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

BackgroundWhile advancement in treatment have turned HIV into a manageable chronic condition achieving viral suppression, it has become imperative to focus on overall health and improving health-related quality of life of people living with HIV (PLHIV) beyond viral suppression. This study aimed to describe how PLHIV perceive and manage their overall health, factors influencing patient-provider communication, and the impact of poor patient-provider communication on health outcomes.MethodsThis cross-sectional, online survey recruited HIV-positive adults in the United States between February 22 and June 2, 2022, via the Profiles Panel. Data on sociodemographic and health characteristics, and social determinants of health were collected. The study assessed how PLHIV view and manage their overall health by measuring self-rated overall health, Patient Activation Measure^® (PAM^®), general and HIV-specific health locus of control (HLOC). Multivariable analyses were used to identify the barriers and unmet needs in the patient-primary HIV clinician communication.ResultsOf the 781 PLHIV who completed the study, most participants were cisgender male (56.2%), non-Hispanic, White (51.5%), and <50 years old (67.0%). Over 90% of participants reported being virally suppressed or having an undetectable viral load. About one-third (31.5%) reported their overall health as either poor or fair. Participants were highly activated in managing their health with 58.0% at PAM level 3 and 33.3% at level 4 and had high scores across the dimensions of both general and HIV-specific HLOC. Overall, 18.2% of the participants reported suboptimal satisfaction and 16.8% reported facing difficulty in verbalizing their HIV-related health concerns with their primary HIV clinician. One-fourth of the participants reported "sometimes" or "never/rarely" discussing their HIV treatment medications with their primary HIV clinician. Furthermore, participants dissatisfied with their primary HIV clinician were twice as likely to self-report poor overall health (OR: 2.2, 95% CI: 1.38, 3.48).ConclusionThis study underscores the critical role of managing overall health by optimizing patient-provider relationships in influencing individual holistic well-being beyond viral suppression. Healthcare interventions should prioritize strategies to enhance patient communication and satisfaction, recognizing its profound impact on HIV and overall health outcomes.

BackgroundHIV index case testing is a successful early detection and prevention technique that includes providing HIV testing to the biological children and sexual partners of individuals living with HIV. There is inconsistent data about acceptance of HIV index testing in Ethiopia.MethodsA systematic review and meta-analysis were conducted under the guidelines of PRISMA 2020. We searched Google Scholar, Hinari, Science Direct, PubMed, and the Cochrane Library. A total of 3952 participants from 11 cross-sectional studies were included. A random-effects model was used in STATA 17 for analysis. Subgroup, sensitivity, and meta-regression analyses were used to investigate heterogeneity.ResultsPooled acceptance rate was 68.9% (95% CI: 57.6-80.2). Acceptance was higher among those who lived in an urban area, disclosed their HIV status, and had been on ART for more than a year.ConclusionNearly 70% of ART patients in Ethiopia agree to undergo index testing.

ObjectivesSatisfaction with service delivery among people with HIV (PWH) is an important quality of care indicator and may influence retention in care and health outcomes. This study aimed to evaluate satisfaction and its associated factors among PWH in Taiwan.MethodsA self-administered anonymous questionnaire interview with 40 questions was conducted to assess satisfaction within 6 domains of healthcare service delivery at 3 designated hospitals in Taiwan. Satisfaction with each question was measured on a Likert 5-point scale, while overall satisfaction was rated on a scale from 1 to 10. Multivariate analysis was conducted to identify factors associated with overall satisfaction.ResultsFrom January to June 2024, 863 PWH were included. The mean age was 42.9 years and 97.9% were men. The average overall satisfaction score was 8.94 (standard deviation 1.17). Within HIV care, satisfaction was lowest in the waiting time for HIV consultation. Outside of HIV care, higher dissatisfaction was observed with the attitude of the medical staff during the inquiry or disclosure of HIV status. Multivariate analysis revealed that factors positively associated with overall satisfaction included hospital cleanliness, convenience of the registration/billing system, accessibility of hospital location, privacy protection, trustworthiness of doctor(s), shorter waiting time for consultation, and friendliness of the registration and billing staff.ConclusionsOverall satisfaction among PWH was high at the 3 Taiwanese hospitals. Optimization of hospital infrastructure and workflow, strengthening privacy protection, and education for all hospital staff to promote nonjudgmental attitude toward HIV could further improve patient satisfaction and the quality of care.

BackgroundWhile research has identified many associations between socioeconomic factors and human immunodeficiency virus (HIV) nonsuppression, few qualitative studies have defined the mechanisms by which these factors interrelate and lead to HIV nonsuppression. The development of interventions to achieve universal virologic suppression and eliminate transmission will require a deeper understanding of the individual and social processes that drive antiretroviral therapy (ART) nonadherence and consequent viral nonsuppression.MethodsWe used a semistructured interview-based case-study approach to characterize changes across 3 time points in the lived contexts of 11 adolescents and young adults (aged 15-24 years) from intervention and control arms of a longitudinal HIV intervention trial in rural Kenyan and Ugandan communities. We sought to determine commonalities among those who never virally suppressed, those who became nonsuppressed, and those who moved from nonsuppression to viral suppression, exploring social and behavioral micro-processes or causal chains observed among individuals who share these trajectories.ResultsWe found that supportive family environments, high-quality service provision, and residential and partnership stability free of violence, or that permitted freedom to move and maintain extensive social ties both inside and outside one's immediate community, enabled ART adherence. We also found that several factors combine to have effects beyond each individual factor taken singly, for example, medication side effects were influenced by food insecurity; disclosure was most effective with individuals around whom one may potentially take medication, such as co-resident partners; and mobility compromised adherence when patients did not know how or where to access care in new places.RecommendationsOur findings suggest that to improve virologic suppression, clinical care and interventions should include assessment and strategies to address food insecurity, ART disclosure, and home-based violence from intimate partners or other family members. When such factors are present, we suggest referral for services, including violence prevention and protection services, and food provision for those patients who do not adhere because of medication side effects amplified by lack of food. We further recommend that clinics coordinate regionally to anticipate mobility, facilitate transfer of care to other areas, and ensure clients have access to information about care clinics elsewhere in the region.

Long-acting antiretroviral treatment (LA ART) is a forthcoming option for adolescents and young people living with HIV (AYPLHIV), but perspectives on using peer mentors to implement LA ART for AYPLHIV are unknown. We conducted seven focus group discussions (n = 58 participants) from November 2021 to April 2022 in Kenya with four stakeholder groups, including AYPLHIV, healthcare providers, advocates, and policymakers. We used inductive coding and thematic analysis. Our stakeholders articulated peer mentors are crucial in the implementation of LA ART for AYPLHIV in leading communication, facilitating referrals, and providing empathy from lived experiences. Additionally, they can serve as early adopters, help navigate service points, and provide messaging on the benefits and drawbacks of LA ART. They emphasized the necessity of training peer mentors for the LA ART scale-up. Peer mentors are essential for linkage and referring of AYPLHIV to LA ART, and peer mentors' involvement should be integrated into a national implementation plan.

ObjectivesThere is a high prevalence of internalized stigma among people with HIV (PWH) and it is possible that factors associated with stigma differ by gender. Therefore, we evaluated whether gender is an effect modifier of the association between covariates and internalized stigma among 694 PWH.MethodsLinear regression with interaction terms between covariates and gender was used to evaluate significant associations and test for interactions.ResultsWe found a 10-year increase in age was associated with lower stigma among women (β (95% CI): -0.20 (-0.30, -0.10)) but not among men (β = 0). Generalized anxiety disorder (GAD) was associated with higher stigma (GAD & GAD-squared β (95% CI): 0.12 (0.08, 0.187), -0.004 (-0.006, -0.001)) and an increased time since HIV diagnosis was associated with lower stigma (β (95% CI): -0.20 (-0.30, -0.10)).ConclusionsGender-specific interventions should be developed to account for the differences in the association between age and stigma across genders.

Background: Decentralized human immunodeficiency virus (HIV) is a model adopted to improve access to antiretroviral therapy (ART) within communities and mitigate the burden of HIV treatment and care on health care facility. In Ethiopia, these services help HIV clients fully benefit from ART as they are able to access ART within their catchment areas. However, HIV clients still travel out of their catchment areas to commence the ART. Thus, this study aimed to assess the magnitude of out-of-catchment area ART initiation and its associated factors among people living with HIV (PLWHIV) in Western Ethiopia. Methods: This cross-sectional study was conducted among 423 PLWHIV from November 25 to December 30, 2025, at Nekemte Comprehensive Specialized Hospital. A systematic sampling method was used to recruit the study participants. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Logistic regression analysis was computed to identify factors associated with out-of-catchment ART initiation among PLWHIV. Variables with a P value <.25 from the bivariable analysis were entered into the multivariable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and P value <.05 were used to determine a significant association. Results: A total of 423 PLHIV were included in the study. The mean age of study participants was 33.43 ± 9.79 years. One-fifth (22%) of the participants-initiated ART out of their catchment area with 95% (CI: 18.28-26.20). Participants who did not disclose their HIV (AOR = 4.39, 95% CI = 2.45-7.87), tested through voluntary counseling and testing (AOR = 3.99, 95% CI = 2.21-7.19), knowledgeable about HIV/AIDS (AOR = 2.15, 95% CI = 1.18-3.93), using traditional healing (AOR = 1.91, 95% CI = 1.03-3.55), being female (AOR = 2.42, 95% CI = 1.36-4.32), and perceived stigma (AOR = 3.41, 95% CI = 1.88-6.18) were significantly associated with out-of-catchment ART initiation. Conclusion and Recommendation: A substantial number of PLWHIV in study area had initiated ART outside their designated catchment areas. To address this, it is crucial to enhance HIV serostatus disclosure, combat discrimination associated with HIV/AIDS, and promote decentralized HIV care and ART services.

In 2022, a community-academic collaborative team published 5 key recommendations for developing a national action plan to advance the sexual and reproductive health and rights (SRHR) of women living with HIV in Canada. In 2023, a national gathering was convened to strategize implementation of the recommendations across policy, practice, and research settings. Discussions highlighted that meaningful engagement of women living with HIV (recommendation 1) is foundational to implementing the other recommendations. Meaningful engagement requires SRHR stakeholders to: actively dismantle power differentials; commit to engagement as an ongoing process; learn about regionally specific epidemiology and sociostructural forces that create and sustain vulnerability for HIV among women; invest in creating supportive infrastructure; and integrate Equity, Diversity, and Inclusion principles to call diverse groups into the conversation. This Canadian initiative demonstrates how global guidelines can be transformed into nationally tailored action plans to advance the SRHR of women living with HIV, grounded in meaningful engagement.

This letter comments on the study by Masika et al, which demonstrated the feasibility of SMS reminders to improve adverse drug reaction (ADR) reporting among adults on antiretroviral therapy (ART) in Tanzania. Their findings show how mobile messaging can enhance patient awareness and strengthen pharmacovigilance in resource-limited settings. This commentary considers the relevance of this approach for the Philippines, where ADR underreporting persists due to limited digital tools, uneven facility resources, and low patient engagement. With mobile phone penetration exceeding 130%, an SMS-based system could provide an accessible and scalable method for supporting timely ADR reporting among people living with HIV. Adapting the Tanzanian model, while ensuring cultural appropriateness, confidentiality, and integration with national reporting mechanisms, may help address gaps in treatment monitoring and contribute to a more responsive, data-driven ART program.

We examined factors influencing the intention of Black and Hispanic gay and bisexual men aged 18-34 years in Texas to discuss starting long-acting injectable pre-exposure prophylaxis (LAI-PrEP) with healthcare providers. Participants were recruited through geosocial apps and community locations, completed online surveys measuring attitudes, subjective norms, perceived behavioral control (Theory of Planned Behavior), internalized homophobia, medical mistrust, HIV risk, and medical mistrust. Among the final sample (N = 190), 63.5% intended to discuss LAI-PrEP. Poisson regression models indicated that higher attitudinal concerns [adjusted prevalence ratio (aPR): 0.80, 95% confidence interval (CI): 0.70, 0.92; P < 0.01) and higher medical mistrust (aPR: 0.98, 95% CI: 0.97, 0.99; P = 0.01) were linked to lower prevalence of intentions. Seeing a doctor in the past 12 months was associated with higher prevalence of discussing LAI-PrEP (aPR: 1.46, 95% CI: 1.00, 2.13; P = 0.05). Addressing concerns and reducing discrimination are crucial for improving LAI-PrEP uptake in this population.