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

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.

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.

BackgroundCommunity perception, illness definition and meaning attribution to the causes and justification for the consequence of HIV acquisition on People Living With HIV/AIDS (PLWH) cumulatively affect their health-seeking behaviours, stigmatisation, quality of life and survival. The study examines rural Ghanaian dwellers construction of why and how people contract HIV/AIDS and their perception and attitudes towards PLWH.MethodsQualitative case study design and approach with purposive and snowballing sampling techniques facilitated the selection of 15 adult participants comprising two PLWH and other key informants from a rural Ghanaian community. A semi-structured interview guide aided in the collection of data from the participants. Data collected were analysed using NVivo 8 and presented using comparative emerging themes.FindingsParticipants from the community demonstrated varying perceptions and attitudes towards PLWH. Contraction of HIV/AIDS by a person was construed by community members to result from a person's lived unrestricted sexual lifestyle, accidental acquisition, predestination to contract the virus and punishment from ancestors. Others perceived PLWH as just normal beings with a foreign virus. Community-level causal explanations on why people acquired HIV were shaped by community members' educational attainment, religious doctrines and inherent tenets, fear of the virus, regard for professional ethics and perceptions on PLWH gift reception.ConclusionsPublic education and awareness creation interventions should be re-intensified and delivered beyond urban and peri-urban centres to reach core PLWH and their community members within rural communities. Sustained micro-level education on HIV/AIDS awareness with feedback input is critical to stigma reduction.

ObjectiveThis study evaluated the implementation fidelity (IF) of HIV/AIDS Care and Support (C&S) services for orphans and vulnerable children (OVC) at the African Network for Prevention and Protection Children against Neglect (ANPPCAN) Project, Gondar City, 2023.MethodA facility-based convergent parallel mixed-methods design was used to assess IF and identify factors influencing caregiver responsiveness. Quantitative data were collected from 424 OVC caregivers, 385 document reviews, 27 observations, and an inventory checklist. Qualitative data were obtained from five key informant interviews. Data were gathered concurrently, analyzed separately, and integrated during interpretation to provide a comprehensive view.ResultThe overall IF was 67.35%, with adherence at 81.5%, dosage at 45%, and caregiver responsiveness at 70.6%. Responsiveness was significantly associated with having separate waiting rooms, take-home materials, and friendly service delivery.ConclusionAlthough adherence was high, dosage was low and responsiveness moderate, indicating the need to strengthen service delivery components to improve implementation fidelity.

PurposeTo identify key social and structural factors associated with hazardous alcohol and problematic drug use among sexual and gender minority (SGM) adults.MethodsWe conducted a cross-sectional secondary analysis of 2016 to 2019 data from the Generations Study, a probability sample of 1518 SGM adults. Hazardous alcohol and problematic drug use were measured using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) and Drug Use Disorder Identification Test (DUDIT). Candidate predictors included sociodemographic characteristics, minority stressors, adverse childhood experiences, health indicators, and social support. Interpretable machine-learning models with SHapley Additive exPlanations characterized multilevel correlates of 3-level risk categories.ResultsHazardous alcohol use was linked to past smoking, lower social support, cancer history, housing instability, and identity-related stressors. Problematic drug use was linked to conversion-therapy exposure, housing discrimination, legal encounters, and mental-health indicators; prediction was more accurate for drug- than alcohol-use risk.ConclusionStructural vulnerability, discrimination, and identity-related stressors emerged as intervention targets to reduce substance-use disparities in SGM adults.

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.

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.