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

We compared the levels of psychosocial and sexual experiences of adolescents aged 10-19 years who were living with (ALHIV) and affected by HIV who resided in HIV-affected homes of Uganda. Data were collected using a questionnaire that was validated using factor analysis. The levels of psychosocial and sexual experiences of these adolescents were compared using variance and Kruskal-Wallis tests. Results showed that whereas these adolescents were exposed to each observed factor, the ALHIV were significantly more vulnerable to lower education levels, living with sick people, death of both parents, changing homes, living with caregivers who were relatives or alcohol users, negative peer influence, poverty, personal and interpersonal problems, distress, sexual risk behaviour, and negative coping methods, compared to those not living with HIV or unaware of their HIV status. Hence, despite the higher primary education achievement and access to HIV services, ALHIV face a lesser sense of belonging, a higher burden of caring for their family members' sicknesses, higher vulnerability to sexually transmitted diseases, and poorer coping abilities compared to the other adolescents in the same home. Interventions are needed from families, schools and agencies to address the risk and protective factors among these adolescents.

The secondary distribution of HIV self-testing (HIVST) kits has the potential to improve access and uptake of HIV testing. This study assessed the acceptability of secondary distribution of HIVST by people living with HIV (PLHIV) to their sexual partners in Central Kenya and explored the broader perspectives on this strategy. Conducted between November 2019 and April 2023, the study was nested within an interventional study that implemented two approaches to encourage HIV testing among sexual partners of PLHIV: (1) Invitation by PLHIV for clinic-based testing, and (2) distribution of HIVST kits to their sexual partners. One-time in-depth interviews (IDIs) were conducted with PLHIV (n = 21), sexual partners (n = 17), and healthcare providers (n = 10) to assess the acceptability of the HIVST distribution strategy from multiple perspectives. Participants generally perceived the HIVST strategy as acceptable, feasible, and convenient, as it saved both time and cost. However, some participants highlighted the potential for conflict and the lack of counseling services with HIVST, while others were concerned about the accuracy of HIVST. Future research should explore HIVST strategies that integrate user-centred counseling services while also addressing safety concerns related to relationship dynamics and the perceived effectiveness of HIVST kits.

Community-based HIV testing can identify high-risk adolescents and young adults living with HIV (AYALH), but data on long-term outcomes of AYALH identified via community-based testing is limited. We compared outcomes among AYALH 15-24 years identified in community-based campaigns to those who self-presented to an HIV clinic in Haiti. We measured retention 12-months after antiretroviral therapy (ART) initiation and factors associated with retention including time to ART initiation, assessed as a binary variable: immediate (≤7 days from HIV diagnosis) or delayed (>7 days from HIV diagnosis). Focus group discussions with providers highlighted AYALH's experience of entering care via both routes and recommendations for improving outcomes. 606 AYALH tested HIV-positive: 191 community-testers and 415 clinic-testers. Sociodemographic characteristics differed between groups: mean age 21 vs. 22 (p < 0.01), 88% vs. 74% female (p < 0.01), and 90% vs. 74% reported no income (p < 0.01). 12-month retention was 57% among community-testers and 68% among clinic-testers (p = 0.05). Those who immediately initiated ART had higher odds of non-retention (aOR, 1.62; 95%CI: 1.04-2.54; p = 0.03). Qualitative data suggested community-testers lack social support and were less emotionally prepared for diagnosis. Community-testers who immediately initiated ART were at highest risk of non-retention and are in need of enhanced psychosocial and clinical support to optimize outcomes.

We conducted a participatory workshop with pregnant or parenting young women to co-create innovative PrEP delivery strategies informed by their lived experiences. Nine pregnant or parenting young women (n = 6 aged 18-24; n = 3 aged 25-28) were recruited from the FastPrEP study, an implementation project in South Africa. Participants ranked barriers to PrEP access and use, with early clinic closures listed as the biggest challenge, followed by community PrEP-related stigma, pill burden, side effects, partner resistance, and missed appointments. Their proposed solutions included after-hours clinic opening times and alternative delivery models such as mobile clinics, home courier delivery, locker pick-up, and pharmacy access; community education led by providers and peers; long-acting PrEP (particularly injectables); side-effect remedies and lower-toxicity options like vaginal rings; co-packaging of PrEP and condoms with educational materials; and appointments reminders. Participants also designed their "dream PrEP delivery package." Participants wanted discreet packaging, convenient delivery platforms, and bundled access to sexual and reproductive health products, including PrEP, condoms, self-test kits, and menstrual hygiene items. Engaging pregnant or parenting young women as co-designers of PrEP delivery strategies is feasible and generates practical, user-driven solutions. Their insights underscore the importance of stigma-free, community-based, convenient, differentiated, and person-centred PrEP delivery.

Mass incarceration in the United States is a social-structural driver of health for sexual and gender minoritized adults (SGMA). The aim of this study was to develop a conceptual framework for post-release healthcare to use in adapting a mobile health unit (MHU) for SGMA returning from jail. We used concept mapping to answer a focal prompt regarding health-related needs for SGMA post-release. We recruited SGMA with recent incarceration experience and relevant community partners to participate in 4 concept mapping sessions. Multidimensional scaling produced a two-dimensional point map of all statements and their relative relationships and hierarchical cluster analysis illustrated clusters of needs. SGMA community members (n = 16) and community partners (n = 13) generated 109 unique statements describing post-release healthcare-related needs for SGMA. Participants sorted and rated these items, creating a map of 10 clusters of needs: Physical Health, LGBTQ-Affirming Mental Health Care, Release Planning, Release Aftercare, Peer Support, Immediate Needs, Stabilizing Needs, Resources to Thrive, Access to Education, and Structural Healthcare Advantages. While HIV prevention and treatment were identified as the most important and the best fitting, the vast majority of post-release healthcare needs identified by SGMA related to other social and structural drivers of health to reduce stigma and risk, increase access to important health services like harm reduction and gender-affirming care, improve their economic conditions, and provide social support and safety. This participant-led conceptual framework provides insight regarding important components to include in development and adaptation of interventions to address HIV and other health inequities for SGMA produced and exacerbated by the CLS.

Community-based antiretroviral therapy (ART) distribution is a promising strategy to increase HIV treatment accessibility in Africa, yet population-level coverage and correlates of enrollment are understudied. We pooled data from seven Population-based HIV Impact Assessment surveys (2020-2023) and used survey-weighted multivariable logistic regression with jackknife variance estimation to identify socio-demographic and clinical correlates of enrollment in community, relative to facility-based, ART distribution models. Across countries, 11,629 virally suppressed (<1000 RNA copies/ml) persons on ART for >12 months (mean age: 42.1 years, 67.0% female) self-reported their assigned ART refill model, 2.9% of whom received ART from a community-based pickup point (range: 0.5% in Mozambique to 7.6% in Zimbabwe). Correlates of enrollment in a community-based refill model included rural residence (adjusted odds ratio [adjOR] = 2.24, 95% confidence interval [CI]:1.20-4.21), past-year mobility (adjOR=1.56, 95%CI: 1.05-2.31), ART dispensing intervals of >6 months (adjOR=2.36, 95%CI: 1.11-5.02), and transportation-related barriers to facility-based HIV care (adjOR=1.43, 95%CI: 1.01-2.03). Among virally suppressed males, superior virologic control at the <200 copies/ml (adjOR=7.12, 95%CI: 1.59-31.97) and <400 copies/ml (adjOR=6.08, 95%CI: 1.34-27.57) levels was observed among those enrolled in a community-based, relative to facility-based, ART distribution model. Findings affirm the potential of community-based refill models to reach populations susceptible to HIV care attrition, but coverage estimates remain low, indicating implementation barriers.

Adolescents remain a critical population in the global human immunodeficiency virus (HIV) epidemic, particularly in low - and middle-income countries such as Indonesia, where testing uptake and awareness among youth remain low. This study aimed to develop and evaluate a peer-supported, digital-based HIV education and self-screening intervention tailored for adolescents in Yogyakarta. By integrating digital technology with peer-led support, the intervention addresses stigma-related barriers, limited access to youth-friendly services, and low health literacy. Using a mixed-methods research and development approach, the study will be conducted in three phases: needs assessment, platform development, and a cluster randomised controlled trial. One thousand adolescents aged 15-17 years will be recruited from public high schools and randomly assigned to intervention or control groups. Data will be collected using validated instruments and analysed using difference-in-differences and multilevel modelling to assess knowledge, self-awareness, digital engagement, and testing behaviours. These projected findings suggest that peer-supported digital interventions have the potential to be effective in increasing HIV prevention behaviours among adolescents. Integrating peer education, interactive self-screening, and digital engagement offers a scalable and culturally appropriate model for youth-centred health promotion.

Suicide is a global public health issue, ranking as the tenth leading cause of death worldwide and the second leading cause among individuals aged 15-29. Over 20 individuals living with HIV attempt suicide daily, resulting in fatalities. This study aimed to assess the prevalence of suicidal ideation, attempts and associated factors among individuals living with HIV/AIDS at Wachemo University Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital, Ethiopia. An institution-based, cross-sectional study was conducted among 341 HIV/AIDS patients using a structured questionnaire and systematic random sampling. Descriptive, bivariate and multivariate logistic regression were employed to identify the independent effect of suicidal ideation and attempts. The level of significance was confirmed if the p-value was less than 0.05. This study found that 24.6% and 14.4% of respondents experienced suicidal ideation and attempts, respectively. Psychoactive substance use, family history of mental illness and the educational level of participants were significant factors in suicidal ideation and attempts. The prevalence of suicidal ideation and attempts among people living with HIV/AIDS remains high. Educational attainment and social support were found to be protective factors, while psychoactive substance use increased the risk of suicidal ideation. The finding highlights the need for integrating mental health assessment and suicide prevention strategies into routine HIV care services to improve patient outcomes.

The Perceptions and Practicalities Approach (PaPA) is a recommended framework for designing medication adherence interventions. Little is known about the utility of the PaPA framework in improving antiretroviral therapy (ART) adherence. This systematic review evaluates the efficacy of interventions to improve ART adherence according to the extent to which they apply principles from the PaPA framework. Electronic databases were searched in October 2024. Interventions were classified using the PaPA and whether they were delivered in a low-middle-income country (LMIC) or high-income country (HIC). 85 randomised trials were included (N = 16,401). Interventions classed as PaPA Level 3 improved adherence in both LMICs (k  =  16, (SMD) = 0.44, 95%CI:[0.27;0.62]) and HICs (k = 31, SMD = 0.33, 95%CI:[0.17; 0.49]). PaPA Level 1 interventions (k = 47) did not demonstrate an improvement in adherence compared to usual care in HICs but did in LMICs. Overall, interventions (k = 50, N = 10,004) were associated with greater odds of virological suppression (OR =  1.17, 95%CI:[1.02;1.33], Q = 104.19, p = 0.001;  = 50.58%). PaPA Level 3 interventions were more likely to be associated with suppressed viral load than PaPA Level 1 or 2 interventions. These results suggest that PaPA is an efficacious approach to increasing adherence to ART in HICs. RCTs evaluating the efficacy and acceptability of PaPA-informed interventions in the LMIC context are needed.

Objectives: Persons living with HIV (PLWH) face double the risk of cardiovascular disease (CVD) compared to others. We assessed HIV prevalence among patients presenting to a Tanzanian emergency department (ED) with acute myocardial infarction (AMI) or heart failure (HF).

Methods: In this prospective observational study (Nov 2020-Jan 2023), adults with chest pain or dyspnea were enrolled. Patients without known HIV underwent HIV 1/2 assay and confirmatory testing. AMI was defined per the Fourth Universal Definition; HF by physician diagnosis at discharge. Thirty-day follow-up was via phone or home visit.

Results: Of 836 enrolled participants, 344 (41.1%) met criteria for AMI or HF. Among these, 16 (4.7%) had HIV (15 known, 1 new). In participants without AMI or HF, 17 (3.5%) had known HIV. Follow-up was achieved for 99.8% (n = 834). HIV-positive participants with AMI or HF had higher unadjusted 30-day mortality than HIV-negative participants (37.5% vs 24.5%, OR 1.93, 95% CI: 1.05-3.60, p < 0.05).

Conclusions: Targeted HIV testing for patients with cardiovascular complaints in a Tanzanian ED setting may not be a high-yield method for identifying new HIV cases. Future studies should be tailored to populations underrepresented in current programs. Thirty-day mortality following AMI or HF diagnosis is significantly higher for PLWH in Tanzania, emphasizing the need for interventions to address poor clinical outcomes of CVD among this population.