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

Human immunodeficiency virus (HIV) remains a major public health priority in Australia, with treatment and prevention efforts underpinned by access to government-subsidised antiretroviral therapy (ART) through the Pharmaceutical Benefits Scheme (PBS). In 2023-2024, multiple tenofovir with emtricitabine products used for HIV treatment and pre-exposure prophylaxis (PrEP) were subject to national shortages, raising concerns about access and continuity of care. This study aimed to examine changes in monthly PBS dispensings of tenofovir with emtricitabine before, during and after the reported shortages, and assess potential impacts on HIV diagnostic testing behaviour. Using publicly available aggregated PBS and Medicare Benefits Schedule (MBS) data from January 2023 to December 2024, we quantified trends in ART and PrEP dispensings alongside HIV test claims. We found a 42% reduction in PrEP dispensing during the shortage period, with a notable decline across all PBS-listed PrEP products. Despite the approval of an overseas-registered Section 19A product in October 2024, PrEP dispensing did not return to pre-shortage levels. Diagnostic testing volumes remained relatively consistent across the study period. These findings suggest that HIV prevention efforts may be sensitive to medicine shortages and underscore the value of timely regulatory responses to help maintain access to essential medicines.

Demographic, behavioral, and clinical characteristics have been found to be associated with willingness to use and preferences for different HIV pre-exposure prophylaxis (PrEP) modalities. Limited data are available, however, describing how sexual behavior characteristics affect willingness to use and preferences for PrEP. Given the different clinical characteristics of available PrEP modalities (i.e., daily oral, on-demand oral, long-acting injectable), an individual's sexual behavior (i.e., number of partners, partner characteristics) might affect their preferences for PrEP. We conducted a cross-sectional study among men who have sex with men (MSM) who are not living with HIV to assess the association between willingness to use PrEP and preferences for three different PrEP modalities with key sexual behavior characteristics. We found that willingness to use PrEP was not strongly associated with sexual behavior; however, for each sexual behavior characteristic we examined, preferences were higher for each modality of PrEP compared to no PrEP. As the number of sexual partners in the past 12 months increased, so did preferences for each modality of PrEP compared to no PrEP. Preferences were consistently stronger for injectable compared to oral PrEP. These results indicate that PrEP preferences are responsive to sexual behavior.

Oral liquid formulations of zidovudine (ZDV) and nevirapine (NVP) are the main antiretrovirals (ARVs) for neonates born to mothers living with HIV, but they have limitations including poor palatability, short shelf-life, frequent dosing and supply challenges. Understanding caregiver and provider preferences for infant ARV formulations is essential to guide the development of acceptable alternatives. Within the PETITE-DTG trial in South Africa (NCT05590325), evaluating the pharmacokinetics, safety and acceptability of novel dolutegravir (DTG) formulations in neonates, we explored ARV preferences among mothers (n = 28) and health workers (n = 6). Participants completed interviews ranking six formulations: existing ZDV and NVP syrups, a DTG dispersible tablet (DTG-DT), a novel DTG oral dispersible film (DTG-film) and two pipeline options (long-acting injectable; transdermal patch). Both groups strongly favoured DTG-film, highlighting ease of administration, confidence in accurate dosing and discreetness. Long-acting injectables were next preferred, viewed as convenient despite concerns about discomfort. DTG-DT, ZDV and NVP ranked lower due to preparation challenges and risk of spillage. Transdermal patches were least favoured, with concerns regarding the comfort of neonates, impact of water exposure and effectiveness. These findings underscore strong support for innovative ARV options, emphasizing usability, ease of administration and reduced dosing frequency for the treatment of neonates.

Despite substantial advancements in HIV/AIDS treatment and prevention, HIV-related stigma remains a key barrier to achieving the UNAIDS global goal of ending AIDS by 2030. This study examined the pervasive stigma experienced by people living with HIV (PLHIV) in a secondary health facility in Ghana, exploring its manifestations and impact on mental health. A qualitative exploratory research design was used, involving in-depth interviews with 27 purposively selected PLHIV (aged 25-50 years) between July and November 2024. Participants were recruited from antiretroviral therapy unit of the secondary health facility. Thematic analysis was conducted using Atlas.ti (Version 12), with independent coding and categorization of emerging themes following Braun and Clarke's six-phase framework. Multiple stigma dimensions were identified, including enacted, felt, and self-stigma. Participants reported discrimination from healthcare providers, social isolation, and self-stigmatization, which intensified mental health challenges such as anxiety and depression. Fear of judgment discourages healthcare engagement, reduces adherence to ART, and worsens health outcomes. Stigma negatively affects the mental health of PLHIV. Addressing stigma requires targeted interventions, including stigma-reduction training for healthcare providers, mental health support programs, and policy measures to foster inclusive healthcare environments. By mitigating stigma, health systems can improve both psychological well-being and ART adherence among PLHIV.

Background: Antiretroviral therapy has markedly increased life expectancy among people living with human immunodeficiency virus (HIV), yet the long-term impact of chronic HIV infection on women's quality of life (QoL) and sexual functioning remains poorly understood. Female sexual dysfunction (FSD) is common in women and may impair psychological well-being and social relationships. Understanding how HIV infection intersects with FSD and QoL could inform holistic care for women in resource-limited settings.Objective: To compare QoL and FSD between women living with HIV and HIV-negative women and to identify socio-demographic predictors of poor QoL.Methods: We conducted a hospital-based cross-sectional study in 2024 among 200 women on antiretroviral therapy and 200 age-matched HIV-negative women attending the general outpatient clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. Participants were recruited through systematic sampling; research assistants provided study information and obtained written informed consent. Quality of life was assessed with the World Health Organization Quality of Life 26-item Brief questionnaire (WHOQOL-BREF). Female sexual function was screened with the 19-item Female Sexual Function Index (FSFI); a total score ≤26.55 denoted FSD. Data were analyzed using chi-square tests, independent t-tests and multivariable logistic regression.Results: The mean (±SD) age of participants was 37.1 ± 9.4 years. Overall QoL was significantly worse among women with HIV than HIV-negative women (53% vs 63% reporting good QoL, p = 0.043). Mean QoL scores were lower in the HIV-positive group for the psychological (61 ± 18 vs 54 ± 14; p < 0.001) and environmental domains (69 ± 20 vs 65 ± 16; p < 0.001), while physical and social domain scores were comparable. FSD was highly prevalent in both groups (96% in HIV-positive and 98% in HIV-negative participants; p = 0.40), and FSFI scores were not associated with QoL. In multivariable analysis, rural residence (adjusted odds ratio 3.30, 95% CI 1.31-8.98) and primary-level education (aOR 3.06, 95% CI 1.50-6.38) independently predicted poor QoL.Conclusions: Women living with HIV experience poorer overall QoL than HIV-negative peers, particularly in psychological and environmental domains. Interventions that improve living conditions, strengthen psychosocial support and integrate sexual and mental health services into HIV care, are needed to improve the well-being of women in North-western Nigeria.

The COVID-19 pandemic abruptly altered the way HIV care was accessed and delivered. We sought to assess HIV care indicators during the COVID-19 pandemic in relation to pre-pandemic HIV care patterns in North Carolina. Using statewide HIV surveillance data and group-based trajectory models, we identified pre-pandemic HIV care trajectories in two partially overlapping populations: (1) newly HIV-diagnosed from March 2014 through February 2018, followed from diagnosis to pandemic start (March 1, 2020); and (2) previously HIV-diagnosed before March 2016, followed from March 2016 to pandemic start. We analyzed pandemic-period HIV care indicators in both populations. In newly diagnosed persons, pre-pandemic HIV care attendance trajectories comprised "consistently high," "slowly fluctuating," "steadily decreasing," and "low U-shaped" groups. Trajectories in previously diagnosed persons were similar, although two distinct low groups replaced the "low U-shaped" group. In both populations, the "consistently high" groups had the highest predicted percentages of persons, while the "low" care groups had the lowest. HIV care indicators in the first pandemic year corresponded with pre-pandemic care patterns: most persons with high and fluctuating pre-pandemic care had an HIV laboratory record in the pandemic year, while most persons in the low care groups had no record in that year.

Introduction: HIV/AIDS remains a significant concern in sub-Saharan Africa (SSA), where women face heightened vulnerability due to biological, structural, cultural, and socioeconomic factors. HIV testing is central to prevention and control, yet uptake remains suboptimal. This study examined the association between participation in sexual and reproductive health (SRH) decision-making and HIV testing in Ghana.

Methods: We analyzed cross-sectional data from the 2022 Ghana Demographic and Health Survey, including 7,867 married and cohabiting women aged 15-49. Participation in SRH decision-making was defined as the ability to refuse sex, make family planning and healthcare decisions independently or jointly with a spouse. Descriptive statistics, Rao-Scott chi-square tests, and logistic regression analyses were performed.

Results: Overall, 77.0% of women reported ever testing for HIV, while 52.9% participated in SRH decision-making. HIV testing uptake was lower among women not involved in SRH decisions compared to those who were (72.8% vs. 80.6%; p < 0.001). After adjusting for potential confounders, lack of participation in SRH decision-making was associated with reduced odds of HIV testing (aOR: 0.79, 95% CI: 0.68-0.92, p = 0.002).

Discussion: Efforts to strengthen women's autonomy in SRH decision-making may be an effective strategy to increase HIV testing uptake among married and cohabiting women.

This study aimed to compare the neurocognitive function and neuropsychiatric symptoms of individuals living with HIV and HIV-negative controls, and to evaluate their associations with clinical markers of disease activity. The study included 111 HIV-positive individuals followed at Ankara City Hospital and 54 HIV-negative controls matched for age, sex, and educational level. All participants were assessed using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Vitamin D levels were significantly higher in the control group than in the HIV-positive group (p = 0.043). Using a MoCA cut-off score of 21, the proportion of participants scoring ≥21 was significantly higher among controls (p = 0.036). No significant differences were observed between the groups in depression or anxiety scores (p > 0.05). Additionally, neurocognitive performance and psychiatric symptoms were not significantly associated with CD4 count or HIV RNA levels. These findings indicate that neurocognitive impairment remains prevalent among individuals living with HIV despite effective antiretroviral therapy. Although depression and anxiety levels did not differ between groups, regular neurocognitive and psychiatric assessments remain essential components of comprehensive HIV care, emphasizing the importance of multidisciplinary management.

Antiretroviral therapy (ART) is essential for HIV treatment, yet maintaining high adherence remains challenging in resource-limited settings. Mobile health (mHealth) interventions offer a scalable approach to support adherence. This meta-analysis evaluated the effectiveness of mHealth interventions in improving ART adherence and clinical outcomes among people living with HIV (PLHIV) in low- and middle-income countries. Eight databases were searched through February 2025, and randomised controlled trials (RCTs) evaluating mHealth interventions were included. Risk of bias was assessed using the Cochrane tool, and random-effects models were applied. Seventeen RCTs (n = 2172) met the inclusion criteria. mHealth interventions significantly improved ART adherence compared with standard or alternative approaches (OR = 2.03; 95% CI: 1.44-2.86; p<0.0001). Subgroup analyses indicated moderating effects of geographic region (χ² = 8.84, p = 0.01) and country income level (χ² = 6.44, p = 0.04), with the greatest adherence benefits observed in the Americas (OR = 5.46; 95% CI: 2.20-13.57) and in upper-middle-income countries (OR = 3.45; 95% CI: 1.69-7.06). mHealth interventions also improved viral suppression (OR = 2.27; 95% CI: 1.18-4.36). Although CD4 count improvements were noted, sensitivity analysis suggested this effect was not robust. Overall, mHealth interventions show promise for strengthening ART adherence in resource-limited settings, while further research should explore contextual factors influencing effectiveness.

Primary care providers (PCPs) in Canada frequently report limited knowledge and confidence in prescribing HIV pre-exposure prophylaxis (PrEP). To address this gap, we developed and evaluated an online educational module designed to enhance PCPs' knowledge and PrEP-related clinical skills. Pre- and post-training surveys (n = 38 and n = 20, respectively) showed substantial improvements: understanding of PrEP eligibility increased by 46%; knowledge of medications and monitoring by 55-180%; skills in medication management by 57-68%; skills in client monitoring by 47-84%; and knowledge regarding PrEP discontinuation by 84%. All participants (100%) agreed that the module met their expectations and was highly valuable, applicable, and useful to their clinical practice. Qualitative feedback highlighted the need for audio narration, more downloadable materials, and more inclusive, patient-centered content. Overall, these findings indicate that the online module effectively enhances PCPs' readiness to prescribe oral PrEP and addresses key gaps in HIV prevention training.