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

BackgroundThe co-infection of human immunodeficiency virus (HIV) and neurosyphilis presents a significant clinical challenge due to the increased risk of opportunistic infections, including progressive multifocal leukoencephalopathy (PML).Case PresentationA 23-year-old unmarried male with an unprotected sexual history presented with progressive right upper limb weakness and slurred speech for 10 days. He was diagnosed with HIV and neurosyphilis co-infection, and neuroimaging/cerebrospinal fluid studies confirmed PML.ConclusionsThis case highlights the importance of screening for HIV and neurosyphilis in young patients with neurological symptoms and the need for awareness of opportunistic infections such as PML in immunocompromised individuals.

BackgroundHIV self-tests (HIVSTs) have been promoted as one way to increase testing.MethodsWe extracted data from the GetaKit study for October 11, 2023 to June 30, 2025, focusing on participants to whom we co-offered an HIVST and serology.ResultsWe co-offered HIVST and serology to 3611 persons; 71.9% agreed to go to a lab and 19.4% opted for only the HIVST. Participants who were Black, Indigenous, or Persons of Color were less willing to attend a lab; participants who were men who have sex with men or reported injection drug use or sex work were more willing to attend a lab. First-time testers opted for the HIVST at a higher rate. HIVST did not yield new diagnoses.ConclusionsHIVSTs were an entry point to testing for some but were not the preferred modality for most. Promoting HIVSTs too broadly would not align with patient preference.

Despite progress in human immunodeficiency virus (HIV) prevention, global targets remain unmet, with over 1.3 million new infections annually-driven by adherence challenges, stigma, and daily pill fatigue linked to oral pre-exposure prophylaxis (PrEP). Lenacapavir, a long-acting injectable capsid inhibitor approved by the FDA in June 2025, offers transformative twice-yearly subcutaneous dosing with sustained efficacy and minimal drug interactions. PURPOSE 1 and 2 trials demonstrated near-complete protection across cisgender women, men who have sex with men, transgender individuals, and adolescents, highlighting its potential to overcome barriers to PrEP uptake. Its high acceptability, infrequent dosing, and pharmacologic durability make it ideal for individuals facing stigma, mobility constraints, or limited healthcare access. WHO's endorsement marks a pivotal milestone, but real-world implementation must address cold-chain logistics, cost, provider training, and systemic inequities. Integrating lenacapavir through decentralized delivery models, differentiated care, and inclusive national guidelines will be key to equitable access, decreasing gaps and advancing epidemic control.

BackgroundDue to high-risk sexual networks along their transit routes, Long-distance truckers' (LDTs) risk of HIV is known to be high, as evidenced by prevalence rates of 14.34% in the region. Besides, the spaces in which LDTs operate are often marred with a multitude of barriers to HIV/AIDS risk reduction. However, there is limited evidence on the barriers encountered by LDTs in Kenya, hence the need for the current study.Methods and MethodologyWe used nine key informants and 18 in-depth interviews from purposively sampled participants, such as nurses and LDT peer educators at Kenya's Busia and Namanga international border points. We used semi-structured interview guides to collect data through audio records. Interviews were transcribed, coded, and thematically analysed using the QDA-Miner software to generate themes and sub-themes around barriers to HIV/AIDS risk reduction among LDTs.FindingsOverall, three themes, namely, health system, individual-level, and trucking career-related barriers emerged. The sub-themes under health system barriers included the location of healthcare facilities far from transit routes, long durations of hospital waiting time, and lack of targeted health facilities for LDTs, among several others. Under trucking career-related barriers, the sub-themes comprised tight work schedules, unfavourable trucking career policies, and insecurity along transit routes. For individual barriers, some of the sub-themes were language barriers and lack of awareness of current HIV/AIDS risk reduction services.ConclusionAlongside health system factors, individual level and trucking career-related factors were highlighted as the barriers to HIV/AIDS risk reduction among LDTs in Kenya. The existence of these barriers may complicate the fight against the pandemic in this hard-to-reach population, given their already known vulnerability to HIV infections.

ObjectivesWe examined associations between extreme weather events (EWE), resource insecurities, and HIV vulnerabilities among a purposive sample of adolescent girls and young women (AGYW) aged 16 to 24 in Nairobi and Kisumu, Kenya.MethodsWe conducted multivariable logistic/linear regression on cross-sectional survey data to assess associations between EWE exposure, food insecurity (FI), water insecurity (WI), and sanitation insecurity (SI) with HIV vulnerabilities (transactional sex [TS], intimate partner violence [IPV], sexual relationship power [SRP], and preexposure prophylaxis [PrEP] awareness and acceptability).ResultsAmong participants (n = 597; mean age: 20.13 years; standard deviation = 2.5), in adjusted analyses, SI and WI were associated with increased TS. Increased cumulative EWEs and eco-anxiety were associated with increased IPV. EWE frequency, FI, and SI were associated with reduced SRP. EWE frequency and SI were associated with reduced, and WI with increased, PrEP awareness. EWE frequency and SI were associated with PrEP acceptability.ConclusionResource scarcities and EWEs were associated with HIV vulnerabilities and PrEP acceptability among AGYW.

BackgroundYouth with HIV disproportionately experience psychological trauma, but implementation methods for trauma-informed care are lacking.MethodsTo identify potential processes and determinants of trauma-informed care implementation, we conducted process mapping and qualitative interviews and thematically applied the organizational trauma resilience framework to elicit perceived safety, stability, and nurturance in a pediatric HIV clinic.ResultsForty-three personnel and 8 patient representatives engaged in process mapping; 20 completed qualitative interviews. Clinic culture was described as supportive, cohesive, and equity-focused, but requiring workflow improvements for patient autonomy. Trauma screening, assessment, and interventions were limited/inconsistently applied, with duplicative risk assessments. Support for professional quality of life was limited, despite burnout/attrition reports. Some personnel had trauma-focused training, but ongoing education and culturally responsive policies were needed.ConclusionsProcess mapping presented as a low-burden tool for unveiling gaps and care standards; alongside qualitative interviews, these methods provided practical insights for trauma-informed HIV care.

BackgroundLate diagnosis of HIV remains a critical barrier to effective treatment and improved long-term outcomes. Individuals presenting with low CD4+ T cell counts at diagnosis are at greater risk for opportunistic infections, hospitalization, and mortality. This study aimed to compare clinical, immunological, and virological outcomes among early and late presenters, and to identify factors associated with virologic failure.MethodsWe conducted a retrospective cohort study of 200 patients newly diagnosed with HIV between 2012 and 2019. Participants were categorized into three diagnostic groups based on baseline CD4+ T cell counts: early diagnosis (>350 cells/mm³), late diagnosis 1 (200-350 cells/mm³), and late diagnosis 2 (<200 cells/mm³). Baseline demographics, laboratory markers, clinical outcomes, and treatment responses were compared. Logistic regression was used to evaluate predictors of virologic failure at 6 months.ResultsLate presenters accounted for 71% of the cohort and were more likely to be older, female, unmarried, and have lower education levels. They exhibited significantly lower CD4+ counts, CD4/CD8 ratios, and higher HIV RNA levels at diagnosis (P < .001). Opportunistic infections, hospitalization, and mortality were significantly more common in the late diagnosis 2 group (P < .001). Although virologic suppression was achieved in most patients, immune recovery was significantly impaired in those diagnosed late. Antiretroviral therapy (ART) initiation after 2015 was independently associated with lower risk of virologic failure (OR: 0.39; P = .039).ConclusionLate HIV diagnosis is associated with increased clinical morbidity and impaired immune reconstitution, even in virologically suppressed individuals. Early detection, prompt ART initiation, and routine CD4/CD8 monitoring are essential to optimize outcomes. Public health interventions targeting social determinants may help reduce delays in diagnosis and improve equity in HIV care.

In August 2012, a 47-year-old male patient was diagnosed with human immunodeficiency virus (HIV) infection, with no other underlying disease or opportunistic infection. Baseline measurements revealed an HIV RNA count of 79 400 copies/mL and a CD4+ T-lymphocyte count of 8 cells/μL. Despite successful viral suppression with HIV RNA levels remaining below the detectable threshold for 9 consecutive years following the initiation of antiretroviral therapy, the patient's CD4+ T lymphocyte count persistently remained below 200 cells/μL. Resistance testing of the viral reservoir (HIV DNA) was conducted, which revealed proviral resistance. Based on these results, the antiviral treatment regimen was adjusted. One year later, the patient's immune function had significantly improved, with the CD4+ T lymphocyte count having increased to 319 cells/μL.