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“Will you need this health at all? Will you be alive?”: using the bioecological model of mass trauma to understand HIV care experiences during the war in Ukraine "你还需要这种健康吗?你还能活着吗?":利用大规模创伤的生物生态学模型来理解乌克兰战争期间的艾滋病护理经验
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-19 DOI: 10.1002/jia2.26307
Jill Owczarzak, Olivia Monton, Shannon Fuller, Julia Burlaka, Tetiana Kiriazova, Olga Morozova, Kostyantyn Dumchev
<div> <section> <h3> Introduction</h3> <p>Russia's invasion of Ukraine in February 2022 has severely impacted the healthcare system, including the provision of HIV care. The ongoing war is a human-caused mass trauma, a severe ecological and psychosocial disruption that greatly exceeds the coping capacity of the community. The bioecological model of mass trauma builds on Bronfenbrenner's concept of interaction between nested systems to argue that social context determines the impact of life events on the individual and how an individual responds. This paper uses the bioecological model of mass trauma to explore the impact of Russia's aggression against Ukraine and the ongoing war on HIV-positive people who use drugs in Ukraine, a particularly vulnerable population that may be negatively affected by disruptions to social networks, healthcare infrastructure and economic conditions caused by mass trauma.</p> </section> <section> <h3> Methods</h3> <p>Data were collected between September and November 2022. A convenience sample of 18 HIV-positive people who use drugs were recruited from community organizations that work with people living with HIV, drug treatment programmes, and HIV clinics through direct recruitment and participant referral. A total of nine men and nine women were recruited; the age ranged from 33 to 62 years old (mean = 46.44). Participants completed a single interview that explored how the war had affected their daily lives and access to HIV care and other medical services; their relationships with healthcare providers and social workers; and medication access, supply and adherence. Data were analysed using the Framework Method for thematic analysis.</p> </section> <section> <h3> Results</h3> <p>The war had a profound impact on the social, emotional and financial support networks of participants. Changes in social networks, coupled with limited job opportunities and rising prices, intensified financial difficulties for participants. Relocating to different regions of Ukraine, staying at somebody else's home, and losing connections with social workers impacted medication adherence and created lengthy treatment gaps. Participants also experienced a decreased supply of antiretroviral therapy, concerns about accessing medication for opioid use disorder, and overwhelming fears associated with the war, which overshadowed their HIV-related health concerns and negatively impacted medication adherence.</p> </section> <section> <h3> Conclusions</h3> <p>Our analysis reveals the complex impact of war on social networks and healthcare access. Main
导言俄罗斯于 2022 年 2 月入侵乌克兰,严重影响了乌克兰的医疗保健系统,包括提供艾滋病护理服务。持续不断的战争是人为造成的大规模创伤,是严重的生态和社会心理破坏,大大超出了社区的应对能力。大规模创伤的生物生态模型建立在布朗芬布伦纳的嵌套系统之间相互作用的概念之上,认为社会环境决定了生活事件对个人的影响以及个人如何应对。本文采用大规模创伤的生物生态学模型来探讨俄罗斯对乌克兰的侵略和正在进行的战争对乌克兰 HIV 阳性吸毒者的影响,乌克兰的 HIV 阳性吸毒者是一个特别脆弱的群体,他们可能会受到大规模创伤对社会网络、医疗基础设施和经济条件造成的破坏的负面影响。 方法 数据收集于 2022 年 9 月至 11 月。通过直接招募和参与者转介的方式,从与艾滋病病毒感染者合作的社区组织、戒毒治疗项目和艾滋病诊所招募了 18 名艾滋病病毒呈阳性的吸毒者。其中男性 9 人,女性 9 人;年龄在 33 岁至 62 岁之间(平均年龄为 46.44 岁)。参与者完成了一次访谈,探讨了战争如何影响了他们的日常生活以及获得艾滋病护理和其他医疗服务的机会;他们与医疗服务提供者和社会工作者的关系;以及药物的获取、供应和坚持服用。数据分析采用了专题分析框架法。 结果 战争对参与者的社会、情感和经济支持网络产生了深远影响。社会网络的变化,加上就业机会有限和物价上涨,加剧了参与者的经济困难。搬迁到乌克兰的不同地区、住在别人家里以及失去与社会工作者的联系都影响了服药,造成了长时间的治疗空白。此外,参与者还经历了抗逆转录病毒疗法供应减少、对阿片类药物使用障碍用药的担忧,以及与战争相关的巨大恐惧,这些都给他们与艾滋病相关的健康问题蒙上了阴影,并对坚持用药产生了负面影响。 结论 我们的分析揭示了战争对社会网络和医疗服务的复杂影响。在持续不断的战争中,保持支持网络和合格的医疗服务提供者至关重要。
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引用次数: 0
An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine 对乌克兰 "消除艾滋病毒服务方面的人权障碍 "倡议的实施情况进行评估
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-19 DOI: 10.1002/jia2.26328
Diederik Lohman, Yevheniia Kononchuk, Alexandrina Iovita, Mikhail Golichenko, Valeria Rachinska, Pavlo Skala, Olga Gvozdetska, Serhii Myroniuk, Joseph J. Amon
<div> <section> <h3> Introduction</h3> <p>Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.</p> </section> <section> <h3> Methods</h3> <p>An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.</p> </section> <section> <h3> Results</h3> <p>Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy (“know your rights”); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.</p> </section> <section> <h3> Conclusions</h3> <p>An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a ro
导言 全球范围内,在获得艾滋病毒治疗和预防方面存在着严重的不平等。东欧和中亚地区是世界上新感染艾滋病毒和死亡人数上升最快的地区,其治疗和预防服务的普及率很低,尤其是重点人群和易感人群,他们在艾滋病毒的预防和治疗方面面临着一系列与人权相关的障碍。 方法 采用实施学习评价方法,检查针对乌克兰重点人群和易感人群的 "打破障碍 "倡议的实施情况。在 2022 年 9 月至 2023 年 4 月期间,研究人员对来自乌克兰政府、执行组织和人权专家的 23 名关键信息提供者进行了访谈。研究人员和关键信息提供者采用并行三角测量设计,在共同创造的过程中,试图描述 2021 年至 2023 年(包括俄罗斯 2022 年 2 月全面入侵前后)期间计划实施的成就、挑战和创新。 成果 在全球基金计划文件和关键信息提供者访谈中确定了八项与艾滋病毒有关的基于权利的干预措施,这些措施构成了乌克兰 "打破障碍 "倡议的核心。这些方案旨在:消除羞辱和歧视;确保无歧视地提供医疗服务;促进基于权利的执法做法;扩大法律扫盲("了解你的权利");增加诉诸司法的机会;改进法律、法规和政策;减少性别歧视、有害的性别规范以及暴力侵害妇女和女童行为;动员社区进行宣传。这些计划获得了 590 万美元的资助。主要信息提供者报告说,在俄罗斯入侵之前和之后,在消除人权障碍和扩大干预规模方面取得了重大进展。计划实施者采用了创新方法,包括使用律师助理、热线电话和其他社区主导的干预措施,以确保包括流离失所者在内的关键和弱势群体能够获得预防和护理服务。 结论 采取执行学习评价方法,审查解决艾滋病毒服务人权障碍的方案,将其设计为研究人员、 方案执行人员、政府官员和人权专家之间的共同创造过程,可以对方案产出、成果和影响证 据进行有力的评估,尽管业务环境充满挑战。
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引用次数: 0
A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan 采用公民科学方法开发数字化干预措施,以减少青少年和年轻成人对艾滋病毒的污名化并促进艾滋病毒的自我检测:来自哈萨克斯坦的混合方法分析
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-19 DOI: 10.1002/jia2.26314
Alissa Davis, Susan L. Rosenthal, Joseph D. Tucker, Olga Balabekova, Laura Nyblade, Yihang Sun, Denis Gryazev, Karsten Lunze, Sara E. Landers, Weiming Tang, Azamat Kuskulov, Valera Gulyayev, Assel Terlikbayeva, Sholpan Primbetova, Gaukhar Mergenova, the JasSpark Study Team
<div> <section> <h3> Introduction</h3> <p>Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.</p> </section> <section> <h3> Methods</h3> <p>From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (<i>n</i> = 23), healthcare professionals (<i>n</i> = 12), and representatives from the local government and non-governmental organizations (<i>n</i> = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.</p> </section> <section> <h3> Results</h3> <p>We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (<i>n</i> = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (<i>n</i> = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (<i>n</i> = 36/96, 37.5%), image (<i>n</i> = 28/96, 29.2%) and text (<i>n</i> = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.</p> </section> <section> <h3> Conclusions</h3> <p>Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex healt
导言 哈萨克斯坦是世界上艾滋病毒流行病增长最快的国家之一,青少年中的感染率不断上升。需要采取创新战略来提高艾滋病检测率,减少青少年和年轻人对艾滋病的污名化。公民科学的定义是公众积极参与科学研究任务,它促进并推动社区参与整个研究过程。这项公民科学研究采用众包的方式,让哈萨克斯坦的青壮年参与到开发数字干预措施中来,以减少对艾滋病病毒的污名化并促进艾滋病病毒的自我检测。我们在本文中的目标是描述所使用的方法、其可行性和可接受性,以及青壮年参与这项研究的动机和经验教训。 方法 从 2021 年 10 月到 2022 年 7 月,我们与社区合作研究委员会和青年顾问委员会合作,公开征集多媒体作品,以减少 HIV 检测污名化。符合条件的作品按年龄组(13-19 岁或 20-29 岁)进行分类,并由一个由青少年(23 人)、医疗保健专业人员(12 人)以及当地政府和非政府组织代表(17 人)组成的小组进行评审。每份参赛作品至少由四名评委评审,并按 5 分制进行排名。公开征集活动的前 20 名参赛者被要求提交自我录音,分享他们参加比赛的动机、经验和教训。对定量数据进行了描述性统计。定性数据采用开放式编码。 结果 我们收到了来自哈萨克斯坦 77 名青年的 96 份参赛作品。大约四分之三(n = 75/96)的参赛作品符合评审标准。在符合条件的参赛作品中,超过一半(n = 39/75)的作品在 5 分制中获得了 3.5 分或更高的分数(70.0%)。最常见的参赛作品类型是视频(n = 36/96,37.5%)、图片(n = 28/96,29.2%)和文字(n = 24/96,25.0%)。青少年协会合作开展研究的主要动机包括改善社会和帮助青少年的愿望。主要的挑战包括用简单的语言创建内容以处理复杂的信息、在网上寻找可靠的信息以及技术限制。 结论 众包是可行的,而且在哈萨克斯坦的青少年中接受度很高。公民科学方法在应对当今社区面临的日益复杂的健康和社会挑战方面大有可为。
{"title":"A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan","authors":"Alissa Davis,&nbsp;Susan L. Rosenthal,&nbsp;Joseph D. Tucker,&nbsp;Olga Balabekova,&nbsp;Laura Nyblade,&nbsp;Yihang Sun,&nbsp;Denis Gryazev,&nbsp;Karsten Lunze,&nbsp;Sara E. Landers,&nbsp;Weiming Tang,&nbsp;Azamat Kuskulov,&nbsp;Valera Gulyayev,&nbsp;Assel Terlikbayeva,&nbsp;Sholpan Primbetova,&nbsp;Gaukhar Mergenova,&nbsp;the JasSpark Study Team","doi":"10.1002/jia2.26314","DOIUrl":"https://doi.org/10.1002/jia2.26314","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.&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;From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (&lt;i&gt;n&lt;/i&gt; = 23), healthcare professionals (&lt;i&gt;n&lt;/i&gt; = 12), and representatives from the local government and non-governmental organizations (&lt;i&gt;n&lt;/i&gt; = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.&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;We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (&lt;i&gt;n&lt;/i&gt; = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (&lt;i&gt;n&lt;/i&gt; = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (&lt;i&gt;n&lt;/i&gt; = 36/96, 37.5%), image (&lt;i&gt;n&lt;/i&gt; = 28/96, 29.2%) and text (&lt;i&gt;n&lt;/i&gt; = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.&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;Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex healt","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“…because the social work never ends”: a qualitative study exploring how NGOs responded to emerging needs while upholding responsibility to HIV prevention and treatment during the war in Ukraine "......因为社会工作永无止境":一项定性研究,探讨在乌克兰战争期间,非政府组织如何应对新出现的需求,同时坚持艾滋病毒预防和治疗的责任
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-19 DOI: 10.1002/jia2.26309
Lisa Lazarus, Leigh M McClarty, Nicole Herpai, Daria Pavlova, Tatiana Tarasova, Anna Gnatenko, Tetiana Bondar, Robert Lorway, Marissa L Becker, the Dynamics Study Team

Introduction

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

Methods

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

Results

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

Conclusions

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

导言:自 2022 年 2 月 24 日俄罗斯入侵以来,乌克兰的卫生系统承受了巨大压力,关键基础设施遭到破坏,人力资源大量流失,人员流动受到限制,供应链严重中断。基于奥列克山德-亚雷缅科之后乌克兰社会研究所(UISR after O. Yaremenko)与马尼托巴大学全球公共卫生研究所之间的长期合作关系,我们探讨了全面战争对为乌克兰主要人口群体提供服务的非政府组织(包括慈善组织)的影响。 方法 我们对乌克兰各地为关键人群(即艾滋病毒感染者、性工作者、男男性行为者、注射毒品者和变性者)提供服务的非政府组织的主要代表进行了深入的定性访谈。在 O. Yaremenko 之后,研究所研究小组成员从国家、地区和地方各级组织中招募了参与者。研究小组成员在 2023 年 5 月 15 日至 6 月 7 日期间进行了 26 次访谈(22 次为女性,4 次为男性)。访谈以乌克兰语进行,并通过解释性分析得出关键主题。 结果 应用 Roels 等人提出的 "第一响应者 "概念,我们的研究结果探讨了全面战争如何对乌克兰非政府组织工作人员的个人和组织产生影响。尽管参与者的身心健康受到了影响,但前线工作者仍继续支持艾滋病的预防和治疗,同时也满足了客户和更广泛社区对人道主义援助的需求。此外,尽管工作报酬和补偿不足,前线工作者还是承担了额外的责任,从而在战争的特殊条件下超出了正常的工作量。 结论 在战争等结构性冲击期间,非政府组织发挥着重要的应对作用,调整其服务以满足社 区的紧急需求。当务之急是为非政府组织提供充足的资源,支持其为关键人群提供服务,并加大对其在人道主义援助中的重要作用的支持力度。
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引用次数: 0
Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study 哈萨克斯坦艾滋病毒感染者的心理健康和认知与坚持抗逆转录病毒疗法的关系:横断面研究
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-18 DOI: 10.1002/jia2.26320
Gaukhar Mergenova, Alissa Davis, Louisa Gilbert, Nabila El-Bassel, Assel Terlikbayeva, Sholpan Primbetova, Zhamilya Nugmanova, Andrea Norcini Pala, Deborah Gustafson, Susan L. Rosenthal, Alfiya Y. Denebayeva, Jack DeHovitz
<div> <section> <h3> Introduction</h3> <p>There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.</p> </section> <section> <h3> Methods</h3> <p>We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.</p> </section> <section> <h3> Results</h3> <p>Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (<i>n</i> = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, <i>p</i> < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, <i>p</i> < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, <i>p</i> < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, <i>p</i> < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, <i>p</i> < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, <i>p</i> < 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, <i>p</i> < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, <i>p</i> < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, <i>p</i> < 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, <i>p</i> < 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, <i>p</i> < 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, <i>p</i> < 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, <i>p</i> < 0.005) symptoms had lower ASES scores.</p> </section> <section> <h3> Conclusions</h3> <p>Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness w
导言:在哈萨克斯坦,心理健康和认知与艾滋病病毒感染者(PLWH)坚持抗逆转录病毒治疗(ART)之间存在研究空白。 方法 我们从阿拉木图市艾滋病中心登记处(2019 年 6 月至 11 月)随机挑选并招募了 230 名艾滋病病毒感染者参与横断面研究。我们研究了最近1周和2周自我报告的抗逆转录病毒疗法依从性、依从自我效能量表(ASES)与抑郁症状(患者健康问卷-9 [PHQ-9])、焦虑(广泛性焦虑症工具 [GAD-7])、创伤后应激障碍(创伤后应激障碍清单 [PTSD])、认知功能(PROMIS v2.0 成人认知功能 8a 短表)和遗忘(遗忘评估量表)之间的关联。PHQ-9 和 GAD-7 的症状严重程度≥5 为轻度,≥10 为中度;创伤后应激障碍的症状严重程度≥44 为中度。采用逻辑和线性回归分析。 结果 参与者的年龄中位数为 40.0 岁(IQR:34-47),其中女性占 40.9%(n = 94)。在过去两周内至少错过一次服药的参与者报告至少有轻度抑郁(aOR = 3.34,95% CI:1.22-9.11,p < 0.05)、轻度焦虑(aOR = 3.27,95% CI:1.20-8.92,p < 0.05)和创伤后应激障碍(aOR = 4.04,95% CI:1.15-14.21,p < 0.05)症状的几率更高。上周至少漏服一片药物的参与者至少出现轻度抑郁(aOR = 7.74,95% CI:1.31-45.7,p < 0.05)、中度焦虑(aOR = 21.33,95% CI:3.24-140.33,p < 0.005)和创伤后应激障碍(aOR = 13.81,95% CI:2.36-80.84,p < 0.005)症状的几率更高。认知功能较好的参与者最近一周不坚持治疗的几率较低(aOR = 0.88,95% CI:0.81-0.96,p < 0.005),ASES 评分较高(β = 0.26,95% CI:0.13-0.40,p < 0.005)。记忆力差与最近一周不坚持治疗的几率较高(aOR = 4.64,95% CI:1.76-12.24,p < 0.005)和较低的 ASES 分数(β = -0.31,95% CI:-0.45 至 0.16,p < 0.005)有关。至少有轻度抑郁(β = -0.21,95% CI:-0.35 至 -0.07,p < 0.005)、中度焦虑(β = -0.21,95% CI:-0.34 至 -0.07,p < 0.005)和创伤后应激障碍(β = -0.19,95% CI:-0.33 至 -0.05,p < 0.005)症状者的 ASES 分数较低。 结论 抑郁、焦虑和创伤后应激障碍症状、较差的认知能力和健忘与较差的抗逆转录病毒疗法依从性和较差的依从自我效能有关。对认知能力下降的 PLWH 进行精神疾病评估和治疗,并为其提供支持以提高抗逆转录病毒疗法的依从性至关重要。
{"title":"Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study","authors":"Gaukhar Mergenova,&nbsp;Alissa Davis,&nbsp;Louisa Gilbert,&nbsp;Nabila El-Bassel,&nbsp;Assel Terlikbayeva,&nbsp;Sholpan Primbetova,&nbsp;Zhamilya Nugmanova,&nbsp;Andrea Norcini Pala,&nbsp;Deborah Gustafson,&nbsp;Susan L. Rosenthal,&nbsp;Alfiya Y. Denebayeva,&nbsp;Jack DeHovitz","doi":"10.1002/jia2.26320","DOIUrl":"https://doi.org/10.1002/jia2.26320","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.&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 randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.&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;Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (&lt;i&gt;n&lt;/i&gt; = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, &lt;i&gt;p&lt;/i&gt; &lt; 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, &lt;i&gt;p&lt;/i&gt; &lt; 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, &lt;i&gt;p&lt;/i&gt; &lt; 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, &lt;i&gt;p&lt;/i&gt; &lt; 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, &lt;i&gt;p&lt;/i&gt; &lt; 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, &lt;i&gt;p&lt;/i&gt; &lt; 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) symptoms had lower ASES scores.&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;Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness w","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The HIV epidemic in eastern Europe and central Asia in difficult times: a story of resilience and change 困难时期东欧和中亚的艾滋病毒疫情:复原与变革的故事。
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-17 DOI: 10.1002/jia2.26325
Miłosz Parczewski, Deniz Gökengin
<p>The eastern European and central Asian (EECA) region is facing the fastest-growing HIV epidemic in the world with 160,000 (130,000–180,000) people newly acquiring HIV in 2021, an overall 48% increase in the number of new acquisitions, and a 32% rise in AIDS-related deaths over the past 10 years [<span>1</span>]. The World Health Organization East European region is estimated to accommodate 1.4 million people living with HIV (PWH), with the majority of new transmissions reported to occur locally and to be unrelated to cross-country migrations [<span>2, 3</span>]. Sadly, according to UNAIDS, in 2022 only 62% of people living in the EECA region were aware of their HIV status and 51% of PWH received HIV treatment, which resulted in an overall viral suppression rate of 48% [<span>1</span>]. Common (>50%) late diagnoses (with either AIDS-defining condition or CD4<sup>+</sup> T cell count <350 cells/µl at presentation) [<span>4</span>] further add to the epidemiological issues and complexity of client management [<span>5</span>]. Although the key acquisition risk in the region has changed from unsafe injection practices to heterosexual transmission, access to opioid agonist therapy (OAT) and needle and syringe programmes is often still limited (Kazakhstan) or unavailable (Uzbekistan, Turkmenistan), which results in OAT regional coverage as low as 4%, far below the UNAIDS target of 50%.</p><p>Furthermore, pre-exposure prophylaxis (PrEP) and combination prevention services are of limited availability or not formally implemented across multiple countries in the region usually due to financial barriers to access, such as lack of state funding for medicines, limited technical capacity or cost of service delivery [<span>6</span>]. This results in a substantially larger HIV PrEP gap (the proportion of populations at risk of acquiring HIV “very likely” to use PrEP if accessible, compared with the proportion currently using PrEP) across countries located in the EECA region (up to 45%) compared to the overall median of 17.4% estimate for the European Union [<span>7</span>]. Moreover, there is a high level of stigma across the countries, especially against gay men and other men who have sex with men.</p><p>The growing epidemic and the suboptimal access to prevention, testing and treatment are the main reasons that challenge the 2030 targets.</p><p>The humanitarian crisis related to the Russian invasion and war in Ukraine has challenged the situation even further hindering testing and treatment efforts, forcing both internal displacement (estimated 3.7 million) and external migration of locals as refugees (estimated 6.4 million, as of March 2024) [<span>8</span>]. On top of massive casualties, civilian and healthcare infrastructures were destroyed, forcing refugees to seek safety, protection and assistance, including continued access to medical care. Ukraine is home to ∼260,000 PWH with >130,000 on antiretroviral treatment (ART). Although significant pr
这是一项分组随机对照试验,比较了基于网络的同伴教育者培训和普通健康教育培训。塔吉克男性移民被招募为同伴教育者,并接受了如何降低个人感染艾滋病毒风险以及向同伴传授知识的培训。访谈显示,在同伴教育者和同伴中,暴饮、无安全套性行为、共用注射器和设备行为的基线百分比相当高,而针头清洁行为和艾滋病毒检测的基线百分比则极低。研究干预后,共用针具行为明显减少,但对性行为的影响不大。这项研究表明,针对特定群体的需求并纳入同伴的干预措施,即使在难以接触到的人群中也可能有效。Davis 等人也探讨了与污名相关的问题,他们使用公民科学方法来解决与艾滋病毒相关的污名问题,并增加哈萨克斯坦青少年的艾滋病毒检测[18]。他们呼吁这些人群开发数字材料,并在竞赛中对这些材料进行评估和评级,目的是减少与艾滋病毒相关的污名化并促进艾滋病毒的自我检测。提交的材料由一个包括参赛者同伴、医疗保健专业人员和非政府组织代表在内的委员会进行评审,评分高的材料将获得奖励。青少年和年轻人对该项目表现出浓厚的兴趣,他们既是参赛者,因此提交了大量材料,又是委员会成员,为研究的开发和实施、社交媒体程序的运行、宣传材料的制作以及对提交系统的反馈提供意见。最后,Mergenova 等人[19]介绍了一项同样来自哈萨克斯坦的研究,该研究涉及感染艾滋病毒的艾滋病毒携带者坚持抗逆转录病毒疗法与心理健康和认知障碍的关系。据报道,哈萨克斯坦的艾滋病疫情规模不断扩大,大多数感染者都是注射精神活性物质者。作者对 230 名接受稳定(6 个月)抗逆转录病毒疗法的感染者进行了横断面问卷调查分析,除了抑郁、焦虑、创伤后应激障碍(PTSD)症状以及认知和记忆评估外,还对自我报告的抗逆转录病毒疗法依从性进行了评估。值得注意的是,三分之一的患者报告有精神病史,只有 25% 的患者报告有注射吸毒史,17% 的患者有酗酒史。此外,20%-32%的患者有轻度抑郁或焦虑,6%-10%的患者至少有中度情绪障碍,其中 7% 的患者有创伤后应激障碍症状。毫不奇怪,这些症状与较低的依从性有关--有轻度或中度抑郁症状、轻度或中度焦虑症状、创伤后应激障碍症状或健忘的参与者更有可能错过抗逆转录病毒疗法。相反,较好的认知功能与较好的治疗依从性相关。这项研究强调,为了更好地护理艾滋病感染者,不仅需要对抗病毒疗法进行精确、定期的评估,还需要对心理健康和认知功能进行评估,以便量身定制具体的应对措施,并提供心理健康支持,从而提高治疗依从性,维持最佳的病毒抑制率。大量感染艾滋病毒的吸毒者和移民,以及每个国家不同文化、信仰和结构的独特性,都对应对这一流行病的长期努力提出了挑战。本补编介绍了东欧和中亚地区艾滋病毒疫情的恢复情况、改善人权的持续努力以及综合预防的创新方法,并总结了与污名化和其他社会问题相关的主要挑战。在继续这些努力的同时,进一步的国际支持、承诺和合作对于实现2030年在该地区消除艾滋病的新目标至关重要。所有作者都阅读并批准了最终版本。作者单独对本增刊中表达的观点负责,不代表其所属机构的观点、决定或政策。
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引用次数: 0
The effects of regular home delivery of HIV self-testing and follow-up counselling on HIV testing and prevention outcomes in men who have sex with men who test infrequently in the United States: a pragmatic, virtual randomized controlled trial 在美国,定期上门提供 HIV 自我检测和后续咨询对不经常进行检测的男男性行为者的 HIV 检测和预防结果的影响:一项务实的虚拟随机对照试验。
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-17 DOI: 10.1002/jia2.26318
Tyler B. Wray, Philip A. Chan, Jeffrey D. Klausner, Lori M. Ward, Erik M. S. Ocean, Daniel J. Carr, John P. Guigayoma, Siddhi Nadkarni

Introduction

Past research shows that HIV self-testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care.

Methods

From January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow-up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) use and sexual risk behaviour.

Findings

Eight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (OR = 7.9, 95% CI = 4.9−12.9 and OR = 6.6, 95% CI = 4.2−10.5) and repeat testing (>1 test; OR = 8.5, 95% CI = 5.7−12.6; OR = 8.9, 95% CI = 6.1−13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups.

Conclusions

HIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow-up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.

导言:过去的研究表明,与诊所检测相比,HIV 自我检测(HIVST)可以增加检测次数,并有助于更多的 HIV 诊断。然而,在美国,HIVST 的使用受到了限制,因为人们担心使用 HIVST 的人不太可能与护理联系起来:从 2019 年 1 月到 2022 年 4 月,我们通过在线营销活动在美国招募了 811 名不经常接受检测的男男性行为者(MSM),并以 1:1:1 的比例随机分配他们在一年内每 3 个月接受以下其中一种检测:(1) 短信提醒到当地诊所接受检测(对照组);(2) 邮寄 HIVST 检测包,并提供免费帮助热线(标准 HIVST);(3) 邮寄 HIVST 检测包,并在打开检测包后 24 小时内提供咨询(eTest)。每季度进行一次跟踪调查,评估 HIV 检测、性传播感染 (STI) 检测、暴露前预防 (PrEP) 的使用情况以及性风险行为:八名参与者被确诊感染了艾滋病毒,除一人外,其他人都是通过 HIVST 检测确诊的。与对照组相比,接受标准或电子检测的 HIVST 参与者在 12 个月内接受任何检测(OR = 7.9,95% CI = 4.9-12.9 和 OR = 6.6,95% CI = 4.2-10.5)和重复检测(>1 次检测;OR = 8.5,95% CI = 5.7-12.6; OR = 8.9,95% CI = 6.1-13.4)的几率明显更高。不同研究条件下的性传播感染检测率和 PrEP 采用率没有差异,但在整个研究期间,eTest 条件下报告的性风险事件比其他组少 27%:结论:HIVST 大幅提高了检测率,鼓励男男性行为者更定期地进行检测,并发现了几乎所有新病例,这表明 HIVST 可以更早地诊断出是否感染了艾滋病毒。在艾滋病毒检测后及时提供后续咨询并没有提高性传播感染检测率或 PrEP 的使用率,但一些证据表明,咨询可能会减少性风险行为。为鼓励进行更优化的检测,方案应纳入艾滋病毒检测,并定期将检测包直接寄给受检者。
{"title":"The effects of regular home delivery of HIV self-testing and follow-up counselling on HIV testing and prevention outcomes in men who have sex with men who test infrequently in the United States: a pragmatic, virtual randomized controlled trial","authors":"Tyler B. Wray,&nbsp;Philip A. Chan,&nbsp;Jeffrey D. Klausner,&nbsp;Lori M. Ward,&nbsp;Erik M. S. Ocean,&nbsp;Daniel J. Carr,&nbsp;John P. Guigayoma,&nbsp;Siddhi Nadkarni","doi":"10.1002/jia2.26318","DOIUrl":"10.1002/jia2.26318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Past research shows that HIV self-testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow-up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) use and sexual risk behaviour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Eight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (<i>OR</i> = 7.9, 95% CI = 4.9−12.9 and <i>OR =</i> 6.6, 95% CI = 4.2−10.5) and repeat testing (&gt;1 test; <i>OR</i> = 8.5, 95% CI = 5.7−12.6; <i>OR =</i> 8.9, 95% CI = 6.1−13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow-up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632081","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
Client experiences with “Dynamic Choice Prevention,” a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa 动态选择预防 "是东非农村地区以患者为中心灵活开展艾滋病预防工作的一种模式,其客户经验。
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-17 DOI: 10.1002/jia2.26336
Carol S. Camlin, Titus Arunga, Jason Johnson-Peretz, Cecilia Akatukwasa, Fredrick Atwine, Angeline Onyango, Lawrence Owino, Moses R. Kamya, Maya L. Petersen, Gabriel Chamie, Elijah Kakande, Jane Kabami, Laura B. Balzer, Diane V. Havlir, James Ayieko
<div> <section> <h3> Introduction</h3> <p>Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models.</p> </section> <section> <h3> Methods</h3> <p>In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of <i>n</i> = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and <i>n</i> = 21 healthcare providers (total <i>n</i> = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.</p> </section> <section> <h3> Results</h3> <p>Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.</p> </section> <section> <h3> Conclusions</h3> <p>Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients
导言:确定提供艾滋病预防服务的最佳方法以满足高危人群的需求是当务之急,特别是考虑到生物医学艾滋病预防方案的工具包在不断扩大。一项正在东非农村社区进行的研究通过以患者为中心的结构化艾滋病预防服务模式,评估了对产品、检测模式和护理服务地点选择的接受程度。在这项定性研究中,我们试图了解客户对这种 "动态选择预防模式"(DCP)的体验,并强调行动路径,为艾滋病预防服务模式提供信息:从 2021 年 11 月到 2022 年 3 月,我们有目的性地抽取了 n = 56 名 DCP 试验参与者(横跨门诊部、产前诊所和社区环境)和 n = 21 名医疗服务提供者(总人数 n = 77),对他们进行了深入的半结构式访谈。一个由七人组成的跨地区团队对记录誊本数据进行了翻译和归纳编码。我们采用框架分析法来确定新出现的主题:结果:接受艾滋病暴露前预防疗法(PrEP)的个人报告称,他们感到如释重负,从对感染艾滋病的恐惧中解脱出来,并对能够不顾伴侣的行为而采取行动感到满意。夫妻双方利用该研究提供的一系列方法说服伴侣接受检测并选择 PrEP。暴露后预防(PEP)的使用并不普遍,尽管妇女欢迎在受到性胁迫或性侵犯时使用这种方法。参与者讨论了在熟悉使用方法并确定持续风险后从 PEP 转为 PrEP 的问题。参与者认为自己受到了医疗服务提供者的尊重,信任他们,并对能够直接与他们联系以获得电话支持表示感谢。阻碍采取预防措施的因素包括:耻辱感、对预防方法的经验和知识有限、亲密伴侣关系和家庭中的性别和代际权力动态,以及产品本身导致的对预防方法的负面看法。参与者预计,长效注射 PrEP 可以解决他们在药片大小、每日药片负担和意外披露可能性方面的难题:不同的偏好和接受预防的障碍需要选择不同的艾滋病预防方案、地点和提供方式--但此外,灵活、称职和友好的护理服务对于促进接受也至关重要。帮助客户感受到自己的价值,解决他们的独特需求和挑战,使他们能够优先考虑自己的健康。
{"title":"Client experiences with “Dynamic Choice Prevention,” a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa","authors":"Carol S. Camlin,&nbsp;Titus Arunga,&nbsp;Jason Johnson-Peretz,&nbsp;Cecilia Akatukwasa,&nbsp;Fredrick Atwine,&nbsp;Angeline Onyango,&nbsp;Lawrence Owino,&nbsp;Moses R. Kamya,&nbsp;Maya L. Petersen,&nbsp;Gabriel Chamie,&nbsp;Elijah Kakande,&nbsp;Jane Kabami,&nbsp;Laura B. Balzer,&nbsp;Diane V. Havlir,&nbsp;James Ayieko","doi":"10.1002/jia2.26336","DOIUrl":"10.1002/jia2.26336","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;Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models.&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;In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of &lt;i&gt;n&lt;/i&gt; = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and &lt;i&gt;n&lt;/i&gt; = 21 healthcare providers (total &lt;i&gt;n&lt;/i&gt; = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.&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;Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.&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;Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632080","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
Academic accountability to local communities and society through Programme Science: a case study from the HPV self-sampling programme HOPE in Peru 通过 "计划科学 "对当地社区和社会承担学术责任:秘鲁人乳头瘤病毒(HPV)自采样计划 HOPE 的案例研究。
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-10 DOI: 10.1002/jia2.26297
Patricia Jannet Garcia, Carlos Santos, Marina Chiappe, María Valderrama, Cesar Paul Carcamo
<div> <section> <h3> Introduction</h3> <p>Health challenges in the 21st century underscore the need for adaptable and innovative approaches in public health. Academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programmes to improve societal health. Academic accountability to local communities and society requires universities to actively engage with local communities, understanding the context, their needs, and leveraging their knowledge and local experience. The Programme Science initiative provides a framework to optimize the scale, quality and impact of public health programmes, by integrating diverse approaches during the iterative cycle of research and practice within the strategic planning, programme implementation and programme management and evaluation. We illustrate how the Programme Science framework could be a useful tool for academic institutions to accomplish accountability to local communities and society through the experience of Project HOPE in Peru.</p> </section> <section> <h3> Discussion</h3> <p>Project HOPE applied the Programme Science framework to introduce HPV self-sampling into a women's health programme in Peru. Collaboration with local authorities and community members was pivotal in all phases of the project, ensuring interventions aligned with community needs and addressing social determinants of health. The HOPE Ladies—community women trained and empowered to promote and provide the HPV kits—crafted the messages used through the study and developed strategies to reach individuals and provided support to women's journey through health centres. By engaging communities in co-creating knowledge and addressing health inequities, academic institutions can generate contextually relevant and socially just scientific knowledge. The active participation of community women in Project HOPE was instrumental in improving service utilization and addressing barriers to self-sampling.</p> </section> <section> <h3> Conclusions</h3> <p>The Programme Science approach offers a pathway for academic institutions to enhance their accountability to communities and society at large. By embedding researchers within public health programmes and prioritizing community engagement, academic institutions can ensure that research findings directly inform policy improvements and programmatic decisions. However, achieving this requires a realignment of research agendas and recognition of the value of community engagement. Establishing Programme Science networks involving academia, government and funding entities can further reinforce academic accountability and en
导言:21 世纪的健康挑战凸显了在公共卫生领域采取适应性强的创新方法的必要性。学术机构可以而且应该更有效地促进科学知识的产生和转化,从而制定出更好的计划来改善社会健康。学术界要对当地社区和社会负责,就要求大学积极参与当地社区的活动,了解当地社区的背景和需求,并利用其知识和当地经验。计划科学倡议提供了一个框架,通过在战略规划、计划实施和计划管理与评估的研究与实践迭代周期中整合各种方法,优化公共卫生计划的规模、质量和影响。我们通过秘鲁 "希望工程 "的经验,说明计划科学框架如何成为学术机构对当地社区和社会负责的有用工具:讨论:"希望工程 "应用 "计划科学 "框架,将人乳头瘤病毒(HPV)自我采样引入秘鲁的一项妇女健康计划。在项目的各个阶段,与地方当局和社区成员的合作都至关重要,确保干预措施符合社区需求,并解决健康的社会决定因素。HOPE Ladies--接受过培训并被授权推广和提供 HPV 套件的社区妇女--通过研究起草了所使用的信息,制定了接触个人的策略,并为妇女通过保健中心的旅程提供支持。通过让社区参与共同创造知识和解决健康方面的不平等问题,学术机构可以创造出符合实际情况和社会公正的科学知识。社区妇女对 "希望工程 "的积极参与有助于提高服务利用率和消除自我采样的障碍:计划科学方法为学术机构加强对社区和整个社会的责任提供了一条途径。通过将研究人员纳入公共卫生计划并优先考虑社区参与,学术机构可以确保研究成果直接为政策改进和计划决策提供信息。然而,要做到这一点,需要重新调整研究议程,并认识到社区参与的价值。建立由学术界、政府和资助实体参与的计划科学网络,可以进一步加强学术问责,提高公共卫生计划的影响力。
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引用次数: 0
Applying the Effective Programme Coverage framework to assess gaps in HIV prevention programmes for female sex workers and men who have sex with men in Nairobi, Kenya: findings from an expanded Polling Booth Survey 应用有效方案覆盖框架评估肯尼亚内罗毕女性性工作者和男男性行为者艾滋病毒预防方案的差距:扩大投票站调查的结果。
IF 4.6 1区 医学 Q2 IMMUNOLOGY Pub Date : 2024-07-10 DOI: 10.1002/jia2.26240
Parinita Bhattacharjee, Leigh McClarty, Shajy Isac, Joshua Kimani, Faran Emmanuel, Rhoda Kabuti, Antony Kinyua, Bernadette Kina Kombo, Collins Owek, Helgar Musyoki, Anthony Kiplagat, Peter Arimi, Souradet Yuh-Nan Shaw, Monica Gandhi, Siobhan Malone, James Blanchard, Geoff Garnett, Marissa L. Becker

Introduction

Measuring the coverage of HIV prevention services for key populations (KPs) has consistently been a challenge for national HIV programmes. The current frameworks and measurement methods lack emphasis on effective coverage, occur infrequently, lack timeliness and limit the participation of KPs. The Effective Programme Coverage framework, which utilizes a programme science approach, provides an opportunity to assess gaps in various coverage domains and explore the underlying reasons for these gaps, in order to develop targeted solutions. We have demonstrated the application of this framework in partnership with the KP community in Nairobi, Kenya, using an expanded Polling Booth Survey (ePBS) method.

Methods

Data were collected between April and May 2023 among female sex workers (FSWs) and men who have sex with men (MSM) using (a) PBS, (b) bio-behavioural survey and (c) focus group discussions. Data collection and analysis involved both KP community and non-community researchers. Descriptive analysis was performed, and proportions were used to assess the programme coverage gaps. The data were weighted to account for the sampling design and unequal selection probabilities. Thematic analysis was conducted on the qualitative data.

Results

The condom programme for FSW and MSM had low availability (60.2% and 50.9%), contact (68.8% and 65.9%) and utilization (52.1% and 43.9%) coverages. The pre-exposure prophylaxis (PrEP) programme had very low utilization coverage for FSW and MSM (4.4% and 2.8%), while antiretroviral therapy utilization coverage was higher (86.6% and 87.7%). Reasons for coverage gaps included a low peer educator-to-peer ratio, longer distance to the clinics, shortage of free condoms supplied by the government, experienced and anticipated side effects related to PrEP, and stigma and discrimination experienced in the facilities.

Conclusions

The Effective Programme Coverage framework allows programmes to assess coverage gaps and develop solutions and a research agenda targeted at specific domains of coverage with large gaps. The ePBS method works well in collecting data to understand coverage gaps rapidly and allows for the engagement of the KP community.

导言:衡量艾滋病毒预防服务对重点人群(KPs)的覆盖率一直是国家艾滋病毒计划面临的挑战。目前的框架和衡量方法缺乏对有效覆盖率的重视,不经常出现,缺乏及时性,并限制了关键人群的参与。有效计划覆盖率框架采用计划科学的方法,提供了一个机会来评估各个覆盖领域的差距,并探索造成这些差距的根本原因,从而制定有针对性的解决方案。我们与肯尼亚内罗毕的 KP 社区合作,采用扩大投票站调查 (ePBS) 方法展示了这一框架的应用:方法:2023 年 4 月至 5 月期间,我们使用(a)投票站调查(PBS)、(b)生物行为调查和(c)焦点小组讨论,在女性性工作者(FSWs)和男男性行为者(MSM)中收集了数据。金伯利进程社区和非社区研究人员参与了数据收集和分析工作。对数据进行了描述性分析,并使用比例来评估计划覆盖范围的差距。考虑到抽样设计和不平等的选择概率,对数据进行了加权处理。对定性数据进行了专题分析:针对性工作者和男男性行为者的安全套计划的可用率(60.2% 和 50.9%)、接触率(68.8% 和 65.9%)和使用率(52.1% 和 43.9%)均较低。暴露前预防(PrEP)计划在女性同性恋者和男男性行为者中的使用覆盖率很低(4.4% 和 2.8%),而抗逆转录病毒疗法的使用覆盖率较高(86.6% 和 87.7%)。造成覆盖率差距的原因包括同伴教育者与同伴的比例较低、距离诊所较远、政府提供的免费安全套短缺、与 PrEP 相关的经验和预期副作用,以及在医疗机构中遭受的羞辱和歧视:有效计划覆盖范围框架允许计划评估覆盖范围的差距,并针对差距较大的特定覆盖范围制定解决方案和研究议程。ePBS 方法能很好地收集数据,迅速了解覆盖面的差距,并让 KP 社区参与进来。
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引用次数: 0
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Journal of the International AIDS Society
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