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

Despite the successful rollout of antiretroviral therapy (ART) and positive ART outcomes in the Kingdom of Eswatini, adolescents still present poor ART outcomes including low viral load suppression and suboptimal ART adherence. The aim of the study was to explore the perceptions of adolescents living with HIV (ALHIV) on the barriers and facilitators to ART adherence in Eswatini. We conducted a qualitative study using in-depth interviews among 29 ALHIV and on ART in Eswatini in December 2023. Adolescents aged 10-19 years who were aware of their HIV status were recruited purposively from five Teen Clubs in the Hhohho region. Six barriers to ART were reported by participants namely perceived stigma and discrimination, competing demands between ART schedules and their personal and social lives, medication issues, health facility factors, lack of transport and food, and diminishing support from caregivers. The main facilitators of ART adherence were having a social support system, status disclosure, privacy, HIV and ART knowledge, and motivation to stay alive. Supportive environments are crucial to enhance ART adherence among ALHIV. These can be promoted through multi-component interventions that target status disclosure, increase knowledge of HIV and ART, ensure privacy and address stigma and discrimination.

Depression is common among people living with HCV and HIV, which contributes to health services utilization (HSU). It is unknown whether successful HCV treatment affects this. We examined depressive symptoms and HSU in people co-infected with HIV-HCV and their association with sustained virologic response (SVR) during the direct-acting antiviral era. We predicted depressive symptoms by a random forest classifier in the Canadian Co-infection Cohort. HSU was measured by inpatient and out-patient visits in the previous six months. We fit zero-inflated negative binomial models. Of the 1153 HCV RNA+participants, 530 were treated and of them, 95% achieved SVR. Without SVR, inpatient and out-patient visits were 17% and 5% higher among those with depressive symptoms than those without respectively; with SVR, this association disappeared. SVR was associated with 24% fewer inpatient visits. Thus, depressive symptoms were associated with a modest increase in HSU, and SVR appears to attenuate this effect.

ABSTRACTEngaging in HIV care services can be challenging for refugees as they navigate new care systems while meeting daily needs. This pilot study assessed Early Community Client-led ART Delivery (Early CCLAD) as a differentiated care strategy for those newly diagnosed with HIV in Nakivale Refugee Settlement, Uganda. Early CCLAD was a community antiretroviral therapy delivery option where group members take turns coming to the health center.Adults accessing routine HIV testing were offered participation in the study. Participants completed intake surveys, and those interested in joining a community group received the intervention when feasible. The primary outcome was linkage to HIV clinical care within 90 days. Exit interviews were conducted to identify program benefits and challenges.Out of 2793 individuals enrolled, 92 tested positive for HIV and 74 (80.4%) were willing to participate in Early CCLAD. After 6 months, all participants in Early CCLAD groups had initiated ART and 87.0% achieved viral suppression. Convenience, social support and community building were identified as program benefits, while challenges included member commitment, reliability and mobility. Early CCLAD demonstrated feasibility and acceptability as an intervention strategy in a refugee settlement. Further research is needed to assess the scalability and long-term outcomes.

Adolescent girls and young women (AGYW) seeking post-abortal care (PAC) remain at risk of unintended pregnancies and HIV due to infrequent condom use. Integrating HIV prevention services, such as PrEP, into PAC services offers an opportunity to enhance reach, uptake, and efficiency, particularly in high-burden settings like Kenya. However, data on acceptability, feasibility, and sustainability of PAC clinics as entry points for PrEP is limited. A cross-sectional qualitative study, part of a cluster-randomized trial in 14 Kenyan public and private facilities, explored the integration of PrEP delivery for AGYW aged 15-30 within PAC clinics. Using in-depth interviews, focus group discussions, and key informant interviews, the study gathered perspectives from AGYW, providers, and implementing partners. Guided by the theoretical framework of acceptability, findings revealed receptiveness for the integration as a timely and effective intervention to expand PrEP reach, enhance access , and reduce stigma. Provider competence, their attitudes towards the integration, and AGYWs' confidence in using PrEP were identified as critical influencers. Essentail operational considerations were staffing, availability of safe spaces, commodity management, and efficient reporting systems. The study highlights the acceptability and scalability of integrating PrEP services into PAC while emphasizing the need for strategies to enhance operational efficiency.

The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil.

Food insecurity is a prevalent social determinant of health for people living with HIV and is associated with suboptimal treatment outcomes. While clinic-based efforts to address food insecurity have increased over the past decade, few studies have explored the perspectives of paitents and caregivers managing chronic illnesses such as HIV. Caregiver insights are particularly critical in pediatric HIV care, where caregivers often play a central role in screening and referral processes. This study examined the experiences of adolescents and young adults living with HIV and caregivers of children with HIV, to inform screening and referral practices within a pediatric palliative care clinic in Atlanta, GA. We conducted audio-recorded, in-depth interviews (n = 14) and focus groupswith 10 patients and caregivers living with food insecurity. Thematic analysis, guided by our interview topics, revealed five key themes: (1) trust in providers, (2) coping by "making it work", (3) barriers to healthy eating, (4) challenges to medication adherence, and (5) recommendations for cross-sector resource connection. Our findings underscore the need for partnerships between clinics and community-based organizations, bolstered by structural and systems-level interventions and policies, to promote food security and well-being for pediatric patients in complex care settings.

The aim of this systematic review was to summarize the dietary intake of children and adolescents living with HIV and its association with cardiovascular risk factors. PubMed/MEDLINE, Scopus, Web of Science, BIREME and LILACS were searched for original observational studies. The studies were extracted between June and August 2021, in addition to a manual search of references. Twelve studies involving 1,805 participants aged 6.5 to 17.3 years were included. An association between energy intake, low sugar and fat intake and the presence of lipodystrophy syndrome was reported in 1 of the 12 (8.3%) studies, between fat intake and plasma lipid levels in 1 (8.3%), and between low fiber intake and high z-scores for BMI in 1 (8.3%); there was a positive correlation between cholesterol intake and plasma triglyceride levels in 1 study (8.3%). In conclusion, a dietary pattern of low consumption of fruits and vegetables was identified, but few studies have reported associations between dietary intake and cardiovascular risk factors. Thus, there is a need for nutritional guidance strategies aimed at changing inappropriate eating habits in order to reduce cardiovascular risk factors in this population.

Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008-2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender (male, female) beneficiaries with HIV and explored within and between gender group differences in the predicted probability of engagement in the HIV Care Continuum. Transgender and gender-diverse individuals had a higher predicted probability of every HIV-related care outcome vs. cisgender individuals, with TFN individuals showing the highest probability of HIV care visit engagement, sexually transmitted infection screening, and antiretroviral treatment receipt and persistence. Notably, except for sexually transmitted infection screening, cisgender females and TMN people had a slightly lower probability of engaging in HIV-related care than TFN people and cisgender males. Although transgender and gender-diverse beneficiaries living with HIV had better engagement in the HIV Care Continuum than cisgender individuals, findings highlight disparities in engagement for TMN individuals and cisgender females, though engagement was still low for Medicare beneficiariesof all genders. Interventions are needed to reduce HIV care engagement barriers for all Medicare beneficiaries.

The advent of effective antiretroviral treatments has led to the reclassification of HIV as a chronic disease for those on an effective treatment plan. However, the well-being of individuals with HIV is adversely affected by a number of factors, including stigma and discrimination, which hinder access to healthcare. To address this issue, it is first necessary to understand the current levels of knowledge and stigma surrounding HIV, and consequently, HIV Outcomes Italy has created a survey with the aim of assessing these levels.A total of 914 healthcare professionals, comprising clinicians, obstetricians, nurses and LPNs (licensed practical nurses) participated in an anonymous online survey with questions pertaining to knowledge on HIV, stigma, and training on STIs (sexually transmitted infections). The survey was conducted in Italy between August 2022 and February 2023.The results show a reasonable level of knowledge regarding HIV-related topics among healthcare workers. However, a notable minority exhibited deficiencies. The findings indicate the presence of stigma, both in the form of observed discriminatory practices and in the form of personal enactment of discriminatory behaviour.The results of the survey indicate an inverse relationship between knowledge and stigma, emphasising the need for ongoing and specific education on HIV.

The most significant progress in addressing the HIV/AIDS epidemic has been the development of antiretroviral therapy (ART). However, ensuring a high degree of treatment adherence is necessary to prevent resistance and disease progression. We conducted a cross-sectional study to evaluate adherence to ART through the calculation of the medication possession ratio (MPR) and to identify risk factors for suboptimal adherence in a cohort of HIV-positive patients receiving care at a Colombian healthcare institution across 16 cities. Records of 12,145 users were analyzed, and a multivariate logistic regression model was performed, considering optimal adherence (MPR > =  95%) versus suboptimal adherence (MPR < 95%) as the reference. Suboptimal adherence to ART was identified in 29% of users. Residence region, presence of HIV-defining illnesses, chronic kidney disease (CKD), co-infections such as hepatitis C, tuberculosis, and sexually transmitted infections, treatment duration of more than 5 years, and non-suppressed viral load were identified as risk factors for non-adherence. This underscores the need to identify interventions for those vulnerable groups to minimize the likelihood of non-adherence and to intervene in care models focused on the medical needs of these patients.