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Intention and preference to use long-acting injectable PrEP among MSM in the Netherlands: a diffusion of innovation approach. 荷兰 MSM 使用长效注射 PrEP 的意向和偏好:创新扩散方法。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-05-07 DOI: 10.1080/09540121.2024.2307378
Haoyi Wang, Hanne M L Zimmermann, David van de Vijver, Kai J Jonas

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is efficacious in preventing HIV among men-who-have-sex-with-men (MSM) and will be soon available in Europe. This study investigated the intention and preference to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach. This study had a cross-sectional design nested within a cohort study established in 2017 to understand oral PrEP use among MSM. 309 MSM completed the survey on their awareness, interest, intention, and preference for LAI-PrEP in June 2022. Among them, 83% showed high/very-high interest in, and 63% showed high/very-high intention to use LAI-PrEP. A repeated innovator effect from the early adopters to LAI-PrEP was not observed. Early adopters did not show increased intention to use LAI-PrEP compared to other MSM subgroups, but neither did PrEP-naïve nor PrEP-discontinued MSM. However, among the 218 current oral PrEP users, suboptimal adherence was associated with preference for LAI-PrEP but not with intention to use it. In conclusion, our findings indicated that an effective, available, and affordable LAI-PrEP would be welcomed in the Netherlands, but that its introduction may not significantly expand PrEP coverage. However, the introduction of LAI-PrEP in the Netherlands could prove beneficial to MSM with suboptimal adherence to oral PrEP.

长效注射型暴露前预防疗法(LAI-PrEP)在男男性行为者(MSM)中预防艾滋病非常有效,不久将在欧洲上市。本研究采用创新扩散法调查了荷兰 MSM 使用 LAI-PrEP 的意向和偏好。本研究采用横断面设计,嵌套于2017年为了解MSM口服PrEP使用情况而开展的一项队列研究中。2022年6月,309名男男性行为者完成了关于他们对LAI-PrEP的认识、兴趣、意向和偏好的调查。其中,83%的人对使用LAI-PrEP表现出很高/非常高的兴趣,63%的人对使用LAI-PrEP表现出很高/非常高的意向。早期采用者对LAI-PrEP的重复创新效应未被观察到。与其他 MSM 亚群相比,早期采用 LAI-PrEP 的 MSM 并未表现出更高的使用意愿,但未采用 PrEP 或已停止 PrEP 的 MSM 也未表现出更高的使用意愿。然而,在目前的 218 名口服 PrEP 使用者中,次优依从性与对 LAI-PrEP 的偏好有关,但与使用意向无关。总之,我们的研究结果表明,有效、可用且负担得起的 LAI-PrEP 将在荷兰受到欢迎,但其引入可能不会显著扩大 PrEP 的覆盖范围。然而,在荷兰引入 LAI-PrEP 可能会对口服 PrEP 依从性不佳的 MSM 有益。
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引用次数: 0
Stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis. AIDSimpact 特刊:俄罗斯不坚持艾滋病护理的男男性行为者的污名化、血清状况披露、应对策略以及社会资本资源的作用:定性分析。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-01-30 DOI: 10.1080/09540121.2024.2305785
Yuri A Amirkhanian, Anastasia Y Meylakhs, Anna V Kuznetsova, Jeffrey A Kelly, Katherine G Quinn

The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.

艾滋病疫情在俄罗斯持续蔓延,但接受治疗的情况却不尽如人意。这项定性研究旨在了解俄罗斯未坚持治疗的男男性行为者(MSM)艾滋病病毒感染者的社会资本资源、生活污名化经历、应对方法和披露情况。在网上招募的 25 名 HIV 阳性男男性行为者通过 Zoom 完成了深度访谈,并使用 MAXQDA 软件对数据进行了分析。在与医疗服务提供者和亲属(尤其是男性)等社会关系较弱的人交往时,更有可能遭遇污名化。亲密的朋友--通常是其他艾滋病毒呈阳性的男男性行为者和女性亲属--最能给予支持,也最不容易造成污名化。在披露艾滋病毒血清状况时,最常考虑的是类似的人。减少污名化影响的应对策略包括忽视污名化经历、寻求社交圈成员的支持、尽量减少与污名化者的接触、寻求与艾滋病毒呈阳性者建立新的关系、通过参与宣传活动主动减少污名化,以及纠正神话和教育他人了解艾滋病毒感染。这些发现突出表明,有必要采取干预措施,帮助艾滋病毒呈阳性的男男性行为者建立可接受的社会资本资源,以减少污名化的影响,并在其社会网络中建立支持,通常是与其他艾滋病毒呈阳性的男男性行为者建立支持。
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引用次数: 0
"What if I got rejected by the girl? I would rather stop the pills": barriers and facilitators of adherence to antiretroviral therapy for emerging adults aged 18-29 living with HIV in Zimbabwe. "如果我被女孩拒绝了怎么办?我宁愿停药":津巴布韦 18-29 岁新感染艾滋病毒的成年人坚持抗逆转录病毒疗法的障碍和促进因素。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-03-27 DOI: 10.1080/09540121.2024.2332462
Rebecca Jopling, Wilson Mutsvuke, Madison Fertig, Conall O'Cleirigh, Walter Mangezi, Melanie Abas

Emerging adults aged 18-29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18-29 to adhere to ART.

与老年人相比,18-29 岁的新兴成年人病毒抑制率高,抗逆转录病毒疗法的依从性也较差。我们对津巴布韦 24 名近期有病毒抑制史的新成人进行了半结构式访谈,以探讨坚持抗逆转录病毒疗法的障碍和促进因素。访谈采用归纳主题分析法进行编码。参与者的平均年龄为 23 岁,65% 为男性,79% 表示在出生时感染了艾滋病毒。共发现了 12 个妨碍坚持抗逆转录病毒疗法的障碍。由于披露可能带来的负面影响而隐瞒艾滋病病毒感染状况对坚持抗逆转录病毒疗法有很大影响。这对于正在建立亲密关系的成年人来说尤为重要。据报告,远离家乡、贫困、心理健康状况不佳、孤独、重大生活事件、酗酒、医疗系统障碍和污名化也是影响坚持治疗的障碍。在披露艾滋病病毒感染状况后,来自同伴和家人的支持、电话提醒、解决问题的坚持策略、了解其他艾滋病病毒感染者,这些都是坚持抗逆转录病毒疗法的促进因素。对药物的信念以及与医疗服务提供者的关系既是坚持治疗的障碍,也是坚持治疗的促进因素。减少耻辱感、促进同伴支持和治疗常见精神障碍的干预措施可促进 18-29 岁的新成人坚持抗逆转录病毒疗法。
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引用次数: 0
Empowering and supporting frontline providers in the paediatric-adolescent HIV response: results from participatory priority-setting and group discussions in twenty-four sites in twelve high HIV-burden African countries. 在儿科-青少年艾滋病防治工作中增强一线服务提供者的能力并为其提供支持:在 12 个艾滋病高发非洲国家的 24 个地点开展的参与式优先事项确定和小组讨论的结果。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-02-05 DOI: 10.1080/09540121.2024.2308023
Lesley Gittings, Nokuzola Ncube, Agnes Ronan, Isobella Chimatira, Luann Hatane

Children and adolescents living with HIV in Africa experience poor outcomes across the HIV cascade of care. Paediatric and adolescent-friendly services are crucial to their well-being, and recent years have seen a call for urgent service improvements. While frontline health workers are responsible for these services, less attention has been given to their contextual realities, and what constitutes an enabling service delivery environment. We engaged participatory priority-setting and group discussions across twenty-four sites in twelve high HIV-burden African countries in November 2022 with 801 frontline paediatric-adolescent providers. Data were analysed using thematic analysis and priority mapping. We constructed a socio-ecological model for supportive and empowering service delivery environments for frontline paediatric-adolescent HIV services. Individual-level themes related to well-being, self-care and mental health. Interpersonal themes included supportive supervision/mentorship, teamwork and acknowledgement. At the organisational level, resources, physical infrastructure and confidential spaces were included. The community level included feeling appreciated and positive stakeholder relationships. The structural level included funding, discriminatory SRHR policies and guidelines. Results provide insight into priorities, challenges and needs of frontline providers in the paediatric-adolescent HIV response. Improving the well-being of HIV-affected children and adolescents requires greater investment and attention to creating more caring, supportive environments for their frontline providers.

在非洲,感染艾滋病毒的儿童和青少年在整个艾滋病毒级联护理过程中的治疗效果不佳。儿科和青少年友好型服务对他们的福祉至关重要,近年来,人们呼吁紧急改善服务。虽然一线医务工作者负责提供这些服务,但人们对他们的实际情况以及什么是有利的服务提供环境关注较少。2022 年 11 月,我们在非洲 12 个艾滋病高发国家的 24 个地点与 801 名一线儿科和青少年医疗服务提供者进行了参与式优先事项设定和小组讨论。我们采用专题分析和优先事项规划对数据进行了分析。我们构建了一个社会生态模型,用于为一线儿科-青少年艾滋病服务机构提供支持性和赋权服务环境。个人层面的主题涉及幸福感、自我保健和心理健康。人际层面的主题包括支持性监督/指导、团队合作和认可。组织层面的主题包括资源、物质基础设施和保密空间。社区层面的主题包括被欣赏感和积极的利益相关者关系。结构层面包括资金、歧视性的性健康和生殖健康及权利政策和指导方针。研究结果有助于深入了解儿科青少年艾滋病防治工作中一线服务提供者的优先事项、挑战和需求。要改善受艾滋病毒影响的儿童和青少年的福祉,就必须加大投入,关注为一线服务提供者创造更多关爱和支持的环境。
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引用次数: 0
How do new crises impact HIV risk behaviour - exploring HIV risk behaviour according to COVID-19-related orphanhood status in South Africa? 新危机如何影响艾滋病毒风险行为--根据南非与 COVID-19 相关的孤儿状况探讨艾滋病毒风险行为?
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-05-06 DOI: 10.1080/09540121.2024.2333435
Tatenda Mawoyo, Kathryn J Steventon Roberts, Christina Laurenzi, Sarah Skeen, Stefani Du Toit, Ramsha Hisham, Lucie Cluver, Lorraine Sherr, Mark Tomlinson

The COVID-19 pandemic resulted in high death rates globally, and over 10.5 million children lost a parent or primary caregiver. Because HIV-related orphanhood has been associated with elevated HIV risk, we sought to examine HIV risk in children affected by COVID-19 orphanhood. Four hundred and twenty-one children and adolescents were interviewed, measuring seven HIV risk behaviours: condom use, age-disparate sex, transactional sex, multiple partners, sex associated with drugs/alcohol, mental health and social risks. Approximately 50% (211/421) experienced orphanhood due to COVID-19, 4.8% (20/421) reported living in an HIV-affected household, and 48.2% (203/421) did not know the HIV status of their household. The mean age of the sample was 12.7 years (SD:2.30), of whom 1.2% (5/421) were living with HIV. Eighty percent (337/421) reported at least one HIV risk behaviour. HIV sexual risk behaviours were more common among children living in HIV-affected households compared to those not living in HIV-affected households and those with unknown household status (35.0% vs. 13.6% vs.10.8%, X2 = 9.25, p = 0.01). Children living in HIV-affected households had poorer mental health and elevated substance use (70.0% vs. 48.5%, X2 = 6.21, p = 0.05; 35.0% vs. 19.9%, X2 = 4.02, p = 0.1306, respectively). HIV-affected households may require specific interventions to support the health and well-being of children and adolescents.

摘要 COVID-19 大流行导致全球高死亡率,超过 1050 万儿童失去了父母或主要照顾者。由于与艾滋病相关的孤儿与艾滋病风险升高有关,我们试图研究受 COVID-19 孤儿影响的儿童的艾滋病风险。我们对 421 名儿童和青少年进行了访谈,测量了七种 HIV 风险行为:安全套的使用、不同年龄段的性行为、性交易、多个性伴侣、与毒品/酒精相关的性行为、心理健康和社会风险。约 50%(211/421)的受访者因 COVID-19 而成为孤儿,4.8%(20/421)的受访者称生活在受 HIV 影响的家庭中,48.2%(203/421)的受访者不知道其家庭的 HIV 感染状况。样本的平均年龄为 12.7 岁(标准差:2.30),其中 1.2%(5/421)为 HIV 感染者。80%的样本(337/421)报告了至少一种 HIV 风险行为。与未受艾滋病毒影响的家庭和家庭状况未知的儿童相比,受艾滋病毒影响家庭的儿童更常见艾滋病毒性危险行为(35.0% vs. 13.6% vs. 10.8%,X2 = 9.25,p = 0.01)。生活在受艾滋病毒影响家庭的儿童心理健康状况较差,药物使用率较高(分别为 70.0% vs. 48.5%,X2 = 6.21,p = 0.05;35.0% vs. 19.9%,X2 = 4.02,p = 0.1306)。受艾滋病毒影响的家庭可能需要特定的干预措施来支持儿童和青少年的健康和福祉。
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引用次数: 0
Lost to follow up: the (non)psychosocial barriers to HIV/AIDS care in southeast Nigeria. 失去后续治疗:尼日利亚东南部艾滋病毒/艾滋病护理的(非)社会心理障碍。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2023-09-04 DOI: 10.1080/09540121.2023.2253507
Elochukwu Ernest Uzim, Po-Han Lee

Medication withdrawal remains a problem in Nigeria's HIV care. The Enugu state of southeast Nigeria has 3,736 people living with HIV/AIDS (PLHIV), with a 1.9% HIV-positive prevalence rate among the age band of 15-49 years, higher than 1.3%, the national average for the same cohort. Despite the disease burden, many cases are "lost to follow-up" in this region. Through four focus groups of patients (20 participants in total) and in-depth interviews with four clinicians from four public hospitals, this study aimed to understand the barriers to attending healthcare appointments faced by young adults. The participants were recruited through flyers, posters, and snowballs at clinics; both data sets were first analysed separately yet used to triangulate each other. We found that clinical interruptions are mainly attributable to factors such as stigma, suicidal ideation, loss of means of livelihood due to PLHIV's "new identities", and thus poverty and malnutrition. These barriers, complicated by the COVID-19 pandemic and armed conflicts in the region, have made medication adherence further challenging. Therefore, we recommend the Nigerian government integrate non-biomedical support for PLHIV into people-centred HIV care.

停药仍然是尼日利亚艾滋病护理中的一个问题。尼日利亚东南部的埃努古州有 3736 名艾滋病毒/艾滋病感染者(PLHIV),其中 15-49 岁年龄段的艾滋病毒阳性率为 1.9%,高于全国同类人群 1.3%的平均水平。尽管疾病负担沉重,但该地区仍有许多病例 "失去随访"。本研究旨在通过四个患者焦点小组(共 20 名参与者)和对四家公立医院的四名临床医生的深入访谈,了解青壮年在就诊时面临的障碍。参与者是通过传单、海报和在诊所滚雪球的方式招募的;两组数据首先分别进行分析,然后再相互进行三角测量。我们发现,中断就诊的主要原因包括污名化、自杀倾向、因艾滋病毒携带者的 "新身份 "而失去谋生手段,以及贫困和营养不良。这些障碍因 COVID-19 的流行和该地区的武装冲突而变得更加复杂,使得坚持服药变得更加困难。因此,我们建议尼日利亚政府将对艾滋病毒感染者的非生物医学支持纳入以人为本的艾滋病毒护理中。
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引用次数: 0
Peripartum mobility and maternal/child separation among women living with HIV in South Africa. 南非感染艾滋病毒妇女的围产期流动性和母婴分离问题。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-01-04 DOI: 10.1080/09540121.2023.2299745
Kate Clouse, Sandisiwe Noholoza, Sindiswa Madwayi, Megan Mrubata, Natalie N Robbins, Carol S Camlin, Landon Myer, Tamsin K Phillips

This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.

这项前瞻性队列研究调查了南非 200 名感染艾滋病病毒的孕妇和产后妇女的流动模式。参与者在怀孕三个月时从南非开普敦附近的常规产前护理机构登记,并在产后随访六个月。在登记和随访时收集了定量数据。尽管研究时间很短,而且当时正值 COVID-19 大流行,但参与者的流动性(自我报告)很普遍。虽然大多数人表示目前居住地稳定,但 71% 的人有第二个主要居住地,主要在东开普省(EC)。受工作、教育和家庭生活的影响,参与者一生中搬家的次数中位数为两次。在研究期间,20% 的参与者符合研究中关于旅行的定义(7 天以上,50 公里以上),旅行的目的地主要是东开普省,中位持续时间为 30 天。超过三分之一有其他在世子女的参与者表示,这些子女与他们分开居住,主要由母亲的家人照顾。这些研究结果表明,有必要采取有针对性的干预措施,为流动人口,尤其是感染艾滋病毒的围产期妇女提供持续的护理支持。这项研究为了解流动性动态提供了有价值的见解,并强调了这一人群所面临的独特障碍,有助于改善资源有限环境中的艾滋病护理工作。
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引用次数: 0
"We did more than survive": lessons learned from studies of risk and resilience of young people growing up with HIV and mental health needs. 艾滋病影响 2023:"我们所做的不仅仅是生存":从对感染艾滋病毒并有心理健康需求的青少年的风险和恢复能力的研究中汲取的经验教训。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.1080/09540121.2024.2308745
Ohemaa B Poku, Afifa Ahmed, Lucy Liotta, Luke Kluisza, Reuben N Robbins, Elaine J Abrams, Claude A Mellins

Despite advances in HIV-treatment, adolescents and young adults (AYA) with HIV (AYAHIV) face myriad challenges. They are less likely than children and older adults to be virally suppressed and are at higher risk for mental health conditions compared to their peers who do not have HIV. AYA are also developing in the context of numerous biomedical, neurocognitive, and psychosocial developmental changes. Normative challenges during this time can be exacerbated by HIV and can result in significant physical and mental health problems. Yet, many AYAHIV have shown resilience with positive assets and resources and few health or mental health problems. Historically research has had a risk-focused approach to understanding AYAHIV needs. This paper discusses the rationale for a shift from a risk-focused only approach to one that examines AYAHIV needs from both a risk and resilience perspective. This paper presents: (1) epidemiological data on AYAHIV; (2) conceptual models for understanding both risk (e.g., poverty, stress, trauma, limited resources) and resilience/protective factors (e.g., family and peer support, future orientation, problem-solving skills); (3) global data examining risk and protective factors for physical and mental health challenges; and (4) promising interventions that incorporate elements of resilience to improve overall outcomes among AYAHIV.

尽管艾滋病毒治疗取得了进展,但感染艾滋病毒的青少年和年轻成人(AYAHIV)仍面临着无数挑战。与未感染 HIV 的同龄人相比,他们比儿童和老年人更不可能得到病毒抑制,患精神疾病的风险也更高。此外,青少 年还处于生物医学、神经认知和社会心理发展变化的阶段。这一时期的正常挑战可能会因艾滋病毒而加剧,并可能导致严重的身心健康问题。然而,许多青少年艾滋病病毒感染者表现出了顽强的生命力,他们拥有积极的资产和资源,很少出现健康或心理健康问题。在了解 AYAHIV 的需求方面,研究工作历来以风险为重点。本文讨论了从只关注风险的方法转变为从风险和复原力两个角度研究 AYAHIV 需求的方法的理由。本文介绍了(1) 有关青少年艾滋病病毒感染者的流行病学数据;(2) 理解风险(如贫困、压力、创伤、资源有限)和抗逆力/保护因素(如家庭和同伴支持、未来导向、解决问题的技能)的概念模型;(3) 检查身体和心理健康挑战的风险和保护因素的全球数据;(4) 纳入抗逆力因素以改善青少年艾滋病病毒感染者总体结果的有前途的干预措施。
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引用次数: 0
Unexpected CD4 decay, hidden adherence gaps, resilience, and the need for long-acting therapy in a single HIV outpatients' cohort. 单个艾滋病门诊病人队列中的 CD4 意外下降、隐性依从性差距、复原力和对长效疗法的需求。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-01-03 DOI: 10.1080/09540121.2023.2298768
Chiara Mariani, Fabio Borgonovo, Martina Gerbi, Giuliano Rizzardini, Amedeo F Capetti

This single-centre, single-cohort study examines hidden non-adherence to antiretroviral therapy in a setting of persistent optimal viral suppression but concordant absolute and percent CD4 decay by >10% from the previous test. After the finding of important drug holidays in two virologically suppressed patients, between January 2021 and January 2022 all PLWH who fulfilled CD4 decay criteria were asked for how long therapy was interrupted, how many days before re-testing CD4 and HIV RNA was it resumed and the reason for interruption. Of 668 HIV-infected subjects, 61 fulfilled the pre-specified criteria for significant CD4 decay and 15 (2.25% of the total, 25% of the CD4 decay group) admitted long-lasting treatment interruptions, compensated by treatment resumption before the subsequent testing. Eleven treatment interruptions exceeded 28 days, and none was shorter than 15 days. CD4 recovery was worse at 6 months in non-adherent subjects (-0.5 vs + 16/mmc, p < 0.0001) and in non adherence vs immune decay time-related with COVID-19 (0 vs + 22/mmc, p < 0.0001). Reasons for interrupting treatment were travel, psychological, poverty-related, addiction and sentimental sphere problems. Long-acting regimens, with stringent control of precision in timely administration, may protect PLWH from damaging their health status and possibly transmit HIV.

这项单中心、单队列研究探讨了在病毒持续处于最佳抑制状态,但 CD4 绝对值和百分比与上次检测相比下降>10%的情况下,是否存在不坚持抗逆转录病毒治疗的隐患。在发现两名病毒学抑制患者出现重要的药物休止期后,在 2021 年 1 月至 2022 年 1 月期间,对所有符合 CD4 下降标准的 PLWH 进行了调查,询问他们中断治疗多长时间、在重新检测 CD4 和 HIV RNA 前多少天恢复治疗以及中断治疗的原因。在 668 名艾滋病病毒感染者中,有 61 人符合预先指定的 CD4 显著下降标准,15 人(占总数的 2.25%,CD4 下降组的 25%)承认长期中断治疗,但在随后的检测前恢复了治疗。有 11 人的治疗中断时间超过 28 天,没有人的治疗中断时间短于 15 天。在 6 个月时,未坚持治疗者的 CD4 恢复情况较差(-0.5 vs + 16/mmc,P p
{"title":"Unexpected CD4 decay, hidden adherence gaps, resilience, and the need for long-acting therapy in a single HIV outpatients' cohort.","authors":"Chiara Mariani, Fabio Borgonovo, Martina Gerbi, Giuliano Rizzardini, Amedeo F Capetti","doi":"10.1080/09540121.2023.2298768","DOIUrl":"10.1080/09540121.2023.2298768","url":null,"abstract":"<p><p>This single-centre, single-cohort study examines hidden non-adherence to antiretroviral therapy in a setting of persistent optimal viral suppression but concordant absolute and percent CD4 decay by >10% from the previous test. After the finding of important drug holidays in two virologically suppressed patients, between January 2021 and January 2022 all PLWH who fulfilled CD4 decay criteria were asked for how long therapy was interrupted, how many days before re-testing CD4 and HIV RNA was it resumed and the reason for interruption. Of 668 HIV-infected subjects, 61 fulfilled the pre-specified criteria for significant CD4 decay and 15 (2.25% of the total, 25% of the CD4 decay group) admitted long-lasting treatment interruptions, compensated by treatment resumption before the subsequent testing. Eleven treatment interruptions exceeded 28 days, and none was shorter than 15 days. CD4 recovery was worse at 6 months in non-adherent subjects (-0.5 vs + 16/mmc, <i>p</i> < 0.0001) and in non adherence vs immune decay time-related with COVID-19 (0 vs + 22/mmc, <i>p</i> < 0.0001). Reasons for interrupting treatment were travel, psychological, poverty-related, addiction and sentimental sphere problems. Long-acting regimens, with stringent control of precision in timely administration, may protect PLWH from damaging their health status and possibly transmit HIV.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The path towards an HIV-free generation: engaging adolescent boys and young men (ABYM) in sub-Saharan Africa from lessons learned and future directions. 实现无艾滋病毒一代的途径:从吸取的经验教训和未来方向看撒哈拉以南非洲地区少男少女(ABYM)的参与。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-01-24 DOI: 10.1080/09540121.2024.2307391
Tawanda Makusha, Lesley Gittings

This paper highlights the pressing need to address the HIV epidemic among adolescent boys and young men (ABYM) in sub-Saharan Africa. Despite progress in HIV prevention, ABYM still experience low diagnosis rates, treatment adherence, and linkage to care. The paper emphasizes ABYM's vulnerability due to societal norms, limited healthcare access, and economic pressures. It calls for gender-responsive interventions, including comprehensive sexual education, youth-friendly health services, community engagement, and targeted outreach. Comprehensive sexual education is pivotal in HIV prevention for ABYM, providing them with age-appropriate sexual health knowledge and safer sexual practices to reduce HIV incidence. Harmful masculine norms must be countered to promote respectful relationships, benefiting boys, men, and their partners. Inadequate access to youth-friendly health services hampers HIV prevention. Establishing spaces with confidential, non-judgmental care offering testing, counselling, circumcision, and provision of pre-exposure prophylaxis (PrEP) is essential, especially considering ABYM's unique clinic experiences. Engaging communities, leaders, educators, and peers combats stigma and discrimination. ABYM's input in intervention design, targeted outreach, and innovative technology enhances effectiveness of HIV prevention programmes. Economic factors should also be addressed. Comprehensive multi-sectoral interventions, including conditional cash transfers, effective for AGYW, could benefit ABYM. Addressing structural factors alongside behaviour change and social support is key.

本文强调了解决撒哈拉以南非洲地区少男少女(ABYM)中艾滋病流行问题的迫切需要。尽管在艾滋病预防方面取得了进展,但男童和青年男子的诊断率、治疗依从性和护理联系率仍然很低。本文强调,由于社会规范、有限的医疗保健途径和经济压力,ABYM 很容易受到感染。文件呼吁采取促进性别平等的干预措施,包括全面的性教育、关爱青年的医疗服务、社区参与和有针对性的外联活动。全面的性教育对于预防 ABYM 感染艾滋病毒至关重要,它为他们提供了与年龄相适应的性健康知识和更安全的性行为方式,以降低艾滋病毒的感染率。必须抵制有害的男性规范,促进相互尊重的关系,使男孩、男性及其伴侣受益。无法获得充分的青年友好型医疗服务阻碍了艾滋病的预防。特别是考虑到 ABYM 独特的诊所经验,建立一个提供检测、咨询、包皮环切术和接触前预防(PrEP)的保密、非批判性护理场所至关重要。让社区、领导者、教育工作者和同龄人参与进来,可以消除耻辱感和歧视。ABYM 在干预设计、有针对性的外联和创新技术方面的投入可提高艾滋病毒预防计划的有效性。还应解决经济因素。全面的多部门干预措施,包括有条件的现金转移,对女青年和青年妇女有效,可使女青年和青年运动受益。在改变行为和提供社会支持的同时,解决结构性因素也很关键。
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Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv
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