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Crisis prevention and response in Ryan white-funded HIV clinics. 瑞安-怀特资助的艾滋病诊所的危机预防和应对措施。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-04 DOI: 10.1080/09540121.2024.2417908
Jakarra Jenkins, Olivia C Manders, Caroline W Kokubun, Kate Anderson, Jessica M Sales, Ameeta S Kalokhe

ABSTRACTThe high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response.

摘要艾滋病病毒感染者(PWH)中创伤的高发率及其对艾滋病结果的负面影响突出表明,瑞安-怀特资助的艾滋病诊所(RWCs)需要实施包括危机预防和应对在内的创伤知情护理(TIC)。作为对 RWCs 采用的 TIC 实践进行混合方法研究的一部分,我们对来自东南部 RWCs 的 36 名管理者、提供者和员工进行了定性访谈,探讨危机预防和应对策略。访谈以药物滥用和心理健康服务管理局的 TIC 框架为指导,并采用框架驱动的定性主题方法进行分析。危机预防策略包括:使用电子病历识别有危机风险的患者;同伴导航员帮助患者绕过诊所的公共场所;制定协议确保施暴者与受害者的配对不会同时安排;社工帮助患者识别危机触发因素并制定安全计划;以及为有大量创伤史的患者提供专门的安全空间。危机应对措施包括将患者转介到现场和社区危机接收、创伤支持和心理健康服务机构,以及配备现场安保人员和警报系统。一些参与者要求在应对协议方面接受更多培训。研究结果突出表明,有必要在 RW 网络范围内开展 TIC 培训,并分享危机预防和应对方面的最佳实践。
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引用次数: 0
HIV and sexual health needs of young key populations in Papua New Guinea: results of biobehavioural surveys (2016-2017). 巴布亚新几内亚年轻重点人群的艾滋病毒和性健康需求:生物行为调查结果(2016-2017年)。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-03 DOI: 10.1080/09540121.2024.2414083
Angela Kelly-Hanku, Xinyi Li, Ruthy Boli, Barne Willie, Janet Gare, Simon Pekon, Josephine Gabuzzi, Rebecca Narokobi, Angelyn Amos, Herick Aeno, Martha Kupul, Sophie Ase, Parker Hou, Lesley Bola, Damian Weikum, Steven G Badman, Peniel Boas, Andrew J Vallely, Avi J Hakim

Papua New Guinea lacks data characterising the sexual health needs of younger key populations (KP): female sex workers (FSW) and commercially and sexually exploited girls (CSE), men who have sex with men (MSM), and transgender women (TGW). Biobehavioural surveys among KP were conducted in three cities. We conducted unweighted and weighted analysis for sample and population proportions, respectively. Variables associated with younger versus older age (15-24 versus ≥25 years) were included in the multivariable analysis. Younger FSW/CSEG had greater odds of having both Neisseria gonorrhoea and Chlamydia trachomatis (aOR:3.2, 95%CI 2.0-5.0), or having either infection (aOR:2.2, 95%CI 1.2-4.1) than older peers. They also had lower odds of having tested for HIV (aOR: 0.6, 95%CI 0.4-0.8). Younger MSM/TGW had greater odds of paying for sex in the <6 months (aOR:2.2, 95%CI: 1.5-3.1) and of having been paid for sex (aOR:1.6, 95%CI 1.1-2.4) than their older peers (≥25 years). Younger MSM/TGW had lower odds of having contact with a peer educator ≤12 months (aOR:0.6, 95%CI 0.4-0.9) and having tested for HIV (aOR:0.6, 95%CI: 0.4-0.9). All key populations have substantial sexual health needs, but those of younger members are greatest. Younger key populations would likely benefit from health services designed specifically for them.

巴布亚新几内亚缺乏有关年轻关键人群(KP)性健康需求特征的数据,这些关键人群包括女性性工作者(FSW)和遭受商业和性剥削的女童(CSE)、男男性行为者(MSM)以及变性妇女(TGW)。我们在三个城市对 KP 进行了生物行为调查。我们分别对样本和人口比例进行了非加权和加权分析。年轻与年长(15-24 岁与≥25 岁)的相关变量被纳入多变量分析。与年龄较大的同龄人相比,年轻的 FSW/CSEG 同时感染淋病奈瑟菌和沙眼衣原体(aOR:3.2, 95%CI 2.0-5.0)或其中一种感染(aOR:2.2, 95%CI 1.2-4.1)的几率更高。他们接受 HIV 检测的几率也较低(aOR:0.6,95%CI 0.4-0.8)。年轻的 MSM/TGW 在以下情况下支付性费用的几率更高
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引用次数: 0
Patients' and specialists' perspectives on health care quality and on people living with HIV health-related quality of life in Spain: a cross-sectional survey. 西班牙患者和专家对医疗质量和艾滋病毒感染者与健康相关的生活质量的看法:横断面调查。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI: 10.1080/09540121.2024.2377983
María J Fuster-RuizdeApodaca, María José Galindo, Concha Amador

Spain was close to meeting the 90-90-90-treatment target set by UNAIDS. However, data on health care quality regarding people with HIV and their health-related quality of life (HRQoL) after the COVID-19 pandemic onset is scarce. By considering the perspective of people with HIV and HIV specialists, we aimed to determine some aspects of the quality of care in Spain, such as access to health resources or satisfaction with primary and speciality care, and assess people with HIV health-related quality of life. Ex post facto cross-sectional surveys were administered to 502 people with HIV and 101 HIV clinicians. Unmet needs related to healthcare system and healthcare resources access and to antiretroviral treatment administered by hospital pharmacies were detected. There was also room for improvement in the primary care service delivery and in various aspects concerning people's with HIV HRQoL. About one-fourth of them experienced stigmatisation in the healthcare setting, which was significantly related to HRQoL. Women, heterosexual participants and those with problems accessing the healthcare system scored poorer in the HRQoL scales. Moreover, according to our data, HIV specialists did not seem to be fully aware of patients' with HIV needs and overestimated their HRQoL.

西班牙已接近实现联合国艾滋病规划署设定的 90-90-90 治疗目标。然而,有关 COVID-19 大流行后艾滋病病毒感染者的医疗质量及其健康相关生活质量(HRQoL)的数据却很少。通过考虑艾滋病病毒感染者和艾滋病专家的观点,我们旨在确定西班牙医疗质量的某些方面,如医疗资源的获取或对初级和专科医疗的满意度,并评估艾滋病病毒感染者与健康相关的生活质量。我们对 502 名艾滋病病毒感染者和 101 名艾滋病临床医生进行了事后横断面调查。调查发现,与医疗保健系统和医疗保健资源的获取以及医院药房提供的抗逆转录病毒治疗有关的需求尚未得到满足。在提供初级保健服务以及与艾滋病毒感染者的 HRQoL 有关的各个方面,也有改进的余地。其中约四分之一的人在医疗环境中受到侮辱,这与他们的 HRQoL 有很大关系。女性、异性恋参与者和在使用医疗系统方面存在问题的人在 HRQoL 量表中的得分较低。此外,根据我们的数据,艾滋病专家似乎并不完全了解艾滋病患者的需求,并高估了他们的 HRQoL。
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引用次数: 0
Perceptions of a community-based HIV/STI testing program among Black gay, bisexual, and other MSM in Baltimore: a qualitative analysis. 巴尔的摩黑人男同性恋、双性恋和其他 MSM 对社区 HIV/STI 检测项目的看法:定性分析。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-07-08 DOI: 10.1080/09540121.2024.2372722
Rashida Hassan, Nicole Thornton, Hope King, Gabrielle Aufderheide, Bradley Silberzahn, Steven Huettner, Jacky M Jennings, Kimberly N Evans, Errol L Fields

Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.

黑人男同性恋、双性恋和其他男男性行为者(GBM)受到艾滋病毒和性传播感染的影响尤为严重。安全空间4性健康(Safe Spaces 4 Sexual Health,SS4SH)是一项社区知情、身份中立的HIV/STI检测干预措施,它将通过地理社交网络应用程序和社交媒体进行的在线宣传与移动车检测相结合。2018-2019 年期间,我们招募了 25 名参与者进行访谈,了解他们对 SS4SH 与诊所检测相比的看法。参与者的年龄在 21-65 岁之间(平均 35 岁);22 人(88%)被认定为黑人/非裔美国人;20 人(80%)被认定为同性恋;10 人(40%)是 HIV 感染者。对访谈内容进行了转录、编码,并采用修改后的主题恒定比较法进行了分析。访谈中出现了五个主题,其中两个主题涉及对在线宣传材料的看法(参与者被吸引到醒目和切中要害的信息中,并希望信息更具多样性和代表性),三个主题涉及对移动宣传车的偏好(参与者发现 SS4SH 提供了更多的舒适性、更多的隐私/保密性,并提高了可访问性和效率)。GBM 越来越多地使用地理社交网络应用程序来结识性伴侣,量身定制的在线外联活动有可能接触到历来得不到充分服务的人群。SS4SH 是一种减少障碍的策略,可作为一种不分身份的服务方法的切入点,并有助于减少污名化,使获得 HIV 服务正常化。
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引用次数: 0
Who wants long-Acting injectable antiretroviral therapy? Treatment preferences among adults with HIV in Florida. 谁需要长效注射抗逆转录病毒疗法?佛罗里达州成年 HIV 感染者的治疗偏好。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-01 DOI: 10.1080/09540121.2024.2383872
Rebecca J Fisk-Hoffman, Yiyang Liu, Charurut Somboonwit, Maya Widmeyer, Shantrel Canidate, Mattia Prosperi, Robert L Cook

Long-acting injectable (LAI) antiretroviral therapy (ART) is available to people with HIV (PWH), but it is unknown which PWH prefer this option. Using the Andersen Behavioral Model this study identifies characteristics of PWH with greater preference for LAI ART. Cross-sectional data from the Florida Cohort, which enrolled adult PWH from community-based clinics included information on predisposing (demographics), enabling (transportation, income), and need (ART adherence <90%) factors. ART preference was assessed via a single question (prefer pills, quarterly LAI, or no preference). Confounder-adjusted multinomial logistic regressions compared those who preferred pills to the other preference options, with covariates identified using directed acyclic graphs. Overall, 314 participants responded (40% non-Hispanic Black, 62% assigned male, 63% aged 50+). Most (63%) preferred the hypothetical LAI, 23% preferred pills, and 14% had no preference. PWH with access to a car (aRRR 1.97 95%CI 1.05-3.71), higher income (aRRR 2.55 95%CI 1.04-6.25), and suboptimal ART adherence (aRRR 7.41 95% CI 1.52-36.23) were more likely to prefer the LAI, while those who reported having no social network were less likely to prefer the LAI (aRRR 0.32 95% CI 0.11-0.88). Overall LAI interest was high, with greater preference associated with enabling and need factors.

艾滋病病毒感染者(PWH)可以选择长效注射抗逆转录病毒疗法(ART),但哪些艾滋病病毒感染者更愿意选择这种疗法尚不清楚。本研究采用安德森行为模型(Andersen Behavioral Model)确定了更倾向于接受 LAI 抗逆转录病毒疗法的艾滋病感染者的特征。佛罗里达队列(Florida Cohort)从社区诊所招募了成年艾滋病感染者,该队列的横截面数据包含了艾滋病感染者的倾向性(人口统计学)、有利条件(交通、收入)和需求(坚持抗逆转录病毒疗法)等信息。
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引用次数: 0
Acceptability, facilitators, and barriers to a hypothetical HIV vaccine in the pre-exposure prophylaxis era. 暴露前预防时代假定的艾滋病疫苗的可接受性、促进因素和障碍。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-07-04 DOI: 10.1080/09540121.2024.2372715
Aaron Richterman, Caroline O'Brien, Fatemeh Ghadimi, Elijah Sumners, Andre Ford, Nafisah Houston, Sebrina Tate, Nancy Aitcheson, Hervette Nkwihoreze, John B Jemmott, Florence Momplaisir

Little is known about the pre-implementation context for a preventive HIV vaccine. We conducted interviews of individuals in Philadelphia recruited at Penn clinics and community-based organizations serving LGBTQ-identifying persons of color who 1) were cisgender men who had sex with men, or were transgender-identified, 2) had a sexually transmitted infection in the last 12 months, or sex with multiple partners within the last two weeks. We assessed acceptability, facilitators, and barriers to a hypothetical HIV vaccine using an integrated analysis approach. We interviewed 30 individuals between 2/2023-9/2023. Participants were supportive of an HIV vaccine and reported that they would strongly consider receiving one if one became available. Participants contextualized a hypothetical vaccine with the current HIV prevention context, primarily pre-exposure prophylaxis (PrEP), indicating that they would evaluate any future vaccine in comparison to their experience within the PrEP landscape.Reported facilitators for a hypothetical HIV vaccine included vaccine access, knowledge, and understanding; their risk for HIV exposure; and perceived benefits of the vaccine. Barriers included lack of understanding of the purpose of a vaccine, stigma surrounding HIV and sexual practices that may surface towards people who seek vaccination, and potential issues with effectiveness, side effects, or lack of availability.

人们对预防性艾滋病疫苗实施前的情况知之甚少。我们对费城宾大诊所和社区组织招募的人员进行了访谈,这些人员的服务对象是具有 LGBTQ 特征的有色人种,他们 1) 是与男性发生过性关系的顺性别男性,或具有跨性别特征;2) 在过去 12 个月内曾感染过性传播疾病,或在过去两周内与多个性伴侣发生过性关系。我们采用综合分析方法评估了假定的 HIV 疫苗的可接受性、促进因素和障碍。我们在 2023 年 2 月至 2023 年 9 月期间对 30 人进行了访谈。参与者对 HIV 疫苗持支持态度,并表示如果有疫苗,他们会积极考虑接种。参与者将假想疫苗与当前的艾滋病预防环境(主要是暴露前预防(PrEP))结合起来,表示他们会将未来的疫苗与他们在 PrEP 环境中的经验进行比较评估。阻碍因素包括:对疫苗的目的缺乏了解;对寻求接种疫苗的人可能会产生的有关艾滋病毒和性行为的污名化;有效性、副作用或缺乏可用性方面的潜在问题。
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引用次数: 0
Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001-2015. 2001-2015 年,医疗补助计划(Medicaid)受益人中的艾滋病毒感染者继续接受护理和坚持抗逆转录病毒疗法的情况。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI: 10.1080/09540121.2024.2383901
Jacqueline E Rudolph, Keri L Calkins, Xueer Zhang, Yiyi Zhou, Xiaoqiang Xu, Eryka L Wentz, Corinne E Joshu, Bryan Lau

Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid - an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001-2015, aged 18-64, living in 14 US states. We estimated the monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001-2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.

社会经济地位、居住地和种族/民族在 HIV 护理方面的差异阻碍了疫情控制的进展。在美国,医疗补助计划是低收入人群的保险来源,目前还没有任何研究全面描述了加入该计划的艾滋病病毒感染者的艾滋病护理流程。我们分析了美国 14 个州 2001-2015 年加入医疗补助计划的 246127 名 18-64 岁艾滋病病毒感染者的数据。我们估算了护理级联四个步骤的月流行率:保留护理/坚持抗逆转录病毒疗法;保留/不坚持;不保留/不坚持;不保留/不坚持。如果受益人每 6 个月接受一次门诊治疗,则视为继续接受治疗。依从性基于药物持有率。我们使用非参数多州方法估算了患病率,将死亡作为竞争事件,并使用反删减概率加权法估算了医疗补助的退出情况。在 2001-2015 年期间,无论是总体还是在所有分组中,感染艾滋病毒的受益人中坚持接受抗逆转录病毒治疗的比例都有所上升。到 2015 年,约有一半的受益人继续接受护理,42% 的受益人坚持抗逆转录病毒疗法。我们发现,不同种族/族裔和地区之间存在显著差异。我们的工作凸显了在此期间,不同保险状况的艾滋病护理级联中存在的重要差异。
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引用次数: 0
Nucleoside/nucleotide reverse transcriptase inhibitor-associated weight gain in people living with HIV: data from the Copenhagen Comorbidity in HIV Infection (COCOMO) study. 核苷/核苷酸逆转录酶抑制剂导致的艾滋病病毒感染者体重增加:哥本哈根艾滋病病毒感染并发症(COCOMO)研究数据。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1080/09540121.2024.2383871
Karen Brorup Heje Pedersen, Marco Gelpi, Andreas Dehlbæk Knudsen, Alessandra Meddis, Moises Alberto Suarez-Zdunek, Shoaib Afzal, Børge Nordestgaard, Susanne Dam Nielsen, Thomas Benfield

Weight gain effects of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors in people with HIV (PWH) have been sparsely studied.Participants were enrolled in the Copenhagen Comorbidity in HIV Infection (COCOMO) study. PWH receiving a backbone of emtricitabine, or lamivudine combined with abacavir, tenofovir disoproxil, or tenofovir alafenamide were analysed. Weight gain according to ART backbone and to the third drug was analysed using a multiple linear regression model. Non-ART risk factors were also determined using multiple linear regression.A total of 591 participants were included in the analysis. The majority were middle-aged, virally suppressed males with a mean BMI just above the normal range. Both tenofovir disoproxil/emtricitabine or lamivudine and abacavir /emtricitabine or lamivudine, but not tenofovir alafenamide /emtricitabine or lamivudine were associated with weight gain over two years (0.6 kg, p = 0.025; 1.0 kg, p = 0.005). The third drugs associated with weight increase were non-nucleoside reverse transcriptase inhibitors (NNRTI) (p = 0.035), dolutegravir (p = 0.008) and atazanavir (p = 0.040). Non-ART risk factors for gaining weight were low or normal BMI, age <40 years, underweight, inactivity or highly active at baseline.Tenofovir disoproxil and abacavir-based ART regimens were associated with a small weight gain. Third drug NNRTI, dolutegravir and atazanavir were associated with an increase in weight.

关于核苷/核苷酸逆转录酶抑制剂对艾滋病病毒感染者(PWH)体重增加影响的研究很少。研究分析了接受恩曲他滨或拉米夫定联合阿巴卡韦、替诺福韦酯或替诺福韦丙烯酰胺治疗的艾滋病病毒感染者。使用多元线性回归模型分析了抗逆转录病毒疗法骨干药物和第三种药物的体重增加情况。此外,还利用多元线性回归确定了非抗逆转录病毒疗法的风险因素。大部分参与者为病毒已被抑制的中年男性,平均体重指数略高于正常范围。替诺福韦二吡呋酯/恩曲他滨或拉米夫定和阿巴卡韦/恩曲他滨或拉米夫定都与两年内体重增加有关(0.6 千克,p = 0.025;1.0 千克,p = 0.005),但替诺福韦阿拉非酰胺/恩曲他滨或拉米夫定与此无关。第三种与体重增加有关的药物是非核苷类逆转录酶抑制剂(NNRTI)(p = 0.035)、多罗替拉韦(p = 0.008)和阿扎那韦(p = 0.040)。体重增加的非抗逆转录病毒药物风险因素包括体重指数(BMI)低或正常,年龄
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引用次数: 0
Incidence of prostate cancer in Medicaid beneficiaries with and without HIV in 2001-2015 in 14 states. 2001-2015 年 14 个州感染和未感染艾滋病毒的医疗补助受益人的前列腺癌发病率。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI: 10.1080/09540121.2024.2383875
Filip Pirsl, Keri Calkins, Jacqueline E Rudolph, Eryka Wentz, Xiaoqiang Xu, Bryan Lau, Corinne E Joshu

Prostate cancer (PCa) incidence is reportedly lower in men with HIV compared to men without HIV for unknown reasons. We describe PCa incidence by HIV status in Medicaid beneficiaries, allowing for comparison of men with and without HIV who are similar with respect to socioeconomic characteristics and access to healthcare. Men (N = 15,167,636) aged 18-64 with ≥7 months of continuous enrollment during 2001-2015 in 14 US states were retained for analysis. Diagnoses of HIV and PCa were identified using non-drug claims. We estimated cause-specific (csHR) comparing incidence of PCa by HIV status, adjusted for age, race-ethnicity, state of residence, year of enrollment, and comorbid conditions, and stratified by age and race-ethnicity. Hazard of PCa was lower in men with HIV than men without HIV (csHR = 0.89; 95% CI: 0.80, 0.99), but varied by race-ethnicity, with similar observations among non-Hispanic Black (csHR = 0.79; 95% CI: 0.69, 0.91) and Hispanic (csHR = 0.85; 95% CI: 0.67, 1.09), but not non-Hispanic white men (csHR = 1.17; 95% CI: 0.91, 1.50). Findings were similar in models restricted to men aged 50-64 and 40-49, but not in men aged 18-39. Reported deficits in PCa incidence by HIV status may be restricted to specific groups defined by age and race ethnicity.

据报道,与未感染 HIV 的男性相比,感染 HIV 的男性的前列腺癌(PCa)发病率较低,原因不明。我们按医疗补助受益人的 HIV 感染状况对 PCa 发病率进行了描述,以便对在社会经济特征和医疗保健服务方面相似的男性 HIV 感染者和非 HIV 感染者进行比较。我们保留了美国 14 个州 2001-2015 年间连续参保时间≥7 个月的 18-64 岁男性(N=15,167,636)进行分析。艾滋病毒和 PCa 的诊断是通过非药物索赔确定的。我们估算了按 HIV 感染状况比较的 PCa 特定病因(csHR)发病率,并对年龄、种族-人种、居住州、注册年份和合并症进行了调整,同时按年龄和种族-人种进行了分层。感染 HIV 的男性患 PCa 的风险低于未感染 HIV 的男性(csHR = 0.89;95% CI:0.80,0.99),但因种族族裔而异,在非西班牙裔黑人中观察到的结果相似(csHR = 0.79; 95% CI: 0.69, 0.91)和西班牙裔男性(csHR = 0.85; 95% CI: 0.67, 1.09),但在非西班牙裔白人男性(csHR = 1.17; 95% CI: 0.91, 1.50)中的观察结果相似。在仅限于 50-64 岁和 40-49 岁男性的模型中,研究结果与此类似,但在 18-39 岁男性中却没有发现。根据艾滋病病毒感染状况而报告的 PCa 发病率下降可能仅限于由年龄和种族族裔界定的特定群体。
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引用次数: 0
Barriers and facilitators to implementing evidence-based integrated HIV and behavioral health care: perspectives from seven federal ending the HIV epidemic jurisdictions. 实施以证据为基础的艾滋病毒和行为健康综合护理的障碍和促进因素:来自七个联邦结束艾滋病毒流行辖区的观点。
IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-05-21 DOI: 10.1080/09540121.2024.2354897
Karen McKinnon, Cody Lentz, Daria Boccher-Lattimore, Francine Cournos, Ariana Pather, Stephen Sukumaran, Adam Thompson, Lori DeLorenzo, Michael Hager, Robert H Remien, Claude A Mellins

The federal Ending the HIV Epidemic (EHE) initiative was created to reduce new US HIV infections, largely through pre-exposure prophylaxis and HIV treatments that reduce HIV transmissibility to zero. Behavioral health disorders (mental health and substance use) remain significant barriers to achieving EHE goals. Addressing behavioral health (BH) disorders within HIV primary care settings has been promoted as a critical EHE strategy. Implementation of efficacious HIV-BH care integration and its impact on HIV-related health outcomes is not well documented. In a federally-funded, exploratory phase implementation science study, we used the Collective Impact Framework to engage partners in seven EHE jurisdictions about the feasibility, acceptability, and sustainability of implementing HIV-BH integration interventions within local HIV settings. Partners concluded that full integration will remain the exception unless health systems invest in collaborative practice, professional training, appropriate health technology, and inter-system communication. Partners supported smaller incremental improvements including transdiagnostic approaches to reinforce each team member's sense of value in the shared endeavor. This early phase implementation science study identified research and implementation gaps that are critical to fill to end the HIV epidemic. Both the Collective Impact Framework and implementation science show promise for guiding future implementation of evidence-based HIV-BH intervention integration.

联邦 "结束艾滋病毒流行"(EHE)倡议旨在减少美国艾滋病毒新感染病例,主要是通过接触前预防和艾滋病毒治疗,将艾滋病毒传播率降至零。行为健康疾病(心理健康和药物使用)仍然是实现 EHE 目标的重大障碍。在艾滋病初级医疗机构中解决行为健康(BH)障碍问题已被作为一项重要的 EHE 战略加以推广。实施有效的 HIV-BH 护理整合及其对 HIV 相关健康结果的影响并没有得到很好的记录。在一项由联邦政府资助、处于探索阶段的实施科学研究中,我们使用了集体影响框架(Collective Impact Framework),让七个 EHE 管辖区内的合作伙伴参与讨论在当地 HIV 机构内实施 HIV-BH 整合干预措施的可行性、可接受性和可持续性。合作伙伴的结论是,除非卫生系统在合作实践、专业培训、适当的卫生技术和系统间沟通方面进行投资,否则全面整合仍将是一种例外。合作伙伴支持小规模的渐进式改进,包括跨诊断方法,以加强每个团队成员在共同事业中的价值感。这项早期阶段的实施科学研究确定了研究和实施方面的差距,这些差距对于消除艾滋病毒流行至关重要。集体影响框架和实施科学都为指导未来实施以证据为基础的 HIV-BH 干预整合带来了希望。
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Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv
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