Isabella Robson, Misheck Mphande, Jiyoung Lee, Julie Anne Hubbard, Joseph Daniels, Khumbo Phiri, Elijah Chikuse, Thomas J. Coates, Morna Cornell, Kathryn Dovel
<div> <section> <h3> Introduction</h3> <p>There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment.</p> </section> <section> <h3> Methods</h3> <p>We audio-recorded counselling sessions to assess the quality of implementation (<i>n</i> = 50) by male HCWs from two cadres (nurse, <i>n</i> = 10 and lay cadre, <i>n</i> = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021−June 2022.</p> </section> <section> <h3> Results</h3> <p>All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (<i>n</i> = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (<i>n</i> = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (<i>n</i> = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (<i>n</i> = 16 and <i>n</i> = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres.</p> </section> <section> <h3> Conclusions</h3> <p>Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing train
{"title":"Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi","authors":"Isabella Robson, Misheck Mphande, Jiyoung Lee, Julie Anne Hubbard, Joseph Daniels, Khumbo Phiri, Elijah Chikuse, Thomas J. Coates, Morna Cornell, Kathryn Dovel","doi":"10.1002/jia2.26270","DOIUrl":"10.1002/jia2.26270","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We audio-recorded counselling sessions to assess the quality of implementation (<i>n</i> = 50) by male HCWs from two cadres (nurse, <i>n</i> = 10 and lay cadre, <i>n</i> = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021−June 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (<i>n</i> = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (<i>n</i> = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (<i>n</i> = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (<i>n</i> = 16 and <i>n</i> = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing train","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747053","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}
<p>Paediatricians caring for children living with HIV started sounding alarm bells about their poorer clinical outcomes from the very beginnings of the HIV epidemic. They were routinely diagnosed late and with advanced disease, lacked appropriate antiretroviral formulations for treatment and their viruses became resistant to these regimens more rapidly, and suffered higher mortality rates [<span>1</span>]. As those who survived became adolescents, they experienced long-term side effects of their treatment, increased risks for non-communicable diseases, and the social and mental health impacts of stigma, discrimination and orphanhood [<span>2, 3</span>]. Adults with perinatal HIV are now being managed with limited standards around optimal care delivery.</p><p>UNAIDS estimates that there were about 660,000 (560,000–760,000) adults 20–24 years of age living with perinatally acquired HIV in 2023, 88% of whom were in Africa (UNAIDS 2024 epidemiologic estimates). In Asia, Thailand was one of the earliest countries to begin a national HIV treatment programme for children in the mid-2000s, and now ∼1800 adults >18 years of age are estimated to be living with perinatal HIV—with the oldest in their third decade (Thai National AIDS Program, 2022 data). Although many national surveillance systems do not capture the mode of HIV acquisition, data on age at diagnosis are sufficient to identify those with early exposure to HIV and antiretroviral therapy and track them into adulthood. There is an urgent need for evidence-based guidelines for the treatment and care of adults with perinatal HIV that can be implemented in low- and middle-income country (LMIC) settings, as well as standardized provider training to effectively implement them.</p><p>In high-income contexts like the United States (US) and the United Kingdom (UK), most of those with perinatal HIV have already transitioned into adult life and HIV care, with some entering their fifth decade [<span>4, 5</span>]. Data on their outcomes are sobering. In the US, by age 30, the cumulative incidence of type-2 diabetes among those with perinatally acquired HIV was 19%, 22% for hypertension and 25% for chronic kidney disease [<span>6</span>]. A modelling study estimated that life expectancy in US male youth with perinatal HIV was 10.4 years lower and in female youth 11.8 years lower than their HIV-negative peers [<span>7</span>]. A UK study showed that a lower nadir CD4 count in early childhood had an ongoing negative impact on CD4 by age 20 [<span>8</span>].</p><p>Research from LMICs has reflected increased risks for adolescents with perinatal HIV that similarly bode poorly for their health outcomes as adults. Cohorts from South Africa and Thailand have reported bone, cardiac, neurocognitive or respiratory impairments [<span>2, 9</span>]. The lack of prior access to human papillomavirus vaccines has put the current generation of young adults at risk for anogenital cancers (e.g. cervical) [<span>10</span>]. Ear
{"title":"Adults with perinatally acquired HIV in low- and middle-income settings: time for a generational shift in HIV care and global guidance","authors":"Annette H. Sohn, Mary-Ann Davies","doi":"10.1002/jia2.26338","DOIUrl":"10.1002/jia2.26338","url":null,"abstract":"<p>Paediatricians caring for children living with HIV started sounding alarm bells about their poorer clinical outcomes from the very beginnings of the HIV epidemic. They were routinely diagnosed late and with advanced disease, lacked appropriate antiretroviral formulations for treatment and their viruses became resistant to these regimens more rapidly, and suffered higher mortality rates [<span>1</span>]. As those who survived became adolescents, they experienced long-term side effects of their treatment, increased risks for non-communicable diseases, and the social and mental health impacts of stigma, discrimination and orphanhood [<span>2, 3</span>]. Adults with perinatal HIV are now being managed with limited standards around optimal care delivery.</p><p>UNAIDS estimates that there were about 660,000 (560,000–760,000) adults 20–24 years of age living with perinatally acquired HIV in 2023, 88% of whom were in Africa (UNAIDS 2024 epidemiologic estimates). In Asia, Thailand was one of the earliest countries to begin a national HIV treatment programme for children in the mid-2000s, and now ∼1800 adults >18 years of age are estimated to be living with perinatal HIV—with the oldest in their third decade (Thai National AIDS Program, 2022 data). Although many national surveillance systems do not capture the mode of HIV acquisition, data on age at diagnosis are sufficient to identify those with early exposure to HIV and antiretroviral therapy and track them into adulthood. There is an urgent need for evidence-based guidelines for the treatment and care of adults with perinatal HIV that can be implemented in low- and middle-income country (LMIC) settings, as well as standardized provider training to effectively implement them.</p><p>In high-income contexts like the United States (US) and the United Kingdom (UK), most of those with perinatal HIV have already transitioned into adult life and HIV care, with some entering their fifth decade [<span>4, 5</span>]. Data on their outcomes are sobering. In the US, by age 30, the cumulative incidence of type-2 diabetes among those with perinatally acquired HIV was 19%, 22% for hypertension and 25% for chronic kidney disease [<span>6</span>]. A modelling study estimated that life expectancy in US male youth with perinatal HIV was 10.4 years lower and in female youth 11.8 years lower than their HIV-negative peers [<span>7</span>]. A UK study showed that a lower nadir CD4 count in early childhood had an ongoing negative impact on CD4 by age 20 [<span>8</span>].</p><p>Research from LMICs has reflected increased risks for adolescents with perinatal HIV that similarly bode poorly for their health outcomes as adults. Cohorts from South Africa and Thailand have reported bone, cardiac, neurocognitive or respiratory impairments [<span>2, 9</span>]. The lack of prior access to human papillomavirus vaccines has put the current generation of young adults at risk for anogenital cancers (e.g. cervical) [<span>10</span>]. Ear","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732995","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}
Micah Piske, Bohdan Nosyk, Justin C. Smith, Bianca Yeung, Benjamin Enns, Xiao Zang, Patrick S. Sullivan, Wendy S. Armstrong, Melanie A. Thompson, Gaea Daniel, Carlos del Rio
<div> <section> <h3> Introduction</h3> <p>Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US “Ending the HIV Epidemic” (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative.</p> </section> <section> <h3> Methods</h3> <p>We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June−December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation.</p> </section> <section> <h3> Results</h3> <p>We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA—particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (<i>N</i> = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma.</p> </section> <section> <h3> Conclusions</h3> <p>Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery
导言：美国 "结束艾滋病毒流行"（EHE）倡议的目标是到 2030 年将艾滋病毒发病率降低 90%，佐治亚州亚特兰大 20 个符合条件的大都市区（EMA）中有四个县目前被列为优先考虑的地区。由于亚特兰大艾滋病疫情存在差异，因此有必要对当地的服务可用性、未满足的需求以及组织能力进行检查，以实现 EHE 目标。我们对亚特兰大 EMA 进行了一次混合方法评估，以检查艾滋病毒流行病学和服务的地理分布、服务需求以及 EHE 计划每个支柱的组织基础设施：我们收集了 2021 年县级数据（2022 年 6 月期间），这些数据来自多个来源，包括AIDSVu（HIV 感染率和新诊断）、美国疾病控制和预防中心的网络工具（HIV 检测和暴露前预防[PrEP]地点）以及佐治亚州公共卫生部（HIV 检测、PrEP 筛查、病毒抑制和合作伙伴服务访谈）。此外，我们还向在整个 EMA 地区主要 HIV 护理机构工作的当地主要利益相关者分发了一份在线调查，以评估服务的可用性、未满足的需求和组织基础设施（2022 年 6 月至 12 月）。组织实施变革准备情况调查问卷评估了需要扩大或实施服务的组织氛围：结果：我们发现整个 EMA 在 HIV 疾病负担和服务可用性方面存在种族/民族和地域差异，尤其是在 EMA 南部各县的 HIV 检测和 PrEP 方面。目前未被 EHE 优先考虑的五个县（Clayton、Douglas、Henry、Newton 和 Rockdale）占 EMA 新诊断病例的 16%，但 Conclusions：要实现国家目标并解决亚特兰大大都会区的艾滋病差异问题，必须大幅扩大 EHE 所有支柱的服务范围。有关 HIV 流行病学和服务提供情况的高分辨率地理数据以及社区意见可为支持地方 EHE 工作提供有针对性的指导。
{"title":"Ending the HIV Epidemic in Metropolitan Atlanta: a mixed-methods study to support the local HIV/AIDS response","authors":"Micah Piske, Bohdan Nosyk, Justin C. Smith, Bianca Yeung, Benjamin Enns, Xiao Zang, Patrick S. Sullivan, Wendy S. Armstrong, Melanie A. Thompson, Gaea Daniel, Carlos del Rio","doi":"10.1002/jia2.26322","DOIUrl":"10.1002/jia2.26322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US “Ending the HIV Epidemic” (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June−December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA—particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (<i>N</i> = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747051","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}
Jonathan M King, Francesca Di Giallonardo, Ansari Shaik, Skye McGregor, Julie Yuek Kee Yeung, Tharshini Sivaruban, Frederick J Lee, Philip Cunningham, Dominic E Dwyer, Steven J Nigro, Andrew E Grulich, Anthony D Kelleher
Introduction
New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use.
Methods
Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis.
Results
Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008).
Conclusions
In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.
{"title":"Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use","authors":"Jonathan M King, Francesca Di Giallonardo, Ansari Shaik, Skye McGregor, Julie Yuek Kee Yeung, Tharshini Sivaruban, Frederick J Lee, Philip Cunningham, Dominic E Dwyer, Steven J Nigro, Andrew E Grulich, Anthony D Kelleher","doi":"10.1002/jia2.26308","DOIUrl":"10.1002/jia2.26308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, <i>p</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11260875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732997","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}
Ingrid Jiayin Lu, Romain Silhol, Marc d'Elbée, Marie-Claude Boily, Nirali Soni, Odette Ky-Zerbo, Anthony Vautier, Artlette Simo Fosto, Kéba Badiane, Metogara Traoré, Fern Terris-Prestholt, Joseph Larmarange, Mathieu Maheu-Giroux, for the ATLAS Team
<div> <section> <h3> Introduction</h3> <p>HIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (<i>Auto Test VIH, Libre d'Accéder à la connaissance de son Statut</i>) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost-effectiveness of community-led HIVST in Côte d'Ivoire, Mali and Senegal.</p> </section> <section> <h3> Methods</h3> <p>An HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP—female sex workers (FSW), and men who have sex with men (MSM)—and their sexual partners and clients. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019–2039). The ATLAS-only scenario mimicked the 2-year implemented ATLAS programme, whereas the ATLAS-scale-up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.</p> </section> <section> <h3> Results</h3> <p>The ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88–$210) per DALY averted in Côte d'Ivoire, $92 ($88–$210) in Mali and 27$ ($88–$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122–$338) per DALY averted in Côte d'Ivoire, $224 ($118–$415) in Mali and $61 ($18–$128) in Senegal.</p> </section> <section> <h3> Conclusions</h3> <p>Both the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services.</p> </
{"title":"Cost-effectiveness analysis of community-led HIV self-testing among key populations in Côte d'Ivoire, Mali, and Senegal","authors":"Ingrid Jiayin Lu, Romain Silhol, Marc d'Elbée, Marie-Claude Boily, Nirali Soni, Odette Ky-Zerbo, Anthony Vautier, Artlette Simo Fosto, Kéba Badiane, Metogara Traoré, Fern Terris-Prestholt, Joseph Larmarange, Mathieu Maheu-Giroux, for the ATLAS Team","doi":"10.1002/jia2.26334","DOIUrl":"10.1002/jia2.26334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>HIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (<i>Auto Test VIH, Libre d'Accéder à la connaissance de son Statut</i>) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost-effectiveness of community-led HIVST in Côte d'Ivoire, Mali and Senegal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP—female sex workers (FSW), and men who have sex with men (MSM)—and their sexual partners and clients. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019–2039). The ATLAS-only scenario mimicked the 2-year implemented ATLAS programme, whereas the ATLAS-scale-up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88–$210) per DALY averted in Côte d'Ivoire, $92 ($88–$210) in Mali and 27$ ($88–$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122–$338) per DALY averted in Côte d'Ivoire, $224 ($118–$415) in Mali and $61 ($18–$128) in Senegal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services.</p>\u0000 </","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11260876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732996","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}
<div> <section> <h3> Introduction</h3> <p>Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices.</p> </section> <section> <h3> Methods</h3> <p>We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations.</p> </section> <section> <h3> Results</h3> <p>A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP.</p> </section> <section> <h3> Conclusions</h3> <p>Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essent
{"title":"Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries","authors":"Oksana Kovtun, Elvira Tilek kyzy, Nadira Masiumova","doi":"10.1002/jia2.26311","DOIUrl":"https://doi.org/10.1002/jia2.26311","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essent","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/jia2.26311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730027","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}
Olga Morozova, Marina Kornilova, Olena Makarenko, Svitlana Antoniak, Mariia Liulchuk, Olga Varetska, Kostyantyn Dumchev
<div> <section> <h3> Introduction</h3> <p>Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites—tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)—offers an objective measure of adherence.</p> </section> <section> <h3> Methods</h3> <p>To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.</p> </section> <section> <h3> Results</h3> <p>Most participants (53.8%, <i>n</i> = 84/156) had no detectable metabolites at both assessments; 7.1% (<i>n</i> = 11/156) were consistently taking ≥2 doses/week; 1.3% (<i>n</i> = 2/156) were consistently taking ≥4 doses/week; 13.5% (<i>n</i> = 21/156) exhibited improved and 21.8% (<i>n</i> = 34/156) had worsened adherence at 6 compared to 3 months. “White coat compliance” (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.</p> </section> <section> <h3> Conclusions</h3> <p>Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer p
{"title":"Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers","authors":"Olga Morozova, Marina Kornilova, Olena Makarenko, Svitlana Antoniak, Mariia Liulchuk, Olga Varetska, Kostyantyn Dumchev","doi":"10.1002/jia2.26319","DOIUrl":"https://doi.org/10.1002/jia2.26319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites—tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)—offers an objective measure of adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most participants (53.8%, <i>n</i> = 84/156) had no detectable metabolites at both assessments; 7.1% (<i>n</i> = 11/156) were consistently taking ≥2 doses/week; 1.3% (<i>n</i> = 2/156) were consistently taking ≥4 doses/week; 13.5% (<i>n</i> = 21/156) exhibited improved and 21.8% (<i>n</i> = 34/156) had worsened adherence at 6 compared to 3 months. “White coat compliance” (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer p","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"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/jia2.26319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary Ellen Mackesy-Amiti, Mahbatsho Bahromov, Judith A. Levy, Jonbek Jonbekov, Casey M. Luc
<div> <section> <h3> Introduction</h3> <p>The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.</p> </section> <section> <h3> Methods</h3> <p>The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (<i>n</i> = 280). All PEs and NMs (<i>n</i> = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.</p> </section> <section> <h3> Results</h3> <p>At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (<i>p</i> < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (<i>p</i> < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.</p> </section> <section> <h3> Conclusions</h3> <p>The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not ame
{"title":"Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial","authors":"Mary Ellen Mackesy-Amiti, Mahbatsho Bahromov, Judith A. Levy, Jonbek Jonbekov, Casey M. Luc","doi":"10.1002/jia2.26310","DOIUrl":"https://doi.org/10.1002/jia2.26310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (<i>n</i> = 280). All PEs and NMs (<i>n</i> = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (<i>p</i> < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (<i>p</i> < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not ame","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"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/jia2.26310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"“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","authors":"Jill Owczarzak, Olivia Monton, Shannon Fuller, Julia Burlaka, Tetiana Kiriazova, Olga Morozova, Kostyantyn Dumchev","doi":"10.1002/jia2.26307","DOIUrl":"https://doi.org/10.1002/jia2.26307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our analysis reveals the complex impact of war on social networks and healthcare access. Main","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/jia2.26307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730304","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}
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
{"title":"An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine","authors":"Diederik Lohman, Yevheniia Kononchuk, Alexandrina Iovita, Mikhail Golichenko, Valeria Rachinska, Pavlo Skala, Olga Gvozdetska, Serhii Myroniuk, Joseph J. Amon","doi":"10.1002/jia2.26328","DOIUrl":"https://doi.org/10.1002/jia2.26328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy (“know your rights”); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a ro","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"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/jia2.26328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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