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

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.

Herpes Simplex Virus types 1 and 2 (HSV-1 and HSV-2) are prevalent STIs among men who have sex with men (MSM), yet remain underexamined in the U.S.. Data from the P18 cohort sub-study, P18 Viral (N = 520), were used to examine factors associated with HSV-1 and HSV-2 infection among a sample of young adult cisgender gay men. We aimed to assess (1) the seroprevalence rates of HSV-1 and HSV-2, and (2) sociodemographic, behavioral, and health-related correlates of infection. HSV-1 seroprevalence was three times higher than HSV-2. HSV-2 seropositivity was significantly associated with HIV-positive status, lower income, greater frequency of anal insertive sex, and marginalized racial identities. Similarly, HSV-1 + HSV-2 coinfection was related to HIV-positive status, low to moderate income, and non-Hispanic/Latino Black or Mixed race/ethnicity. HIV status emerged as the strongest independent risk factor for both HSV-2 and HSV-1 + HSV-2 infection, and after adjusting for confounders. These findings highlight that HSV risk is shaped by intersecting behavioral, social, and structural factors, not just individual sex behaviors, and that STI conditions are syndemic. Future research should explore the mechanisms linking HIV to HSV-1 and HSV-2 among MSM, with attention to health risks influenced by social and structural determinants.

Rhode Island has experienced an increasing burden of HIV and other sexually transmitted infections (STIs) among young, gay, bisexual, and other men who have sex with men, accounting for 83% of HIV diagnoses in 2021. This evaluation examined men who have sex with men's perceptions of the effectiveness, gaps, and needs of sexual health services. Semi-structured interviews were conducted with 20 men who have sex with men in Rhode Island recruited from community-based organizations, listservs, and social apps from September 2023 to February 2024. Thematic analysis focused on barriers and facilitators of HIV testing, past experiences with STI testing and notification services, and access to sexual health information. Participants highlighted barriers to testing services such as location, stigma, and transportation, as well as facilitators (e.g., convenience, welcoming environment, co-located services). Participants expressed difficulties in accessing and understanding general health information as it pertained to HIV and STIs. Our findings suggest that men who have sex with men experience barriers to accessing and navigating sexual health services. HIV and other STI mitigation infrastructure must be embedded within resources that are already accessible to these populations.

Research has examined the impact of HIV stigma on people with HIV (PWH), but little work has explored how stigmatizing beliefs toward PWH and instrumental stigma - the misplaced fears of infection through everyday contact with PWH - may serve as a barrier to HIV testing. We analyzed responses from 3,271 US adults in the fall 2021 ConsumerStyles Survey to estimate the prevalence of these stigmas and examine associations with sociodemographic factors. Multivariate regression showed that adults who identify as heterosexual, those aged 65 years and older, those with lower educational attainment, those living in the South, and those who did not know someone with HIV reported higher stigmatizing beliefs about PWH and instrumental stigma. Men and individuals in non-metro areas also exhibited greater stigmatizing beliefs. Race was significantly associated with instrumental stigma, with non-white adults reporting higher levels than white adults. Higher stigmatizing beliefs scores were significantly associated with a lower likelihood of HIV testing. These findings highlight the persistence of stigmatizing beliefs toward PWH in the US, which may hinder engagement with HIV testing, a key component of HIV prevention efforts.

Medication adherence is essential to achieve sustained viral suppression for individuals living with human immunodeficiency virus (HIV). The use of alcohol and substances may interfere with medication adherence and lead to adverse outcomes. Thus, this review sought to examine the literature on behavioral interventions that improve medication adherence among individuals with HIV who are using alcohol or drugs. Articles were included if they met the following criteria: (a) included individuals diagnosed with HIV (b) were published in English between January 1, 2000 and June 15, 2023, (c) evaluated a behavioral intervention to increase medication adherence, (d) reported at least one medication adherence outcome, (e) were randomized controlled trials or quantitative pre-post designs, and (f) were comprised primarily of individuals using alcohol or drugs. Twenty-two papers representing 20 unique studies were included in the review. Most were undertaken in the United States. Multiple interventions demonstrated efficacy in increasing medication adherence among individuals using alcohol or substances. Interventions with structural intervention components or delivered via text/mHealth also demonstrated relatively consistent efficacy support. Findings were mixed regarding reductions in alcohol and/or substance use, as well as sustaining improvement in medication adherence. Recommendations for future trials include diversifying recruitment methods and examining scalability.

Research on the diet of PLWH in South Africa is limited. We assessed the association between BMI and diet quality of PLWH on ART in Cape Town. We recruited 246 participants between 2021 and 2022. Information on demographics, infection, treatment, anthropometry, and physical activity was obtained. Diet quality was assessed using the Alternate Healthy Eating Index (aHEI). Anthropometry was measured using BMI, waist circumference, mid-upper-arm circumference, and waist-to-hip ratio. Participants were mostly females (70%) with an average age of 46 years, 28% were overweight, and 40% obese. Females were more obese than males (91% vs 9%, p < 0.001). Age was not associated with BMI. Leisure physical activity score was significantly different within BMI categories (p < 0.001). Over one-third of participants were being treated for at least one comorbidity, mostly hypertension, dyslipidemia, and dysglycemia. Average daily intakes of the components of the aHEI indicated a low compliance with the index recommendation. The mean aHEI score was 41.9, indicating diet quality was lower than average, and was not significantly different between BMI categories. Diet quality among PLWH in this study is suboptimal, irrespective of BMI; this needs to be addressed. Investigations of psychosocial factors affecting the nutritional and health status of PLWH is needed.

In South Africa, HIV prevalence among people over 50 exceeds 18.5%, yet research and interventions for older people living with HIV (OPLWH) remain limited. Evidence links HIV stigma to poor health outcomes, but little is known about OPLWH's experiences in resource-limited settings. This study explores how OPLWH understand and experience intersecting stigmas, and how these shape engagement in care. Using a qualitative exploratory design, we conducted semi-structured in-depth interviews, body mapping and social network analyses with 30 OPLWH from three clinics. Data were transcribed, translated and thematically analysed using a stigma framework. While structural stigma was limited, participants described intersecting stigmas related to age, gender and sexuality. Historically enacted stigma, linked to the pre-ART era, had declined as HIV became normalised. However, community and anticipated stigma continued to influence disclosure and coping strategies, often leading to concealment. Internalised stigma initially hindered care engagement and caused isolation, but support and time fostered resilience. Financial insecurity, co-morbidities and family roles amplified stigma's effects, yet participants developed coping strategies that strengthened psychological resilience. Despite stigma, OPLWH demonstrated strategies to ensure mitigation and agency and self-efficacy, highlighting the need for multi-level interventions addressing stigma within broader social and economic contexts.

Individuals living with HIV/AIDS (PLWHA) face significant physical, psychological and social challenges, even with the progress made in antiretroviral therapy (ART). The integration of palliative care has been shown to enhance quality of life and reduce symptom burden; however, there is limited evidence from India on this topic. This cross-sectional study investigated the unmet palliative care needs of PLWHA attending a tertiary HIV clinic in Karnataka, India. Out of 118 eligible patients, 97 (82.2%) agreed to participate from January to June 2019. Data were gathered using the Supportive and Palliative Care Indicators Tool (SPICT-LIS), the Edmonton Symptom Assessment Scale - Revised (ESAS-R) and the Needs Assessment Tool for Progressive Disease (NAT: PD). Overall, 43.3% of participants met the SPICT-LIS criteria for palliative care needs, and 42.3% reported experiencing at least one severe symptom, with fatigue, pain and depression being the most common. Factors such as functional impairment (Karnofsky Performance Status < 80), recent hospitalization, and CD4 counts below 200 cells/μL were significant predictors of the need for palliative care. Despite these findings, 97.6% of eligible participants had never received palliative services. Barriers to care included stigma, lack of awareness and limited integration of services. These findings suggest the urgent need to incorporate palliative care into ART programs to improve the quality of life and address ongoing health disparities among PLWHA in India.

Human Immunodeficiency Virus (HIV) infection remains a common comorbidity among patients with fractures, yet a few studies have examined whether exercise can prevent bone demineralisation in this group. It is unclear whether people living with HIV who sustain fractures may experience improvements in bone mineral density (BMD), function or quality of life (QoL) following structured exercise. This study assessed the feasibility of a home-based exercise programme aimed at improving BMD, functional capacity and QoL, and explored whether densitometry can detect exercise-related changes in South African patients with femoral shaft fractures. A randomised controlled trial was conducted at the Chris Hani Baragwanath Orthopaedic Clinic. Participants with femoral shaft fractures were randomly allocated to an intervention or control group and assessed for gait, function, BMD, physical activity, and QoL at baseline and at 6 and 12 weeks post-surgery. Of the 22 participants (mean age 34.64 ± 8.09 years), 63.6% were male, and 27.3% were HIV positive. By week 12, the intervention group showed higher BMD at the right toe, right thumb and greater trochanter but decreased at fracture sites. Mobility scores improved in the intervention group. Exercise enhanced BMD at weight-bearing sites and supported faster recovery of mobility, although gains were limited at fracture locations.