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

People with a previous HIV diagnosis (PWHDx) who are out of care (OOC) (PWHDx OOC) represent a significant but often overlooked population in the United States, accounting for nearly half of new HIV transmissions annually. Emergency departments (EDs), frequently accessed by PWHDx OOC for unscheduled care, are uniquely positioned to identify and re-engage these individuals in HIV care. While ED-based HIV efforts have traditionally focused on diagnosing new infections, this paper reviews and evaluates 3 models EDs can implement to identify PWHDx OOC: routine HIV screening, health information exchange, and electronic health record alerts. We describe each model using examples from the literature, assessing their feasibility, scalability, and effectiveness in identifying patients and determining care status. By synthesizing current approaches, this paper highlights practical and policy-relevant pathways for expanding ED-based HIV services beyond diagnosis, offering concrete guidance for healthcare systems aiming to meet the national "Ending the HIV Epidemic" goals.

BackgroundIn Cameroon, people living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and an increased risk of cardiovascular mortality. Managing HTN in this population is a major challenge. This qualitative study, conducted at the Yaoundé Central Hospital, Cameroon, in 2024, explored the barriers and facilitators to hypertension management in PLHIV.MethodsThe study involved 15 participants, including 9 PLHIV diagnosed with hypertension, 03 healthcare providers, and 03 psychosocial agents. A quota sampling approach was used to recruit participants. Data was collected through 12 in-depth interviews and a focus group with 3 psychosocial agents. Data collection took place over a period of 5 months, from January to May 2024. A semistructured interview guide was used to explore participants' perceptions of hypertension management. Data analysis was based on the COM-B model to interpret the results, using NVivo software.ResultsIdentified barriers included a lack of knowledge about hypertension, difficulties in accessing medications due to high costs, and psychosocial issues such as family stress affecting treatment adherence. Additionally, cultural and religious beliefs, such as a preference for traditional treatments and miraculous healings, limited engagement with conventional medicine. However, facilitators included regular visits for ART follow-up, which allowed for hypertension screening, and financial support from families that facilitated access to treatment. The proactive involvement of healthcare providers and continuous communication also contributed to treatment adherence.ConclusionThe study highlights the need for interventions that address socio-economic, cultural, and medical barriers to improve hypertension management in PLHIV, particularly through enhancing access to care and raising awareness.

BackgroundHuman immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome Acquired immunodeficiency syndrome can affect any age group, and it is the major cause of pediatric morbidity and mortality worldwide; challenges persist in identifying and linking all HIV-exposed infants to early infant diagnosis and care.MethodsA cross-sectional study was done using secondary data extracted from the medical records of 244 HIV-exposed children from HIV-infected mothers who were on follow-up from January 2018 to December 2023 and enrolled in four public hospitals. Data were collected and imported into Epi-Data and exported to SPSS version 26.0 for analysis. A binary logistic regression model was used to fit each variable.ResultsAmong 244 HIV-exposed infants, 10 (4.1%) were diagnosed as HIV positive. Children who received cotrimoxazole preventive therapy {AOR 0.89 = 95% CI (0.02-0.79)} and children born at a health facility 91.2% {AOR 0.088 = 95% CI (0.01-0.58)} were associated with positive HIV sero-status.ConclusionThe level of HIV infection among infants was relatively high compared with the global goal of less than 2% for 2030.

Background: The incidence of sexually transmitted infections (STIs) remains high among men who have sex with men (MSM) living with human immunodeficiency virus (HIV) (PWH). This study determined the prevalence of asymptomatic STIs in MSM PWH attending an HIV clinic in Mexico City.

Methods: This cross-sectional study (May 2022-November 2023) included self-questionnaires on STI-related behaviors and symptoms, urethral samples for multiplex polymerase chain reaction (PCR), and serological tests for syphilis, HBV, and HCV.

Results: Among 261 patients, 56.7% were receiving antiretroviral therapy, 41.8% had suppressed HIV-1 viral load, and 26.1% tested positive for at least one STI in urethral PCR. The most prevalent microorganisms were Ureaplasma urealyticum (14.9%), Mycoplasma hominis (6.9%), Mycoplasma genitalium (4.2%), and Chlamydia trachomatis (3.1%). Multiple infections were identified in 5.3% of cases. Seroprevalence rates for syphilis, HBV, and HCV were 17.6%, 6.5%, and 3.1%, respectively. Current smoking and insertive anal sex were the only statistically significant associated factors.

Conclusions: This study underscores the high frequency of asymptomatic STIs and the importance of regular screening.

ObjectiveThis study assessed the prevalence and factors associated with lipodystrophy and dyslipidemia among 105 children (aged 5 to 15 years) on HAART at the Komfo Anokye Teaching Hospital.MethodsIn this cross-sectional study, data collection included anthropometric measurements, clinical evaluations, dietary assessments, and lipid profile assessments. Logistic regression and students' t-test were used to identify associations, with significance set at P < .05.ResultsLipodystrophy prevalence was 11.4%, with lipohypertrophy (10.5%) more common than lipoatrophy (0.9%). Dyslipidemia affected 25.7% of participants. Participants who had entered puberty (as indicated by Tanner staging) were approximately 10 times more likely to have lipodystrophy (OR = 9.91; 95% CI: 1.32-74.23, P = .026). Higher mid-upper arm circumference was associated with significantly lower odds of lipodystrophy (OR = 0.60; 95% CI: 0.36-0.99, P = 0. 046. Participants with lipodystrophy had lower odds of elevated triglycerides (OR: 0.1; 95% CI: 0.00-0.62 P = .029). Previous lopinavir/ritonavir use was significantly associated with reduced odds of dyslipidemia (OR: 0.21; 95% CI: 0.05-0.91, P = .036).ConclusionThe high prevalence of dyslipidemia and lipodystrophy emphasizes the need for routine lipid and other metabolic assessments among children and adolescents living with HIV.

Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises.

PurposeTo address gaps in progress in coverage of HIV diagnosis and treatment services for children and adolescents living with HIV compared to adults, the Faith-Based Action for Scaling Up Testing and Treatment for Epidemic Response (FASTER) initiative facilitated partnerships between government, civil society organizations, private sector, and faith-based organizations. FASTER addressed structural barriers to pediatric and adolescent HIV testing and treatment services, expanded access to innovative drugs and diagnostics, and scaled up evidence-based interventions across four countries (Nigeria, Tanzania, Uganda, and Zambia). The purpose of this analysis is to describe progress towards the six FASTER priority actions and to identify persistent programmatic gaps for targeted interventions and ongoing quality improvement efforts.MethodsAggregate data on seventeen FASTER performance indicators and routine monitoring, evaluation, and reporting indicators from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) were compared between baseline and endline of the initiative across 245 FASTER priority facilities.Major findingsMeasurable progress was observed across all indicators. Key successes included expansion of registration of priority pediatric diagnostics across all countries, and an increase in the proportion of children receiving multi-month dispensing, from 64% to 73%. Areas with ongoing service gaps were identified. For instance, fewer than half of facilities reported achieving rates of ≥90% completion of family trees for index testing in children or post-breastfeeding HIV testing for infants.ConclusionThis assessment at health facilities implementing the FASTER initiative demonstrated progress towards improving HIV services for children and adolescents. It also identified opportunities for continued improvement to address ongoing gaps. Lessons learned from the FASTER initiative can inform national strategies to rapidly advance progress to improve services for children, adolescents.

ObjectivesPreexposure prophylaxis (PrEP) uptake among young sexual minority men of color remains low. Tailored motivational interviewing (TMI) has been shown to promote behavior change across the youth HIV prevention and care continua but has not been tested in PrEP. This study tested the proof of concept of the TMI for PrEP Choices (TMI-PC) implementation package among a cohort of providers.MethodsThis included: (1) online modules (2) TMI workshop; and (3) Motivational Interviewing (MI) technique practice and feedback. Providers completed surveys prior to and posttraining and 2 coded standard patient interactions; one following the workshop and one three months after the workshop.ResultsAt baseline, providers reported high familiarity and confidence with PrEP overall and daily oral PrEP. On-demand and injectable PrEP familiarity increased significantly among providers. Immediately posttraining, half of the providers scored in the intermediate or advanced fidelity range, which increased to 75% at follow-up. Change in mean MI coach rating scale scores among providers increased significantly.ConclusionThis study provides proof of concept for the TMI-PC Implementation Package, which appears to be ready for testing in a randomized clinical trial.