM.MethodsA total of 486 sexually active, HIV negative/unknown MSM (Median age: 26 years; (IQR: 23-34) were included. Latent class analysis (LCA) identified behavior patterns based on condomless sex, numbers of male sex partners, group sex, commercial sex, and sexualized drug use. Associations with demographics, HIV testing, and PrEP uptake were examined.ResultsFour classes were identified: reserved (34%), selective (36%), safe players (14%), and unrestrained (16%). The unrestrained showed the highest sexualised drug use (62%), binge drinking (22%), and PrEP use (27-40%). Safe players had high HIV testing rates (89%) but lower PrEP use compared to the unrestrained. Over one-quarter of the reserved had not tested for HIV in the past year, with similarly low PrEP uptake. Selective participants had HIV testing ≥5 times in the past year (21%), preferred self-testing (75%), and had a ∼30% PrEP uptake. Across all classes, >82% preferred direct PrEP delivery (rather than clinic collected). The top three barriers to accessing PrEP were; cost (45%), concerns about side effects (41%), and lack of knowledge about where to obtain PrEP (34%).ConclusionsDistinct behavioral profiles indicate the need for tailored prevention strategies integrating education and accessible PrEP delivery.

BackgroundSyphilis notifications, including congenital syphilis, have increased markedly in recent years across the European Union/European Economic Area (EU/EEA), raising renewed public health concerns. This study aimed to characterise long-term trends in adult syphilis notifications in the EU/EEA from 2000 to 2023 and to examine recent patterns in congenital syphilis using joinpoint regression analysis.MethodsAnnual crude notification rates for adult syphilis (per 100,000 population, 2000-2023) and congenital syphilis (per 100,000 live births, 2010-2023) were obtained from the ECDC Surveillance Atlas. Joinpoint regression was applied to identify significant trend changes, estimate Annual Percent Change (APC) and, where appropriate, Average Annual Percent Change (AAPC).ResultsIn the EU/EEA, adult syphilis rates declined from 2000 to 2007 (APC -8.76%), increased from 2007 to 2021 (APC +3.32%), and rose sharply after 2021 (APC +24.65%). Overall AAPC (2000-2023) was +1.12%. Congenital syphilis rates declined between 2010 and 2016 (APC -11.92%), then increased between 2016 and 2023 (APC +9.16%).ConclusionsSyphilis notifications in the EU/EEA show a sustained resurgence, with recent acceleration and a parallel rising trend in congenital syphilis. Reinforcement of STI screening, timely treatment, and strengthened antenatal care are urgently warranted.

IntroductionAcute HIV infection (AHI) diagnosis is challenging due to complex diagnostics and low prevalence. We tested different targeting approaches for AHI testing using data from a cross-sectional study of STI burden in Eswatini.MethodsFrom June 2022 to April 2023, adults underwent routine HIV and viral load (VL) testing (Xpert) and completed a questionnaire on socio-demographics, behavioral characteristics and current symptoms. AHI was defined as negative/discordant serial HIV rapid diagnostic test and VL ≥10,000 copies/mL. We used lasso regression to determine risk factors for AHI and build study-specific predictor risk score (PRS). We evaluated the ability of the PRS and other targeting approaches to predict AHI.ResultsOf 1064 participants, ten (0.9%) had AHI. The 10-parameter PRS at cut-off ≥10.8 had the area under the curve (AUC) 0.87 (0.86-0.89), sensitivity 100% (69.2-100), and proportion needed to test (PNT) 26.1%. At the cut-off ≥14.1 the AUC was 0.85 (0.71-0.98), sensitivity 80% (44.4-97.5) and PNT 11.5%. A previously developed PRS and targeting young women reporting AHI symptoms also performed well, but not the WHO-recommended clinical screening criteria for AHI (sensitivity 40%).ConclusionsTargeted approaches that combine AHI symptoms and locally relevant characteristics may be an efficient way to support the scale-up of AHI testing.

BackgroundWe assessed STI incidence, prevalence, and associated factors, and changes in sexual behaviours among MSM using HIV pre-exposure prophylaxis (PrEP) in West Java province, Indonesia.MethodsThe Indonesia PrEP pilot program was a prospective, real-world implementation study providing oral daily or event-driven PrEP among key populations (KPs) in Indonesia. Participants completed baseline and three-monthly follow-up visits between 2021 and 2023, providing data on HIV tests, sexual behaviours, and changes in STIs.Results311 MSM were included in the analyses (median age 26.95, 54.34% chose D-PrEP, 16.40% had a history of STIs). During follow-up, STI prevalence increased, from 8.57% at month-three (M3) to 12.5% at M12. The STI incidence rate was 15.4/100 person-years [PYs] (9.78-23.16; 23 new STIs over 149 PYs). Multiple sexual partners and condomless last sex decreased, while inconsistent condom use increased. History of STIs before PrEP initiation (age-adjusted odds ratio [aOR] 5.02, 2.21-11.39, p < 0.001), condom use at last sex (aOR 3.24, 1.07-9.80, p = 0.037), and not having ≥2 sexual partners (aOR 0.12, 0.03-0.47, p = 0.002) were associated with STIs.ConclusionsAmong MSM in West Java, an increase in the prevalence of STIs was observed, but not exceeding the prevalence before PrEP initiation, which was related to sexual behaviours.

Background: In 2024, national guidance was issued for doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections (STIs). The study purpose was to evaluate doxy-PEP use in patients with increased risk of STI exposure at a large, urban health system. Methods: IRB-exempt study of adult patients with clinic encounters for increased risk of STI exposure and testing for N. gonorrhoeae, C. trachomatis, and T. pallidum from 01/01/2023-31/10/2024. Patients were identified using ICD-10 code Z20.XX and STI testing. Doxy-PEP prescription utilization was evaluated after a dedicated doxy-PEP order was implemented with appropriate patient counseling instructions. The primary outcome was the proportion of doxy-PEP prescriptions utilized in at-risk patients; secondary outcomes were utilization of the dedicated doxy-PEP order and abnormal STI testing within 3-months of the doxy-PEP prescription. Results: 4234 high-risk sexual patient encounters were documented; 7.37% of patients received a doxy-PEP prescription. Of these, 29.5% were ordered utilizing a dedicated doxy-PEP order. Most patients who received a doxy-PEP prescription were Black (96.6%), men (92.6%), with a median (IQR) age of 29 (24-37) years, and had private/commercial insurance (42%). One patient had abnormal syphilis testing within 3-months of doxy-PEP prescription. Conclusions: These findings highlight doxy-PEP underutilization and the need for broader provider engagement and advanced antimicrobial stewardship interventions.

BackgroundFemale sex workers (FSWs) are at high risk for sexually transmitted infections (STIs). This study estimated the prevalence of STIs caused by Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and identified factors related to oral, vaginal, or anal intercourse among FSWs in informal settings in Tshwane, South Africa.MethodsSamples were collected from 200 FSWs aged 18 and older in Pretoria who engaged in transactional sex. Participants completed a questionnaire on demographics, sexual history, and HIV testing. Three swabs (rectal, oral, and endocervical) from each participant were tested for NG, CT, MG, and TV.ResultsOf the 200 participants, 53 (26.5%) had at least one infection. Of these infections, the most common site of infection was genital (100 %), followed by the rectum (45.3 %), and pharynx (20.8 %). CT and TV were detected in 24 (12.0%) participants, while NG and MG were found in 20 (10.0%) participants. Most of the infected FSWs (32/53) had one sexually transmitted pathogen, while 21 (40%) had multiple STIs. Substance use was significantly associated with the presence of an STI.ConclusionThis study reveals a high burden of STIs among FSWs, highlighting pathogen prevalence at genital and extragenital sites. These findings underscore the need for targeted STI control interventions for high-risk groups like FSWs in South Africa.

BackgroundAdherence to HIV care is pivotal for achieving viral suppression, preventing viral transmission, and improving health outcomes. Despite advancements in antiretroviral therapy, many people living with HIV (PLHIV) are disengaged from care, compromising treatment effectiveness.MethodsA retrospective cohort study was conducted on 81 episodes of care dropout at a Portuguese hospital between 2018 and 2024. A multidisciplinary team (physicians, nurses, social workers, and mental health professionals) implemented a structured program to reengage patients. Demographic, clinical, and socioeconomic data were collected at baseline and after 6 months.Results79% percent of the participants returned to care, with 68% resuming antiretroviral therapy. Although most patients achieved improved viral load suppression after returning, 27% were lost to follow-up after 6 months. Foreign-born individuals were associated with a lower likelihood of re-engagement. Common barriers include financial hardship, limited social support, and unaddressed mental health needs.ConclusionsA multidisciplinary approach effectively reconnected PLHIV to care and achieved enhanced virological outcomes. However, persistent socioeconomic and psychosocial challenges can lead to repeated disengagement. Long-term, targeted interventions, particularly for vulnerable groups, are required to sustain retention and ensure improved HIV management and overall patient well-being.

BackgroundThis study compares three large language models (LLMs) in answering common HIV questions, given ongoing concerns about their accuracy and reliability in patient education.MethodsModels answered 63 HIV questions. Accuracy (5-point Likert), readability (Flesch-Kincaid, Gunning Fog, Coleman-Liau), and reliability (DISCERN, EQIP) were assessed.ResultsClaude 3.7 Sonnet showed significantly higher accuracy (4.54 ± 0.44) compared to ChatGPT-4o (4.29 ± 0.49) and Gemini Advanced 2.0 Flash (4.31 ± 0.50) (p < .001). ChatGPT-4o had lower accuracy in disease definition, follow-up, and transmission routes, while Gemini Advanced 2.0 Flash performed poorly in daily life and treatment-related questions. Readability analyses indicated ChatGPT-4o produced the most accessible content according to Flesch-Kincaid and Coleman-Liau indices, whereas Claude 3.7 Sonnet was most comprehensible by Gunning Fog standards. Gemini Advanced 2.0 Flash consistently generated more complex texts across all readability measures (p < .001). Regarding reliability, Claude 3.7 Sonnet achieved "good" quality on DISCERN, while others were rated "moderate" (p = .059). On EQIP, Claude 3.7 Sonnet (median 61.8) and ChatGPT-4o (55.3) were classified as "good quality with minor limitations," whereas Gemini Advanced 2.0 Flash (41.2) was rated "low quality" (p = .049).ConclusionsClaude 3.7 Sonnet is preferable for accuracy and reliability, while ChatGPT-4o offers superior readability. Selecting LLMs for HIV education should consider accuracy, readability, and reliability, emphasizing regular assessment of content quality and cultural sensitivity.

BackgroundPromoting health and quality of life for people living with HIV (PLHIV) in low-resource settings is vital. Understanding perceptions of physical activity (PA) and factors influencing participation can guide culturally appropriate interventions. This study explored how PLHIV in Central Uganda perceive PA, factors affecting its acceptability, and views on integrating PA into antiretroviral treatment (ART) services.MethodsA qualitative exploratory design was used. Semi-structured interviews were conducted with 12 adults (7 women, 5 men) on ART for at least 1 year. Data were analysed using content analysis, guided by the socio-ecological model.ResultsPerceptions of PA were shaped by intersecting factors across multiple levels. Individual factors included perceived weakness, comorbidities, fear of health risks, low awareness of PA benefits, body image concerns, competing demands, and seasonal food insecurity. Family and community-level barriers included stigma, gender norms, and lack of support. Institutional barriers involved limited health worker engagement and absence of PA-related incentives.ConclusionsReshaping perceptions and improving PA acceptability requires stronger health system involvement. Embedding PA promotion into routine HIV care and engaging health workers can help address barriers across levels. A multi-level public health approach is needed to integrate PA into biopsychosocial HIV care.