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

We evaluated a couple-based intervention targeting human immunodeficiency virus (HIV) care needs of women, with the option to support HIV-related needs of male partners. Adult women with HIV adherence difficulties in a monogamous relationship with a male partner for ≥6 months were recruited in KwaZulu-Natal, South Africa. Twenty couples were randomized (1:1) to either START Together, a five-session manualized behavioral intervention, or treatment as usual, adherence counseling referral. Assessments were completed at baseline, post-treatment, and follow-up. Of the ten couples randomized to START Together, 70% attended at least one intervention session (feasibility); of those, 71% attended all five sessions (acceptability). Independently rated interventionist fidelity was very high (M ≥ 2.94 out of 3). Women's self-reported antiretroviral therapy adherence increased similarly in both interventions. For men, self-reported antiretroviral therapy adherence increased up to 25 percentage points in START Together, but not treatment as usual. Findings suggest that START Together may be potentially beneficial for improving HIV outcomes for men.

BackgroundLaunched in the United States (US) in 2016, the 'undetectable equals untransmittable' (U = U) message has revolutionized human immunodeficiency virus (HIV) management by affirming that individuals on antiretroviral therapy (ART) with undetectable viral loads (VL) cannot sexually transmit the virus. This study aimed to assess the knowledge and understanding of U = U and factors associated with the lack of understanding among people living with HIV (PLHIV) in the US.MethodsA cross-sectional, online survey was fielded from February to June 2022 in the US to PLHIV aged ≥18 years who were currently taking ART. Data on sociodemographic variables, HIV-related and general health characteristics were collected. The study assessed the knowledge and understanding of U = U and sources of U = U information. Multivariable analyses were used to identify the factors associated with the lack of U = U understanding among PLHIV.ResultsA total of 781 PLHIV completed the study and were included in the analysis. Most participants were <50 years old (67.0%), cisgender males (56.2%), and majority having at least some college education (80.5%). More than half (54.5%) of the participants did not know the meaning of the U = U. Sources of learning about the meaning of 'undetectable' included a healthcare provider (HCP) alone (50.4%), the U = U campaign alone (7.6%), both an HCP and the U = U campaign (14.7%), and sources other than HCPs or the U = U campaign (32.2%); 3.1% of participants reported having never heard the term before. About 12.0% of the participants were unaware of their VL status. After adjusting for covariates, PLHIV who lacked an understanding of U = U were more likely to have a college degree or higher education (OR: 0.6, 95% CI: 0.41-0.86, P = 0.006), recent HIV diagnosis (6 months to <12 months) (OR: 2.06, 95% CI: 1.14-3.77, P = 0.018), suboptimal ART adherence (OR: 2.74, 95% CI: 1.88-4.01, P < 0.001), and lack HCP communication about the importance of an undetectable VL compared to those who understood U = U.ConclusionThe study highlights substantial gaps in understanding U = U among PLHIV and in HCP-patient communication. These findings underscore the need for targeted education for both PLHIV and HCPs, emphasizing the clinical implications and benefits of U = U in relation to HIV prevention.

Biktarvy, a once-daily combination of bictegravir, emtricitabine, and tenofovir alafenamide (TAF), is a highly effective antiretroviral therapy for HIV management. Although well-tolerated, rare but serious complications such as lactic acidosis can occur, particularly in patients on nucleoside reverse transcriptase inhibitors. We present the case of a 36-year-old male with HIV/AIDS and chronic kidney disease, who was admitted with altered mental status and acute hypoxic respiratory failure. Imaging confirmed atypical pneumonia. Initial labs revealed elevated lactate and creatinine. He was treated with broad-spectrum antibiotics, and after clinical improvement, Biktarvy was resumed. Within 24 h, his lactate spiked to 21.8 mmol/L. Suspecting TAF-induced lactic acidosis, Biktarvy was discontinued. Continuous renal replacement therapy, along with L-carnitine and thiamine, was initiated based on a literature review. The patient's condition improved significantly. Upon discharge, lactate and creatinine returned to baseline. At outpatient follow-up, he remained clinically stable on Dolutegravir-Rilpivirine and Entecavir.

Successful transition from paediatric to adult HIV care programme is a critical developmental milestone in the care trajectory of adolescents living with HIV (ALHIV). The transition process involves a shift from a structured, caregiver-supported healthcare model to one that requires independence and self-management. This process should be guided and supportive to ensure continued engagement in care and optimal adherence when ALHIV are transferred. This study utilised photovoice methods to explore the transition experiences of ALHIV in the Cape Town Metropole. Audio-recorded focus group data were transcribed verbatim and subjected to reflexive thematic analysis. Three distinctive patterns of behaviour from ALHIV were identified as themes. Type 1: socially reliant, dependent adolescent who heavily relies on family and peer support and struggles with adherence. Type 2: socially disconnected, hyper-independent adolescent, who is self-reliant, seeks solitude, and is generally resistant to external support. We configured a third (ideal) type, who is interdependent and able to self-manage their chronic condition, but within a supportive health care environment that provides positive healthcare and transition experiences. The findings underscore the need for supportive transition models promoting self-management skills, while facilitating a symbiotic relation with healthcare staff promoting sustained engagement in care well into adulthood. We recommend that adolescent or youth friendly services for ALHIV be expanded to support and monitor the transition process and outcomes in the adult HIV program.

BackgroundThe widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of people living with HIV (PLWHIV). However, this success is accompanied by a growing burden of non-communicable diseases, particularly hypertension, which has emerged as a leading contributor to morbidity and mortality in sub-Saharan Africa. Despite this growing concern, data on the burden and care cascade of hypertension among PLWHIV in routine care settings remain limited in Cameroon.ObjectiveTo assess the prevalence, associated factors, and care cascade of hypertension among PLWHIV receiving follow-up at Yaoundé Central Hospital in Cameroon in 2024.MethodsWe conducted a cross-sectional descriptive study at the Day Hospital of Yaounde Central Hospital, a national referral center for HIV care. PLWHIV aged ≥21 years and under active follow-up were included. Hypertension was defined as systolic and/or diastolic blood pressure ≥140/90 mm Hg or current use of antihypertensive medication. Logistic regression analyses were performed to identify factors associated with hypertension, including clinical and HIV-related parameters.ResultsA total of 554 participants were enrolled, of whom 74.0% were women, with a mean age of 50.9 years. The overall prevalence of hypertension was 36.8% (95% CI: 32.9-40.9) and was higher among men than women (45.1% vs 33.9%). Among hypertensive individuals (n = 204), 66.7% had initiated antihypertensive treatment, 45.6% were retained in care, and only 22.6% had controlled blood pressure. Factors independently associated with hypertension included longer ART duration (>16 years) (adjusted OR = 1.88; P = .036), WHO clinical stage II at HIV diagnosis (adjusted OR = 1.56; P = .033), and suppressed viral load (<1000 copies/mL), which was paradoxically associated with a higher risk of hypertension (adjusted OR = 0.42 for unsuppressed viral load; P = .041). No significant association was found with ART regimen lines.ConclusionHypertension affects more than one-third of PLWHIV in this urban HIV referral center, yet important gaps persist in treatment initiation, retention, and control. These findings highlight the urgent need for integrated hypertension screening and management strategies within HIV care services in Cameroon to reduce long-term cardiovascular risks.

Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) counselors play a crucial, albeit challenging, role in preventing and controlling HIV. People living with HIV (PLHIV) need emotional support in addition to clinical treatment. Counseling is more difficult for female counselors, considering the psychological and emotional aspects of HIV counseling.

Methodology: A qualitative study design was used to understand the complexity of the challenges faced by female HIV counselors. Interpretative phenomenological analysis (IPA) was employed as the research design. A small, homogeneous sample was purposively selected, comprising all 11 female HIV counselors in the Kashmir province and one female counselor in Leh (Ladakh). The IPA methodology was utilized, which emphasizes meaning-making and understanding the counselor's perspectives. The study was conducted from December 2022 to January 2023, with data collected through in-depth interviews at the counselors' workplaces and via Zoom for the Leh participant. Data were analyzed thematically using the IPA approach, revealing the counselors' real-life experiences, perceptions, and challenges.

Results: The analysis generated two superordinate themes with multiple overarching themes and sub-themes: Intrusive emotional and psychological experiences: Counselors experienced significant emotional strain, including emotional exhaustion, burnout, and stigma. Inadequate skills for effective counseling of people who inject drugs (PWID): Limited training hindered effective counseling for substance users and PWID, highlighting the need for specialized training.

Conclusion: Female HIV counselors in Kashmir face numerous psychological and emotional challenges, including emotional exhaustion, burnout, and stigma. Additionally, there is a lack of adequate training for counseling substance users. Addressing these issues through specialized training, stigma reduction initiatives, and mental health support is crucial for improving HIV counseling services and the overall HIV/AIDS response in the region.

Background: In 2020, people living with HIV (PLHIV) in France were worried that the COVID-19 health crisis would lead to long-term changes in their HIV care. Using data from the anonymous, online, cross-sectional survey ACOVIH, which was completed by PLHIV between July and September 2020, this study explored factors associated with worry about long-term changes to HIV care after the end of the first lockdown (17 March-11 May 2020). Methods: Using multivariate logistic regression, we compared participants who declared they were worried about long-term changes with those who did not, in terms of their demographic, behavioral, and socioeconomic characteristics, as well as their experience of the COVID-19 crisis and access to care. Results: Among the 249 respondents, 61.5% (n = 153) declared having worries about long-term changes to HIV care. Specifically, after adjustment for gender and age, PLHIV born outside of France (adjusted odds ratios (aOR) [95%CI] = 2.57[1.44;6.76]), those whose financial situation deteriorated since the beginning of the pandemic (4.87[1.97;13.20]), those with a history of HIV opportunistic infections (3.27[1.53;7.32]), and respondents who took psychotropic drugs (3.21[1.50;7.22]) were all more likely to declare having worries. In terms of related determinants, a deterioration in communication with their HIV medical team (3.47[1.61;7.94]), having worries about COVID-19 (1.36[1.14;1.62]), and believing that HIV treatment increased the risk of COVID-19 infection (1.52[1.15;2.03]), were all significantly associated with having worries about long-term changes to HIV care. Conclusion: In the context of future disease epidemics, taking into account the profiles of individual PLHIV, and providing clearer, targeted information on HIV care, could help reduce worry in this population about the continuity of HIV care and could foster efficient communication with care providers.

BackgroundOral preexposure prophylaxis (PrEP) effectively prevents HIV but is underutilized in the United States, particularly among populations with higher incidence of HIV. Emergency departments (EDs), which often care for medically underserved individuals, could play a key role in expanding PrEP access. However, integrating PrEP into ED workflows presents challenges.MethodsThis qualitative study involved interviews with 22 stakeholders from 15 EDs and 4 sexual health clinics across the United States. Participants included ED leaders, providers, and navigators. The data were analyzed using a PrEP care cascade model, focusing on provider buy-in, patient identification, education, PrEP initiation, and linkage to care.ResultsKey barriers included limited provider knowledge, ED priorities focused on acute care, and the reliance on grant funding without long-term plans for sustainability. Successful programs relied on ED champions to advocate for PrEP and improve staff engagement. Some EDs offered same-day PrEP prescriptions or starter packs, which improved uptake, but most relied on referrals and had low follow-up rates. Patient identification strategies, such as using navigators or risk scores, varied across sites. Education was often led by ancillary staff, as ED providers had limited time and training. Sustainability remained a major challenge, as most programs were dependent on short-term funding.ConclusionsTo expand PrEP access in EDs, it is essential to address systemic barriers, improve provider training and establish sustainable funding models. Streamlined workflows, dedicated staff, and targeted interventions can help EDs play a more active role in HIV prevention.

BackgroundThe United States recently expanded infant feeding guidelines for persons living with HIV to include chest/breastfeeding.MethodsA qualitative study was conducted through in-depth interviews with 15 service providers and 7 pregnant/lactating persons living with HIV about infant feeding preferences/experiences and implementation determinants of the revised guidelines. Thematic analysis, guided by the Health Equity Implementation Framework, identified opportunities and constraints to equitable adoption and implementation of the revised infant feeding guidelines for persons living with HIV in the United States.ResultsProviders and persons living with HIV embraced the revised guidelines, citing expanded autonomy in infant feeding choices, destigmatization and normalization of breastfeeding. Nevertheless, overlapping individual (breastfeeding reticence given quantifiable but residual vertical HIV transmission risks), institutional (inconsistent provider/organizational knowledge and resources), and structural (siloed care) implementation barriers were identified.ConclusionsEquitable guideline rollout should consider person-centered counseling, clear communication around risks, and coordinated public sector-led dissemination.