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

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.

IntroductionTransportation vulnerability is a major barrier to HIV care for many people living with HIV (PLHIV)-especially in the rural southern United States (US), given limited public transportation infrastructure and long travel times to HIV care. Rideshare services have proliferated in recent years, and rideshare interventions are now being used in some HIV clinics to overcome transportation barriers. However, little is known about how PLHIV in the southern US perceive rideshare services and whether they are willing to use them to access HIV care-information that is critical for optimizing the implementation of rideshare interventions. The goal of this mixed-methods study was to examine implementation-related factors relevant to uptake of a concierge rideshare intervention among PLHIV in South Carolina.MethodsA total of 160 PLHIV with self-reported transportation vulnerability were enrolled in a randomized clinical trial to test effectiveness of a concierge rideshare intervention. Prior to intervention implementation, all PLHIV completed brief surveys assessing transportation-related barriers to HIV care and implementation-related factors pertaining to rideshare services. Additional semi-structured individual interviews were also completed by a smaller subset of participants (n = 20) to capture personal experiences and insight into perceptions of rideshare services for accessing HIV care.ResultsMean scores indicated favorable perceptions of rideshare interventions across the domains of comfort, ease of use, and safety. However, mean scores also indicated participant concerns with costs associated with rideshare, as well as privacy protections. T-tests showed nonsignificant differences in perceptions of rideshare by gender. Qualitative analysis yielded six key themes-"safety/comfort," "privacy protections", "appeal/enjoyment," "convenience/ease", "issues encountered", and "cost"-which aligned with three implementation factors (ie, feasibility, acceptability, adoption) that are relevant for successful implementation of rideshare interventions.ConclusionWhile the majority of PLHIV had favorable views of using rideshare services to access HIV treatment and care, several obstacles need to be addressed to ensure the success of rideshare interventions, including HIV-related stigma and technological barriers.

BackgroundThis study examines chemsex patterns among gay, bisexual, and other men who have sex with men (GBMSM) and their link to depression using a longitudinal approach. Recognizing and addressing chemsex is crucial for human immunodeficiency virus (HIV) care providers, as it supports harm reduction and effective HIV prevention and treatment for GBMSM.MethodsFrom 2017 to 2021, GBMSM at two sexual health clinics completed follow-up questionnaires. We identified chemsex trajectories using group-based modeling and assessed their association with depressive symptoms over two years using multivariable logistic models.ResultsAmong 256 GBMSM, three chemsex patterns were found: "never or rarely engaged" (87.4%), "consistently engaged" (8.8%), and "high, decreasing and reinitiated" (3.8%). There were no significant differences in depressive symptoms between the "never or rarely engaged" group and the other patterns.ConclusionsThe study reveals diverse chemsex behaviors but does not provide clear evidence linking these patterns to differences in depressive symptoms among GBMSM.

BackgroundHIV continues to be an important public health concern in South Carolina (SC). However, an examination of providers' willingness to use mHealth technologies to address ongoing barriers to HIV care and prevention strategies, particularly among men who have sex with men (MSM) is currently lacking in SC. We therefore explored HIV care providers' perceptions of HIV testing and treatment uptake among MSM, and providers' willingness to use mHealth technology to address barriers to HIV testing and treatment in SC.MethodsBetween August and December 2021, we conducted semistructured virtual interviews with 10 HIV care providers recruited purposively based on their experience (2-11 years of service) providing HIV-related services to MSM in peri-urban (n = 7) and rural (n = 3) SC. The interviews were audio recorded, lasted 40-70 min, and were transcribed verbatim. The interview transcripts were analyzed inductively.ResultsFive themes emerged from the analysis: (a) challenges to HIV testing services; (b) concerns about HIV knowledge and status in the MSM community; (c) mixed feelings about HIV self-testing; (d) providers' perception of HIV treatment uptake and retention; and (e) potential of mHealth technology for the delivery of HIV care. Overall, participants reported limited resources, homophobia, medical mistrust, distance, medical costs, and HIV-related stigma as major barriers to HIV testing and treatment uptake in their localities (especially in rural areas). Particularly, they reported that MSM experience significant stigma associated with their sexual orientation and HIV.ConclusionsGiven barriers to care such as stigma and lack of access to care still impede MSM from receiving appropriate HIV services, mHealth-connected approaches could potentially address the barriers to HIV testing and care among MSM and improve their health outcomes. This is key to ending the HIV epidemic in SC and the United States by 2030.

ObjectiveAdverse drug reactions (ADRs) induce iatrogenic harm in antiretroviral therapy (ART) care continuum. However, there is a dearth of concrete evidence in a resource-limited setting. Thus, this study was designed to consolidate existing knowledge, thereby informing policy and clinical care to improve patient safety.DesignSystematic review and meta-analysis.Data sourcesPubMed, CINAHL, Web of Science, and EMBASE databases were searched.Eligibility criteriaEmploying the condition, context, and population framework, observational primary studies were included.Data extraction and synthesisIndependent reviewers undertook data extraction and synthesis. This meta-analysis employed the random-effects restricted maximum likelihood (REML) method, with its protocol preregistered on the International Register of Systematic Reviews (CRD42024546390).ResultsThe pooled prevalence of ADRs was 36.7% [95% CI: 26.6-46.9, I² = 99.64%].ConclusionAltogether, this study revealed that ART-related ADRs in Ethiopia was 36.7%, underscoring rigorous monitoring. Giving special emphasis to patients with female gender, advanced disease, comorbidities, malnutrition, TB treatment, and poor adherence is a prudent decision.

IntroductionIn Sub-Saharan Africa, there are knowledge gaps on adverse drug reactions (ADRs) of antiretroviral treatment. This study examined the acceptability and feasibility of short message service (SMS) to increase awareness about the importance of reporting ADRs among people living with HIV (PLHIV) in Tanzania.MethodsIn this pilot study, PLHIV consented to participate and received SMS asking about their health. Responses to messages generated a flow of follow-up questions through SMS that determined the presence of ADRs. Technical feasibility was calculated based on the percentage of SMS sent and delivered, and acceptability was based on SMS replies. We conducted focus group discussions and in-depth interviews with participants and healthcare workers to understand experiences and acceptability of the system. Qualitative data were analyzed using thematic content analysis, and quantitative data were summarized using descriptive analyses.ResultsNinety-two participants were recruited. Sixty-two (67.4%) were women. The mean age was 42 years (SD ± 12). Among the sent SMS, 100 (95.2%) were replied to. Themes identified through qualitative data were: high motivation to report ADR, well-understood SMS content, no concerns about unwanted disclosure, and network difficulties.ConclusionThe SMS system is a user-friendly intervention and highly accepted based on qualitative data among PLHIV in Tanzania.