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“From an HCV and HIV point of view, it's been remarkable”: A qualitative study about using prescribed safer supply to support people who use drugs along the HIV and HCV prevention and treatment cascades in Ontario, Canada “从丙型肝炎病毒和艾滋病毒的角度来看，这是了不起的”：一项关于使用处方更安全的供应来支持加拿大安大略省沿着艾滋病毒和丙型肝炎病毒预防和治疗级联使用药物的人的定性研究
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70038
Adrian Guta, Katherine Rudzinski, Marilou Gagnon, Rose A. Schmidt, Gillian Kolla, Danielle German, David Kryszajtys, Melissa Perri, Andrea Sereda, Christopher Sterling-Murphy, Carol Strike

Introduction

Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care.

Methods

We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research.

Results

SSPs supported HIV/HCV care by first addressing patients’ substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs.

Conclusions

SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.

尽管在艾滋病毒和丙型肝炎病毒（HCV）治疗方面取得了进展，但药物使用者（PWUD）在预防和治疗方面面临着重大障碍。为不受管制的药品供应提供处方药品替代品的安全供应规划可能为加强医疗保健参与和以人为本的护理创造机会。方法我们在2021年2月至10月期间对加拿大安大略省的四个ssp进行了定性研究。对52名患者和21名提供者（包括医生、注册执业护士、护士和专职保健专业人员）进行了半结构化访谈。访谈探讨了更安全的供应和艾滋病毒/丙型肝炎病毒护理方面的经验。分析采用了实施研究综合框架指导下的专题技术。结果ssp通过首先解决患者的药物使用需求来支持HIV/HCV护理，这为随后建立更广泛的健康参与的信任创造了机会。提供者认为，更安全的供应模式为puwud提供了他们想要的东西，从而为讨论艾滋病毒、丙型肝炎病毒和其他性传播和血液传播感染提供了机会。ssp为支持艾滋病毒和丙型肝炎病毒检测和开始治疗的患者提供了机会，更安全的供应药物与艾滋病毒和丙型肝炎病毒药物捆绑在一起，以支持依从性。非惩罚性方法通过优先考虑患者的自主权，帮助克服了以前的负面医疗保健经历。实施方面的挑战包括平衡灵活的、以病人为导向的护理与方案要求之间的关系，以及围绕个人需求协调全面的服务。结论ssp可以通过围绕他们的优先事项和生活现实建立服务来改善PWUD的HIV/HCV护理服务。通过日常配药和一揽子服务将更安全的供应与艾滋病毒/丙型肝炎病毒护理相结合，显示出吸引以前与护理脱节的人的希望。虽然研究结果表明治疗效果有所改善，但局限性包括COVID-19期间的数据收集、部分人群的代表性有限以及仅关注阿片类药物规划。在加拿大，特殊服务计划面临越来越多的审查和关闭，因此需要研究长期成果和方案可持续性。
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引用次数: 0
Person-centred HIV prevention in an era of innovation and uncertainties 在创新和不确定的时代，以人为本的艾滋病毒预防
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70043
Andrew Mujugira, Iskandar Azwa, Marie-Claude Lavoie
<p>Person-centred care (PCC) is a healthcare approach that focuses on understanding and respecting clients’ preferences, values and beliefs. It aims to empower clients by actively involving them in their own care and highlighting the importance of effective communication and relationships between providers and clients [<span>1-3</span>]. Person-centred health systems are widely endorsed in political and policy statements as essential for addressing health system challenges, promoting equity in access, delivering quality and effective care, and ensuring that no one is left behind [<span>4</span>]. Despite widespread recognition of these PCC principles, current healthcare delivery models often fall short of these ideals because they tend to be disease-focused, fragmented and siloed, emphasising specific programmatic outputs, putting pressure on health workers and jeopardising client-centred care delivery [<span>5</span>]. There is an urgent need to transition from disease-focused health systems to those centred on individuals because nearly half of the global population lacks equitable access to essential healthcare services.</p><p>This transformation requires innovative solutions that meet client needs while maintaining accessibility and continuity of care. Recent advances in HIV prevention, including long-acting injectables for pre-exposure prophylaxis (LAI-PrEP), create unprecedented opportunities for PCC. In 2024, the ground-breaking PURPOSE 1 trial reported 100% efficacy among young women receiving twice-yearly lenacapavir​ [<span>6</span>]. Similarly, the PURPOSE 2 trial demonstrated that HIV incidence was 96% lower with lenacapavir compared to the background incidence [<span>7</span>]. For the first time, individuals can choose from multiple PrEP options—pills, rings or injectables—that align with their sexual behaviours, needs, preferences and life circumstances. Health providers need to educate and counsel individuals about these options, providing evidence-based information about their effectiveness, side effects and requirements (such as adherence to daily dosing or injection schedule) to facilitate autonomous and informed decision-making.</p><p>HIV self-testing (HIVST) utilisation can be improved through PCC approaches and complement PrEP. A meta-analysis of 33 studies from around the globe found that HIVST kit distribution by sexual partners, peers or through online platforms achieved higher testing rates than facility-based testing [<span>8</span>]. Significantly, it expanded testing coverage in key populations without reducing test accuracy or safety. Recent evidence suggests that HIVST streamlines HIV screening for people on PrEP and promotes PrEP uptake by individuals not accessing care. It can be leveraged to support PrEP initiation, continuation and re-engagement in care [<span>9</span>]. Technological innovations, such as LAI-PrEP and HIVST, represent only one component of effective prevention. To maximise their effectiveness, i
与此同时，在莫桑比克，社区成员得到了法律专业人士和同行的支持，解决了与艾滋病毒服务相关的人权问题，成功解决了6018起报告案件中的90%。在牙买加，民间社会组织改进了被称为“了解你的权利”的法律扫盲倡议，并形成了多机构联盟来解决污名化和歧视问题。因此，将社区主导的人权努力与以人为中心的艾滋病毒预防和治疗相结合，有可能克服护理方面的结构性障碍。第二个主题侧重于提供超越传统保健模式的综合服务，以覆盖由于包括污名和歧视在内的多层次障碍而很少寻求艾滋病毒预防服务的人群，例如关键人群和青年。在印度，Mitr诊所为跨性别妇女提供全面的方法，将性别确认服务与艾滋病毒检测和PrEP相结合。激光脱毛和激素治疗等服务吸引了客户，促进了他们获得艾滋病毒预防服务（Shaikh等）。结果，62%的符合条件的客户接受了艾滋病毒检测，在585名对PrEP感兴趣的客户中，几乎所有人（98%）都接受了检测。这些干预措施显示了为服务不足人群提供以客户为中心的综合护理的价值。加拿大的一项定性研究调查了服务提供者和护理接受者在艾滋病毒/丙型肝炎病毒综合护理和为吸毒者提供更安全的供应方案方面的经验（Guta等人）[b]。该方案由保健专业人员管理，侧重于以人为本、非惩罚性和了解创伤的方式提供服务。提供者指出，更安全的供应模式促进了与吸毒者讨论预防艾滋病毒、丙型肝炎病毒和其他性传播和血源性感染。在南非，以社区为基础的同伴导航达到了75%的青年，他们参加了一项楔形分步聚类随机试验，支持的可接受性很高；93%的人接受了艾滋病毒检测，63%的人接受了可治愈的性传播感染检测，结果显示性传播感染流行率为29%，其中85%与治疗有关（Busang等人）。男性比女性更有可能获得PrEP，这表明针对男性特定PrEP需求和偏好的量身定制的干预措施可以提高吸收率。这些不同的例子表明，讨论如何从给人群贴上“难以接触”的标签转变为将重点放在可以向他们提供哪些综合服务以及艾滋病毒预防服务上。第三个主题包括侧重于新技术的论文，包括数字卫生解决方案、数据卫生系统和护理点（POC）测试。在全球一级，世界卫生组织提出了关于以人为本的艾滋病毒战略信息的指导方针，重点是加强数字数据系统，以协调和增加对国家卫生信息系统基本数据要素的使用，从而改善艾滋病毒应对，包括艾滋病毒预防。Dalal等人调查了21个国家，收集了这些指南在国家层面实施的数据。在18个参与国（82%）中，所有这些国家都纳入了建议的艾滋病毒检测数据要素，而且几乎所有国家都解决了垂直传播问题。然而，只有一半提供了计算PrEP覆盖率的必要数据。由于法律障碍，阿片类激动剂维持治疗等减少危害服务仅在8个国家提供；其中，75%收集了所需的OAMT数据元素。这些发现突出了在全球实施世卫组织数字卫生指南方面的重大差距，特别是在预防措施监测和减少危害数据收集方面，强调了在加强艾滋病毒监测系统方面持续提供技术支持的重要性。同样，正在利用技术改善口服PrEP的使用。最近的研究侧重于确定以证据为基础的干预措施，以改善PrEP规划的依从性和保留性。Rotsaert等人进行的一项系统综述发现，双向文本提醒或POC替诺福韦检测结合HIV生物反馈咨询可提高孕妇和产后妇女口服PrEP的延续率[10]。虽然POC性传播感染检测不影响PrEP的开始或持续率，但STI诊断是PrEP摄取的预测因子。未来的PCC干预研究应探索风险认知、STI诊断、PrEP使用和药物水平反馈之间的相互作用。来自亚洲的两篇论文展示了如何将数字干预措施结合起来，提供实时的个性化艾滋病毒预防信息，并确定PrEP依从性的预测属性。旨在支持坚持或自我护理的移动健康（mHealth）应用程序可以根据用户提供的数据和偏好定制信息、建议和提醒。 包含自我监控和视觉反馈的移动健康应用程序有可能增加PrEP的使用。泰国的“支持你”倡议使用移动应用程序为年轻人，特别是性和性别少数群体提供以人为本的支持，在提供艾滋病毒传播工具包和基于文本的非评判性实时咨询的同时确保隐私（Sripanidkulchai等人）。通过高参与度证明了该规划的有效性：56%是首次测试者，未确诊的艾滋病毒患病率为3.6%，其中60.2%与护理有关。这一成功凸显了数字工具、社区参与、TikTok网红和量身定制的信息传递如何有效克服污名化和获得医疗保健的机会有限等障碍。基于这些移动医疗参与策略的证据，研究人员还利用机器学习技术来更好地理解和预测数字健康平台内的用户行为模式。一项针对移动健康应用程序的机器学习研究发现，年龄、PrEP使用累积量、避孕套使用情况以及与未使用PrEP的艾滋病毒阴性伴侣的肛交事件预测了台湾男性使用PrEP的情况（Liao等人）。以人为中心的数字卫生干预措施的使用正在迅速发展，将出现新的科学研究问题，即如何将其纳入常规临床护理并评估其对PrEP持久性的持续影响。在美国全球卫生计划史无前例的资金削减和重组之后，2025年全球艾滋病防治工作发生了非同寻常的变化。这种中断将严重影响PCC，导致服务减少、质量下降、客户负担增加和医疗保健系统能力减弱。来自低收入和中等收入国家的证据表明，患者体验恶化，自付费用增加，护理连续性中断。联合国艾滋病规划署预计，永久停止目前由总统防治艾滋病紧急救援计划支持的艾滋病毒规划将导致2025年至2029年期间新增660万艾滋病毒感染病例。在这种环境下，倡导增加资源、全球和国内支持、为艾滋病毒预防工作提供资金以及使捐助资源与当地需求保持一致至关重要。要在全面护理需求和财政限制之间取得平衡，就需要创新战略和合作伙伴关系。优先考虑高影响、高成本效益和社区主导的干预措施是PCC bbb可持续发展的关键。将以人为中心的艾滋病毒预防干预措施规模化需要一个综合战略，将生物医学、行为和社会干预措施整合到现有的医疗保健系统中[22,25]，同时积极地让社区参与服务的设计和提供。此外，在个人、社区和政策层面实施以证据为基础的艾滋病毒预防战略，例如将预防措施、抗逆转录病毒治疗和行为支持结合起来，以提高接受和坚持，对于提高人口层面的影响至关重要。同样重要的是，要解决阻碍获得保健的污名化和歧视问题。倡导增加资源，支持艾滋病毒预防工作，增加国内资金来源，并确保捐助资源符合当地需求，有助于确保PCC干预措施的可持续性。尽管有这些维持以人为本的艾滋病毒干预措施的策略，如移动健康应用程序、同伴导航、双向短信和POC检测，但长期资金不足、资金大幅减少和普遍存在的多层次耻辱等挑战继续对护理构成重大障碍。AM、IA和M-CL没有相互竞争的利益需要报告。所有作者都对手稿的构思和写作做出了贡献。所有作者审阅并批准了最终版本。这项工作没有收到任何资金。
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引用次数: 0
Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services 南非农村青年以人为本的艾滋病毒护理和预防：来自Thetha Nami的初步实施结果，以及在流动性健康服务中动员同伴导航员的新分步试验
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70032
Jacob Busang, Nqobile Ngoma, Thembelihle Zuma, Carina Herbst, Nonhlanhla Okesola, Natsayi Chimbindi, Jaco Dreyer, Theresa Smit, Kristien Bird, Lucky Mtolo, Osee Behuhuma, Willem Hanekom, Kobus Herbst, Limakatso Lebina, Janet Seeley, Andrew Copas, Kathy Baisley, Maryam Shahmanesh
<div> <section> <h3> Introduction</h3> <p>Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.</p> </section> <section> <h3> Methods</h3> <p><i>Thetha Nami ngithethe nawe</i> is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).</p> </section> <section> <h3> Results</h3> <p>Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; <i>p</i> < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; <i>p</i> < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.</p> </section> <section> <h3> Conclusions</h3> <p>Community-based and person-centred approaches delivered thr
尽管以抗逆转录病毒疗法（ART）为基础的预防有效，但人口水平的影响仍然有限，因为传统服务无法覆盖艾滋病毒感染高风险人群。我们调查了在南非夸祖鲁-纳塔尔省，以社区为基础的同伴导航员与性健康和生殖健康（SRH）服务一起提供的以青年为中心和量身定制的艾滋病毒预防是否可以调动青少年和年轻人（AYA）对艾滋病毒暴露前预防（PrEP）和抗逆转录病毒治疗的需求。方法采用聚类随机楔形试验（SWT）对某农村卫生人口监测点的40个聚类进行研究。分组随机分为第一阶段（早期）或第二阶段（延迟）接受干预。经过培训的地区同伴导览员对15-30岁的青年进行了需求评估，以量身定制健康宣传、社会心理支持和转诊到护士领导的流动性健康和生殖健康诊所，这些诊所还提供艾滋病毒检测、身份中立的抗逆转录病毒治疗和口服PrEP。我们报告了在SWT （NCT05405582）的第一阶段，20个干预集群的性健康健康服务吸收情况。结果2022年6月至2023年9月，在目标人群13000名青少年中，同行导航员达到9742人（74.9%），其中男性46.8%。在9576名进行需求评估的个体中，同伴导航员确定141人（1.5%）有社会需求，4138人（43.5%）有中高健康需求。这些人被转介到流动诊所，就诊人数为2269人（54.8%），其中男性959人（42.3%）。艾滋病毒检测使用率高（92.7%;2103/2269），其中10.1%（212/2103）为艾滋病毒检测阳性，其中62人（29.2%）为首次开始抗逆转录病毒治疗。女性的HIV感染率高于男性（15.1% vs. 3.3%; p < 0.001）。在临床参与者中，96.8%的人接受了PrEP资格筛查，38.5%的人认为符合条件并提供了PrEP。在接受性传播感染（STI）检测的1433人中（63.2%），418人（29.2%）检测呈阳性，女性的STI患病率更高（37.2% vs. 17.9%; p < 0.001）。其中，385人（92.1%）接受了性传播感染治疗。在1310名女性中，769名（58.7%）报告首次就诊时未使用任何避孕措施，275/769名（35.8%）在试验期间开始避孕。结论：通过训练有素的同伴导航员提供的以社区为基础和以人为本的方法可以将AYA与性健康生殖健康和艾滋病毒预防/护理需求与流动性健康生殖健康服务联系起来。
{"title":"Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services","authors":"Jacob Busang,&nbsp;Nqobile Ngoma,&nbsp;Thembelihle Zuma,&nbsp;Carina Herbst,&nbsp;Nonhlanhla Okesola,&nbsp;Natsayi Chimbindi,&nbsp;Jaco Dreyer,&nbsp;Theresa Smit,&nbsp;Kristien Bird,&nbsp;Lucky Mtolo,&nbsp;Osee Behuhuma,&nbsp;Willem Hanekom,&nbsp;Kobus Herbst,&nbsp;Limakatso Lebina,&nbsp;Janet Seeley,&nbsp;Andrew Copas,&nbsp;Kathy Baisley,&nbsp;Maryam Shahmanesh","doi":"10.1002/jia2.70032","DOIUrl":"https://doi.org/10.1002/jia2.70032","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;&lt;i&gt;Thetha Nami ngithethe nawe&lt;/i&gt; is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Community-based and person-centred approaches delivered thr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237385","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
Harnessing digital health data for person-centred HIV prevention monitoring: a survey of national health information systems 利用数字卫生数据进行以人为本的艾滋病毒预防监测：国家卫生信息系统调查
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70039
Shona Dalal, Bradley Mathers, Dominik Stelzle, Lilly M. Nyagah, Francis Agbo, Dennis Annang, Saiprasad Prabhakar Bhavsar, Stone Mbiriyawanda, Bongiwe Mhlanga, Tshepo Molapo, Lowrence Moro, Peter Mudiope, Linea Ngwali, Mwiche Siame Nyirenda, Isabel Sathane, Rajatashuvra Adhikary, Monica Alonso Gonzalez, Polin Chan, Annette Gerritsen, Kiyohiko Izumi, Giorgi Kuchukhidze, Antons Mozalevskis, Georges Perrin, Ahmed S. Alaama, Madidimalo Tebogo, Annette Verster, Daniel Low-Beer

Introduction

Measuring HIV prevention impact is challenging because prevention is started and stopped as needed, and individual-level data availability has been suboptimal or not collected. WHO's 2022 Consolidated guidelines on person-centred HIV strategic information aim to bridge this gap by recommending a minimum dataset for HIV prevention monitoring.

Methods

We surveyed the availability of 42 HIV prevention data elements collected on an individual from WHO's recommended minimum dataset in 21 countries’ national health information systems during a Prevention Outcome Monitoring Workshop held in September 2024 in Gaborone, Botswana. Over 150 participants representing ministries of health and programme implementers from 21 countries in Africa and Asia, as well as representatives from global organizations, attended. National HIV prevention managers completed the survey covering: registration (client demographics, use of unique identification, key population status), HIV testing, HIV prevention and vertical transmission. Data element availability determined which prevention indicators each country could calculate. Additionally, we describe global data on the use of unique identification for key populations.

Results

Of the 21 attending countries, 18 completed the survey. Fifteen countries (83%) used unique identification in their national health information systems. All 18 countries collected HIV testing data elements, while 14–18 countries (78–100%) collected those for vertical transmission. However, prevention data availability varied widely. Different data elements on pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) were collected by 13–17 (72–94%) countries, condoms by 15 (83%) and voluntary medical male circumcision by 11 (61%) countries. Data elements on harm reduction were available in 4–6 countries among 8–10 countries providing services. While all countries could calculate HIV testing indicators, around 90% could for vertical transmission, 50–94% for PrEP/PEP and 40–75% for harm reduction. Only two countries could calculate linkage to prevention, which incorporates all prevention interventions. Kenya was the only country that collected all recommended person-centred data elements. Overall, up to 37 of 105 reporting countries had a nationally harmonized personal unique identification method for key populations.

Conclusions

Data building blocks for HIV prevention exist in most n

衡量艾滋病毒预防影响具有挑战性，因为预防是根据需要开始和停止的，而且个人层面的数据可用性不够理想或没有收集。世卫组织2022年《以人为本的艾滋病毒战略信息综合指南》旨在通过建议艾滋病毒预防监测的最低数据集来弥合这一差距。在2024年9月在博茨瓦纳哈博罗内举行的预防结果监测研讨会期间，我们调查了在21个国家的国家卫生信息系统中从世卫组织推荐的最低数据集中收集的42个艾滋病毒预防数据要素的可获得性。来自非洲和亚洲21个国家的卫生部和方案执行者的150多名代表以及全球组织的代表出席了会议。全国艾滋病毒预防管理人员完成了调查，内容包括：登记（客户人口统计、使用唯一识别、关键人口状况）、艾滋病毒检测、艾滋病毒预防和垂直传播。数据要素的可得性决定了每个国家可以计算哪些预防指标。此外，我们还描述了使用关键种群的唯一标识的全球数据。结果在21个参与调查的国家中，有18个完成了调查。15个国家（83%）在其国家卫生信息系统中使用唯一标识。所有18个国家都收集了艾滋病毒检测数据要素，而14-18个国家（78% - 100%）收集了垂直传播数据要素。然而，预防数据的可用性差异很大。13-17个（72-94%）国家收集了接触前预防（PrEP）和接触后预防（PEP）的不同数据，15个（83%）国家收集了避孕套，11个（61%）国家收集了自愿接受男性割礼的数据。在提供服务的8-10个国家中，有4-6个国家提供了关于减少伤害的数据。虽然所有国家都可以计算艾滋病毒检测指标，但垂直传播方面的指标约为90%，PrEP/PEP方面的指标为50-94%，减少危害方面的指标为40-75%。只有两个国家可以计算与预防的联系，其中包括所有预防干预措施。肯尼亚是唯一收集了所有建议的以人为中心的数据要素的国家。总体而言，105个报告国家中有37个国家对关键人口采用了全国统一的个人唯一识别方法。结论：大多数国家卫生信息系统中存在预防艾滋病毒的数据模块。使这些系统与全球标准保持一致，有可能进一步加强以人为本的艾滋病毒预防监测。
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引用次数: 0
Empowering at-risk Thai adolescents and young adults: an observational study of “Stand By You” – a person-centred online service model for HIV self-screening, text-based counselling and linkage to care 授权有风险的泰国青少年和年轻人：一项关于“站在你身边”的观察性研究——这是一种以人为本的艾滋病毒自我筛查、基于文本的咨询和与护理联系的在线服务模式
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70040
Kantarida Sripanidkulchai, Supattra Rungmaitree, Yuitiang Durier, Theppharit Thiamprasert, Vitharon Boon-Yasidhi, Peerawong Werarak, Yenjit Somphoh, Pornvilai Urujchutchairut, Pichapun Pongsakul, Benjawan Khumcha, Alan Maleesatharn, Kulkanya Chokephaibulkit
<div> <section> <h3> Introduction</h3> <p>Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of Stand By You, a mobile application, in delivering HIV-related services to at-risk Thai AYAs.</p> </section> <section> <h3> Methods</h3> <p>Deidentified data from clients who accessed Stand By You services between August 2022 and February 2024 were analysed. HIV self-testing (HIVST) services were promoted through TikTok influencers to target AYAs vulnerable to HIV. An automated chatbot provided real-time responses to client inquiries, and trained counsellors provided confidential, text-based counselling daily. Clients who completed risk assessments received personalized recommendations for HIVST based on their risk profile. Clients who submitted their HIVST results received post-test counselling and linkage to care and prophylactic treatment. Multivariable logistic regression was used to assess risk factors for reactive HIVST kit results. The per unit direct cost of the programme's performance metrics were assessed.</p> </section> <section> <h3> Results</h3> <p>A total of 8863 clients provided 11,536 risk assessments. The majority were male (76.3%), under the age of 30 (76.0%), identified as members of key populations (60.4%) and first-time testers (56.1%). Additionally, 27.8% had a history of sexually transmitted infections (3,202/11,536), 16.5% reported receiving money or incentives for sex (1908/11,536) and clients indicated an average of 2.6 sexual partners in the past month (SD 3.4). Out of 7585 submitted HIVST results, 3.6% were reactive (<i>n</i> = 274); 60.2% were linked to care (<i>n</i> = 165/274) and 10.4% are in the process of linkage (<i>n</i> = 23/274). Of the 5.3% invalid results reported (<i>n</i> = 401/7585), nearly all were non-reactive by the second HIVST (117/187). A history of testing HIV negative (adjusted odds ratio [aOR] 0.54 [95% CI 0.40–0.72], <i>p</i> < 0.001) and receiving pre-exposure prophylaxis (aOR 0.20 [95% CI 0.06–0.64], <i>p</i> = 0.007) were independently associated with reduced odds of a reactive result. Average direct cost was $18.7, $40.3 and $1100 USD per distributed HIVST kit, first-time tester and new client linked to care, respectively.</p> </section> <section> <h3> Conclusions</h3> <p>AYA populations at risk for HIV can be effectively reached through mobile phone applications that provide services anonymously. Online strategies for HIVST delivery and supportiv
青少年和年轻成人（AYA）感染艾滋病毒的风险不成比例。以人为本的在线平台可以有效地为AYA提供艾滋病毒检测服务。我们评估了“支持你”（Stand By You）这一移动应用程序在向泰国有艾滋病毒风险的儿童助理提供艾滋病毒相关服务方面的有效性。方法分析2022年8月至2024年2月期间使用Stand By You服务的客户的身份数据。通过TikTok网红推广艾滋病毒自检服务，以针对易感染艾滋病毒的未成年人。一个自动聊天机器人对客户的询问提供实时回应，训练有素的咨询师每天提供保密的、基于文本的咨询。完成风险评估的客户根据其风险概况收到了针对艾滋病毒传播的个性化建议。提交艾滋病毒检测结果的客户获得了检测后咨询，并与护理和预防性治疗联系起来。多变量逻辑回归用于评估hiv检测结果的危险因素。评估了方案绩效指标的单位直接成本。结果共8863名客户提供了11,536份风险评估。大多数是男性（76.3%），30岁以下（76.0%），被确定为关键人群（60.4%）和首次测试者（56.1%）的成员。此外，27.8%的人有性传播感染史（3,202/11,536），16.5%的人报告接受金钱或奖励进行性行为（1908/11,536），客户表示在过去一个月平均有2.6个性伴侣（SD 3.4）。在7585份提交的hiv检测结果中，3.6%是反应性的（n = 274）；60.2%与护理相关（n = 165/274）， 10.4%处于相关过程中（n = 23/274）。在5.3%的无效结果报告（n = 401/7585）中，几乎所有的第二次hiv检测无反应（117/187）。HIV阴性检测史（校正比值比[aOR] 0.54 [95% CI 0.40-0.72], p < 0.001）和接受暴露前预防（aOR 0.20 [95% CI 0.06-0.64], p = 0.007）与反应性结果的几率降低独立相关。每个分发的艾滋病毒检测试剂盒、首次测试者和与护理相关的新客户的平均直接成本分别为18.7美元、40.3美元和1100美元。结论通过匿名提供服务的手机应用程序可以有效地接触到aids高危人群。提供艾滋病毒传播服务的在线战略和基于文本的支持性咨询可以产生高需求、高参与和与护理的成功联系。
{"title":"Empowering at-risk Thai adolescents and young adults: an observational study of “Stand By You” – a person-centred online service model for HIV self-screening, text-based counselling and linkage to care","authors":"Kantarida Sripanidkulchai,&nbsp;Supattra Rungmaitree,&nbsp;Yuitiang Durier,&nbsp;Theppharit Thiamprasert,&nbsp;Vitharon Boon-Yasidhi,&nbsp;Peerawong Werarak,&nbsp;Yenjit Somphoh,&nbsp;Pornvilai Urujchutchairut,&nbsp;Pichapun Pongsakul,&nbsp;Benjawan Khumcha,&nbsp;Alan Maleesatharn,&nbsp;Kulkanya Chokephaibulkit","doi":"10.1002/jia2.70040","DOIUrl":"https://doi.org/10.1002/jia2.70040","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of Stand By You, a mobile application, in delivering HIV-related services to at-risk Thai AYAs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Deidentified data from clients who accessed Stand By You services between August 2022 and February 2024 were analysed. HIV self-testing (HIVST) services were promoted through TikTok influencers to target AYAs vulnerable to HIV. An automated chatbot provided real-time responses to client inquiries, and trained counsellors provided confidential, text-based counselling daily. Clients who completed risk assessments received personalized recommendations for HIVST based on their risk profile. Clients who submitted their HIVST results received post-test counselling and linkage to care and prophylactic treatment. Multivariable logistic regression was used to assess risk factors for reactive HIVST kit results. The per unit direct cost of the programme's performance metrics were assessed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 8863 clients provided 11,536 risk assessments. The majority were male (76.3%), under the age of 30 (76.0%), identified as members of key populations (60.4%) and first-time testers (56.1%). Additionally, 27.8% had a history of sexually transmitted infections (3,202/11,536), 16.5% reported receiving money or incentives for sex (1908/11,536) and clients indicated an average of 2.6 sexual partners in the past month (SD 3.4). Out of 7585 submitted HIVST results, 3.6% were reactive (&lt;i&gt;n&lt;/i&gt; = 274); 60.2% were linked to care (&lt;i&gt;n&lt;/i&gt; = 165/274) and 10.4% are in the process of linkage (&lt;i&gt;n&lt;/i&gt; = 23/274). Of the 5.3% invalid results reported (&lt;i&gt;n&lt;/i&gt; = 401/7585), nearly all were non-reactive by the second HIVST (117/187). A history of testing HIV negative (adjusted odds ratio [aOR] 0.54 [95% CI 0.40–0.72], &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and receiving pre-exposure prophylaxis (aOR 0.20 [95% CI 0.06–0.64], &lt;i&gt;p&lt;/i&gt; = 0.007) were independently associated with reduced odds of a reactive result. Average direct cost was $18.7, $40.3 and $1100 USD per distributed HIVST kit, first-time tester and new client linked to care, respectively.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;AYA populations at risk for HIV can be effectively reached through mobile phone applications that provide services anonymously. Online strategies for HIVST delivery and supportiv","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237236","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
Enhancing PrEP adherence through person-centred mobile app interventions: a real-world data and machine learning approach using UPrEPU among gay, bisexual and other men who have sex with men in Taiwan 通过以人为中心的移动应用程序干预提高PrEP依从性：在台湾同性恋、双性恋和其他男男性行为者中使用UPrEPU的真实世界数据和机器学习方法
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-08 DOI: 10.1002/jia2.70033
Jay Chiehen Liao, Huei-Jiuan Wu, Tsan-Tse Chuang, Tsai-Wei Chen, Carol Strong

Introduction

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that relies on good adherence in high-risk scenarios. To understand the factors that predict adherence, technology such as mobile applications like UPrEPU—allowing for logging users’ daily behaviours at close to the time they have sex or PrEP intake—can be used as a person-centred, self-care intervention. This study aims to develop a machine learning model using logs of sexual activities and user attributes recorded in the UPrEPU mobile application in Taiwan to predict whether a sexual event was protected by oral PrEP among gay, bisexual and other men who have sex with men (GBMSM).

Methods

We used data from the UPrEPU app collected between January 2022 and May 2023 in Taiwan. The dataset included information on users’ sex events, such as the timing and users’ sex roles (e.g. versatile, receptive or insertive partner), and the dynamic user-based attributes related to sexual behaviours and PrEP use. Various subsets of these features were employed in CatBoost models to predict whether the sex events were associated with correct PrEP use. We evaluated the models’ performance using five-fold cross-validation. The influential features were identified through feature importance analysis and Shapley Additive Explanations (SHAP) values to explain the models.

Results

A total of 198 users recorded 2356 anal sex events on UPrEPU. The model with dynamic user-based attributes outperformed those without them. The most parsimonious model had a good prediction performance (accuracy = 75%, precision = 78%, recall = 90%, F1-score = 83%) and identified the key features of PrEP protection. The model with five dynamic user-based attributes—age, cumulative PrEP use, condom use and the proportion of anal sex events with HIV-negative partners not on PrEP—significantly outperformed the model based on event-level attributes alone.

Conclusions

Behavioural patterns significantly influence PrEP adherence among GBMSM. Person-centred mobile applications such as UPrEPU provide valuable data for tailored, just-in-time interventions, enhancing adherence. Recognizing these patterns can guide person-centred interventions. Incorporating these insights into clinical care or digital tools may improve consultations and support timely, informed HIV prevention decisions.

暴露前预防（PrEP）是一种有效的艾滋病毒预防工具，它依赖于在高危情况下的良好坚持。为了了解预测依从性的因素，可以使用诸如uprepu之类的移动应用程序（允许记录用户在性生活或PrEP摄入时间附近的日常行为）等技术作为以人为本的自我保健干预措施。本研究旨在开发一种机器学习模型，利用台湾UPrEPU移动应用程序中记录的性活动日志和用户属性，来预测同性恋、双性恋和其他男男性行为者（GBMSM）的性事件是否受到口服PrEP的保护。方法：我们使用了2022年1月至2023年5月在台湾收集的upu应用程序数据。该数据集包括关于用户性事件的信息，如时间和用户的性角色（如多变性、接受性或插入性伴侣），以及与性行为和PrEP使用相关的基于用户的动态属性。CatBoost模型使用这些特征的不同子集来预测性事件是否与正确使用PrEP相关。我们使用五重交叉验证来评估模型的性能。通过特征重要性分析和Shapley加性解释（SHAP）值对模型进行解释，确定影响特征。结果198名吸毒者在upu上记录了2356次肛交事件。具有基于用户的动态属性的模型优于没有这些属性的模型。最简洁的模型预测准确率为75%，精密度为78%，召回率为90%，f1评分为83%，能够准确识别PrEP防护的关键特征。该模型具有5个基于用户的动态属性——年龄、累积PrEP使用情况、安全套使用情况以及与未使用PrEP的hiv阴性伴侣进行肛交的比例——显著优于仅基于事件级属性的模型。结论行为方式对GBMSM的PrEP依从性有显著影响。以人为本的移动应用程序，如upupu，为量身定制的及时干预措施提供了宝贵的数据，提高了依从性。认识到这些模式可以指导以人为本的干预措施。将这些见解纳入临床护理或数字工具可以改善咨询，并支持及时、知情的艾滋病毒预防决策。
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引用次数: 0
Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey 赞比亚艾滋病毒感染者中高血压和糖尿病的患病率和危险因素：一项基于设施的全国性横断面调查的结果。
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-10-07 DOI: 10.1002/jia2.70051
Chomba Mandyata, Sivile Suilanji, Samuel Bosomprah, Paul Somwe, Cosmas Zyambo, Mwiche Musukuma, Aggrey Mweemba, Malizgani Paul Chavula, Chipefwe Sichilima, Phoebe Bwembya, Mpanji Siwingwa, Richard Chibale, Henry Phiri, Joseph Zulu, Halwindi Hikabasa, Wilbroad Mutale
<div> <section> <h3> Introduction</h3> <p>Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia.</p> </section> <section> <h3> Methods</h3> <p>We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR).</p> </section> <section> <h3> Results</h3> <p>In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3−23.6), 26.7% (CI: 25.5−27.9) and 12.5% (CI: 11.6−13.4), respectively. In the multivariable model, being 30–44 (PR = 2.1; CI: 1.5−2.9), 45–49 (PR = 3.3; CI: 2.4−4.7) and 60 years or older (PR = 4.7; CI: 3.3−6.8) compared to those aged 18–29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2−1.5) and obese (PR = 1.9; CI: 1.6−2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3−3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4−3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1−1.6) and obese (PR = 1.6; CI: 1.3−2.0), compared to those with normal weight, showed a significant association with diabetes mellitus.</p> </section> <section> <h3> Conclusions</h3> <p>The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate t
导言：尽管越来越多的证据表明撒哈拉以南非洲地区非传染性疾病（NCDs）的负担日益加重，但赞比亚艾滋病毒感染者（PLHIV）中高血压、前驱糖尿病和糖尿病的全国患病率在很大程度上是未知的。本研究旨在确定赞比亚成人艾滋病毒感染者中高血压和糖尿病的全国患病率及其相关危险因素。方法：我们在赞比亚52个农村和城市地区的149个抗逆转录病毒治疗（ART）诊所进行了一项横断面研究，该研究基于世界卫生组织（WHO）非传染性疾病风险因素监测逐步方法（STEPS）和赞比亚基于人口的艾滋病毒影响评估（ZAMPHIA）问卷。我们采用按比例抽样的方法选择地区和诊所，目标是5775名艾滋病毒携带者。数据收集时间为2023年10月1日至2023年11月30日。我们估计了高血压和糖尿病的患病率，并使用稳健泊松回归分析与社会人口统计学、行为和hiv相关危险因素以及报告患病率（PR）的关联。结果：在最终分析中，我们纳入了来自全国52个地区和149个ART诊所的5204名参与者，其中67.2%为女性，71.3%来自城市地区。高血压、前驱糖尿病和糖尿病的患病率分别为22.5%（95%可信区间[CI]: 21.3-23.6）、26.7% （CI: 25.5-27.9）和12.5% （CI: 11.6-13.4）。在多变量模型中，与18-29岁相比，30-44岁（PR = 2.1, CI: 1.5-2.9）、45-49岁（PR = 3.3, CI: 2.4-4.7）和60岁及以上（PR = 4.7, CI: 3.3-6.8）；丧偶、离婚或分居的人与从未结婚的人相比；与正常体重相比，体重超重（PR = 1.4; CI: 1.2-1.5）和肥胖（PR = 1.9; CI: 1.6-2.1）与高血压相关。受过大专或大学教育的艾滋病毒感染者（PR = 2.1; CI: 1.3-3.4）与没有受过正规教育的人相比；高总胆固醇≥6.2 mmol/l （PR = 2.2; CI: 1.4-3.6）与理想总胆固醇(结论：赞比亚PLHIV患者中高血压和糖尿病的患病率非常高。这强调了需要立即采取强有力的干预策略，以减轻高血压和糖尿病的高患病率，以及相关的危险因素，特别是在这一弱势人口群体中。
{"title":"Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey","authors":"Chomba Mandyata,&nbsp;Sivile Suilanji,&nbsp;Samuel Bosomprah,&nbsp;Paul Somwe,&nbsp;Cosmas Zyambo,&nbsp;Mwiche Musukuma,&nbsp;Aggrey Mweemba,&nbsp;Malizgani Paul Chavula,&nbsp;Chipefwe Sichilima,&nbsp;Phoebe Bwembya,&nbsp;Mpanji Siwingwa,&nbsp;Richard Chibale,&nbsp;Henry Phiri,&nbsp;Joseph Zulu,&nbsp;Halwindi Hikabasa,&nbsp;Wilbroad Mutale","doi":"10.1002/jia2.70051","DOIUrl":"10.1002/jia2.70051","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3−23.6), 26.7% (CI: 25.5−27.9) and 12.5% (CI: 11.6−13.4), respectively. In the multivariable model, being 30–44 (PR = 2.1; CI: 1.5−2.9), 45–49 (PR = 3.3; CI: 2.4−4.7) and 60 years or older (PR = 4.7; CI: 3.3−6.8) compared to those aged 18–29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2−1.5) and obese (PR = 1.9; CI: 1.6−2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3−3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4−3.6), versus desirable total cholesterol (&lt;5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1−1.6) and obese (PR = 1.6; CI: 1.3−2.0), compared to those with normal weight, showed a significant association with diabetes mellitus.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate t","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237491","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
Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda 传统治疗师可以帮助促进艾滋病毒血清状态披露：来自乌干达农村定性研究的结果
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-09-25 DOI: 10.1002/jia2.70031
Srija Gogineni, Gabriel Nuwagaba, Misha Hooda, Sylvia Natukunda, Constance Birungi, William Bugeza, Maureen Tushabe, Denis Nansera, Winnie Muyindike, Carolyn Marie Audet, Juliet Mwanga-Amumpaire, Radhika Sundararajan
<div> <section> <h3> Introduction</h3> <p>In Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda.</p> </section> <section> <h3> Methods</h3> <p>This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices.</p> </section> <section> <h3> Results</h3> <p>Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH.</p> </section> <section> <h3> Conclusions</h3> <p>THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.</p> </section>
在乌干达，艾滋病毒相关的污名和歧视仍然是艾滋病毒护理参与和血清状态披露的主要障碍。虽然披露血清状态可以改善艾滋病毒护理的可及性、参与性和保持性，但由于担心负面后果，许多艾滋病毒感染者不愿披露。传统治疗师是值得信赖的社区成员，提供可获得和保密的社会心理支持。本研究探讨了THs在促进乌干达西南部脱离临床护理的艾滋病毒感染状况披露中的作用。方法本定性子研究嵌套于一项聚类随机试验中，该试验评估了这种方法支持乌干达西南部艾滋病毒护理的PLWH的有效性。从2023年8月至2024年6月，对22名治疗师（14名女性）和16名PLWH（10名女性）进行了深入的半结构化个人访谈。访谈探讨了艾滋病毒护理的经验和治疗者促进的支持，以参与并继续从事艾滋病毒护理。数据按主题进行了分析，特别注意血清状态披露做法。结果：(1)基于信任、保密性和个性化护理的考虑，接受人工授理服务的艾滋病患者比医护人员更倾向于使用人工授理服务；(2)与艾滋病毒相关的耻辱和对家庭暴力的恐惧阻碍了家庭内部的披露，但向治疗师披露提供了更安全的选择；(3)在某些情况下，这是PLWH首先向其披露其身份的个人；(4)积极鼓励和促进PLWH向家庭成员披露病情，提供指导和调解困难的谈话。这些发现强调了这种方法在减少信息披露障碍和促进支持性网络以改善艾滋病患者生活质量方面的关键作用。结论：这为乌干达农村地区的艾滋病毒状况披露提供了一种具有文化敏感性和可信赖的途径。他们在社区中的独特地位使他们能够消除耻辱，建立信任并促进安全的披露做法。通过培训和与正规卫生保健系统的合作，将治疗人员纳入艾滋病毒护理，可以加强艾滋病病毒卫生保健机构的联系、依从性、保留性和总体护理结果。未来的研究应该探索可扩展的模型，以利用这种方法的积极影响和潜力来改善艾滋病毒护理服务。
{"title":"Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda","authors":"Srija Gogineni,&nbsp;Gabriel Nuwagaba,&nbsp;Misha Hooda,&nbsp;Sylvia Natukunda,&nbsp;Constance Birungi,&nbsp;William Bugeza,&nbsp;Maureen Tushabe,&nbsp;Denis Nansera,&nbsp;Winnie Muyindike,&nbsp;Carolyn Marie Audet,&nbsp;Juliet Mwanga-Amumpaire,&nbsp;Radhika Sundararajan","doi":"10.1002/jia2.70031","DOIUrl":"https://doi.org/10.1002/jia2.70031","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146479","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
Artificial intelligence for HIV care: a global systematic review of current studies and emerging trends 人工智能用于艾滋病毒护理：当前研究和新趋势的全球系统综述
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-09-24 DOI: 10.1002/jia2.70045
Sanele Ngcobo, Edith Madela Mntla, Jonathan Shock, Murray Louw, Linda Mbonambi, Thato Serite, Theresa Rossouw
<div> <section> <h3> Introduction</h3> <p>Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The present review aimed to systematically identify, map and synthesize studies on the use of AI methods across the HIV care continuum, including applications in HIV testing and linkage to care, treatment monitoring, retention in care, and management of clinical and immunological outcomes.</p> </section> <section> <h3> Methods</h3> <p>A comprehensive literature search was conducted across databases, including PubMed and ProQuest Central, Scopus and Web of Science, covering studies published between 2014 and 2024. The review followed PRISMA guidelines, screening 3185 records, of which 47 studies were included in the final analysis.</p> </section> <section> <h3> Results</h3> <p>Forty-seven studies were grouped into four thematic areas: (1) HIV testing, AI models improved diagnostic accuracy, with ML achieving up to 100% sensitivity and 98.8% specificity in self-testing and outperforming human interpretation of rapid tests; (2) Retention in care and virological response, ML predicted clinic attendance, viral suppression and virological failure (72–97% accuracy; area under the curve up to 0.76), enabling early identification of high-risk patients; (3) Clinical and immunological outcomes, AI predicted disease progression, immune recovery, comorbidities and HIV complications, achieving up to 97% CD4 status accuracy and outperforming clinicians in tuberculosis diagnosis; (4) Testing and treatment support, AI chatbots improved self-testing uptake, linkage to care and adherence support. Methods included random forests, neural networks, support vector machines, deep learning and many others.</p> </section> <section> <h3> Discussion</h3> <p>AI has the potential to transform HIV care by improving early diagnosis, treatment adherence and retention in care. However, challenges such as data quality, infrastructure limitations and ethical considerations must be addressed to ensure successful implementation.</p> </section> <section> <h3> Conclusions</h3> <p>AI has demonstrated immense potential to address gaps in HIV care, improving diagnostic accuracy, enhancing retention strategies and supporting effective treatment monitoring. These advancements contribute towards achieving the UNAIDS 95-95-95 targets. However, challenges
人工智能（AI），特别是机器学习（ML）已经成为艾滋病毒护理领域的变革性工具，推动了诊断、治疗监测和患者管理方面的进步。本综述旨在系统地识别、绘制和综合有关在艾滋病毒护理连续体中使用人工智能方法的研究，包括在艾滋病毒检测和与护理的联系、治疗监测、保留护理以及临床和免疫结果管理中的应用。方法综合检索PubMed、ProQuest Central、Scopus、Web of Science等数据库，检索2014 - 2024年间发表的研究成果。审查遵循PRISMA指南，筛选了3185份记录，其中47份研究被纳入最终分析。结果47项研究分为四个主题领域：(1)人工智能模型提高了HIV检测的诊断准确性，ML在自我检测中达到100%的灵敏度和98.8%的特异性，优于快速检测的人工解释；(2)留用治疗和病毒学应答，ML预测临床就诊、病毒抑制和病毒学失败（准确率72-97%，曲线下面积达0.76），能够早期识别高危患者；(3)临床和免疫学结果，AI预测疾病进展、免疫恢复、合并症和HIV并发症，CD4状态准确率高达97%，在结核病诊断方面优于临床医生；(4)测试和治疗支持，AI聊天机器人提高了自我测试的接受程度，与护理的联系和依从性支持。方法包括随机森林、神经网络、支持向量机、深度学习等。人工智能有可能通过改善早期诊断、治疗依从性和保留治疗来改变艾滋病毒护理。然而，必须解决数据质量、基础设施限制和道德考虑等挑战，以确保成功实施。人工智能在解决艾滋病毒护理差距、提高诊断准确性、加强保留策略和支持有效治疗监测方面显示出巨大潜力。这些进展有助于实现艾滋病规划署95-95-95目标。然而，数据质量和医疗系统集成等挑战仍然存在。未来的研究应优先考虑适合高负担、资源有限环境的可扩展人工智能解决方案，以最大限度地发挥其对全球艾滋病毒护理的影响。普洛斯彼罗编号普洛斯彼罗2024 CRD42024517798可从：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024517798
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引用次数: 0
Impact of the Anti-Homosexuality Act on HIV service delivery in Uganda: Evidence from community-led monitoring 《反同性恋法》对乌干达艾滋病毒服务的影响：来自社区主导监测的证据
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-09-12 DOI: 10.1002/jia2.70030
Allan Nsubuga, Frank Mugisha, Beatrice Ajonye, Kenneth Mwehonge, Elise Lankiewicz, Patrick Drake, Esther Joan Kilande, Alice Kayongo, Alana R. Sharp
<div> <section> <h3> Introduction</h3> <p>In 2023, the Ugandan government enacted the Anti-Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same-sex relations. While arrests, harassment and violence have been reported, evidence of the AHA's impact on HIV healthcare delivery is limited. Community-led monitoring (CLM) is an accountability mechanism that uses community-gathered evidence to advocate for improved healthcare quality and is well-positioned to describe changes in access and quality of care.</p> </section> <section> <h3> Methods</h3> <p>Data from the CLM programme in Uganda were used to identify changes in healthcare delivery and use related to the AHA. As part of the CLM programme, routine survey data were collected from clients and managers in 320 public health facilities and 50 drop-in centres (DICs) from 2022 to 2024. Survey data were analysed using a difference-in-differences logistic model to measure changes in indicator measures before and after the AHA was signed into law. Seven semi-structured individual interviews were conducted with DIC facility managers, deductively coded and thematically analysed.</p> </section> <section> <h3> Results</h3> <p>In public health facilities and DICs, the proportion of respondents identified as men who have sex with men (MSM) declined significantly after AHA. In facilities, all categories of key populations (KPs) reported high levels of discrimination. After the AHA, MSM reported significant reductions in key HIV-related services compared to other populations, including lower rates of pre-exposure prophylaxis (PrEP) counselling, lower participation in support groups and having fewer friendly staff interactions. In DICs, all types of clients were less likely to be referred to health facilities, receive PrEP and find the DIC easy to access after the AHA was signed. DIC managers described experiencing harassment, violence and staffing challenges due to AHA, which they responded to by leveraging partnerships with local and global allies, providing virtual services, and seeking registration as full-service clinics.</p> </section> <section> <h3> Conclusions</h3> <p>Data from the Uganda CLM programme provide an early view of the impact of the AHA on service delivery in public health facilities and DICs. While DICs and health facilities developed strategies to build resiliency and adapt, the AHA created significant barriers to care. These findings provide empirical warnings of the barriers experienced by KPs when accessing healthcare services in a criminaliz
2023年，乌干达政府颁布了《反同性恋法案》（AHA），其中包括扩大和加强对双方同意的同性关系的刑事处罚。虽然有逮捕、骚扰和暴力的报道，但证明美国艾滋病协会对艾滋病毒保健服务的影响的证据有限。社区主导的监测（CLM）是一种问责机制，它使用社区收集的证据来倡导改善医疗保健质量，并且很好地描述了在获取和医疗质量方面的变化。方法使用乌干达CLM项目的数据来确定与AHA相关的医疗服务和使用的变化。作为CLM方案的一部分，从2022年至2024年从320个公共卫生设施和50个救助中心的客户和管理人员那里收集了常规调查数据。使用差异中的差异逻辑模型对调查数据进行分析，以测量AHA签署成为法律之前和之后指标测量的变化。与DIC设施经理进行了七次半结构化的个人访谈，演绎编码和主题分析。结果在公共卫生机构和社区卫生中心，经AHA治疗后被确定为男男性行为者（MSM）的受访者比例显著下降。在设施中，所有类别的关键人群（KPs）都报告受到高度歧视。在美国心脏协会之后，与其他人群相比，男男性行为者报告的主要艾滋病毒相关服务显著减少，包括接触前预防（PrEP）咨询的比例降低，支持小组的参与减少以及友好的工作人员互动减少。在DIC中，所有类型的客户都不太可能被转介到卫生设施，接受PrEP，并且在AHA签署后发现DIC容易获得。DIC的管理人员描述了由于AHA而遭受的骚扰、暴力和人员配备方面的挑战，他们通过与当地和全球盟友建立伙伴关系，提供虚拟服务，并寻求注册为全方位服务诊所来应对这些挑战。结论：来自乌干达CLM方案的数据提供了AHA对公共卫生设施和社区中心服务提供的影响的初步看法。虽然地区中心和卫生机构制定了建立复原力和适应能力的战略，但美国卫生协会却在护理方面设置了重大障碍。这些发现提供了经验警告，当在刑事定罪的背景下获得医疗保健服务时，KPs所经历的障碍。
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