Journal of the International Association of Providers of AIDS Care最新文献

IntroductionYoung women in sub-Saharan Africa bear a disproportionate HIV burden yet rarely participate in cure-related studies. Analytical treatment interruptions (ATI), used to assess sustained control off therapy, raise clinical, ethical, and psychosocial concerns.MethodsWe conducted a longitudinal qualitative study within a Phase 2A ATI trial (NCT05281510) at the FRESH site in Durban, South Africa. Nineteen women living with HIV (median age 26) completed in-depth interviews at 4 timepoints. We applied framework analysis informed by the Lazarus-Folkman stress and coping model.ResultsParticipants enrolled to contribute to science, reduce pill burden, and due to trust in the clinical team. They anticipated viral rebound, resistance, stigma, and partner transmission. Over time, many reported improved emotional well-being, using meaning-based strategies (pride in contribution) and problem-focused strategies (self-monitoring, condom negotiation). Burdens included stigma, selective disclosure, partner resistance, frequent visits, and blood draws. Benefits included increased HIV literacy, self-management, and comfort with procedures.ConclusionATI-inclusive clinical trials can be acceptable when designs include clear and ongoing education, strong confidentiality protections, mental health and peer support, partner-inclusive risk reductions, and flexible scheduling with practical supports to minimize participation burden and potential psychosocial harms.Clinical trial registrationNCT05281510.

BackgroundThis study aimed to examine how health literacy, knowledge of HIV/AIDS, and public stigma are associated with social distance toward people living with HIV/AIDS (PLWH), as a behavioral manifestation of stigma, among the general Japanese population.MethodsWe conducted an online cross-sectional survey targeting adults (age range: 20-60 s) from among the 2.2 million registrants in Rakuten Insight from September 20 to 25, 2019. Stratified randomized sampling was performed according to the region, sex, and age. The study participants were 2268 eligible for analysis (effective response rate: 90.7%).ResultsModels were examined using hierarchical multiple regression analysis. The results indicated that low-level knowledge of HIV/AIDS affected social distance to PLWH (B = 3.77, (95% CI, 1.30 to 6.24)). 'Access,' 'understand,' 'appraise' and 'use' of European health literacy survey questionnaire affected social distance to PLWH (B = .03, (-.07 to .13); - B = .15, (-.27 to -.04); B = .06, (-.04 to .17); B = -.07, (-.19 to .05)). Public stigma of HIV/AIDS affected social distance to PLWH (B = .97, (.92 to 1.01)).ConclusionsThese findings indicate that health literacy not only maintains and promotes individual health but also has the potential to reduce social distance toward PLWH.

BackgroundLoss to follow-up (LTFU) remains a major challenge to successful antiretroviral therapy (ART), contributing to increased morbidity, mortality, and drug resistance, particularly in Sub-Saharan Africa. Evidence on the timing and predictors of LTFU in rural Ethiopia is limited. This study aimed to determine the time to LTFU and its predictors among adults on ART in selected health facilities of Ilu Aba Bor Zone, Southwest Ethiopia.MethodsA retrospective cohort study was conducted among 372 adults living with human immune virus (HIV) on ART at 4 public health facilities from October 2018 to November 2022. Data were extracted from standardized ART forms and patient charts. Kaplan-Meier survival analysis estimated survival probabilities, and Cox proportional hazards regression identified predictors of LTFU, reporting adjusted hazard ratios with 95% confidence intervals (CI). Proportional hazards assumptions were checked using Schoenfeld residuals and log-log plots.ResultsOver 6993 person-months of follow-up (median: 19 months), 70 participants (18.8%) were LTFU, mostly within the first year (34.3% in the first 6 months; 32.9% in the second 6 months). Independent predictors included absence of a registered phone number, World Health Organization clinical stage III/IV, noninitiation of cotrimoxazole preventive therapy, nondisclosure of HIV status, and poor or fair adherence.ConclusionLTFU was common during early antiretroviral. Strengthening patient tracing, promoting disclosure, initiating preventive therapy, and improving adherence support may enhance retention and contribute to achieving human Immune deficiency virus epidemic control targets.

BackgroundThe use of dolutegravir (DTG)-based antiretroviral therapy (ART) has been associated with the development of hyperglycemia. This study determined the prevalence and factors associated with hyperglycemia among people living with HIV (PLWH) on DTG-based ART in Uganda.MethodsWe conducted a cross-sectional study among 219 systematically recruited PLWH on DTG-based ART for ≥1 year at a Health Centre IV in Central Uganda. Data were collected using a structured questionnaire, anthropometric measurements, and laboratory investigations. Logistic regression was performed to identify factors associated with hyperglycemia.ResultsOut of 219 participants, 45 had fasting glucose ≥110 mg/dL, giving a hyperglycemia prevalence of 20.55% (95% confidence interval [CI]: 15.68%-26.45%). Overweight (aOR 8.11, 95% CI: 2.76-23.85, P < .001) and abnormal waist-to-hip ratio (aOR 4.36, 95% CI: 1.23-15.37, P = .022) were significantly associated with hyperglycemia.ConclusionsHyperglycemia is prevalent among PLWH on DTG-based ART and is potentially associated with overweight and abnormal waist-to-hip ratio.

Objective: To analyze the predisposition to use pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) and associated factors among men who have sex with men (MSM). Method: Cross-sectional, analytical study, developed at the Testing and Counseling Center and social locations of the target population, in Teresina, Piauí, Brazil, with a sample composed of 320 MSM, recruited by the snowball sampling technique. Data collection was performed in two consecutive stages, the first being HIV testing and counseling. The second stage consisted of the application of instruments to characterize the sample regarding sociodemographic aspects, sexual behavior, knowledge, and acceptability of PrEP for HIV and an HIV Risk Perception Scale. For the descriptive analysis, measures of position and dispersion were used. In the univariate analysis, Simple Logistic Regression was used, with selection by the Wald test at the 20% level. In the multivariate analysis, Multiple Logistic Regression with a Bayesian approach was used. Results: MSM in the age group between 20 and 39 years were predominant 290 (90.6%), income greater than four minimum wages 103 (32.2%) and complete higher education 219 (68.4%). The expressive majority 297 (92.8%) reported predisposition to use PrEP for HIV, which was associated with MSM with complete higher education (OR = 5.56; 95% CI = 1.03-30.44; P = 0.046), having presented signs/symptoms of STI in the last 12 months (OR = 3.08; 95%CI = 1.05-9.09; P = 0.041) and satisfactory knowledge about PrEP (OR = 1.69; 95%CI = 1.01-2.83; P = 0.045). Conclusion: A high predisposition to use PrEP was found among MSM in the sample, despite the unsatisfactory knowledge about PrEP and unsatisfactory perception of risk regarding HIV. Understanding the risk factors and protective factors for the use of this important prevention method is essential for its expansion and consequent effectiveness in controlling the HIV epidemic.

Toxoplasmic encephalitis (TE) and primary central nervous system (CNS) lymphoma are the major differential diagnoses of ring-enhanced brain lesions in acquired immunodeficiency syndrome (AIDS). Biopsy may be difficult; thus, empirical anti-toxoplasma therapy is often initiated. We report an AIDS patient receiving chemotherapy for Kaposi's sarcoma who developed TE. Weekly gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated diminishment of ring enhancement 7 days after treatment, preceding neurological improvement and lesion size reduction. This early radiological change, captured by rare weekly gadolinium-enhanced MRI, was useful for differentiating TE from lymphoma before neurological improvement.

BackgroundFollowing its approval by the US Food and Drug Administration in January 2021, clinics have moved to implement the first long-acting antiretroviral regimen (cabotegravir [CAB] and rilpivirine [RPV]) into routine care.MethodsIn this qualitative implementation study, we characterize health worker experiences with the introduction of CAB/RPV into a safety net HIV clinic in the Southeastern US during the first 10 months of service integration. Interviews were analyzed using directed content analysis and results were synthesized using the updated Consolidated Framework for Implementation Research.ResultsHealth workers described both successes and challenges. Successes included strong awareness of and enthusiasm for CAB/RPV and the integration of supportive resources over time. Challenges included inconsistent communication about logistics, perceived pressures on human resources, and concerns about structural barriers affecting patient access to care.ConclusionsFindings highlight the resource demands of implementing CAB/RPV, and the complex array of factors that shape successful implementation.

BackgroundDifferentiated service delivery models (DSDMs) are client-centered approaches to HIV care that improve efficiency through simplification, task shifting, and decentralization. However, utilization of Ethiopia's community-based DSDM remains low, and its determinants are not well understood.ObjectiveTo assess the utilization of and factors associated with community-based DSDM among ART users in Dessie public health facilities, Northeast Ethiopia, 2025.MethodsA convergent mixed-methods cross-sectional study was conducted among 635 randomly selected ART users. Quantitative data were collected using interviewer-administered questionnaires and analyzed using multivariable logistic regression in STATA 16. In-depth interviews with purposively selected ART users were analyzed thematically to explore contextual barriers and facilitators.ResultsOverall, 17.1% (95% CI: 14.3-20.3%) utilized community-based DSDM. Utilization was positively associated with primary education, HIV status disclosure, and ART regimen change, but negatively associated with prior loss to follow-up and baseline CD4 ≥ 500 cells/mm³. Qualitative findings highlighted information gaps, stigma, and misconceptions as barriers, while peer support facilitated uptake.ConclusionCommunity-based DSDM utilization remains suboptimal, underscoring the need for strengthened counseling, stigma reduction, and targeted patient education to enhance uptake.

IntroductionVirological failure is defined as a plasma viral load >1000 copies/mL on 2 consecutive tests after 3 months of adherence support and 6 months of ART. In Ethiopia, limited studies have developed risk prediction models, though such models are vital for guiding patient-specific interventions and improving HIV treatment outcomes.ObjectiveThis study aims to determine the incidence and prognostic factors of virologic failure among HIV patients on first-line HAART following the one-J program at Felege Hiwot Hospital, Northwest Ethiopia, in 2025.MethodsA retrospective cohort study was conducted using patient records from Felegehiwot Comprehensive Specialized Hospital. Data were analyzed with STATA 17 and R 4.5.0. Descriptive statistics and multivariable logistic regression (via LASSO-selected predictors) were applied to develop a simplified nomogram. Model performance was evaluated using discrimination, calibration, and decision curve analysis to assess clinical utility.ResultThe incidence of virologic failure was 20.2% (95% CI: 17.9-22.6). Key predictors included TB-HIV co-infection, INH prophylaxis, CPT, adverse drug reactions, disclosure, alcohol use, smoking, and CD4 level. The model showed good performance (AUC = 0.817; reduced AUC = 0.810), strong calibration (Brier = 0.117), and superior clinical benefit in decision curve analysis.ConclusionA nomogram integrating 8 predictors TB-HIV co-infection, INH prophylaxis, CPT, adverse drug reaction history, disclosure status, alcohol use, smoking status, and CD4 count showed excellent discrimination (AUC = 0.817) and good calibration, indicating strong potential for individualized risk prediction in HIV patient management.

Globally, the number of adolescents and young adults (AYAs) living with human immunodeficiency virus (HIV) has steadily increased; however, retaining them in antiretroviral treatment (ART) remains a challenge. This scoping review identifies and synthesizes research findings on ART adherence of AYAs living with HIV in South Africa. We conducted electronic searches across various databases and identified 20 peer-reviewed articles. Five key themes that characterize the research on ART adherence among AYAs living with HIV emerged. The themes include balancing healthcare and daily activities, desire for HIV status secrecy, psychosocial implications and knowledge of ART. Availability of support was found to enhance ART adherence. ART adherence barriers included treatment and healthcare-specific challenges requiring adjustments from facilities and AYAs. Enhancing ART adherence requires individuals' knowledge of ART and acceptance of their HIV status. The Healthcare system may need to be flexible to accommodate this group as they navigate between daily activities and ART adherence.