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

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.

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.

BackgroundDespite global declines in HIV incidence, new infections continue to rise in Latin America. Oral tenofovir-based HIV pre-exposure prophylaxis (PrEP) is effective and can reduce incidence where implemented. PrEP PERU is a prospective cohort study evaluating daily oral PrEP delivery at HIV/AIDS service organizations (ASOs) in Peru.MethodsWe assessed 12-month PrEP retention and adherence among men who have sex with men (MSM) enrolled at 4 ASOs in Lima before the COVID-19 pandemic. The analysis included participants with ≥12 months of follow-up before the March 2020 lockdown. Follow-up visits occurred at weeks 4, 12, and quarterly thereafter. We used robust Poisson regression to evaluate associations between baseline characteristics and 2 outcomes: retention (attending ≥3 follow-up visits within 12 months) and optimal adherence (proportion of days covered ≥80%).ResultsAmong 264 MSM who initiated PrEP, median age was 31 years (IQR: 27-37). Retention at 12 months was 71%, and 55% achieved optimal adherence. Retention was associated with age ≥30 and bisexual identity in adjusted models. Optimal adherence was associated with being employed at baseline.ConclusionsPrEP delivery through ASOs in Lima is feasible and supports sustained engagement among MSM. Targeted strategies are needed to improve outcomes among younger individuals.

BackgroundThe delivery of counselling services remains an integral part in the prevention and treatment continuum of HIV/AIDS. To deliver effective counselling services, the psychological well-being of HIV/AIDS counselors need to be prioritized.AimWe sought to explore the various psychological well-being issues faced by HIV/AIDS counselors in the Volta region of Ghana and the approaches they adopt in addressing these challenges.MethodsA descriptive phenomenological study was conducted among sixteen HIV/AIDS counselors to explore the psychological well-being challenges they face and the coping mechanisms they adopt. The data were thematically analyzed using the Atlas.ti software.ResultsPsychological well-being challenges of HIV/AIDS counselors identified were stress, depression, anxiety and anger. Coping mechanisms, including engaging in recreational and spiritual activities, creating a conducive working environment, being conscious while conducting HIV tests, accepting the nature of their work, and routinely self-testing for HIV were identified. Other mechanisms include motivation from family, assistance from key stakeholders, support from superiors at work, and motivation from clients. Recommended solutions on how to improve the psychological well-being of HIV/AIDS counselors includes education on HIV/AIDS to minimize stigma, assignment of clinical psychologists to counselors, cooperation from clients, employing more HIV/AIDS counselors and providing incentives to counselors.ConclusionTo improve HIV counselling in the Volta region and the country in general, there is a need for the Ghana AIDS Commission and the Ghana Health Service to contextualize and address the psychological well-being challenges of HIV/AIDS counselors in the country, taking into consideration, their proffered mitigation strategies and recommendations.

BackgroundSerum Alanine aminotransferase to High density lipoprotein cholesterol ratio (ALT-to-HDL-C ratio) has been identified as a significant predictor of non-alcoholic fatty liver disease, a hepatic manifestation of metabolic syndrome. This study investigated the association between serum aminotransferases to high-density lipoprotein cholesterol ratios and metabolic syndrome (MetS) among people living with HIV (PLWH) on Dolutegravir (DTG)-based antiretroviral therapy (ART) in South Western Uganda.MethodsWe conducted a secondary analysis study from June 15, 2025 to August 20, 2025 using a dataset generated from hospital-based cross-sectional study that investigated an association between aspartate aminotransferase to alanine aminotransferase ratio and MetS among 377 PLWH who were on DTG-based ART at Ruhoko Health Centre IV, South Western Uganda.ResultsThe prevalence of MetS was 44.6%(168/377); 95% CI: 39.6 - 49.6 and significantly increased from the lowest to the highest ALT-to-HDL-C ratio tertiles (30.2% vs 47.7% vs 56.1%, p < 0.001). In the adjusted model, higher ALT-to-HDL-C ratio was significantly associated with MetS. Individuals in the second tertile had 2.35-fold higher odds (aOR 2.35, 95% CI: 1.26-4.41, p = 0.008), and those in the third tertile had over fourfold higher odds (aOR 4.65, 95% CI: 2.25-9.61, p < 0.001) of MetS compared to the lowest tertile. ALT-to-HDL-C ratio at an optimal cutoff of 0.33 had a significant ability (AUC=0.820, 95%CI: 0.782 - 0.861) to differentiate between participants with MetS from those without MetS at a sensitivity of 92% and specificity of 54%.ConclusionHigher ALT-to-HDL-C ratio is potentially associated with MetS. Since both ALT and HDL-C are routine measurements in HIV Care, this warrants further studies on the potential of ALT-to-HDL-C ratio as a biomarker for MetS.

BackgroundChildren with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population.MethodsThis longitudinal study evaluated ND screening implementation at a health clinic in Kenya, from 9/2021 to 8/2023. Children aged 18-36 months with perinatal HIV exposure were screened using a 12-item general ND tool. Implementation outcomes-acceptability, feasibility, fidelity, and sustainability-were assessed through time-motion observations, clinic records, and semi-structured interviews with caregivers and staff.ResultsOf 507 eligible children, 405 (80%) were screened. Screening rates were consistent over 24 months, with average time reduced to under 5 min. Facilitators included staff collaboration and caregiver support; barriers included time constraints and child temperament.ConclusionsND screening was acceptable, feasible, and sustainable. Policymakers should embed ND screening within national child health programs, invest in workforce training and task-sharing models, strengthen referral and follow-up systems, and ensure affordable access to services.

ObjectiveMental health symptoms hinder engagement in antiretroviral therapy (ART) adherence among persons with HIV (PWH). Existing information on barriers and facilitators to mental health treatment in PWH is limited. This qualitative study explored barriers and facilitators to mental health treatment and ART adherence in PWH.MethodsPWH (n = 16) and health professionals (N = 6) completed semi-structured interviews.ResultsThree themes describe how and why barriers to care intersected: (1) health systems were not equipped to accommodate the unique needs of people with HIV who needed mental health treatment; (2) complex mental health challenges intersected with other barriers; (3) a stable home base and community were critical to health but difficult to maintain.ConclusionSeveral participants suggested integrating mental health and HIV care.

BackgroundHuman immunodeficiency virus (HIV) stigma has detrimental impacts on HIV care outcomes, mental health, and psychosocial well-being. Adolescents living with HIV (ALWH) in Malawi experience HIV stigma as gossip, insults, and physical distancing, contributing to decreased HIV care engagement and mental health issues including depression, substance use disorders, and suicidality. To inform future stigma-reduction interventions for this vulnerable population, we investigate how HIV stigma impacts an ALWH's ability to meaningfully participate in their social roles and responsibilities.MethodsThis qualitative study recruited 68 participants from three government healthcare facilities in Lilongwe, Malawi. Our study sample consisted of 13 ALWH aged 13-19 years who screened positive for depressive symptoms on the Beck Depression Inventory-II with a score ≥13 (5 females, 8 males) and 55 stakeholders aged 13-54 years (38 females, 17 males). Guided by the What Matters Most Framework, we conducted 13 in-depth interviews and 10 focus group discussions with ALWH, adolescent peers without HIV, caregivers, teachers, HIV care providers, and mental health providers to examine culturally relevant manifestations of HIV stigma and its impact on ALWH's ability to fulfill socially expected roles. We organized data into four life domains-home, community, school, healthcare-which we analyzed to understand how stigma hinders social role performance, to assess how role fulfillment shapes stigma, and to identify strategies to reduce stigma.ResultsALWH identified their most salient social roles as being a family member, church member, student, friend, and active participant in one's healthcare. In each life domain, HIV stigma negatively impacted an ALWH's ability to meaningfully engage in their prescribed roles, resulting in ostracization from family and friends, displacement from one's home or school, disengagement from church, poor school performance and attendance, and reduced retention in HIV care. Key recommendations from study participants included engagement and collaboration with caregivers, increasing counseling services for ALWH with peer support, promoting community awareness and education, and redress systems for acts of stigmatization.ConclusionsThis study revealed that HIV stigma disrupts an ALWH's ability to fulfill key social roles in home, community, school, and healthcare settings. Stigmatization from caregivers within the home has the most detrimental impact on ALWH, identifying caregivers as critical part of stigma-reduction efforts. To effectively address stigma across all life domains, targeted stigma-reduction is needed, particularly through specialized counseling that addresses the unique aspects of ALWH personhood, and community education to disseminate accurate knowledge.

IntroductionCrowdsourcing engages the community to create and share solutions; this participatory method could be used to create effective pre-exposure prophylaxis (PrEP) promotions. We explored acceptability of using crowdsourcing to develop PrEP promotions among sexual minority men (SMM) and sexual health providers in Alabama.MethodsWe conducted focus group discussions (FGDs) with SMM and interviews with sexual health providers with guides grounded in the Theoretical Framework of Acceptability. We employed thematic analysis through deductive and inductive coding.ResultsTen SMM (60% Black, 50% younger than 30 years) participated in FGDs, and six providers completed interviews. We found four themes: 1) Personal identity and background inform the participation and products of crowdsourcing, 2) SMM and providers are motivated to participate in crowdsourcing, 3) Crowdsourcing participants require resources to effectively engage, and 4) Logistic and social factors are barriers to crowdsourcing participation.DiscussionCrowdsourcing as a strategy to create PrEP promotions in the Southern United states would be acceptable and feasible in the correct context. These formative, yet novel, findings demonstrate that SMM and sexual health providers would be willing to participate in crowdsourcing events and also provide key insight to design crowdsourcing events.

ObjectiveThis cross-sectional study examined how types of disability and comorbidities influence retention in care (RIC) among people with HIV (PWH) in Houston/Harris County, Texas, USA.MethodsData from 1142 participants in the Houston Medical Monitoring Project (2015-2021) were analyzed. Descriptive statistics, bivariate analyses, and multivariable logistic regression were used to evaluate factors associated with RIC.ResultsApproximately 74.9% of participants were retained in care. Compared to PWH without specific comorbidities, those with dyslipidemia and kidney disease had higher odds of RIC (AOR: 2.66; 95% CI: 1.40-5.03 and AOR: 14.08; 95% CI: 1.44-138.12, respectively). PWH reporting only mobility disability had increased odds of RIC (AOR: 3.40; 95% CI: 1.33-8.71), while those reporting only visual disability had reduced odds of RIC (AOR: 0.38; 95% CI: 0.16-0.87). Durable viral suppression was strongly associated with greater RIC (AOR: 7.96; 95% CI: 5.28-11.99).ConclusionComorbidities and disability types significantly influence retention in HIV care. Tailored interventions are needed to improve RIC among PWH, particularly those with visual disabilities.