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Development of a home-based pre-exposure prophylaxis care delivery system for long-acting injectable cabotegravir: a formative exploration of patient preferences. 为长效注射卡博替拉韦开发基于家庭的暴露前预防护理系统:对患者偏好的形成性探索。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-09-08 DOI: 10.1080/09540121.2024.2397128
Janelly Gonzalez, Paulina A Rebolledo, Aaron J Siegler, Wenting Huang, Kenneth H Mayer, Valeria D Cantos

Cabotegravir (CAB-LA), the only Food and Drug Administration-approved injectable pre-exposure prophylaxis (PrEP), is effective and may address PrEP uptake disparities among Black and Latino sexual and gender minority (SGM) men. Uptake of CAB-LA may require developing innovative non-clinic-based care delivery strategies in home-based settings. We explored SGM men's opinions on a future home-based CAB-LA PrEP care service to guide the adaptation of PrEP@Home, an existing home-based PrEP system for oral PrEP. Through 14 in-depth interviews with current or former SGM male participants in the PrEP@Home study, we explored the acceptability of a home-based injectable PrEP system and examined visit and communication-related preferences. All participants considered home-based CAB-LA care to be acceptable and 8/14 would utilize the system if available. Convenience and comfort with using a home-based system impacted the overall acceptance of the approach. Factors influencing acceptability included clinical teams' affiliation with healthcare systems, a credentialed two-person team, and staff identity verification methods. Logistical preferences included communicating pre-visit patient instructions, allowing flexible scheduling hours, and the use of text, phone calls, or mobile app communication methods based on urgency. Conclusively, a home-based CAB-LA PrEP delivery system was acceptable among the interviewed SGM men, guiding its development and future implementation.Trial registration: ClinicalTrials.gov identifier: NCT03569813.

卡博替拉韦(CAB-LA)是唯一获得美国食品和药物管理局批准的注射型暴露前预防疗法(PrEP),其疗效显著,可解决黑人和拉丁裔性与性别少数群体(SGM)男性在接受 PrEP 治疗方面的差异。要提高 CAB-LA 的使用率,可能需要在家庭环境中制定创新的非诊所护理服务策略。我们探讨了 SGM 男性对未来基于家庭的 CAB-LA PrEP 护理服务的看法,以指导 PrEP@Home 的调整,PrEP@Home 是一种现有的基于家庭的 PrEP 系统,用于口服 PrEP。通过对 PrEP@Home 研究的现任或前任 SGM 男性参与者进行 14 次深入访谈,我们探讨了居家注射式 PrEP 系统的可接受性,并研究了与就诊和沟通相关的偏好。所有参与者都认为家庭 CAB-LA 护理是可以接受的,8/14 的参与者表示如果有这种系统就会使用。使用家用系统的便利性和舒适度影响了这种方法的总体接受度。影响可接受性的因素包括临床团队与医疗系统的隶属关系、经认证的双人团队以及员工身份验证方法。后勤方面的偏好包括传达就诊前的患者指导、允许灵活的排班时间,以及根据紧急程度使用短信、电话或移动应用程序通信方法。最终,受访的 SGM 男性接受了以家庭为基础的 CAB-LA PrEP 交付系统,这为该系统的开发和未来实施提供了指导:试验注册:ClinicalTrials.gov identifier:NCT03569813.
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引用次数: 0
Examining HIV pre-exposure prophylaxis (PrEP) acceptability among rural people who inject drugs: predictors of PrEP interest among syringe service program clients. 研究农村注射吸毒者对艾滋病毒暴露前预防疗法(PrEP)的接受程度:注射器服务计划客户对 PrEP 感兴趣的预测因素。
IF 16.4 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-13 DOI: 10.1080/09540121.2024.2390067
Hilary L Surratt, Sarah Brown, Abby L Burton, Will Cranford, Christie Green, Stephanie M Mersch, Rebecca Rains, Philip M Westgate

Rural communities in the US have increasing HIV burden tied to injection drug use, yet engagement in pre-exposure prophylaxis (PrEP) care has been low among people who inject drugs (PWID). Syringe service programs (SSPs) are widely implemented in Kentucky's Appalachian region, presenting an important opportunity to scale PrEP services. This paper examines PrEP awareness, interest and preferences among PWID attending community-based SSPs in Appalachia. Eighty participants were enrolled from two SSP locations. Eligibility included: ≥ 18 years old, current injection drug use and SSP use, and an indication for PrEP as defined by CDC guidelines. Participants completed a structured baseline interview. Predictors of PrEP awareness, interest and formulation preferences were examined. 38.8% reported baseline awareness of PrEP, 50% expressed high interest in PrEP, and 48.1%reported a preference for injectable PrEP. Significant bivariate predictors of PrEP interest included: current worry about health, higher perceived HIV risk, higher community HIV stigma, and higher enacted substance use stigma in the past year; in the adjusted model, enacted substance use stigma remained significant. Findings demonstrate substantial interest in PrEP among rural PWID. Intrapersonal and social determinant factors were associated with PrEP interest, which suggests the importance of multi-level intervention targets to increase PrEP uptake.

美国的农村社区因注射吸毒而造成的艾滋病负担日益加重,但注射吸毒者(PWID)参与接触前预防(PrEP)护理的比例却很低。注射器服务计划(SSP)在肯塔基州的阿巴拉契亚地区广泛实施,为扩大 PrEP 服务提供了重要机会。本文研究了阿巴拉契亚地区参加社区 SSP 的注射吸毒者对 PrEP 的认识、兴趣和偏好。两个 SSP 地点共招募了 80 名参与者。符合条件的人群包括:年龄≥ 18 岁、目前使用注射毒品和使用 SSP,以及有疾病预防控制中心指南规定的 PrEP 适应症。参与者完成了结构化基线访谈。研究人员对 PrEP 的认知、兴趣和配方偏好进行了预测。38.8%的受试者报告了对 PrEP 的基线认知,50%的受试者表示对 PrEP 非常感兴趣,48.1%的受试者报告了对注射式 PrEP 的偏好。PrEP 兴趣的重要双变量预测因素包括:当前对健康的担忧、较高的艾滋病风险感知、较高的社区艾滋病耻辱感以及过去一年中较高的药物使用耻辱感;在调整模型中,药物使用耻辱感仍然重要。研究结果表明,农村感染者对 PrEP 非常感兴趣。个人内部因素和社会决定因素与 PrEP 的兴趣相关,这表明多层次干预目标对于提高 PrEP 的吸收率非常重要。
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引用次数: 0
A scoping review of interventions targeting HIV stigma in women living with HIV. 对针对女性艾滋病病毒感染者的艾滋病污名化干预措施进行范围界定审查。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI: 10.1080/09540121.2024.2408682
Zhongfang Yang, Qianqian Hu, Weijie Xing, Zheng Zhu, Michael V Relf, Dalmacio Dennis Flores, Yan Hu

Since its initial detection in the 1980s, AIDS has become a significant global health threat, disproportionately affecting women. Stigma constitutes the substantial barrier to accessing healthcare for women living with HIV (WLWH). This scoping review based on the Population, Concept, and Context (PCC) framework aimed to provide evidence-based guidance for clinical caregivers to develop intervention strategies and assess their effectiveness. From database inception to May 2023, research on stigma interventions for WLWH was searched in databases including Embase (OVID), MEDLINE (OVID), CINAHL (EBSCO), ProQuest, Scopus, WANFANG, VIP, CNKI, and SinoMed. Literature was screened based on inclusion and exclusion criteria, and results were extracted for scoping review. Twelve studies were included featuring information-based, skills-based interventions, and a combination of both, targeting individuals and institutions. Six studies reported significant reduction in stigma. Assessment tools used included the 7-item Questionnaire on Attitudes toward AIDS Victims (AQAV-7), the 40-item HIV Stigma Scale (HSS-40), the 14-item Chronic Illness Stigma Scale (SSCI-14), the 28-item Internalization HIV-Related Stigma Scale (IHSS-28), the 57-item Internalized Stigma Scale (IS-57), and the 6-item Internalized AIDS-Related Stigma Scale (IA-RSS-6). Validation of existing intervention and the development of mechanisms linking interventions to stigma reduction are needed.

自 20 世纪 80 年代首次发现艾滋病以来,艾滋病已成为全球健康的重大威胁,对妇女的影响尤为严重。污名化是女性艾滋病感染者(WLWH)获得医疗服务的主要障碍。本范围综述基于人群、概念和背景(PCC)框架,旨在为临床护理人员制定干预策略和评估其有效性提供循证指导。从数据库建立之初到 2023 年 5 月,我们在 Embase (OVID)、MEDLINE (OVID)、CINAHL (EBSCO)、ProQuest、Scopus、WANFANG、VIP、CNKI 和 SinoMed 等数据库中检索了有关 WLWH 耻辱化干预的研究。根据纳入和排除标准对文献进行筛选,并提取结果进行范围界定审查。共纳入了 12 项研究,这些研究以个人和机构为对象,介绍了基于信息的干预措施、基于技能的干预措施以及两者的结合。六项研究报告称,成见明显减少。使用的评估工具包括 7 个项目的艾滋病受害者态度问卷(AQAV-7)、40 个项目的艾滋病耻辱感量表(HSS-40)、14 个项目的慢性病耻辱感量表(SSCI-14)、28 个项目的艾滋病相关耻辱感内化量表(IHSS-28)、57 个项目的耻辱感内化量表(IS-57)和 6 个项目的艾滋病相关耻辱感内化量表(IA-RSS-6)。需要对现有干预措施进行验证,并建立将干预措施与减少污名化联系起来的机制。
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引用次数: 0
Digital technology for HIV self-management in low- and middle-income countries: a scoping review of adolescents' preferences. 中低收入国家艾滋病毒自我管理的数字技术:青少年偏好范围审查。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-08 DOI: 10.1080/09540121.2024.2383868
Leonie Weyers, Talitha Crowley, Lwandile Tokwe

Digital health technology interventions have shown promise in enhancing self-management practices among adolescents living with Human Immunodeficiency Virus (ALHIV). The objective of this scoping review was to identify the preferences of ALHIV in low- and middle-income countries (LMICs) concerning the use of digital health technology for the self-management of their chronic illness. Electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Plus with Full Text), Central (Cochrane Library), Epistemonikos, and Medline (EbscoHost), were searched. The review focused on English articles published before June 2023, that described a technology intervention for ALHIV specifically from LMIC. The screening and data extraction tool Covidence facilitated the scoping review process. Of the 413 studies identified, 10 were included in the review. Digital health technology interventions can offer enhanced support, education, and empowerment for ALHIV in LMICs. However, barriers like limited access, stigma, and privacy concerns must be addressed. Tailoring interventions to local contexts and integrating technology into healthcare systems can optimize their effectiveness.Review registration: OSF REGISTRIES (https://archive.org/details/osf-registrations-eh3jz-v1).

数字健康技术干预措施在加强人类免疫缺陷病毒感染者(ALHIV)青少年自我管理实践方面大有可为。本范围综述旨在确定中低收入国家(LMICs)的 ALHIV 在使用数字医疗技术进行慢性病自我管理方面的偏好。研究人员检索了电子数据库,包括 PubMed、Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Plus with Full Text)、Central (Cochrane Library)、Epistemonikos 和 Medline (EbscoHost)。综述的重点是 2023 年 6 月之前发表的英文文章,这些文章专门描述了针对低收入和中等收入国家 ALHIV 的技术干预措施。筛选和数据提取工具 Covidence 为范围界定审查过程提供了便利。在确定的 413 项研究中,有 10 项被纳入综述。数字健康技术干预措施可为低收入国家的 ALHIV 提供更有力的支持、教育和赋权。但是,必须解决访问受限、污名化和隐私问题等障碍。根据当地情况调整干预措施并将技术整合到医疗保健系统中可以优化其有效性:奥斯陆基金登记处 (https://archive.org/details/osf-registrations-eh3jz-v1)。
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引用次数: 0
Adherence to antiretroviral therapy and its association with quality of life among people with HIV in the United States. 美国艾滋病病毒感染者坚持抗逆转录病毒疗法及其与生活质量的关系。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-19 DOI: 10.1080/09540121.2024.2391439
Bekana K Tadese, Fritha Hennessy, Phoebe Salmon, Tim Holbrook, Girish Prajapati

Adherence to antiretroviral therapy (ART) is critical for people with HIV (PWH) to achieve and maintain virologic suppression and minimize drug resistance. This study aimed to use real-world data to characterize ART adherence and its effect on quality of life (QoL) in PWH. Data were drawn from the Adelphi HIV Disease Specific Programme™, a cross-sectional survey of physicians and PWH in the United States, conducted June-October 2021. Demographic and clinical characteristics, ART adherence and treatment satisfaction for PWH were reported by physicians. PWH completed standardized QoL questionnaires. Adherence level was categorized into completely, mostly and less adherent. Regression analysis was used to investigate factors associated with adherence and the association between adherence and QoL measures. Of 578 PWH, 189 (32.7%) were not completely adherent. Having AIDS-defining illnesses, anxiety/depression or being symptomatic was significantly associated with lower adherence. Reasons for poor adherence included forgetting, difficulties integrating into routine and side effects. QoL scores were significantly higher in the completely adherent group. These findings highlight the strong association between suboptimal adherence and QoL among PWH and key factors and PWH reasons that may lead to suboptimal adherence. Interventions aimed at improving the QoL of PWH by understanding these factors are warranted.

坚持抗逆转录病毒疗法(ART)对于艾滋病病毒感染者(PWH)实现和维持病毒学抑制以及最大限度地减少耐药性至关重要。本研究旨在利用真实世界的数据来描述坚持抗逆转录病毒疗法及其对 PWH 生活质量(QoL)的影响。数据来自阿德尔菲艾滋病特定项目™,这是一项针对美国医生和PWH的横断面调查,于2021年6月至10月进行。医生报告了艾滋病感染者的人口统计学和临床特征、抗逆转录病毒疗法的依从性和治疗满意度。PWH 填写了标准化的 QoL 问卷。依从程度分为完全依从、基本依从和不太依从。回归分析用于研究与坚持治疗相关的因素以及坚持治疗与 QoL 测量之间的关系。在 578 名艾滋病感染者中,有 189 人(32.7%)没有完全坚持治疗。患有艾滋病定义性疾病、焦虑/抑郁或有症状与依从性较低有显著关系。依从性差的原因包括忘记、难以融入日常工作和副作用。完全依从组的 QoL 评分明显更高。这些研究结果突出表明,在残疾人中,依从性不达标与 QoL 之间存在密切联系,而导致依从性不达标的关键因素和残疾人原因也可能导致依从性不达标。有必要通过了解这些因素来采取干预措施,以改善残疾人的 QoL。
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引用次数: 0
The impact of determinants of health on the relationship between stigma and health in people living with HIV. 健康决定因素对艾滋病毒感染者污名化与健康之间关系的影响。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-09-17 DOI: 10.1080/09540121.2024.2401379
Jason M Lo Hog Tian, James R Watson, Janet A Parsons, Robert G Maunder, Michael Murphy, Lynne Cioppa, A McGee, Wayne Bristow, Anthony R Boni, Monisola E Ajiboye, Sean B Rourke

Determinants of health are important drivers of health states, yet there is little work examining their role in the relationship between HIV stigma and health. This study uses moderation analysis to examine how determinants of health affect the relationship between enacted, internalized, and anticipated stigma and mental health. Quantitative data was collected on 337 participants in Ontario, Canada at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with each determinant of health (age, gender, sexual orientation, ethnicity, geographic region, education, employment, and basic needs) acting as the moderator between types of stigma at t1 and mental health at t2. Age was a significant moderator for the relationship between internalized and enacted stigma at t1 and mental health at t2. Region was a moderator for enacted and anticipated stigma and mental health. Sexual orientation was a moderator for anticipated stigma and mental health. Lastly, having basic needs was a moderator for enacted and anticipated stigma and mental health. Our findings suggest that intervention strategies may be more effective by incorporating supports for these determinants of health in addition to stigma reduction to improve mental health.

健康的决定因素是健康状况的重要驱动因素,但很少有研究探讨这些因素在 HIV 耻辱感与健康关系中的作用。本研究采用调节分析法来研究健康决定因素如何影响已形成、内化和预期的污名化与心理健康之间的关系。在 2018 年 8 月至 2019 年 9 月的基线(t1)和 2021 年 2 月至 2021 年 10 月的随访(t2)期间,收集了加拿大安大略省 337 名参与者的定量数据。分别建立了健康决定因素(年龄、性别、性取向、种族、地理区域、教育、就业和基本需求)的调节模型,以调节 t1 阶段的污名类型与 t2 阶段的心理健康之间的关系。年龄是 t1 阶段内化成见和形成成见与 t2 阶段心理健康之间关系的重要调节因素。地区是已形成鄙视和预期鄙视与心理健康之间的调节因子。性取向是预期成见与心理健康的调节因子。最后,满足基本需求也是已形成和预期成见与心理健康的调节因素。我们的研究结果表明,除了减少成见以改善心理健康外,如果干预策略能够结合对这些健康决定因素的支持,可能会更加有效。
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引用次数: 0
Perceptions of the attributes of new long-acting HIV pre-exposure prophylaxis formulations compared with a daily, oral dose among South African young women: a qualitative study. 南非年轻女性对新型长效艾滋病暴露前预防制剂与每日口服制剂的属性比较:一项定性研究。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-06 DOI: 10.1080/09540121.2024.2383878
Patience Shamu, Saiqa Mullick, Nicola J Christofides

Oral PrEP is highly effective against the acquisition of HIV but is underutilised by young women. New options, like the monthly dapivirine vaginal ring (DVR) and injectable long-acting cabotegravir (CAB-LA), are emerging. However, little is known about young women's perceptions of these alternatives. This qualitative study explored perceptions of the attributes of PrEP technologies in South Africa. Young women accessing sexual health services were purposively selected to participate in 22 in-depth interviews, five focus group discussions and two workshops using the nominal group technique, between August 2022 and March 2023. A thematic approach guided by the diffusion of innovation attributes, including relative advantage, compatibility with the student's lives, complexity of the technology, and trialability, was used for data analysis. The DVR was the least preferred because of lower efficacy, the perceived complexity of inserting it in the vagina and some safety concerns. Oral PrEP, which some had tried and discontinued, was least compatible with students' busy schedules. Integrating PrEP and contraceptives with similar return visit patterns could enhance service delivery. Intensive demand creation campaigns will be needed to increase PrEP utilisation and dispel myths about the vaginal ring.

口服 PrEP 对预防艾滋病病毒感染非常有效,但年轻女性对它的利用率却很低。新的选择正在出现,如每月一次的达匹韦林阴道环(DVR)和可注射的长效卡博替拉韦(CAB-LA)。然而,人们对年轻女性对这些替代品的看法知之甚少。这项定性研究探讨了南非对 PrEP 技术特性的看法。在 2022 年 8 月至 2023 年 3 月期间,研究人员有目的性地挑选了接受性健康服务的年轻女性参加了 22 次深入访谈、5 次焦点小组讨论和 2 次采用名义小组技术的研讨会。数据分析采用了以创新扩散属性为指导的主题方法,包括相对优势、与学生生活的兼容性、技术的复杂性和可试用性。DVR 最不受欢迎,因为其疗效较低、插入阴道的复杂性和一些安全问题。口服 PrEP 最不符合学生繁忙的日程安排,有些学生尝试过口服 PrEP 后又停止使用。将 PrEP 和具有类似回访模式的避孕药具结合起来,可以加强服务的提供。为提高 PrEP 的使用率并消除对阴道环的误解,需要开展密集的需求创造活动。
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引用次数: 0
Childhood sexual trauma and opioid use among older adults living with HIV. 感染艾滋病毒的老年人童年时期的性创伤与阿片类药物的使用。
IF 16.4 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-12 DOI: 10.1080/09540121.2024.2390066
Monique J Brown, Sravya Sunkara, Amandeep Kaur, Prince Nii Ossah Addo, Daniel Amoatika, Elizabeth Crouch

Childhood sexual abuse (CSA) has been linked to substance use and substance use disorders in adulthood. However, there have been limited studies examining the relationship between CSA and opioid use among older adults living with HIV (OALH). Therefore, the aim of this study was to determine the association between CSA and opioid use among OALH (n = 91). Data were obtained from an HIV clinic population in South Carolina using paper-and-pen, and online questionnaires. CSA was operationalized using six questions from the Early Trauma Inventory-Self Report Form (Yes vs. No). Opioid use was self-report of the use of opioids including: heroin, fentanyl, Oxycontin, Vicodin, codeine, morphine (used vs. never used). Nested crude and multivariable logistic regression models adjusting for sociodemographic confounders were used to determine the association between CSA and opioid use. After adjusting for race, gender, age, and education, OALH who were CSA survivors were 21 times more likely to currently use opioids compared to OALH who were not exposed to CSA (adjusted OR: 21.1; 95% CI: 1.78-250.0). The association seen between CSA history and opioid use may be due to unresolved trauma among OALH. Trauma-informed interventions addressing CSA may help to reduce opioid use among OALH.

童年性虐待(CSA)与成年后的药物使用和药物使用障碍有关。然而,对感染艾滋病毒的老年人(OALH)中 CSA 与阿片类药物使用之间关系的研究却很有限。因此,本研究旨在确定 OALH(n = 91)中 CSA 与阿片类药物使用之间的关系。研究使用纸笔问卷和在线问卷从南卡罗来纳州的一家艾滋病诊所人群中获取数据。CSA 采用早期创伤量表-自我报告表(是与否)中的六个问题进行操作。阿片类药物使用情况是对阿片类药物使用情况的自我报告,包括:海洛因、芬太尼、奥施康定、维柯丁、可待因、吗啡(使用过与从未使用过)。使用嵌套粗略和多变量逻辑回归模型(调整社会人口混杂因素)来确定 CSA 与阿片类药物使用之间的关联。在对种族、性别、年龄和教育程度进行调整后,与未接触过 CSA 的 OALH 相比,CSA 幸存者目前使用阿片类药物的可能性要高出 21 倍(调整后 OR:21.1;95% CI:1.78-250.0)。CSA史与阿片类药物使用之间的关联可能是由于OALH中的创伤未得到解决。针对 CSA 的创伤干预措施可能有助于减少 OALH 中阿片类药物的使用。
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引用次数: 0
Utility of the Alcohol Use Disorder Inventory Test in determining caseness for alcohol use disorder among persons receiving antiretroviral therapy. 酒精使用障碍量表测试在确定接受抗逆转录病毒治疗者是否患有酒精使用障碍方面的实用性。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-06-13 DOI: 10.1080/09540121.2024.2365853
Ashraf Kagee, Wylene Saal, Adelle Sterley

We sought to determine the utility of the Alcohol Use Disorder Identification Test (AUDIT) in screening for alcohol use disorder (AUD) among 688 users of antiretroviral therapy (ART). We used the receiver operating characteristic (ROC) curve analysis to assess whether the AUDIT reliably detected AUD against the Structured Clinical Interview for the DSM (SCID). Of the samples, 22.09% (CI: 19.05% to 25.38%) of participants met the diagnostic criteria for AUD. Among men (n = 135) and women (n = 553), the prevalence estimates were 31.9% and 19.7%, respectively. For men, a cut-off score of 6 predicted AUD with 88.36% (95%CI: 74.92-96.11) sensitivity and 88.04% (95%CI: 79.61-93.88) specificity. For women, a cut-off score of 4 on the AUDIT yielded an optimal sensitivity of 92.66% (95% CI: 86.05%-96.78%) and a specificity of 93.24% (95% CI: 90.49-95.40%). For men, the AUDIT yielded a positive predictive value (PPV) of 75.55% (95% CI: 66.26%-85.87%) and a negative predictive value (NPV) of 91.49% (95% CI: 87.63-97.37%); for women the PPV and NPV were 77.09% (70.34%-82.68%) and 98.11% (96.37%-99.02%), respectively. The instrument's good sensitivity and specificity indicate it is likely to be useful for screening and referral of ART users who are probably cases of AUD.

我们试图确定酒精使用障碍鉴定测试(AUDIT)在筛查 688 名抗逆转录病毒疗法(ART)使用者中酒精使用障碍(AUD)的实用性。我们使用受试者操作特征曲线(ROC)分析来评估 AUDIT 与 DSM 结构化临床访谈(SCID)相比是否能可靠地检测出 AUD。在样本中,22.09%(CI:19.05% 至 25.38%)的参与者符合 AUD 的诊断标准。在男性(n = 135)和女性(n = 553)中,患病率估计值分别为 31.9% 和 19.7%。对于男性,6 分临界值预测 AUD 的灵敏度为 88.36%(95%CI:74.92-96.11),特异度为 88.04%(95%CI:79.61-93.88)。对于女性而言,AUDIT 临界值为 4 分的最佳灵敏度为 92.66%(95%CI:86.05%-96.78%),特异度为 93.24%(95%CI:90.49%-95.40%)。对于男性,AUDIT 的阳性预测值 (PPV) 为 75.55%(95% CI:66.26%-85.87%),阴性预测值 (NPV) 为 91.49%(95% CI:87.63%-97.37%);对于女性,PPV 和 NPV 分别为 77.09%(70.34%-82.68%)和 98.11%(96.37%-99.02%)。该工具良好的灵敏度和特异性表明,它可能有助于筛查和转诊可能患有 AUD 的抗逆转录病毒疗法使用者。
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引用次数: 0
Antiretroviral therapy adherence among peripartum women with HIV in Kenya: an explanatory mixed methods study using dry blood spot measures and narrative interviews. 肯尼亚感染艾滋病毒的围产期妇女坚持抗逆转录病毒疗法的情况:一项采用干血斑测量法和叙述性访谈法的解释性混合方法研究。
IF 16.4 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-06 DOI: 10.1080/09540121.2024.2383885
K Hampanda, H Grubbs, J Castillo-Mancilla, P L Anderson, J Thorne, A Helova, J M Turan, M Onono, L L Abuogi

ABSTRACTAdherence to antiretroviral therapy (ART) remains sub-optimal among pregnant and postpartum women with HIV (PPWH) in high HIV prevalence low resource settings with few effective behavioral interventions. A large body of qualitative literature has established general barriers and facilitators to ART adherence in PPWH at various levels (individual, interpersonal, structural). However, research exploring the underlying behavioral mechanisms of ART adherence in PPWH with objectively verified adherence biomarkers is extremely limited. We conducted 24 in-depth interviews with postpartum women in western Kenya who had linked ART drug concentrations obtained from three dried blood spot samples across the peripartum period. Among PPWH with a low drug concentration (n = 13) compared to those with continuously high drug concentrations (n = 11), distinct themes emerged related to HIV status disclosure, social support, interactions with the health system, and health beliefs. By combining ART biomarkers with patient reported challenges, there is the potential for real-time interventions to support sustained ART adherence among PPWH and improve maternal and infant health outcomes.

ABSTRACTA 在艾滋病病毒感染率高、资源匮乏、几乎没有有效行为干预措施的情况下,感染艾滋病病毒的孕妇和产后妇女(PPWH)坚持抗逆转录病毒疗法(ART)的情况仍未达到最佳。大量定性文献已从不同层面(个人、人际、结构)确定了阻碍孕妇和产后妇女坚持抗逆转录病毒疗法的一般障碍和促进因素。然而,利用客观验证的坚持抗逆转录病毒疗法生物标志物来探索 PPWH 坚持抗逆转录病毒疗法的潜在行为机制的研究却极为有限。我们对肯尼亚西部的产后妇女进行了 24 次深入访谈,这些妇女在整个围产期都在使用从三个干血斑样本中获得的抗逆转录病毒疗法药物浓度。与药物浓度持续偏高的产妇(11 人)相比,药物浓度偏低的产妇(13 人)与药物浓度持续偏高的产妇(11 人)在 HIV 感染状况披露、社会支持、与医疗系统的互动以及健康信念方面出现了不同的主题。通过将抗逆转录病毒疗法生物标志物与患者报告的挑战相结合,有可能采取实时干预措施,支持 PPWH 持续坚持抗逆转录病毒疗法,改善母婴健康状况。
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Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv
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