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Cost-effectiveness analysis of community-led HIV self-testing among key populations in Côte d'Ivoire, Mali, and Senegal 在科特迪瓦、马里和塞内加尔的重点人群中开展社区主导的艾滋病毒自我检测的成本效益分析。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-21 DOI: 10.1002/jia2.26334
Ingrid Jiayin Lu, Romain Silhol, Marc d'Elbée, Marie-Claude Boily, Nirali Soni, Odette Ky-Zerbo, Anthony Vautier, Artlette Simo Fosto, Kéba Badiane, Metogara Traoré, Fern Terris-Prestholt, Joseph Larmarange, Mathieu Maheu-Giroux, for the ATLAS Team

Introduction

HIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (Auto Test VIH, Libre d'Accéder à la connaissance de son Statut) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost-effectiveness of community-led HIVST in Côte d'Ivoire, Mali and Senegal.

Methods

An HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP—female sex workers (FSW), and men who have sex with men (MSM)—and their sexual partners and clients. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019–2039). The ATLAS-only scenario mimicked the 2-year implemented ATLAS programme, whereas the ATLAS-scale-up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.

Results

The ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88–$210) per DALY averted in Côte d'Ivoire, $92 ($88–$210) in Mali and 27$ ($88–$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122–$338) per DALY averted in Côte d'Ivoire, $224 ($118–$415) in Mali and $61 ($18–$128) in Senegal.

Conclusions

Both the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services.

导言：艾滋病毒自我检测（HIVST）是提高重点人群（KP）诊断覆盖率的一项有前途的策略。ATLAS (Auto Test VIH, Libre d'Accéder à la connaissance de son Statut) 计划在三个西非国家实施了 HIVST，在 2019 年至 2021 年期间发放了超过 38 万套试剂盒，重点是由社区主导，由关键人群向其同伴发放，随后再向其伴侣和客户二次发放。我们旨在评估科特迪瓦、马里和塞内加尔由社区主导的艾滋病毒检测的成本效益：我们根据具体国家的流行病学数据对艾滋病毒传播动态模型进行了调整和校准，并利用该模型预测艾滋病毒检测的影响。我们考虑了 HIVST 在两个主要群体--女性性工作者 (FSW) 和男男性行为者 (MSM) --及其性伴侣和客户中的分布情况。我们将两种方案的成本效益与 20 年内（2019-2039 年）不采用 HIVST 的反事实方案进行了比较。纯 ATLAS 方案模拟了实施 2 年的 ATLAS 计划，而 ATLAS 扩大方案则在 2025 年之前实现了在性工作者和 MSM 中 95% 的 HIVST 传播覆盖率。主要结果是避免残疾调整寿命年数（DALY）。采用增量成本效益比 (ICER) 对各种方案进行比较。成本计算从医疗服务提供者的角度进行。成本贴现率为 4%，转换为 2022 美元，并使用成本函数进行估算，以适应规模经济：结果：纯 ATLAS 方案在 20 年内具有很高的成本效益，即使在支付意愿阈值较低的情况下也是如此。在科特迪瓦，每减少 1 DALY 的 ICER 中位数为 126 美元（88 美元-210 美元），在马里为 92 美元（88 美元-210 美元），在塞内加尔为 27 美元（88 美元-210 美元）。扩大 ATLAS 计划的规模也将具有成本效益，并将产生重大的流行病学影响。在扩大规模的情况下，科特迪瓦每减少 1 DALY 的 ICER 为 199 美元（122-338 美元），马里为 224 美元（118-415 美元），塞内加尔为 61 美元（18-128 美元）：与不开展艾滋病毒检测的情况相比，在西非实施和可能扩大由社区主导的艾滋病毒检测计划具有很高的成本效益。这些研究结果支持扩大社区主导的艾滋病毒检测范围，以覆盖那些可能无法获得常规检测服务的人群。
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引用次数: 0
Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries 做自己是一种缺陷：2022 年在六个东欧、高加索和中亚国家使用 REAct 系统分析与性取向、性别认同和艾滋病毒有关的有记录的侵权行为
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26311
Oksana Kovtun, Elvira Tilek kyzy, Nadira Masiumova

Introduction

Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices.

Methods

We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations.

Results

A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP.

Conclusions

Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essent

导言：消除艾滋病毒防治服务的法律障碍对于实现 2030 年全球消除艾滋病毒和艾滋病流行的目标至关重要，尤其是在东欧、高加索和中亚地区。尽管国家承诺维护人权，但男同性恋、双性恋和其他男男性行为者（gbMSM）以及变性人（TP）仍然面临污名化和歧视。本文分析了 6 个国家 2022 年报告的基于性取向和性别认同（SOGI）及艾滋病病毒的侵权行为，突出了这些行为的特点及其与立法和执法实践的联系。 方法 我们使用 REAct 系统（一种记录和应对侵犯关键人群权利行为的工具）对 2022 年亚美尼亚、哈萨克斯坦、吉尔吉斯斯坦、塔吉克斯坦、乌兹别克斯坦和乌克兰记录在案的性别、性取向和社会性别认同（gbMSM）和 TP 侵犯权利案件进行了研究。最初，我们根据《日惹原则》采用了定向内容分析法来分析侵权叙述。通过上下文、显性和隐性编码制定了一个编码手册，并将主题、类别和编码转换成定量变量进行统计分析。描述性统计用于确定侵权行为的特征。 结果 共记录了 456 起与性别暴力和艾滋病毒有关的侵权案件，从塔吉克斯坦的 22 起到乌克兰的 217 起不等。大多数侵权行为涉及男男性行为者（76.5%），五分之一涉及变性者，主要是变性妇女。在亚美尼亚和中亚，记录了多人实施或多人侵权的复杂侵权行为。隐私权通常受到侵犯，往往是通过公开的方式。还记录了侵犯享有能达到的最高健康标准的权利（13.6%）和免受医疗虐待的权利（2.6%）的案件。其他侵犯权利的情况时有发生，每个国家都表现出不同的侵权模式和侵权类型。在乌克兰，2022 年的全面战争影响了所记录案件的性质，反映了全球监测、研究与监测机制和专题项目所面临的挑战。 结论 事实证明，监测侵犯权利的情况对于评估性别、高加索和中亚地区的性别、高加索和中亚地 区的情况是有效的，尤其是在研究不足和多样化的东欧、高加索和中亚地区。由于侵权行为与立法和执法实践都有关联，因此必须采取综合干预措施，最大限度地减少结构性和人际间的污名化。
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引用次数: 0
Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial 在莫斯科注射毒品的塔吉克男性移民中开展预防艾滋病毒的网络同伴教育干预后风险行为的变化：分组随机对照试验
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26310
Mary Ellen Mackesy-Amiti, Mahbatsho Bahromov, Judith A. Levy, Jonbek Jonbekov, Casey M. Luc

Introduction

The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.

Methods

The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (n = 280). All PEs and NMs (n = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.

Results

At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (p < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (p < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.

Conclusions

The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not ame

导言："塔吉克斯坦人艾滋病毒/艾滋病移民自学干预方法"（MASLIHAT）招募并培训塔吉克斯坦注射毒品劳工移民作为同伴教育者（PE），向他们提供艾滋病毒预防信息，并鼓励他们在散居地的社会网络中采用降低风险的规范和做法，同时降低自身感染艾滋病毒的风险。 方法 MASLIHAT 干预措施在莫斯科进行了分组随机对照试验，12 个招募点被分配到 MASLIHAT 干预措施或同等时间的同伴教育者培训（TANSIHAT）中，重点关注其他健康状况。从 2021 年 10 月到 2022 年 4 月，140 名注射毒品的塔吉克男性移民被招募为同伴教育者，参加为期 5 个课时的 MASLIHAT 培训或 TANSIHAT 非艾滋病毒对比条件。两组中的每名参与者都招募了两名注射毒品的网络成员（NMs），目的是与他们分享所学到的信息和积极的改变策略（n = 280）。所有 PE 和 NM（n = 420）都参加了基线访谈和每 3 个月一次的跟踪访谈，为期 1 年。所有人都接受了艾滋病咨询和检测。修正的混合效应泊松回归测试了注射行为、性风险行为和大量饮酒方面的群体差异。 结果 在基线时，两组中均有 75% 的参与者报告了接受性注射器共用（RSS）行为，42% 的参与者报告了无安全套性行为，20% 的参与者报告了每月至少一次的酗酒行为。与 TANSIHAT 相比，MASLIHAT 的感染者和非感染者的 HIV 风险行为保持不变，但在接受性共用注射器和共用辅助设备方面，干预效果显著，且持续了 12 个月（p < 0.0001）。性危险行为发生率的显著下降也与 MASLIHAT 干预措施有关（p < 0.01），但与对比条件无关。在这两种情况下，酗酒都没有受到影响；MASLIHAT干预对饮酒频率有短暂的影响，但在9个月后就消失了。 结论 MASLIHAT 同伴教育干预对减少注射艾滋病病毒相关的危险行为非常有效，对减少 PE 和 NM 的性行为危险行为效果一般。以网络为基础的同伴教育是注射吸毒者预防艾滋病的重要工具，尤其是在不适合以社区为基础减少伤害的环境中。
{"title":"Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial","authors":"Mary Ellen Mackesy-Amiti,&nbsp;Mahbatsho Bahromov,&nbsp;Judith A. Levy,&nbsp;Jonbek Jonbekov,&nbsp;Casey M. Luc","doi":"10.1002/jia2.26310","DOIUrl":"https://doi.org/10.1002/jia2.26310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (<i>n</i> = 280). All PEs and NMs (<i>n</i> = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (<i>p</i> &lt; 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (<i>p</i> &lt; 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not ame","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers 乌克兰注射吸毒者坚持每日口服艾滋病毒预防性治疗的模式：生物标志物分析
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26319
Olga Morozova, Marina Kornilova, Olena Makarenko, Svitlana Antoniak, Mariia Liulchuk, Olga Varetska, Kostyantyn Dumchev

Introduction

Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites—tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)—offers an objective measure of adherence.

Methods

To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.

Results

Most participants (53.8%, n = 84/156) had no detectable metabolites at both assessments; 7.1% (n = 11/156) were consistently taking ≥2 doses/week; 1.3% (n = 2/156) were consistently taking ≥4 doses/week; 13.5% (n = 21/156) exhibited improved and 21.8% (n = 34/156) had worsened adherence at 6 compared to 3 months. “White coat compliance” (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.

Conclusions

Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer p

导言：建议注射吸毒者（PWID）每天口服替诺福韦/恩曲他滨（TDF/FTC）进行艾滋病暴露前预防（PrEP），但覆盖率很低。由于以往的研究都是在受控环境下进行的，而且主要依赖于自我报告，因此 PrEP 在注射吸毒者中的实际效果尚不清楚。对 PrEP 代谢物--替诺福韦二磷酸酯（TFVdp）和恩曲他滨三磷酸酯（FTCtp）进行分析，可以客观地衡量依从性。 方法 为了分析乌克兰感染者坚持 PrEP 的纵向模式，我们使用了 2020 年 7 月至 2021 年 3 月期间在基辅开展的社区实施试验的数据，以测试短信提醒对提高坚持率的效果。在 199 名注册参与者中，有 156 人（78.4%）坚持了 6 个月。根据 3 个月和 6 个月时评估的 TFVdp/FTCtp 水平，我们确定了不同依从性模式的组别（依从性≥2 剂/周、改善、恶化、不依从）。我们使用多项式逻辑回归分析了依从性的相关因素。 结果 大多数参与者（53.8%，n = 84/156）在两次评估中均未检测到代谢物；7.1%（n = 11/156）坚持服药≥2次/周；1.3%（n = 2/156）坚持服药≥4次/周；13.5%（n = 21/156）与3个月相比，6个月的依从性有所改善，21.8%（n = 34/156）有所恶化。"白大衣依从性"（评估前增加剂量）很常见。坚持用药与以下因素有关：短信提醒、年龄较小、有工作、收入较低、注射吸毒时间较长、近期有高风险注射行为（共用接受式注射器、使用预灌封注射器、后装或前装注射器、共用容器）、过去 6 个月内没有用药过量、通过性交感知到 HIV 风险以及较高的 PrEP 自我效能感。饮酒与不坚持使用 PrEP 相关。依从性改善组和依从性恶化组没有差异。 结论 作为一项独立的干预措施，每日口服 PrEP 可能无法在吸毒者中达到预期效果，因此需要测试其他 PrEP 配方和创新的综合降低风险策略，尤其是在东欧和中亚地区与注射吸毒相关的艾滋病毒流行以及乌克兰因与俄罗斯的战争而面临公共卫生危机的背景下。短信提醒可能对优先考虑 PrEP 的注射吸毒者有效。我们的研究结果为识别可能受益于 PrEP 的吸毒者和需要额外支持的吸毒者提供了实用指导。
{"title":"Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers","authors":"Olga Morozova,&nbsp;Marina Kornilova,&nbsp;Olena Makarenko,&nbsp;Svitlana Antoniak,&nbsp;Mariia Liulchuk,&nbsp;Olga Varetska,&nbsp;Kostyantyn Dumchev","doi":"10.1002/jia2.26319","DOIUrl":"https://doi.org/10.1002/jia2.26319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites—tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)—offers an objective measure of adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most participants (53.8%, <i>n</i> = 84/156) had no detectable metabolites at both assessments; 7.1% (<i>n</i> = 11/156) were consistently taking ≥2 doses/week; 1.3% (<i>n</i> = 2/156) were consistently taking ≥4 doses/week; 13.5% (<i>n</i> = 21/156) exhibited improved and 21.8% (<i>n</i> = 34/156) had worsened adherence at 6 compared to 3 months. “White coat compliance” (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer p","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“Will you need this health at all? Will you be alive?”: using the bioecological model of mass trauma to understand HIV care experiences during the war in Ukraine "你还需要这种健康吗？你还能活着吗？"：利用大规模创伤的生物生态学模型来理解乌克兰战争期间的艾滋病护理经验
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26307
Jill Owczarzak, Olivia Monton, Shannon Fuller, Julia Burlaka, Tetiana Kiriazova, Olga Morozova, Kostyantyn Dumchev

Introduction

Russia's invasion of Ukraine in February 2022 has severely impacted the healthcare system, including the provision of HIV care. The ongoing war is a human-caused mass trauma, a severe ecological and psychosocial disruption that greatly exceeds the coping capacity of the community. The bioecological model of mass trauma builds on Bronfenbrenner's concept of interaction between nested systems to argue that social context determines the impact of life events on the individual and how an individual responds. This paper uses the bioecological model of mass trauma to explore the impact of Russia's aggression against Ukraine and the ongoing war on HIV-positive people who use drugs in Ukraine, a particularly vulnerable population that may be negatively affected by disruptions to social networks, healthcare infrastructure and economic conditions caused by mass trauma.

Methods

Data were collected between September and November 2022. A convenience sample of 18 HIV-positive people who use drugs were recruited from community organizations that work with people living with HIV, drug treatment programmes, and HIV clinics through direct recruitment and participant referral. A total of nine men and nine women were recruited; the age ranged from 33 to 62 years old (mean = 46.44). Participants completed a single interview that explored how the war had affected their daily lives and access to HIV care and other medical services; their relationships with healthcare providers and social workers; and medication access, supply and adherence. Data were analysed using the Framework Method for thematic analysis.

Results

The war had a profound impact on the social, emotional and financial support networks of participants. Changes in social networks, coupled with limited job opportunities and rising prices, intensified financial difficulties for participants. Relocating to different regions of Ukraine, staying at somebody else's home, and losing connections with social workers impacted medication adherence and created lengthy treatment gaps. Participants also experienced a decreased supply of antiretroviral therapy, concerns about accessing medication for opioid use disorder, and overwhelming fears associated with the war, which overshadowed their HIV-related health concerns and negatively impacted medication adherence.

Conclusions

Our analysis reveals the complex impact of war on social networks and healthcare access. Main

导言俄罗斯于 2022 年 2 月入侵乌克兰，严重影响了乌克兰的医疗保健系统，包括提供艾滋病护理服务。持续不断的战争是人为造成的大规模创伤，是严重的生态和社会心理破坏，大大超出了社区的应对能力。大规模创伤的生物生态模型建立在布朗芬布伦纳的嵌套系统之间相互作用的概念之上，认为社会环境决定了生活事件对个人的影响以及个人如何应对。本文采用大规模创伤的生物生态学模型来探讨俄罗斯对乌克兰的侵略和正在进行的战争对乌克兰 HIV 阳性吸毒者的影响，乌克兰的 HIV 阳性吸毒者是一个特别脆弱的群体，他们可能会受到大规模创伤对社会网络、医疗基础设施和经济条件造成的破坏的负面影响。 方法 数据收集于 2022 年 9 月至 11 月。通过直接招募和参与者转介的方式，从与艾滋病病毒感染者合作的社区组织、戒毒治疗项目和艾滋病诊所招募了 18 名艾滋病病毒呈阳性的吸毒者。其中男性 9 人，女性 9 人；年龄在 33 岁至 62 岁之间（平均年龄为 46.44 岁）。参与者完成了一次访谈，探讨了战争如何影响了他们的日常生活以及获得艾滋病护理和其他医疗服务的机会；他们与医疗服务提供者和社会工作者的关系；以及药物的获取、供应和坚持服用。数据分析采用了专题分析框架法。 结果 战争对参与者的社会、情感和经济支持网络产生了深远影响。社会网络的变化，加上就业机会有限和物价上涨，加剧了参与者的经济困难。搬迁到乌克兰的不同地区、住在别人家里以及失去与社会工作者的联系都影响了服药，造成了长时间的治疗空白。此外，参与者还经历了抗逆转录病毒疗法供应减少、对阿片类药物使用障碍用药的担忧，以及与战争相关的巨大恐惧，这些都给他们与艾滋病相关的健康问题蒙上了阴影，并对坚持用药产生了负面影响。 结论 我们的分析揭示了战争对社会网络和医疗服务的复杂影响。在持续不断的战争中，保持支持网络和合格的医疗服务提供者至关重要。
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引用次数: 0
An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine 对乌克兰 "消除艾滋病毒服务方面的人权障碍 "倡议的实施情况进行评估
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26328
Diederik Lohman, Yevheniia Kononchuk, Alexandrina Iovita, Mikhail Golichenko, Valeria Rachinska, Pavlo Skala, Olga Gvozdetska, Serhii Myroniuk, Joseph J. Amon

Introduction

Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.

Methods

An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.

Results

Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy (“know your rights”); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.

Conclusions

An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a ro

导言 全球范围内，在获得艾滋病毒治疗和预防方面存在着严重的不平等。东欧和中亚地区是世界上新感染艾滋病毒和死亡人数上升最快的地区，其治疗和预防服务的普及率很低，尤其是重点人群和易感人群，他们在艾滋病毒的预防和治疗方面面临着一系列与人权相关的障碍。 方法 采用实施学习评价方法，检查针对乌克兰重点人群和易感人群的 "打破障碍 "倡议的实施情况。在 2022 年 9 月至 2023 年 4 月期间，研究人员对来自乌克兰政府、执行组织和人权专家的 23 名关键信息提供者进行了访谈。研究人员和关键信息提供者采用并行三角测量设计，在共同创造的过程中，试图描述 2021 年至 2023 年（包括俄罗斯 2022 年 2 月全面入侵前后）期间计划实施的成就、挑战和创新。 成果 在全球基金计划文件和关键信息提供者访谈中确定了八项与艾滋病毒有关的基于权利的干预措施，这些措施构成了乌克兰 "打破障碍 "倡议的核心。这些方案旨在：消除羞辱和歧视；确保无歧视地提供医疗服务；促进基于权利的执法做法；扩大法律扫盲（"了解你的权利"）；增加诉诸司法的机会；改进法律、法规和政策；减少性别歧视、有害的性别规范以及暴力侵害妇女和女童行为；动员社区进行宣传。这些计划获得了 590 万美元的资助。主要信息提供者报告说，在俄罗斯入侵之前和之后，在消除人权障碍和扩大干预规模方面取得了重大进展。计划实施者采用了创新方法，包括使用律师助理、热线电话和其他社区主导的干预措施，以确保包括流离失所者在内的关键和弱势群体能够获得预防和护理服务。 结论 采取执行学习评价方法，审查解决艾滋病毒服务人权障碍的方案，将其设计为研究人员、 方案执行人员、政府官员和人权专家之间的共同创造过程，可以对方案产出、成果和影响证 据进行有力的评估，尽管业务环境充满挑战。
{"title":"An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine","authors":"Diederik Lohman,&nbsp;Yevheniia Kononchuk,&nbsp;Alexandrina Iovita,&nbsp;Mikhail Golichenko,&nbsp;Valeria Rachinska,&nbsp;Pavlo Skala,&nbsp;Olga Gvozdetska,&nbsp;Serhii Myroniuk,&nbsp;Joseph J. Amon","doi":"10.1002/jia2.26328","DOIUrl":"https://doi.org/10.1002/jia2.26328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy (“know your rights”); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a ro","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan 采用公民科学方法开发数字化干预措施，以减少青少年和年轻成人对艾滋病毒的污名化并促进艾滋病毒的自我检测：来自哈萨克斯坦的混合方法分析
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26314
Alissa Davis, Susan L. Rosenthal, Joseph D. Tucker, Olga Balabekova, Laura Nyblade, Yihang Sun, Denis Gryazev, Karsten Lunze, Sara E. Landers, Weiming Tang, Azamat Kuskulov, Valera Gulyayev, Assel Terlikbayeva, Sholpan Primbetova, Gaukhar Mergenova, the JasSpark Study Team

Introduction

Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.

Methods

From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non-governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.

Results

We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.

Conclusions

Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex healt

导言 哈萨克斯坦是世界上艾滋病毒流行病增长最快的国家之一，青少年中的感染率不断上升。需要采取创新战略来提高艾滋病检测率，减少青少年和年轻人对艾滋病的污名化。公民科学的定义是公众积极参与科学研究任务，它促进并推动社区参与整个研究过程。这项公民科学研究采用众包的方式，让哈萨克斯坦的青壮年参与到开发数字干预措施中来，以减少对艾滋病病毒的污名化并促进艾滋病病毒的自我检测。我们在本文中的目标是描述所使用的方法、其可行性和可接受性，以及青壮年参与这项研究的动机和经验教训。 方法 从 2021 年 10 月到 2022 年 7 月，我们与社区合作研究委员会和青年顾问委员会合作，公开征集多媒体作品，以减少 HIV 检测污名化。符合条件的作品按年龄组（13-19 岁或 20-29 岁）进行分类，并由一个由青少年（23 人）、医疗保健专业人员（12 人）以及当地政府和非政府组织代表（17 人）组成的小组进行评审。每份参赛作品至少由四名评委评审，并按 5 分制进行排名。公开征集活动的前 20 名参赛者被要求提交自我录音，分享他们参加比赛的动机、经验和教训。对定量数据进行了描述性统计。定性数据采用开放式编码。 结果 我们收到了来自哈萨克斯坦 77 名青年的 96 份参赛作品。大约四分之三（n = 75/96）的参赛作品符合评审标准。在符合条件的参赛作品中，超过一半（n = 39/75）的作品在 5 分制中获得了 3.5 分或更高的分数（70.0%）。最常见的参赛作品类型是视频（n = 36/96，37.5%）、图片（n = 28/96，29.2%）和文字（n = 24/96，25.0%）。青少年协会合作开展研究的主要动机包括改善社会和帮助青少年的愿望。主要的挑战包括用简单的语言创建内容以处理复杂的信息、在网上寻找可靠的信息以及技术限制。 结论 众包是可行的，而且在哈萨克斯坦的青少年中接受度很高。公民科学方法在应对当今社区面临的日益复杂的健康和社会挑战方面大有可为。
{"title":"A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan","authors":"Alissa Davis,&nbsp;Susan L. Rosenthal,&nbsp;Joseph D. Tucker,&nbsp;Olga Balabekova,&nbsp;Laura Nyblade,&nbsp;Yihang Sun,&nbsp;Denis Gryazev,&nbsp;Karsten Lunze,&nbsp;Sara E. Landers,&nbsp;Weiming Tang,&nbsp;Azamat Kuskulov,&nbsp;Valera Gulyayev,&nbsp;Assel Terlikbayeva,&nbsp;Sholpan Primbetova,&nbsp;Gaukhar Mergenova,&nbsp;the JasSpark Study Team","doi":"10.1002/jia2.26314","DOIUrl":"https://doi.org/10.1002/jia2.26314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (<i>n</i> = 23), healthcare professionals (<i>n</i> = 12), and representatives from the local government and non-governmental organizations (<i>n</i> = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (<i>n</i> = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (<i>n</i> = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (<i>n</i> = 36/96, 37.5%), image (<i>n</i> = 28/96, 29.2%) and text (<i>n</i> = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex healt","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“…because the social work never ends”: a qualitative study exploring how NGOs responded to emerging needs while upholding responsibility to HIV prevention and treatment during the war in Ukraine "......因为社会工作永无止境"：一项定性研究，探讨在乌克兰战争期间，非政府组织如何应对新出现的需求，同时坚持艾滋病毒预防和治疗的责任
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-19 DOI: 10.1002/jia2.26309
Lisa Lazarus, Leigh M McClarty, Nicole Herpai, Daria Pavlova, Tatiana Tarasova, Anna Gnatenko, Tetiana Bondar, Robert Lorway, Marissa L Becker, the Dynamics Study Team

Introduction

Since the onset of the Russian invasion on 24 February 2022, the health system in Ukraine has been placed under tremendous pressure, with damage to critical infrastructure, large losses of human resources, restricted mobility and significant supply chain interruptions. Based on a longstanding partnership between the Ukrainian Institute for Social Research after Oleksandr Yaremenko (UISR after O. Yaremenko) and the Institute for Global Public Health at the University of Manitoba, we explore the impact of the full-scale war on non-governmental organizations (NGOs, including charitable organizations) providing services for key population groups in Ukraine.

Methods

We conducted in-depth qualitative interviews with key representatives from NGOs working with key population groups (i.e., people living with HIV, sex workers, men who have sex with men, people who inject drugs and transgender people) throughout Ukraine. Members of the UISR after O. Yaremenko research team recruited participants from organizations working at national, regional and local levels. The research team members conducted 26 interviews (22 with women and four with men) between 15 May and 7 June 2023. Interviews were conducted virtually in Ukrainian and interpretively analysed to draw out key themes.

Results

Applying Roels et al.’s notion of “first responders”, our findings explore how the full-scale war personally and organizationally impacted workers at Ukrainian NGOs. Despite the impacts to participants’ physical and mental health, frontline workers continued to support HIV prevention and treatment while also responding to the need for humanitarian aid among their clients and the wider community. Furthermore, despite inadequate pay and compensation for their work, frontline workers assumed additional responsibilities, thereby exceeding their normal workload during the extraordinary conditions of war.

Conclusions

NGOs play a vital role as responders, adapting their services to meet the emergent needs of communities during structural shocks, such as war. There is an urgent need to support NGOs with adequate resources for key population service delivery and to increase support for their important role in humanitarian aid.

导言：自 2022 年 2 月 24 日俄罗斯入侵以来，乌克兰的卫生系统承受了巨大压力，关键基础设施遭到破坏，人力资源大量流失，人员流动受到限制，供应链严重中断。基于奥列克山德-亚雷缅科之后乌克兰社会研究所（UISR after O. Yaremenko）与马尼托巴大学全球公共卫生研究所之间的长期合作关系，我们探讨了全面战争对为乌克兰主要人口群体提供服务的非政府组织（包括慈善组织）的影响。 方法 我们对乌克兰各地为关键人群（即艾滋病毒感染者、性工作者、男男性行为者、注射毒品者和变性者）提供服务的非政府组织的主要代表进行了深入的定性访谈。在 O. Yaremenko 之后，研究所研究小组成员从国家、地区和地方各级组织中招募了参与者。研究小组成员在 2023 年 5 月 15 日至 6 月 7 日期间进行了 26 次访谈（22 次为女性，4 次为男性）。访谈以乌克兰语进行，并通过解释性分析得出关键主题。 结果 应用 Roels 等人提出的 "第一响应者 "概念，我们的研究结果探讨了全面战争如何对乌克兰非政府组织工作人员的个人和组织产生影响。尽管参与者的身心健康受到了影响，但前线工作者仍继续支持艾滋病的预防和治疗，同时也满足了客户和更广泛社区对人道主义援助的需求。此外，尽管工作报酬和补偿不足，前线工作者还是承担了额外的责任，从而在战争的特殊条件下超出了正常的工作量。 结论 在战争等结构性冲击期间，非政府组织发挥着重要的应对作用，调整其服务以满足社 区的紧急需求。当务之急是为非政府组织提供充足的资源，支持其为关键人群提供服务，并加大对其在人道主义援助中的重要作用的支持力度。
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引用次数: 0
Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study 哈萨克斯坦艾滋病毒感染者的心理健康和认知与坚持抗逆转录病毒疗法的关系：横断面研究
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-18 DOI: 10.1002/jia2.26320
Gaukhar Mergenova, Alissa Davis, Louisa Gilbert, Nabila El-Bassel, Assel Terlikbayeva, Sholpan Primbetova, Zhamilya Nugmanova, Andrea Norcini Pala, Deborah Gustafson, Susan L. Rosenthal, Alfiya Y. Denebayeva, Jack DeHovitz

Introduction

There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.

Methods

We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.

Results

Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, p < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, p < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, p < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, p < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, p < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, p < 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, p < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, p < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, p < 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, p < 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, p < 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, p < 0.005) symptoms had lower ASES scores.

Conclusions

Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness w

导言：在哈萨克斯坦，心理健康和认知与艾滋病病毒感染者（PLWH）坚持抗逆转录病毒治疗（ART）之间存在研究空白。 方法 我们从阿拉木图市艾滋病中心登记处（2019 年 6 月至 11 月）随机挑选并招募了 230 名艾滋病病毒感染者参与横断面研究。我们研究了最近1周和2周自我报告的抗逆转录病毒疗法依从性、依从自我效能量表（ASES）与抑郁症状（患者健康问卷-9 [PHQ-9]）、焦虑（广泛性焦虑症工具 [GAD-7]）、创伤后应激障碍（创伤后应激障碍清单 [PTSD]）、认知功能（PROMIS v2.0 成人认知功能 8a 短表）和遗忘（遗忘评估量表）之间的关联。PHQ-9 和 GAD-7 的症状严重程度≥5 为轻度，≥10 为中度；创伤后应激障碍的症状严重程度≥44 为中度。采用逻辑和线性回归分析。 结果 参与者的年龄中位数为 40.0 岁（IQR：34-47），其中女性占 40.9%（n = 94）。在过去两周内至少错过一次服药的参与者报告至少有轻度抑郁（aOR = 3.34，95% CI：1.22-9.11，p < 0.05）、轻度焦虑（aOR = 3.27，95% CI：1.20-8.92，p < 0.05）和创伤后应激障碍（aOR = 4.04，95% CI：1.15-14.21，p < 0.05）症状的几率更高。上周至少漏服一片药物的参与者至少出现轻度抑郁（aOR = 7.74，95% CI：1.31-45.7，p < 0.05）、中度焦虑（aOR = 21.33，95% CI：3.24-140.33，p < 0.005）和创伤后应激障碍（aOR = 13.81，95% CI：2.36-80.84，p < 0.005）症状的几率更高。认知功能较好的参与者最近一周不坚持治疗的几率较低（aOR = 0.88，95% CI：0.81-0.96，p < 0.005），ASES 评分较高（β = 0.26，95% CI：0.13-0.40，p < 0.005）。记忆力差与最近一周不坚持治疗的几率较高（aOR = 4.64，95% CI：1.76-12.24，p < 0.005）和较低的 ASES 分数（β = -0.31，95% CI：-0.45 至 0.16，p < 0.005）有关。至少有轻度抑郁（β = -0.21，95% CI：-0.35 至 -0.07，p < 0.005）、中度焦虑（β = -0.21，95% CI：-0.34 至 -0.07，p < 0.005）和创伤后应激障碍（β = -0.19，95% CI：-0.33 至 -0.05，p < 0.005）症状者的 ASES 分数较低。 结论 抑郁、焦虑和创伤后应激障碍症状、较差的认知能力和健忘与较差的抗逆转录病毒疗法依从性和较差的依从自我效能有关。对认知能力下降的 PLWH 进行精神疾病评估和治疗，并为其提供支持以提高抗逆转录病毒疗法的依从性至关重要。
{"title":"Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study","authors":"Gaukhar Mergenova,&nbsp;Alissa Davis,&nbsp;Louisa Gilbert,&nbsp;Nabila El-Bassel,&nbsp;Assel Terlikbayeva,&nbsp;Sholpan Primbetova,&nbsp;Zhamilya Nugmanova,&nbsp;Andrea Norcini Pala,&nbsp;Deborah Gustafson,&nbsp;Susan L. Rosenthal,&nbsp;Alfiya Y. Denebayeva,&nbsp;Jack DeHovitz","doi":"10.1002/jia2.26320","DOIUrl":"https://doi.org/10.1002/jia2.26320","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (<i>n</i> = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, <i>p</i> &lt; 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, <i>p</i> &lt; 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, <i>p</i> &lt; 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, <i>p</i> &lt; 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, <i>p</i> &lt; 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, <i>p</i> &lt; 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, <i>p</i> &lt; 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, <i>p</i> &lt; 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, <i>p</i> &lt; 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, <i>p</i> &lt; 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, <i>p</i> &lt; 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, <i>p</i> &lt; 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, <i>p</i> &lt; 0.005) symptoms had lower ASES scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness w","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The HIV epidemic in eastern Europe and central Asia in difficult times: a story of resilience and change 困难时期东欧和中亚的艾滋病毒疫情：复原与变革的故事。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-17 DOI: 10.1002/jia2.26325
Miłosz Parczewski, Deniz Gökengin

The eastern European and central Asian (EECA) region is facing the fastest-growing HIV epidemic in the world with 160,000 (130,000–180,000) people newly acquiring HIV in 2021, an overall 48% increase in the number of new acquisitions, and a 32% rise in AIDS-related deaths over the past 10 years [1]. The World Health Organization East European region is estimated to accommodate 1.4 million people living with HIV (PWH), with the majority of new transmissions reported to occur locally and to be unrelated to cross-country migrations [2, 3]. Sadly, according to UNAIDS, in 2022 only 62% of people living in the EECA region were aware of their HIV status and 51% of PWH received HIV treatment, which resulted in an overall viral suppression rate of 48% [1]. Common (>50%) late diagnoses (with either AIDS-defining condition or CD4+ T cell count <350 cells/µl at presentation) [4] further add to the epidemiological issues and complexity of client management [5]. Although the key acquisition risk in the region has changed from unsafe injection practices to heterosexual transmission, access to opioid agonist therapy (OAT) and needle and syringe programmes is often still limited (Kazakhstan) or unavailable (Uzbekistan, Turkmenistan), which results in OAT regional coverage as low as 4%, far below the UNAIDS target of 50%.

Furthermore, pre-exposure prophylaxis (PrEP) and combination prevention services are of limited availability or not formally implemented across multiple countries in the region usually due to financial barriers to access, such as lack of state funding for medicines, limited technical capacity or cost of service delivery [6]. This results in a substantially larger HIV PrEP gap (the proportion of populations at risk of acquiring HIV “very likely” to use PrEP if accessible, compared with the proportion currently using PrEP) across countries located in the EECA region (up to 45%) compared to the overall median of 17.4% estimate for the European Union [7]. Moreover, there is a high level of stigma across the countries, especially against gay men and other men who have sex with men.

The growing epidemic and the suboptimal access to prevention, testing and treatment are the main reasons that challenge the 2030 targets.

The humanitarian crisis related to the Russian invasion and war in Ukraine has challenged the situation even further hindering testing and treatment efforts, forcing both internal displacement (estimated 3.7 million) and external migration of locals as refugees (estimated 6.4 million, as of March 2024) [8]. On top of massive casualties, civilian and healthcare infrastructures were destroyed, forcing refugees to seek safety, protection and assistance, including continued access to medical care. Ukraine is home to ∼260,000 PWH with >130,000 on antiretroviral treatment (ART). Although significant pr

这是一项分组随机对照试验，比较了基于网络的同伴教育者培训和普通健康教育培训。塔吉克男性移民被招募为同伴教育者，并接受了如何降低个人感染艾滋病毒风险以及向同伴传授知识的培训。访谈显示，在同伴教育者和同伴中，暴饮、无安全套性行为、共用注射器和设备行为的基线百分比相当高，而针头清洁行为和艾滋病毒检测的基线百分比则极低。研究干预后，共用针具行为明显减少，但对性行为的影响不大。这项研究表明，针对特定群体的需求并纳入同伴的干预措施，即使在难以接触到的人群中也可能有效。Davis 等人也探讨了与污名相关的问题，他们使用公民科学方法来解决与艾滋病毒相关的污名问题，并增加哈萨克斯坦青少年的艾滋病毒检测[18]。他们呼吁这些人群开发数字材料，并在竞赛中对这些材料进行评估和评级，目的是减少与艾滋病毒相关的污名化并促进艾滋病毒的自我检测。提交的材料由一个包括参赛者同伴、医疗保健专业人员和非政府组织代表在内的委员会进行评审，评分高的材料将获得奖励。青少年和年轻人对该项目表现出浓厚的兴趣，他们既是参赛者，因此提交了大量材料，又是委员会成员，为研究的开发和实施、社交媒体程序的运行、宣传材料的制作以及对提交系统的反馈提供意见。最后，Mergenova 等人[19]介绍了一项同样来自哈萨克斯坦的研究，该研究涉及感染艾滋病毒的艾滋病毒携带者坚持抗逆转录病毒疗法与心理健康和认知障碍的关系。据报道，哈萨克斯坦的艾滋病疫情规模不断扩大，大多数感染者都是注射精神活性物质者。作者对 230 名接受稳定（6 个月）抗逆转录病毒疗法的感染者进行了横断面问卷调查分析，除了抑郁、焦虑、创伤后应激障碍（PTSD）症状以及认知和记忆评估外，还对自我报告的抗逆转录病毒疗法依从性进行了评估。值得注意的是，三分之一的患者报告有精神病史，只有 25% 的患者报告有注射吸毒史，17% 的患者有酗酒史。此外，20%-32%的患者有轻度抑郁或焦虑，6%-10%的患者至少有中度情绪障碍，其中 7% 的患者有创伤后应激障碍症状。毫不奇怪，这些症状与较低的依从性有关--有轻度或中度抑郁症状、轻度或中度焦虑症状、创伤后应激障碍症状或健忘的参与者更有可能错过抗逆转录病毒疗法。相反，较好的认知功能与较好的治疗依从性相关。这项研究强调，为了更好地护理艾滋病感染者，不仅需要对抗病毒疗法进行精确、定期的评估，还需要对心理健康和认知功能进行评估，以便量身定制具体的应对措施，并提供心理健康支持，从而提高治疗依从性，维持最佳的病毒抑制率。大量感染艾滋病毒的吸毒者和移民，以及每个国家不同文化、信仰和结构的独特性，都对应对这一流行病的长期努力提出了挑战。本补编介绍了东欧和中亚地区艾滋病毒疫情的恢复情况、改善人权的持续努力以及综合预防的创新方法，并总结了与污名化和其他社会问题相关的主要挑战。在继续这些努力的同时，进一步的国际支持、承诺和合作对于实现2030年在该地区消除艾滋病的新目标至关重要。所有作者都阅读并批准了最终版本。作者单独对本增刊中表达的观点负责，不代表其所属机构的观点、决定或政策。
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