Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv最新文献

ABSTRACTIdentifying HIV risk factors is important for screening. High adverse childhood experience (ACE) scores (≥ 4) reflect childhood trauma and are associated with HIV risk behaviors. Studies examining ACE and HIV testing are limited, with mixed results. We performed a retrospective cross-sectional study examining ACE score, HIV risk behaviors, and previous HIV testing utilizing the S.C Behavioral Risk Factor Surveillance System over six years. We separately compared individuals <35/≥35 years old, with/without risk behaviors, and with/without previous testing. Using logistic regression, we determined factors associated with risk behaviors and previous testing. Of 55,087 surveyed, 15% reported high ACE. High ACE was associated with risk behaviors (aOR 2.652, 95% CI: 1.987-3.538) and previous testing (aOR 2.340, 95% CI: 2.031-2.696). Female respondents had lower odds of risk behaviors (aOR 0.442, 95% CI: 0.336-0.581) and previous testing (aOR 0.822, 95% CI: 0.736-0.919). Individuals <35 years old more often reported high ACE score (25% vs 14%, p < 0.001), risk behaviors (13% vs 2.5%, p < 0.001), and previous testing (46% vs 30%, p < 0.001). Women, who make up 20% of HIV diagnoses, were less likely to report risk behaviors and testing, suggesting traditional risk factors underestimate risk. ACE score could be evaluated prospectively to identify high-risk women.

Science communicators often grapple with conveying tentative or incremental research findings to the public, particularly regarding progress made toward treating or curing illnesses and diseases. A growing cohort of studies has utilized message experiments to examine how different approaches for communicating scientific uncertainty impact public perceptions. Extending this program, we examine the effects of communicating different levels of uncertainty on public perceptions of advancements in HIV/AIDS research. Participants (N = 306) were randomly assigned to view one of three messages in a single-factor experiment with low-, medium-, or high-uncertainty tweets. Outcome measures included perceived uncertainty and support for HIV research. Tweets with a greater emphasis on uncertainty decreased individuals' support not just for the research reported but for research in this critical field as a whole; the way individuals interpret the level of uncertainty presented in the tweets played a crucial role in shaping their attitudes towards supporting HIV/AIDS research. Perceived uncertainty mediated this relationship. As the messaging became more uncertain, participants were more likely to perceive higher levels of uncertainty overall. Participants who perceived greater levels of uncertainty were inclined to express a reduced level of support for HIV/AIDS research. The source of the uncertainty influenced message credibility.

ABSTRACTIn the combined antiretroviral therapy era, limited information exists about cognitive function in children exposed perinatally to human immunodeficiency virus (HIV). To address this, we evaluated executive function (EF) among groups with known HIV exposure status during the perinatal period and at ages 6-10 years: children HIV-infected perinatally (CPHIV, n = 99), children born to HIV-infected mothers, but were HIV negative at enrollment (CPHEU, n = 97), and HIV unexposed, uninfected community controls (CHUU, n = 98). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) to assess two dimensions of child EF (BRI: Behavioral Regulation Index; MCI: Metacognition Index) and a combination of these dimensions (General Executive Composite). We derived Z-scores for BRIEF measures using the CHUU group as the reference and used generalized linear models to estimate mean differences among the groups. The CPHIV and CPHEU groups did not differ from the CHUU group on the GEC or MCI. However, the CPHIV group scored lower than CHUU on the BRI, which is indicative of better functioning in this domain (β = -0.40, 95% CI -0.77, -0.03). Results were unaffected following adjustment. EF scores did not differ substantially across perinatal HIV exposure groups, though we observed evidence that CPHIV may thrive in the BRI domain.

Despite years of preventive interventions, Mother-to-child transmission (MTCT) of HIV remains high in low- and middle-income countries. This study aimed to identify risk factors associated with MTCT of HIV in Ghana. A 1:1 unmatched case-control study was conducted among HIV-infected mothers and their exposed children (184 cases and 184 controls) using data from the 2021-2022 HIV-Positive Babies Audit by the National AIDS/STI Control Programme in Ghana. Only variables with missing values ≤ 5% were included in univariable logistic regression analysis. Variables with p-values ≤ 0.20 were entered into multivariable logistic regression. Six variables were considered: marital status, employment status, mode of delivery, supervision of delivery, type of antiretroviral (ARV) prophylaxis for the baby, and duration of ARV prophylaxis. After adjustment, lack of ARV prophylaxis (AOR = 4.35, 95% CI: 2.41-7.83, p < 0.001) and ARV prophylaxis for less than 12 weeks (AOR = 75.70, 95% CI: 17.18-333.62, p < 0.001) significantly increased the odds of MTCT of HIV. The predictive power of the multivariable logistic regression model was 81%. Introducing systems to ensure that all HIV-exposed babies in Ghana receive at least 12 weeks of ARV prophylaxis is crucial for significantly reducing the burden of MTCT of HIV.

We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.

Since the introduction of pre-exposure prophylaxis (PrEP) in Taiwan in 2016, understanding factors influencing awareness and willingness among sexual minority men (SMM) remains critical. This study investigated predictors of PrEP awareness and willingness among SMM in Taiwan. A cross-sectional online survey conducted between April and May 2023 included 379 HIV-negative or status-unknown cisgender men identifying as gay, bisexual, or men who have sex with men, aged 18-59. Using stochastic search variable selection (SSVS), regression models identified key factors associated with PrEP awareness and willingness. Results revealed high awareness (96.9%) but moderate willingness (75.5%) to use PrEP. Regular HIV/STI testing, using apps to find sex partners, and community affinity significantly predicted both awareness and willingness. Additionally, internalized stigma, higher education, financial stress, and sexualized substance use were linked to awareness, while enacted stigma and PrEP awareness were associated with willingness. These findings highlight the need for targeted strategies to address stigma and barriers to awareness and willingness. Leveraging digital platforms and fostering community engagement are essential for strengthening these critical precursors in HIV prevention among SMM in Taiwan.

Lack of adherence to antiretroviral therapy (ART) and poor retention in care are significant barriers to ending HIV epidemics. Treatment adherence support effectiveness may be constrained by limited understanding of the benefits of ART. We evaluated a visual and tactile tool, the B-OK Bottles ("B-OK"), that incorporates human-centered design and behavioral economics principles and is designed to change and strengthen mental models about HIV. We enrolled 118 adults living with HIV who were clients of medical case managers in Philadelphia. All participants completed a pre-intervention survey, a B-OK intervention and a post-intervention survey. A subset (N = 52) completed qualitative interviews. Co-primary outcomes were differences pre- to post-intervention for 11 questions about HIV awareness, knowledge, attitudes, intentions and perception. Qualitative interviews were assessed using an integrated analysis approach. Participants had a median age of 55 years (IQR 47-60), 65% were male sex (N = 77), and 72% identified as non-Hispanic Black (N = 85). B-OK was associated with improved awareness and understanding of HIV terminology, changes in HIV treatment attitudes, and increased intention to rely on HIV treatment for transmission prevention. Qualitative interview results aligned with the quantitative findings. These findings provide a strong rationale to further evaluate the potential for B-OK to improve HIV treatment adherence support.

The attitudes of People Living with HIV (PLWH) towards frailty and maintaining quality of life (QOL) whilst ageing is largely unknown. This study examines how PLWH perceive being assessed for frailty and ageing, and the importance of QOL as they age. 40 semi-structured interviews were conducted. Many of the participants voiced that ageing was unexpected and were unprepared for this. Main themes for ageing included self-determination and loss of independence; concern for the future including care provision, services required for ageing and fear of admission into aged care. Themes associated with frailty were, future loss of physical function and the assessment process reflecting both positive (proactive) and negative (confronting) responses regarding ageing and frailty as many participants felt they were too young to be considered frail. Themes for quality of life included the importance of self-expression and independence; connection to others, having adequate finances to enjoy life, having baseline needs met such as housing and having a positive outlook on the future. This study highlighted the importance of talking about ageing and how frailty is framed in discussions to develop individualised strategies for PLWH to decrease risk factors for frailty.

The challenges of recruiting participants for end-of-life (EOL) research are multifaceted. The Last Gift study at the University of California San Diego, an observational study for people with HIV (PWH) with terminal illness, appeals to the altruism of potential participants and community of allied health providers. Involvement of the latter group highlights a potential ethical conundrum of a "dual role", as primary care providers (PCPs) navigate between clinical responsibilities to their patients, along with opportunities to discuss clinical research. To explore this conundrum and better understand study recruitment dynamics of the Last Gift study, we analyzed screening and enrollment data for a 12-month period (2022-2023). We found that PCPs can play an important role in the recruitment of PWH into EOL research, as having PCPs discuss the study with potential participants yielded more successful enrollments than contact by the study team alone. Our manuscript proposes considerations to mitigate dual role conflicts, including ensuring ethical awareness, prioritizing clinical care and offering strategies to involve PCPs in recruitment without causing unnecessary burden or coercion. These insights aim to guide similar EOL research efforts, emphasizing the need for balanced, ethical recruitment processes in the sensitive context of terminal illness.

People living with HIV (PLWH) have a higher prevalence of mental ill health compared to the general population. We aimed to understand the impact of the COVID-19 pandemic and omitting routine HIV appointments on the mental health (MH) of PLWH. Between April 2020 and March 2021, routine appointments for "stable" PLWH were replaced by virtual consultations. MH assessments using standardised questionnaires were compared before and during the pandemic. Full data were available for 426 individuals after excluding those with incomplete data and those requiring early review for non-MH-related issues. The results showed that 277 (65%) experienced no/minimal MH symptoms throughout, indicating robust MH. For depression, scores worsened in 59 (13.8%), improved in 62 (14.6%) and remained stable in 305 (71.6%). For anxiety, scores worsened in 55 (12.9%), improved in 64 (15%) and remained stable in 307 (72.1%). A total of 98.4% of individuals remained virally suppressed, with 7 developing a detectable viral load. One person stopped antiretroviral treatment secondary to an MH crisis. Findings suggest that the COVID-19 pandemic did not significantly impact the overall MH in our cohort of PLWH. It also demonstrates an effective implementation of virtual consultations. The complex nature of MH in PLWH highlights the need for individualised MH care.