Journal of the International AIDS Society最新文献_第4页

Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility 最新的艾滋病毒暴露后预防指南：继续努力提高可及性。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-22 DOI: 10.1002/jia2.26393

Lao-Tzu Allan-Blitz, Kenneth H. Mayer

Introduction

HIV transmission is ongoing in both high- and low-resource settings. Post-exposure prophylaxis (PEP) remains an important tool in preventing HIV; however, PEP is significantly underutilized. The multitude of barriers to PEP implementation include low patient and provider awareness and acceptability, limited access to treatment and prevention services, and high rates of stigma. The World Health Organization (WHO) recently released updated guidance on the delivery of HIV PEP. This commentary aims to highlight the salient changes, evaluate how such recommendations can overcome the existing barriers to PEP implementation and discuss strategies needed to put the updated guidance into practice.

Discussion

The 2024 WHO PEP guidelines continue a trend towards increasing access to PEP. Most notably, the WHO now provides strong recommendations that: (1) PEP be delivered in community settings (e.g. pharmacies, police stations and online platforms), and (2) PEP delivery and monitoring be done via task sharing involving non-specialist health workers (e.g. pharmacists or community health workers). The guidelines also emphasize that the PEP encounter is an important educable moment whereby a transition to pre-exposure prophylaxis among individuals at continued risk for HIV infection should be discussed. The decentralization of PEP delivery has the potential to overcome numerous barriers to PEP implementation, reduce time to initiation and support adherence with the 28-day course. To translate the recommendations into delivery programmes, however, much more work is needed. Detailed templates can help overcome the heterogeneity of both the community settings in which PEP can now be provided and the populations (e.g. survivors of sexual assault, healthcare workers, sex workers, etc.) among whom PEP may be indicated. Training of the workforce will be essential, which should include, as emphasized by the WHO, training in trauma-based care. Novel formulations of and delivery mechanisms for PEP are also emerging, and how such iterations can synergize with decentralized PEP delivery programmes remains to be seen.

Conclusions

The updated WHO PEP guidelines make major strides towards increasing access to PEP. Realization of such aims will require ongoing evaluation and support given the heterogeneity in who benefits most from PEP.

导言：在资源丰富和资源贫乏的环境中，艾滋病毒的传播都在持续。暴露后预防 (PEP) 仍是预防 HIV 的重要工具；然而，PEP 的使用率却严重不足。实施 PEP 所面临的众多障碍包括：患者和医疗服务提供者对 PEP 的认知度和接受度较低、获得治疗和预防服务的途径有限，以及污名率较高。世界卫生组织（WHO）最近发布了关于提供 HIV PEP 的最新指南。本评论旨在强调其中的突出变化，评估这些建议如何能够克服实施 PEP 的现有障碍，并讨论将最新指南付诸实践所需的策略：2024 年世卫组织 PEP 指南延续了增加 PEP 普及率的趋势。最值得注意的是，世卫组织现在强烈建议(1) 在社区环境（如药房、警察局和在线平台）中提供 PEP，以及 (2) 通过非专业卫生工作者（如药剂师或社区卫生工作者）分担任务的方式提供和监测 PEP。该指南还强调，PEP 是一个重要的教育时机，应在此讨论在有持续感染艾滋病毒风险的人群中过渡到暴露前预防的问题。分散提供 PEP 有可能克服实施 PEP 的诸多障碍，缩短启动时间并支持坚持 28 天的疗程。然而，要将这些建议转化为实施计划，还需要做更多的工作。详细的模板可以帮助克服现在可以提供 PEP 的社区环境和可能需要 PEP 的人群（如性侵犯幸存者、医护人员、性工作者等）的多样性。对医务人员进行培训至关重要，其中应包括世界卫生组织强调的创伤护理培训。PEP 的新配方和给药机制也在不断涌现，这些新配方和给药机制如何与分散的 PEP 给药计划协同增效仍有待观察：最新的世界卫生组织 PEP 指南在增加 PEP 普及率方面取得了重大进展。鉴于从 PEP 中获益最多的人群存在差异，实现这些目标将需要持续的评估和支持。

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引用次数: 0

The ground has shifted under PEPFAR: what does that mean for its future? PEPFAR 的基础已经发生变化：这对其未来意味着什么？

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-22 DOI: 10.1002/jia2.26396

Jennifer Kates, Brian Honermann, Gregorio Millett

<p>PEPFAR, the U.S. global HIV programme, has been credited with saving 25 million lives and changing the trajectory of the HIV/AIDS pandemic [<span>1</span>]. Last year, more than 20 million people were on antiretroviral therapy with support from PEPFAR, almost 2 million were newly enrolled on pre-exposure prophylaxis and 327,000 healthcare workers were directly supported by the program. PEPFAR also estimates that more than 5 million babies have been born without HIV. In addition, studies have found that PEPFAR funding is significantly associated with several, positive, knock-on effects beyond HIV, including increases in the gross domestic product (GDP) per capita growth rate, educational retention and childhood vaccination rates [<span>2</span>].</p><p>Created in 2003 in the United States by a Republican President, with strong, bipartisan support in Congress at the time, PEPFAR has largely maintained that support across multiple administrations and congresses, often standing outside the political fray in Washington, DC. But the ground upon which PEPFAR sits has shifted in fundamental ways, perhaps most obviously manifest in the challenges it recently faced in securing a 5-year reauthorization [<span>3</span>]. These shifts are multifaceted and intertwined and, in most cases, not specific to PEPFAR or HIV, but taken together, suggest a “rethink” for PEPFAR's next phase. Here, we explore some of these shifts and the questions they pose going forward, questions that have become even more important given the outcome of the U.S. election; a second Trump administration and a changing balance in Congress likely mean, at a minimum, even greater scrutiny of the programme.</p><p>One of the greatest shifts is in the global economy. While recovering, it continues to experience the economic effects of the COVID-19 pandemic, with GDP growth remaining below historic averages. Fiscal space is further strained by high inflation and the ongoing costs of multiple wars and humanitarian assistance [<span>4</span>]. For donor governments, these fiscal strains present challenges for financing health and development needs, including for HIV, and many are shifting away [<span>5</span>]. For low- and middle-income countries, rising debt burden threatens their economic recovery, with many poorer now than before COVID-19 [<span>4</span>].</p><p>More broadly, reports have found that the human rights environment in many countries is deteriorating, with negative effects on health [<span>6</span>]. This has particular implications for HIV given that many of the populations most affected—men who have sex with men, transgender women, people who use drugs and other marginalized groups—already face human rights barriers that put them at increased risk for HIV and complicate the ability to control HIV [<span>6</span>]. There is also evidence that civic space is closing in many localities, making it more difficult for civil society organizations to operate and organize and presenti

PEPFAR 是美国的一项全球艾滋病计划，它拯救了 2,500 万人的生命，改变了艾滋病毒/艾滋病的流行轨迹[1]。去年，2000 多万人在 PEPFAR 的支持下接受了抗逆转录病毒治疗，近 200 万人新接受了暴露前预防治疗，327,000 名医疗工作者直接得到了该计划的支持。据《总统艾滋病紧急救援计划》估计，500 多万婴儿在出生时没有感染艾滋病毒。此外，研究还发现，PEPFAR 的资金与 HIV 以外的几种积极的连锁反应有显著关联，包括人均国内生产总值 (GDP) 增长率、教育保留率和儿童疫苗接种率的提高 [2]。PEPFAR 于 2003 年由共和党总统在美国创立，当时在国会两党的大力支持下，PEPFAR 在多届政府和国会中基本保持了这种支持，经常置身于华盛顿特区的政治纷争之外。但是，PEPFAR 所处的环境已经发生了根本性的变化，最明显的表现可能就是它最近在获得五年期重新授权时所面临的挑战[3]。这些变化是多方面的、相互交织的，在大多数情况下，并不是 PEPFAR 或 HIV 所特有的，但综合在一起，就表明需要对 PEPFAR 的下一阶段进行 "重新思考"。在此，我们将探讨其中的一些转变及其对未来提出的问题，鉴于美国大选的结果，这些问题变得更加重要；特朗普的第二届政府和国会中不断变化的平衡可能至少意味着对该计划进行更严格的审查。全球经济虽然正在复苏，但仍受到 COVID-19 大流行病的经济影响，GDP 增长率仍低于历史平均水平。高通胀以及多场战争和人道主义援助的持续成本进一步压缩了财政空间[4]。对于捐助国政府来说，这些财政压力对资助健康和发展需求（包括艾滋病毒）构成了挑战，许多捐助国政府正在放弃资助[5]。对于中低收入国家来说，不断增加的债务负担威胁着它们的经济复苏，许多国家现在比 COVID-19 之前还要贫穷[4]。更广泛地说，报告发现许多国家的人权环境正在恶化，对健康产生了负面影响[6]。鉴于许多受影响最严重的人群--男男性行为者、变性妇女、吸毒者和其他边缘化群体--已经面临人权障碍，使他们感染艾滋病毒的风险增加，并使控制艾滋病毒的能力复杂化[6]，这对艾滋病毒的影响尤为明显。还有证据表明，许多地方的公民空间正在关闭，使民间社会组织的运作和组织更加困难，并对艾滋病毒和其他健康需求提出了新的挑战[7]。例如，人们对科学和卫生机构的信任度下降，党派之间的分歧越来越大[8]。最后，近年来，全球卫生与发展领域变得更加复杂，越来越 "拥挤"，出现了许多相互重叠的挑战，有时甚至是相互竞争的挑战。这包括目前的 "资金补充交通堵塞"[9]，即多个机构同时要求捐助国政府提供资金。部分由于 PEPFAR 和全球抗击艾滋病、结核病和疟疾基金所取得的巨大成功，HIV 已不再像以前那样具有紧迫感，这使其筹资工作更具挑战性。事实上，许多捐助国政府已经减少了在艾滋病防治方面的支出，使得美国在艾滋病防治方面的负担越来越重[10]。即使是美国，它仍然是世界上最大的艾滋病捐助政府，其资助额在 2010 年达到了最高水位[11]。但疟疾和结核病等其他传染病的教训表明，当关注度和资金减少时，这些疾病又会死灰复燃[12]。这些更广泛的趋势对 PEPFAR 的支持及其正在进行的工作产生了影响，而 PEPFAR 创建时在任的美国国会议员人数越来越少，更加剧了这种影响。值此世界艾滋病日之际，这些问题和其他问题可能会为重新思考 PEPFAR 的未来提供新的机会，积极主动地重新塑造和重构 PEPFAR，同时继续关注终结艾滋病这一公共卫生威胁这一目标。鉴于美国总统选举的结果，这一点尤为重要。

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引用次数: 0

High retention among key populations initiated on HIV pre-exposure prophylaxis in Kigali City, Rwanda 卢旺达基加利市开始接受艾滋病毒暴露前预防治疗的重点人群中保留率较高。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-20 DOI: 10.1002/jia2.26392

Athanase Munyaneza, Kiran Bhutada, Qiuhu Shi, Natalia Zotova, Etienne Nsereko, Benjamin Muhoza, Gallican Kubwimana, Gad Murenzi, Laetitia Nyirazinyoye, Kathryn Anastos, Viraj V. Patel, Jonathan Ross

Introduction

Key populations (KPs) including female sex workers (FSWs) and men who have sex with men (MSM) in sub-Saharan Africa are disproportionately impacted by HIV. Despite the increasing availability of pre-exposure prophylaxis (PrEP), data on retention remain limited. This study assessed PrEP retention at 1 and 12 months among Rwandan FSWs and MSM.

Methods

We analysed routine clinical data on adult FSWs and MSM receiving PrEP care from 11 health facilities in Kigali, Rwanda between 2019 and 2022. Retention was defined as attendance at regularly scheduled appointments for a PrEP refill. We used logistic regression to assess associations between demographic and clinical characteristics and retention at 1 and 12 months.

Results

Among 2043 PrEP initiators, 1343 (66%) were FSWs and 700 (34%) were MSM. FSWs reported a median number of eight sexual partners in the prior 7 days, 70% reported condomless sex and 94% considered themselves at high HIV risk. About 1239 (92%) and 1032 (77%) were retained at 1 and 12 months, respectively. One-month retention was lower among FSWs living with others (OR 0.59, 95% CI: 0.35−0.99; ref: living alone) or with low HIV risk perception (OR 0.12, 95% CI: 0.04−0.29). At 12 months, low HIV risk perception remained statistically significant (aOR 0.20, 95% CI: 0.12−0.32). At PrEP initiation, MSM reported a median of four sexual partners in the prior 12 months, 88% reported condomless sex and 72% considered themselves at high HIV risk. Retention rates were 96% at 1 month and 82% at 12 months. At 1 month, retention was higher among MSM with some education (OR 12.74, 95% CI: 2.74−70.93; ref: no education). At 12 months, retention was lower among MSM with part-time employment (aOR 0.29, 95% CI: 0.11, 0.76), students (aOR 0.12, 95% CI: 0.04, 0.37) and unemployed (aOR 0.12, 95% CI: 0.05, 0.28); ref: full-employed) and those unaware of PrEP at baseline (aOR 0.15, 95% CI: 0.10, 0.23).

Conclusions

We observed very high rates of PrEP retention among Rwandan FSWs and MSM. Predictors of retention included living situation, employment status, HIV risk perception and low PrEP awareness, but differed between FSWs and MSM. These findings suggest that targeted awareness campaigns tailored to different KPs could improve PrEP retention in care.

导言：撒哈拉以南非洲地区的关键人群（KPs），包括女性性工作者（FSWs）和男男性行为者（MSM），受到艾滋病毒的影响尤为严重。尽管暴露前预防疗法（PrEP）的可用性越来越高，但有关保留率的数据仍然有限。本研究评估了卢旺达家庭主妇和男男性行为者 1 个月和 12 个月的 PrEP 保持率：我们分析了 2019 年至 2022 年期间在卢旺达基加利 11 家医疗机构接受 PrEP 治疗的成年女性同性恋者和男男性行为者的常规临床数据。留用率的定义是定期赴约补服 PrEP 的出勤率。我们使用逻辑回归评估了人口统计学和临床特征与 1 个月和 12 个月的保留率之间的关系：在 2043 名 PrEP 启动者中，有 1343 人（66%）为女性社会工作者，700 人（34%）为男男性行为者。家庭主妇报告的前 7 天性伴侣数量中位数为 8 个，70% 的人报告了无安全套性行为，94% 的人认为自己处于 HIV 高危人群。分别有约 1239 人（92%）和 1032 人（77%）在 1 个月和 12 个月后继续接受治疗。与他人同居（OR 0.59，95% CI：0.35-0.99；参考：独居）或对 HIV 风险感知较低（OR 0.12，95% CI：0.04-0.29）的女性外阴残留者的 1 个月保留率较低。在 12 个月时，低 HIV 风险认知仍具有显著的统计学意义（aOR 0.20，95% CI：0.12-0.32）。在开始使用 PrEP 时，男男性行为者在过去 12 个月中报告的性伴侣中位数为 4 个，88% 的人报告了无安全套性行为，72% 的人认为自己处于 HIV 高风险状态。1 个月和 12 个月的保留率分别为 96% 和 82%。1 个月时，受过一定教育的 MSM 的保留率更高（OR 12.74，95% CI：2.74-70.93；参考：未受过教育）。12 个月时，有兼职工作（aOR 0.29，95% CI：0.11，0.76）、学生（aOR 0.12，95% CI：0.04，0.37）和失业（aOR 0.12，95% CI：0.05，0.28）的 MSM 以及基线时不知道 PrEP 的 MSM 的保留率较低（aOR 0.15，95% CI：0.10，0.23）：我们观察到卢旺达女性同性恋者和男男性行为者中 PrEP 的保留率非常高。保留率的预测因素包括生活状况、就业状况、艾滋病风险认知和对 PrEP 的低认知度，但这在女性外阴残割者和男男性行为者之间存在差异。这些研究结果表明，针对不同的 KPs 开展有针对性的宣传活动可以提高 PrEP 在护理中的保留率。

{"title":"High retention among key populations initiated on HIV pre-exposure prophylaxis in Kigali City, Rwanda","authors":"Athanase Munyaneza, Kiran Bhutada, Qiuhu Shi, Natalia Zotova, Etienne Nsereko, Benjamin Muhoza, Gallican Kubwimana, Gad Murenzi, Laetitia Nyirazinyoye, Kathryn Anastos, Viraj V. Patel, Jonathan Ross","doi":"10.1002/jia2.26392","DOIUrl":"10.1002/jia2.26392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Key populations (KPs) including female sex workers (FSWs) and men who have sex with men (MSM) in sub-Saharan Africa are disproportionately impacted by HIV. Despite the increasing availability of pre-exposure prophylaxis (PrEP), data on retention remain limited. This study assessed PrEP retention at 1 and 12 months among Rwandan FSWs and MSM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed routine clinical data on adult FSWs and MSM receiving PrEP care from 11 health facilities in Kigali, Rwanda between 2019 and 2022. Retention was defined as attendance at regularly scheduled appointments for a PrEP refill. We used logistic regression to assess associations between demographic and clinical characteristics and retention at 1 and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2043 PrEP initiators, 1343 (66%) were FSWs and 700 (34%) were MSM. FSWs reported a median number of eight sexual partners in the prior 7 days, 70% reported condomless sex and 94% considered themselves at high HIV risk. About 1239 (92%) and 1032 (77%) were retained at 1 and 12 months, respectively. One-month retention was lower among FSWs living with others (OR 0.59, 95% CI: 0.35−0.99; ref: living alone) or with low HIV risk perception (OR 0.12, 95% CI: 0.04−0.29). At 12 months, low HIV risk perception remained statistically significant (aOR 0.20, 95% CI: 0.12−0.32). At PrEP initiation, MSM reported a median of four sexual partners in the prior 12 months, 88% reported condomless sex and 72% considered themselves at high HIV risk. Retention rates were 96% at 1 month and 82% at 12 months. At 1 month, retention was higher among MSM with some education (OR 12.74, 95% CI: 2.74−70.93; ref: no education). At 12 months, retention was lower among MSM with part-time employment (aOR 0.29, 95% CI: 0.11, 0.76), students (aOR 0.12, 95% CI: 0.04, 0.37) and unemployed (aOR 0.12, 95% CI: 0.05, 0.28); ref: full-employed) and those unaware of PrEP at baseline (aOR 0.15, 95% CI: 0.10, 0.23).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed very high rates of PrEP retention among Rwandan FSWs and MSM. Predictors of retention included living situation, employment status, HIV risk perception and low PrEP awareness, but differed between FSWs and MSM. These findings suggest that targeted awareness campaigns tailored to different KPs could improve PrEP retention in care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680146","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

Learning from the first: a qualitative study of the psychosocial benefits and treatment burdens of long-acting cabotegravir/rilpivirine among early adopters in three U.S. clinics 向先行者学习：对美国三家诊所早期采用长效卡博特拉韦/利匹韦林的患者进行的心理社会效益和治疗负担定性研究。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-20 DOI: 10.1002/jia2.26394

Katerina A. Christopoulos, Mollie B. Smith, Priyasha Pareek, Alicia Dawdani, Xavier A. Erguera, Kaylin V. Dance, Ryan S. Walker, Janet Grochowski, Francis Mayorga-Munoz, Matthew D. Hickey, Mallory O. Johnson, John Sauceda, Jose I. Gutierrez Jr., Elizabeth T. Montgomery, Jonathan A. Colasanti, Lauren F. Collins, Moira C. McNulty, Kimberly A. Koester

<div> <section> <h3> Introduction</h3> <p>Perspectives on long-acting injectable cabotegravir/rilpivirine (CAB/RPV-LA) from HIV health disparity populations are under-represented in current literature yet crucial to optimize delivery.</p> </section> <section> <h3> Methods</h3> <p>Between August 2022 and May 2023, we conducted in-depth interviews with people with HIV (PWH) at four HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current CAB/RPV-LA use with receipt of ≥3 injections or CAB/RPV-LA discontinuation. We purposefully sampled for PWH who initiated with viraemia (plasma HIV RNA >50 copies/ml) due to adherence challenges, discontinuers, and cis and trans women. Interviews were coded and analysed using thematic methods grounded in descriptive phenomenology. Clinical data were abstracted from the medical record.</p> </section> <section> <h3> Results</h3> <p>The sample (San Francisco <i>n</i> = 25, Atlanta <i>n</i> = 20, Chicago <i>n</i> = 14 for total <i>n</i> = 59, median number of injections = 6) consisted of 48 PWH using CAB/RPV-LA and 11 who had discontinued. The median age was 50 (range 25–73) and 40 (68%) identified as racial/ethnic minorities, 19 (32%) cis or trans women, 16 (29%) were experiencing homelessness/unstable housing, 12 (20%) had recently used methamphetamine or opioids and 11 (19%) initiated with viraemia. All participants except one (who discontinued) had evidence of viral suppression at interview. Typical benefits of CAB/RPV-LA included increased convenience, privacy and freedom from being reminded of HIV and reduced anxiety about forgetting pills. However, PWH who became virally suppressed through CAB/RPV-LA use also experienced an amelioration of feelings of shame and negative self-worth related to oral adherence challenges. Regardless of baseline viral suppression status, successful use of CAB/RPV-LA amplified positive provider/clinic relationships, and CAB/RPV-LA was often viewed as less “work” than oral antiretroviral therapy, which created space to attend to other aspects of health and wellness. For some participants, CAB/RPV-LA remained “work,” particularly with regard to injection site pain and visit frequency. At times, these burdens outweighed the aforementioned benefits, resulting in discontinuation.</p> </section> <section> <h3> Conclusions</h3> <p>CAB/RPV-LA offers a range of logistical, psychosocial and care engagement benefits, which are experienced maximally by PWH initiating with viraemia due to adherence challenges; however, benefits do not always outweigh treatment burdens

导言：在目前的文献中，艾滋病毒健康差异人群对长效注射用卡博替拉韦/利匹韦林（CAB/RPV-LA）的看法所占比例较低，但这对优化治疗至关重要：方法：2022 年 8 月至 2023 年 5 月期间，我们在亚特兰大、芝加哥和旧金山的四家 HIV 诊所对 HIV 感染者（PWH）进行了深入访谈。资格标准为目前使用 CAB/RPV-LA，且注射次数≥3 次或已停止使用 CAB/RPV-LA。我们特意抽取了因坚持治疗而出现病毒血症（血浆 HIV RNA >50 copies/ml）的初诊感染者、停药者以及顺性和逆性女性。采用以描述性现象学为基础的主题方法对访谈进行编码和分析。临床数据摘自病历：样本（旧金山 n = 25，亚特兰大 n = 20，芝加哥 n = 14，总计 n = 59，注射次数中位数 = 6）包括 48 名使用 CAB/RPV-LA 的 PWH 和 11 名停止使用的 PWH。年龄中位数为 50 岁（25-73 岁不等），40 人（68%）为少数种族/民族，19 人（32%）为同性或异性女性，16 人（29%）无家可归/住房不稳定，12 人（20%）最近使用过甲基苯丙胺或阿片类药物，11 人（19%）开始时患有病毒血症。除一人（中断治疗）外，所有参与者在接受访谈时都有病毒抑制的证据。CAB/RPV-LA 的典型益处包括更方便、更私密、更免于被提醒感染艾滋病毒，以及减少对忘带药片的焦虑。然而，通过使用 CAB/RPV-LA 而获得病毒抑制的艾滋病感染者也体验到了与口服药物相关的羞耻感和负面自我价值感的改善。无论基线病毒抑制状态如何，成功使用 CAB/RPV-LA 都会扩大积极的医疗服务提供者/诊所关系，而且 CAB/RPV-LA 通常被视为比口服抗逆转录病毒疗法更少的 "工作"，这就为关注健康和保健的其他方面创造了空间。对一些参与者来说，CAB/RPV-LA 仍然是 "工作"，尤其是在注射部位疼痛和就诊频率方面。有时，这些负担超过了上述益处，从而导致中断：CAB/RPV-LA提供了一系列后勤、社会心理和护理参与方面的益处，由于依从性方面的挑战，感染病毒血症的PWH能够最大限度地体验到这些益处；然而，益处并不总是大于治疗负担，并可能导致中断治疗。我们关于坚持治疗与中断治疗的理由的研究结果可为患者的初次咨询和后续咨询提供参考。

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引用次数: 0

In-utero exposure to tenofovir-containing pre-exposure prophylaxis and bone mineral content in HIV-unexposed infants in South Africa 南非未接触艾滋病毒的婴儿在宫内接触含替诺福韦的暴露前预防药物和骨矿物质含量。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-11 DOI: 10.1002/jia2.26379

Kerusha Reddy, Kimesh L. Naidoo, Carl Lombard, Zukiswa Godlwana, Alicia C. Desmond, Richard Clark, James F. Rooney, Glenda Gray, Dhayendre Moodley

Introduction

Tenofovir disoproxil fumarate (TDF) is a common drug of choice for pre-exposure prophylaxis (PrEP) or as a combination HIV treatment for pregnant women. In-utero exposure to TDF was found to be associated with lower bone mineral content (BMC) in HIV-exposed uninfected neonates. Data for infants born to women taking TDF-PrEP are lacking. The CAP016 randomized control trial was conducted in South Africa between September 2017 and August 2021 and pregnant women either initiated TDF/FTC PrEP in pregnancy (Immediate PrEP arm-IP) or at cessation of breastfeeding (Deferred PrEP arm-DP). In a secondary data analysis, we evaluated BMC in HIV-unexposed infants in the CAP016 trial in the first 18 months of life in association with maternal TDF-PrEP use during pregnancy.

Methods

Infants born to women randomized to the IP arm or DP arm in the CAP016 clinical trial had BMC measurements of the whole body with head (WBH) and lumbar spine (LS) by dual energy X-ray absorptiometry (DXA) at 6, 26, 50 and 74 weeks.

Results

Of 481 infants born to women enrolled in the CAP016 clinical trial, 335 (69.6%) infants had a minimum of one DXA scan of the WBH and LS between 6 and 74 weeks of age (168 IP and 167 DP). Women in the IP arm received TDF-FTC PreP for a median of 19 weeks between initiation in pregnancy and delivery. Using a mixed linear regression model and adjusted for gestational age, sex and ever-breastfed, the mean difference (95% CI) for BMC of the WBH between IP and DP arms were −0.74 (−8.69 to 7.20), −1.26 (−10.75 to 8.23), −9.17 (−20.02 to 1.69) and 5.02 (−6.74 to 16.78) g at 6, 26, 50 and 74 weeks (p = 0.283). Mean differences in BMC of the LS were 0.07 (−0.10 to 0.23), 0.02 (−0.18 to 0.22), −0.14 (−0.36 to 0.09) and 0.14 (−0.11 to 0.38) g at 6, 26, 50 and 74 weeks, respectively (p = 0.329).

Conclusions

In a randomized controlled trial, there were no differences in BMC of the WBH and LS between infants exposed to in-utero TDF-FTC PrEP and unexposed infants in the first 18 months of life.

简介：富马酸替诺福韦二吡呋酯（TDF）是暴露前预防（PrEP）或孕妇艾滋病综合治疗的常用药物。研究发现，宫内暴露于 TDF 与暴露于 HIV 的未感染新生儿骨矿物质含量（BMC）降低有关。目前尚缺乏服用 TDF-PrEP 的妇女所生婴儿的数据。CAP016 随机对照试验于 2017 年 9 月至 2021 年 8 月期间在南非进行，孕妇要么在怀孕期间开始服用 TDF/FTC PrEP（立即 PrEP 组-IP），要么在停止母乳喂养时开始服用 TDF/FTC PrEP（推迟 PrEP 组-DP）。在二次数据分析中，我们评估了 CAP016 试验中暴露于 HIV 的婴儿在出生后 18 个月内的 BMC 与母亲在孕期使用 TDF-PrEP 的关系：CAP016临床试验中被随机分配到IP组或DP组的妇女所生的婴儿在6周、26周、50周和74周时接受了双能X射线吸收测定法（DXA）对全身及头部（WBH）和腰椎（LS）的BMC测量：参加 CAP016 临床试验的妇女所生的 481 名婴儿中，有 335 名婴儿（69.6%）在 6 至 74 周龄期间至少接受过一次头颅和腰椎的 DXA 扫描（168 名 IP 婴儿和 167 名 DP 婴儿）。IP 组妇女从怀孕开始到分娩期间接受 TDF-FTC PreP 治疗的时间中位数为 19 周。使用混合线性回归模型并根据孕龄、性别和曾哺乳情况进行调整后，IP 和 DP 两组在 6、26、50 和 74 周时的 WBH BMC 平均差异（95% CI）分别为-0.74（-8.69 至 7.20）、-1.26（-10.75 至 8.23）、-9.17（-20.02 至 1.69）和 5.02（-6.74 至 16.78）克（p = 0.283）。在 6、26、50 和 74 周时，LS 的 BMC 平均差异分别为 0.07（-0.10 至 0.23）、0.02（-0.18 至 0.22）、-0.14（-0.36 至 0.09）和 0.14（-0.11 至 0.38）克（p = 0.329）：在一项随机对照试验中，在出生后的前18个月中，接受过宫内TDF-FTC PrEP治疗的婴儿与未接受治疗的婴儿在WBH和LS的BMC方面没有差异。

{"title":"In-utero exposure to tenofovir-containing pre-exposure prophylaxis and bone mineral content in HIV-unexposed infants in South Africa","authors":"Kerusha Reddy, Kimesh L. Naidoo, Carl Lombard, Zukiswa Godlwana, Alicia C. Desmond, Richard Clark, James F. Rooney, Glenda Gray, Dhayendre Moodley","doi":"10.1002/jia2.26379","DOIUrl":"10.1002/jia2.26379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tenofovir disoproxil fumarate (TDF) is a common drug of choice for pre-exposure prophylaxis (PrEP) or as a combination HIV treatment for pregnant women. In-utero exposure to TDF was found to be associated with lower bone mineral content (BMC) in HIV-exposed uninfected neonates. Data for infants born to women taking TDF-PrEP are lacking. The CAP016 randomized control trial was conducted in South Africa between September 2017 and August 2021 and pregnant women either initiated TDF/FTC PrEP in pregnancy (Immediate PrEP arm-IP) or at cessation of breastfeeding (Deferred PrEP arm-DP). In a secondary data analysis, we evaluated BMC in HIV-unexposed infants in the CAP016 trial in the first 18 months of life in association with maternal TDF-PrEP use during pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Infants born to women randomized to the IP arm or DP arm in the CAP016 clinical trial had BMC measurements of the whole body with head (WBH) and lumbar spine (LS) by dual energy X-ray absorptiometry (DXA) at 6, 26, 50 and 74 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 481 infants born to women enrolled in the CAP016 clinical trial, 335 (69.6%) infants had a minimum of one DXA scan of the WBH and LS between 6 and 74 weeks of age (168 IP and 167 DP). Women in the IP arm received TDF-FTC PreP for a median of 19 weeks between initiation in pregnancy and delivery. Using a mixed linear regression model and adjusted for gestational age, sex and ever-breastfed, the mean difference (95% CI) for BMC of the WBH between IP and DP arms were −0.74 (−8.69 to 7.20), −1.26 (−10.75 to 8.23), −9.17 (−20.02 to 1.69) and 5.02 (−6.74 to 16.78) g at 6, 26, 50 and 74 weeks (<i>p</i> = 0.283). Mean differences in BMC of the LS were 0.07 (−0.10 to 0.23), 0.02 (−0.18 to 0.22), −0.14 (−0.36 to 0.09) and 0.14 (−0.11 to 0.38) g at 6, 26, 50 and 74 weeks, respectively (<i>p</i> = 0.329).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a randomized controlled trial, there were no differences in BMC of the WBH and LS between infants exposed to in-utero TDF-FTC PrEP and unexposed infants in the first 18 months of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613147","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

Patient and public involvement in HIV research: a mapping review and development of an online evidence map 患者和公众参与艾滋病研究：绘图审查和在线证据地图的开发。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-11 DOI: 10.1002/jia2.26385

David Jackson-Perry, Ellen Cart-Richter, David Haerry, Lindrit Ahmeti, Annatina Bieri, Alexandra Calmy, Marie Ballif, Chloé Pasin, Julia Notter, Alain Amstutz, the Swiss HIV Cohort Study Young Researchers’ Group, and the Swiss HIV Cohort Study

<div> <section> <h3> Introduction</h3> <p>Increasing evidence indicates the benefits of patient and public involvement (PPI) in medical research, and PPI is increasingly expected by funders and publishers. We conducted a mapping review of studies reporting examples of PPI implementation in HIV research, and developed an online evidence map to guide HIV researchers.</p> </section> <section> <h3> Methods</h3> <p>We systematically searched Medline and Embase up until 18 August 2024, including search terms with variations for PPI and HIV. We extracted information from identified studies in duplicate and analysed the data descriptively and qualitatively to describe types of PPI models and reported benefits, challenges, and mitigation strategies. This study was co-initiated and co-led by people living with HIV.</p> </section> <section> <h3> Results</h3> <p>We identified 17 studies reporting PPI in HIV research between 1992 and August 2024. Most PPI examples informed prospective clinical studies, but also qualitative research, questionnaire development, research priority setting and surveys. Ten studies described the number and characteristics of PPI members involved. We observed four PPI models, from a model that solely engaged PPI members for a specific task to a model whereby PPI representatives were integrated into the study team with decision-making authority. Benefits reported included wider dissemination of research results, better understanding of research material and results, and higher levels of trust and learning between researcher and communities. The most commonly reported challenges were the lack of specific resources for PPI, differing levels of knowledge and expertise, concern about HIV status disclosure, and lack of diversity of the PPI team. Uneven power dynamics, tensions, and differing expectations between stake-holder groups were also frequently noted.</p> </section> <section> <h3> Conclusions</h3> <p>This mapping review summarizes published examples of PPI in HIV research for various phases of research. There is a clear need to strengthen the reporting on PPI processes in HIV research, for example by following the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 guidelines, and developing guidance on its hands-on implementation. We embedded PPI from study inception onwards, which potentially pre-empted some of the challenges reported in the reviewed examples. The resulting online evidence map is a starting point to guide researchers on integrating PPI into their own research.</p> </section>

导言：越来越多的证据表明，患者和公众参与（PPI）对医学研究大有裨益，资助者和出版商也越来越期待患者和公众参与。我们对报告在艾滋病研究中实施患者和公众参与（PPI）实例的研究进行了图谱审查，并开发了一份在线证据图谱，为艾滋病研究人员提供指导：我们对 Medline 和 Embase 进行了系统检索，检索期截至 2024 年 8 月 18 日，包括 PPI 和 HIV 的不同检索词。我们从确定的研究中提取了一式两份的信息，并对数据进行了描述性和定性分析，以描述PPI模式的类型以及报告的益处、挑战和缓解策略。本研究由艾滋病病毒感染者共同发起和领导：我们发现有 17 项研究报告了 1992 年至 2024 年 8 月期间艾滋病毒研究中的 PPI。大多数 PPI 实例都为前瞻性临床研究提供了信息，但也包括定性研究、问卷开发、研究优先级设定和调查。十项研究描述了参与其中的 PPI 成员的数量和特征。我们观察了四种公众参与模式，从仅让公众参与成员参与特定任务的模式，到将公众参与代表纳入研究团队并赋予其决策权的模式。据报告，这种模式的好处包括：研究成果得到了更广泛的传播，研究材料和成果得到了更好的理解，研究人员和社区之间的信任和学习水平得到了提高。最常报告的挑战是缺乏用于公众宣传的特定资源、知识和专业技能水平参差不齐、对艾滋病病毒感染状况披露的担忧以及公众宣传团队缺乏多样性。利益相关者群体之间不平衡的权力动态、紧张关系和不同的期望也经常被提及：本图谱审查总结了已发表的艾滋病毒研究中不同研究阶段的公众参与实例。显然，有必要加强对艾滋病研究中患者和公众参与过程的报告，例如遵循《患者和公众参与报告指南》（GRIPP）2 指南，并制定实际操作指南。我们从研究开始之初就将患者和公众参与纳入其中，这可能会预先避免已审查实例中报告的一些挑战。由此产生的在线证据地图是指导研究人员将 PPI 纳入自身研究的起点。

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引用次数: 0

Abstract Supplement HIV Glasgow 10–13 November 2024, Glasgow, UK/Virtual 特刊：摘要增刊 HIV 格拉斯哥 2024 年 11 月 10-13 日，英国格拉斯哥/虚拟。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-08 DOI: 10.1002/jia2.26370

Commonly-used Abbreviations 1

Oral Presentations

Experience in the Implementation of Long-Acting Treatment 3

Antiretroviral Treatment Strategies 5

Infection Prevention 6

Integrase Strand Transfer Inhibitor (INSTI) Resistance 7

Co-morbidities and Co-infections 9

PrEP-ing for the Future 17

Poster Presentations

ARV-based prevention—Vertical transmission 20

ARV-based prevention—PEP 28

ARV-based prevention—PrEP 29

Treatment strategies—Novel therapeutic targets (phase I and II) 45

Treatment strategies—RCTs: Oral and injectable therapy in first line and suppressed switch populations 47

Treatment strategies—Real-world and implementation science studies oral and injectable therapy 66

Treatment strategies—Treatment experienced adults (second line and multi-drug resistance studies) 122

Treatment strategies—Models of care for ageing/frail populations including virological failure and switching 147

Treatment strategies—Rapid ART initiation 149

Treatment strategies—Adherence 158

Clinical management considerations—Women 164

Clinical management considerations—Late presenters 170

Clinical management considerations—People who inject drugs (PWID) 180

Clinical management considerations—Transgender people 181

Clinical management considerations—Adolescents 182

Clinical management considerations—Paediatrics 183

Clinical management considerations—Drug-drug interactions 187

Cure/post-treatment control 194

Opportunistic infections and AIDS-defining cancers 200

Clinical pharmacology 206

Community-based treatment and prevention initiatives, including primary care screening 209

Public health strategies including of policy options 219

Cost and cost-effectiveness 233

Models of care: evaluation of ARV delivery and coverage 237

Co-morbidities and complications of disease and/or treatment—Ageing and frailty 245

Co-morbidities and complications of disease and/or treatment—Cardiovascular/metabolic including weight gain 249

Co-morbidities and complications of disease and/or treatment—Malignancies: non-AIDS defining 273

Co-morbidities and complications of disease and/or treatment—Neurological 280

Co-morbidities and complications of disease and/or treatment—Renal 282

Co-morbidities and complications of disease and/or treatment—Mental health disorders 287

Co-morbidities and complications of disease and/or treatment—Other 291

People living with HIV and COVID-19: Outcomes 304

People living with HIV and mpox virus 307

People living with HIV and sexually transmitted diseases 311

People living with HIV and tuberculosis 320

People living with HIV and viral hepatitis 323

People living with HIV and other diseases 329

Author Index 335

常用缩略语 1口头报告实施长效治疗的经验 3抗逆转录病毒治疗策略 5感染预防 6整合酶链转移抑制剂（INSTI）耐药性 7合并疾病和合并感染 9PrEP-面向未来 17海报报告基于ARV的预防-垂直传播 20基于ARV的预防-PEP 28基于ARV的预防-PrEP 29治疗策略-新的治疗目标（I期和II期） 45治疗策略-RCTs：治疗策略--口服和注射疗法在一线和抑制性转换人群中的应用 47治疗策略--口服和注射疗法的实际应用和实施科学研究 66治疗策略--有治疗经验的成人（二线和多药耐药性研究治疗策略-治疗经验丰富的成人（二线和多药耐药性研究） 122治疗策略-老龄/体弱人群的护理模式，包括病毒学失败和转换 147治疗策略-快速启动抗逆转录病毒疗法 149治疗策略-依从性 158临床管理注意事项-女性 164临床管理注意事项-晚期患者 170临床管理注意事项-注射吸毒者（PWID） 180临床管理注意事项-变性人 181临床管理注意事项-青少年 182临床管理注意事项-儿科 183临床管理注意事项-药物-药物相互作用药物相互作用 187治疗/治疗后控制 194机会性感染和艾滋病定义的癌症 200临床药理学 206基于社区的治疗和预防措施、包括初级保健筛查 209 公共卫生战略，包括政策选择 219 成本和成本效益 233 护理模式：疾病和/或治疗并发症-老龄化和虚弱 245疾病和/或治疗并发症-心血管/代谢，包括体重增加 249疾病和/或治疗并发症-恶性肿瘤：疾病和/或治疗的并发症-神经系统 280疾病和/或治疗的并发症-肾脏 282疾病和/或治疗的并发症-精神疾病 287疾病和/或治疗的并发症-其他 291艾滋病毒感染者和COVID-19：艾滋病病毒感染者与 COVID-19：结果 304艾滋病病毒感染者与 mpox 病毒 307艾滋病病毒感染者与性传播疾病 311艾滋病病毒感染者与结核病 320艾滋病病毒感染者与病毒性肝炎 323艾滋病病毒感染者与其他疾病 329作者索引 335

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引用次数: 0

Excess mortality attributable to AIDS among people living with HIV in high-income countries: a systematic review and meta-analysis 高收入国家艾滋病病毒感染者因艾滋病导致的过高死亡率：系统回顾和荟萃分析。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-04 DOI: 10.1002/jia2.26384

Adam Trickey, Julie Ambia, Robert Glaubius, Cari van Schalkwyk, Jeffrey W. Imai-Eaton, Eline L. Korenromp, Leigh F. Johnson

<div> <section> <h3> Introduction</h3> <p>Identifying strategies to further reduce AIDS-related mortality requires accurate estimates of the extent to which mortality among people living with HIV (PLHIV) is due to AIDS-related or non-AIDS-related causes. Existing approaches to estimating AIDS-related mortality have quantified AIDS-related mortality as total mortality among PLHIV in excess of age- and sex-matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non-AIDS-related.</p> </section> <section> <h3> Methods</h3> <p>We searched Embase on 22/09/2023 for English language studies that contained data on AIDS-related mortality rates among adult PLHIV and age-matched comparator all-cause mortality rates among people without HIV. We extracted data on the number and rates of all-cause and AIDS-related deaths, demographics, ART use and AIDS-related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS-related. The proportion of excess mortality due to AIDS was pooled using random-effects meta-analysis.</p> </section> <section> <h3> Results</h3> <p>Of 4485 studies identified by the initial search, eight were eligible, all from high-income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow-up. Overall, 1,331,742 person-years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person-years. Of these deaths, 7721 (44%) were AIDS-related, an overall AIDS-related mortality rate of 5.8 per 1000 person-years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8–4.0) per 1000 person-years. The meta-analysed percentage of excess mortality that was AIDS-related was 53% (95% CI: 45–61%); 52% (43–60%) in Western and Central Europe and North America, and 71% (69–74%) in the Asia-Pacific region.</p> </section> <section> <h3> Discussion</h3> <p>Although we searched all regions, we only found eligible studies from high-income countries, mostly European, so, the generalizability of these results to other regions and epidemic settings is unknown.</p> </section> <section> <h3> Conclusions</h3> <p>Around half of the excess mortality among PLHIV in high-

导言：要确定进一步降低艾滋病相关死亡率的策略，就必须准确估算出艾滋病病毒感染者（PLHIV）的死亡率在多大程度上是由艾滋病相关或非艾滋病相关原因造成的。现有的艾滋病相关死亡率估算方法将艾滋病相关死亡率量化为艾滋病病毒感染者的总死亡率超过未感染艾滋病的人群中与年龄和性别匹配的死亡率。然而，最近的证据表明，在抗逆转录病毒疗法（ART）覆盖率较高的情况下，艾滋病病毒感染者的超额死亡率中有越来越大的比例与艾滋病无关：我们于 2023 年 9 月 22 日在 Embase 中检索了包含成年 PLHIV 中艾滋病相关死亡率数据以及未感染 HIV 的人群中与年龄相匹配的全因死亡率数据的英文研究。我们提取了有关全因死亡和艾滋病相关死亡的数量和比率、人口统计学、抗逆转录病毒疗法的使用情况以及艾滋病相关死亡率定义的数据。我们计算了艾滋病毒感染者中艾滋病相关超额死亡率的比例。我们采用随机效应荟萃分析法对艾滋病导致的超额死亡率进行了汇总：在初步搜索确定的 4485 项研究中，有 8 项符合条件，全部来自高收入环境：5 项来自欧洲，1 项来自加拿大，1 项来自日本，1 项来自韩国。没有研究只报告了未经治疗的艾滋病毒感染者的死亡率。一项研究仅包括接受抗逆转录病毒疗法的艾滋病毒感染者。在所有研究中，大多数 PLHIV 在随访结束时都接受了抗逆转录病毒疗法。总体而言，共有 1,331,742 人/年的 PLHIV 患者死亡，死亡人数为 17,471 人/年，死亡率为 13.1‰。在这些死亡案例中，有 7721 例（44%）与艾滋病有关，与艾滋病有关的总死亡率为每 1000 人年 5.8 例。普通人群的平均总死亡率为每 1000 人年 2.8 例（95% CI：1.8-4.0）。经荟萃分析，与艾滋病相关的超额死亡率为 53% (95% CI: 45-61%)；西欧、中欧和北美为 52% (43-60%)，亚太地区为 71% (69-74%)：讨论：尽管我们搜索了所有地区，但我们只发现了来自高收入国家（主要是欧洲国家）的符合条件的研究，因此，这些结果能否推广到其他地区和流行病环境尚不得而知：结论：在高收入地区，艾滋病毒感染者的超额死亡率中约有一半与艾滋病无关。需要重视预防和治疗与艾滋病毒感染者非艾滋病死亡相关的合并症。

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引用次数: 0

Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021–2023 暴露前预防措施在易感染艾滋病毒人群中的实施差距：对肯尼亚西部两个社区的横断面分析，2021-2023 年。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-11-04 DOI: 10.1002/jia2.26372

Matthew L. Romo, Glenna Schluck, Josphat Kosgei, Christine Akoth, Rael Bor, Deborah Langat, Curtisha Charles, Paul Adjei, Britt Gayle, Elyse LeeVan, David Chang, Adam Yates, Margaret Yacovone, Julie A. Ake, Fred Sawe, Trevor A. Crowell, for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group

Introduction

Despite the increasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya.

Methods

We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14–55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP.

Results

Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19–24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15–19 years more often reported never taking PrEP compared with those 25–36 years (aPR 1.31, 95% CI: 1.06–1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04–0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60–0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02–1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03–2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40–0.92).

Conclusions

We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.

导言：尽管接触前预防疗法（PrEP）等预防工具越来越多，但撒哈拉以南非洲地区的艾滋病发病率仍然过高。我们研究了肯尼亚艾滋病发病率队列中的参与者对 PrEP 的认识、接受和坚持情况：我们使用了肯尼亚霍马湾和凯里乔艾滋病毒和其他感染多国观察队列（MOCHI）的横断面注册数据。该队列招募了年龄在 14-55 岁之间、近期有过性传播感染、性交易、无安全套性行为和/或注射吸毒史的人。参与者填写了有关 PrEP、人口统计学和性行为的问卷。我们使用多变量稳健泊松回归法估算了从未听说过 PrEP、从未服用过 PrEP 和从未停止过 PrEP 的调整流行率 (aPRs) 和 95% 置信区间 (CIs)：在 2021 年 12 月 12 日至 2023 年 5 月 5 日期间，399 名参与者尝试了 PrEP 问卷调查，其中 316 人（79.2%）为女性，年龄中位数为 22 岁（四分位间范围为 19-24）；390 名参与者中有 316 人（81.0%）从事性工作或性交易。在回答问题的 396 名参与者中，有 120 人（30.3%）从未听说过 PrEP。在听说过 PrEP 的 275 名参与者中，有 206 人（74.9%）从未服用过。在 69 名曾经服用过 PrEP 的参与者中，有 50 人（72.5%）在报名前的某个时间停止了服用。与 25-36 岁的参与者相比，15-19 岁的参与者更常报告从未服用过 PrEP（aPR 1.31，95% CI：1.06-1.61）。知道有人服用 PrEP 的参与者较少报告从未听说过 PrEP（aPR 0.10，95% CI：0.04-0.23）和从未服用过 PrEP（aPR：0.69，95% CI：0.60-0.80）。在家庭周收入低于 1000 肯尼亚先令与高于 1000 肯尼亚先令（aPR：1.40，95% CI：1.02-1.93）和性生活前酗酒/吸毒（aPR：1.53，95% CI：1.03-2.26）的参与者中，停止 PrEP 的情况更为普遍。在从事性工作或性交易的人群中，停止 PrEP 的情况较少（aPR 0.6，95% CI：0.40-0.92）：我们发现，在 PrEP 的认知、接受和坚持方面存在很大差距，这与潜在的系统和个人风险因素有关。我们的分析还突显了在不认识其他人的情况下提高 PrEP 参与度的重要性。

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引用次数: 0

Power, data and social accountability: defining a community-led monitoring model for strengthened health service delivery 权力、数据和社会问责制：确定社区主导的监测模式以加强医疗服务的提供。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-10-24 DOI: 10.1002/jia2.26374

Ndivhuwo Rambau, Soeurette Policar, Alana R. Sharp, Elise Lankiewicz, Allan Nsubuga, Luke Chimhanda, Anele Yawa, Kenneth Mwehonge, Donald Denis Tobaiwa, Gérald Marie Alfred, Matthew M. Kavanagh, Asia Russell, Solange Baptiste, Onesmus Mlewa Kalama, Rodelyn M. Marte, Naïké Ledan, Brian Honermann, Krista Lauer, Nadia Rafif, Susan Perez, Gang Sun, Anna Grimsrud, Laurel Sprague, Keith Mienies

Introduction

Despite international commitment to achieving the end of HIV as a public health threat, progress is off-track and existing gaps have been exacerbated by COVID-19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community-led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence-based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services.

Discussion

Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community-led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community-led advocacy, with the aim of increasing duty-bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long-term approach to building meaningful engagement in systems-wide improvements rather than discrete interventions.

Conclusions

The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.

导言：尽管国际社会承诺要终结艾滋病毒对公共卫生的威胁，但进展却偏离了轨道，COVID-19 与现有流行病的碰撞加剧了现有的差距。由艾滋病毒感染者领导的政治问责和历史性医疗保健宣传模式催生了由社区主导的医疗服务提供监测（CLM），它作为一种社会问责模式，具有提高医疗系统可及性和质量的潜力。然而，社区主导监测模式在加强问责制和改善服务提供方面的有效性取决于它是否符合社会问责机制的循证原则。我们为 CLM 提出了一套统一原则，以支持其对医疗服务质量和可获得性的影响：讨论：在社会问责文献的基础上，界定了社区语言管理的核心实施原则。社区语言管理计划包括社区主导的独立数据收集工作，其中的数据工具和方法由最容易受到服务质量影响的服务用户和社区设计。数据的收集是常规性的，重点是优先考虑和保护受访者，然后用于开展常规的、由社区主导的宣传活动，目的是加强义务承担者对服务使用者的责任。社区联络机制应代表一种广泛的、集体的社区响应，由受影响社区独立领导，包括数据收集和宣传，并应被理解为一种长期方法，以建立对全系统改进的有意义的参与，而不是孤立的干预：CLM 模式是一种重要的社会问责机制，可提高关键医疗服务和系统对社区的响应能力。通过建立对 CLM 原则的集体理解，该模式为更好地推广 CLM 铺平了道路，使实施方法忠实于核心原则，对 CLM 实施方法进行严格审查，对 CLM 对服务质量改善的影响进行评估和评价。

{"title":"Power, data and social accountability: defining a community-led monitoring model for strengthened health service delivery","authors":"Ndivhuwo Rambau, Soeurette Policar, Alana R. Sharp, Elise Lankiewicz, Allan Nsubuga, Luke Chimhanda, Anele Yawa, Kenneth Mwehonge, Donald Denis Tobaiwa, Gérald Marie Alfred, Matthew M. Kavanagh, Asia Russell, Solange Baptiste, Onesmus Mlewa Kalama, Rodelyn M. Marte, Naïké Ledan, Brian Honermann, Krista Lauer, Nadia Rafif, Susan Perez, Gang Sun, Anna Grimsrud, Laurel Sprague, Keith Mienies","doi":"10.1002/jia2.26374","DOIUrl":"10.1002/jia2.26374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite international commitment to achieving the end of HIV as a public health threat, progress is off-track and existing gaps have been exacerbated by COVID-19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community-led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence-based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community-led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community-led advocacy, with the aim of increasing duty-bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long-term approach to building meaningful engagement in systems-wide improvements rather than discrete interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491713","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}

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