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

Introduction: Cigarette smoking remains the leading preventable cause of death in the United States, with prevalence remaining dangerously high in at-risk groups, including people living with Human Immunodeficiency Virus (HIV). Military Veterans with HIV and receiving Veterans Health Administration (VHA) care have a high prevalence of smoking, and risk factors such as hazardous drinking and substance use disorder (SUD), despite access to smoking cessation treatment. Little is known about the prevalence of smoking and smoking cessation medication receipt among Veterans with HIV and co-occurring hazardous drinking or SUD. Methods: In this cohort study, we analysed nationwide VHA electronic health record (EHR) data from 1 October 2015 to 30 September 2021, to examine the prevalence of smoking among Veterans with HIV with and without hazardous drinking or SUD diagnoses. We then assessed VHA cessation prescription rates for the 12 months following the documentation of smoking in the VA EHR. Results: In the overall sample of Veterans with HIV who smoke and have co-occurring hazardous drinking or SUD, 33.9% (N = 3220) were prescribed smoking cessation medications in the 12 months following documented smoking. Among Veterans who smoke with HIV, 42.5% of those with hazardous drinking or SUD were prescribed medication compared to 29.6% of those without hazardous substance use. Discussion: These trends demonstrate that Veterans with HIV who smoke but do not have hazardous drinking or SUD have lower access to smoking cessation pharmacotherapy in VA care. Efforts to provide tobacco cessation pharmacotherapy to this population may improve smoking outcomes.Trial registration: Netherlands National Trial Register identifier: ntr206.

Preventive care receipt is suboptimal for people with HIV. Low physician reimbursement may play a role. We examined physician reimbursement and receipt of five annual preventive care services for Medicaid enrollees with HIV. We used person-level administrative claims (Medicaid Analytic eXtract, 2008-2012), state Medicaid-to-Medicare physician fee ratios representing state-level Medicaid primary care reimbursement relative to Medicare reimbursement (Urban Institute, 2008, 2012), and county-level characteristics for 15 southern states plus DC. Generalized estimating equations assessed the relationship of a 10-percentage point increase in the fee ratio and annual receipt of lipid, glucose, syphilis, and cervical cancer (women only) screening and influenza vaccination. We examined subpopulations requiring greater care, enrollees aged <45 years, managed care enrollees, non-Hispanic Black enrollees, and non-Hispanic White enrollees. The sample included 55,237 adult Medicaid enrollees with HIV (179,002 enrollee-years). Services were received in <50% of total enrollment years except glucose screen (71.2%). A 10-percentage point increase in fee ratio was associated with an 11%-25% increase in the odds of receipt of each service. Findings were largely consistent across subpopulations and among non-Hispanic Black enrollees, but not among non-Hispanic White enrollees. Modest increases in physician reimbursement may improve receipt, and equity in receipt, of preventive care services.

Limited prospective data exist for long-term hormonal contraceptive continuation rates among women living with HIV. We conducted a prospective cohort study of women living with HIV in Lilongwe, Malawi from 2017 to 2021 and evaluated their contraceptive method continuation and ART regimens. Participants initiating either depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant were followed every 24 weeks for up to 192 weeks. 1,359 participants enrolled in the study; 689 initiated the DMPA injection, and 670 initiated the LNG implant. At enrollment, DMPA and implant users had similar age, body mass index, educational levels, number of children, breastfeeding status, future pregnancy intention, CD4 count, and HIV viral load. 1,179 participants (86.8%) usedefavirenz-based therapy at enrollment, with 874 (74.1%) switching to dolutegravir-based therapy by their last study visit. During study follow-up, 225 (32.7%) DMPA and 141 (21.0%) implant users discontinued their initial contraceptive method. Time to method discontinuation differed between the two contraceptive groups (log-rank p < 0.001). The time by which 25% of women had discontinued their initial contraceptive also differed markedly: 76.0 weeks for the DMPA group and 142.7 weeks for the implant group. Future studies can evaluate the factors that lead to contraceptive continuation versus discontinuation among WLWH.

We investigated the progress towards the second and third 95-95-95 UNAIDS targets among adolescents and young adults (AYA) living with HIV in the Ekurhuleni district, South Africa. A total of 39,038 AYA were tested for HIV in 2018, 17.0% (95% CI: 16.6%-17.4%) tested positive, 79.5% (95% CI: 78.5%-80.5%) were aged 20-24, and the majority were females 86.8% (95% CI: 86.0%-87.6%) and of these females 33.8% (95% CI: 32.6%-35.1%) were pregnant. Antiretroviral therapy (ART) initiation rate was 81.9% (95% CI: 81.0%-82.9%) and 63% were initiated on the same day. Viral load suppression had an upward trajectory of 63%, 66%, 71%, 73%, 81%, while retention rate regressed from 67%, 63%, 62%, 60%, 56% over 12, 24, 36, 48 and 60 months. Compared to males, females achieved greater proportions while when comparing the three-age bands, AYA aged 20-24 achieved better outcomes than AYA aged 10-14 and 15-19. These findings underscore the importance of interventions focused on targeted testing and diagnosis, linkage to treatment, retention to care and viral load suppression of younger adolescents (10-14 years) and male AYA and implementation of age and gender disaggregated HIV cascade indicators tracking for this subpopulation.

Objective: Advances in treatment have transformed HIV into a manageable chronic illness, yet people living with HIV (PLHIV) continue to face psychosocial challenges that reduce quality of life (QoL). These factors often co-occur and interact, creating syndemic effects that worsen outcomes. Method: This study examined relationships between HIV-related stigma, mental health difficulties, and social disconnection in predicting QoL. Participants were 213 PLHIV (184 male, 21 female, eight transgender/other/undisclosed) attending Albion, an urban tertiary HIV clinic in Sydney, Australia. They completed questionnaires assessing stigma, mental health, social support, and QoL. Results: HIV-related stigma, mental health difficulties, and social disconnection each independently predicted poorer QoL. A syndemic effect was found between stigma and social disconnection, with QoL lowest when both were high. Conclusions: Psychosocial comorbidities significantly impact QoL in PLHIV. Findings underscore the value of a syndemic framework to guide clinical research and highlight the need for holistic interventions addressing stigma, social support, and mental health.

Heterosexually identifying migrants in Australia are among populations experiencing increasing HIV notifications, highlighting concerns about low rates of sexual health testing and awareness of Pre-Exposure Prophylaxis (PrEP). Utilising in-depth interviews, we explored perceptions of HIV risk among 16 heterosexually identifying migrants from Southeast Asia, Northeast Asia, and sub-Saharan Africa. Domains of inquiry were HIV risk assessment and management, knowledge and attitudes. Participants were majority female, aged 35 years and above, living in Australia for at least three years. Constructed themes were stigma and personal responsibility, access and awareness, proximity and distance, and differing socio-cultural attitudes. Cultural or community-based stigma influenced participants' perceptions of HIV or their reluctance to use PrEP, linked to morality and safety concerns. Limited uptake of PrEP was contrasted by generally high knowledge of HIV transmission, prevention, and treatment. Attitudes and perceptions were commonly influenced by access to sexual health education, exposure to and visibility of HIV information, social proximity to people living with HIV, and sociocultural norms. Participant insights highlight the need for culturally responsive public health education outside dedicated sexual health spaces, particularly regarding PrEP, and reinforce the need for targeted, peer and community-led health promotion responses to support virtual elimination of HIV.

HIV competence, encompassing knowledge, skills, attitudes, and practices to prevent, manage, and reduce HIV impact, is critical for meeting young people's HIV prevention and care needs. This study evaluated the effect of the Community of Practice on HIV (CoP-HIV) educational intervention on staff HIV competence and prevention knowledge in Ugandan schools, where HIV prevalence is rising among youth. Using a stepped-wedge cluster randomized trial, the intervention was implemented across six schools in western Uganda (March-September 2023). It included two eight-hour workshops and a handbook on HIV prevention and care, delivered over one month per school. Data were collected from 174 randomly selected staff (mean age 34.9 years, 49.9% female) at four points: baseline, T1, T2, and T3. Linear mixed-effects modeling showed significant improvements in HIV competence (20-point increase; β = 19.87, SE = 1.02, p < 0.05) and prevention knowledge (5.5-point increase; β = 5.5, SE = 0.97, p < 0.05). Competence varied by school and time, while prevention knowledge improved consistently. The CoP-HIV intervention enhanced staff capacity, demonstrating potential for broader school-based HIV control. Despite pragmatic design strengths, short follow-up and reliance on self-reported data were limitations. Longer-term studies should examine effects on students' preventive behaviors and well-being.

Falls result in adverse outcomes such as hospitalization, disability, and increased mortality among older people. There is a paucity of data on falls among older PLHIV in sub-Saharan Africa. We determined the prevalence and factors associated with falls among older PLHIV in Kampala, Uganda. We carried out a cross-sectional analysis of 500 people aged ≥ 60. We administered structured questionnaires to collect participants' characteristics, the number and type of falls in the previous 2 years. We then performed a modified Poisson regression analysis to assess the factors associated with falls. Overall, 51.2% were male. The mean age was 65 years (SD ± 4.9 years), and 41.2% reported having a fall in the previous 2 years. Falling was associated with being female (prevalence ratio (PR) 1.28, 95% CI: 1.01-1.63), current (PR 1.44, 95% CI: 1.05-1.96), or past alcohol use (PR 1.41, 95% CI: 1.07-1.87), and low household income (PR 1.33, 95% CI: 1.07-1.64). Given the high prevalence of falls found in our study, integrating risk awareness and screening for falls into the routine care of older people with HIV is desirable. Effective education programs aimed at promoting alcohol cessation could reduce the occurrence of falls among older people living with HIV.

Background: Few studies have examined factors linked to depressive symptomatology among caregivers of children and adolescents living with HIV (CALHIV). This study estimated prevalence of depressive symptoms and identified associated factors among caregivers of CALHIV in KwaZulu-Natal, South Africa.

Methods: We used baseline data from a cluster-randomised controlled trial of the impact of a cash transfer program and an economic empowerment intervention on health and well-being caregivers of CALHIV. Depressive symptoms were assessed using 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10), with score of ≥12 indicating presence depressive symptomatology. Correlates of depressive symptoms were identified using multilevel generalised linear models.

Results: The prevalence of depressive symptoms was 57% (95% CI: 51% - 63%). Factors associated with increased odds of depressive symptomatology were residing in peri-urban (OR = 4.80, p = 0.038), having any form of disability (OR = 8.12, p = 0.001), having existing medical condition (OR = 3.27, p = 0.009), experiencing physical abuse in the past 12 months (OR = 3.53, p = 0.020), and low social support (OR = 3.94, p = 0.005).

Conclusion: The prevalence of depressive symptoms was high among Caregivers of CALHIV. These findings highlight the need for targeted, context-specific interventions that include mental health screening for caregivers to support their mental health and well-being.

Women living with HIV (WWH) have an increased risk of invasive cervical cancer due to persistent HPV infection and a weakened immune response. Regular cervical screening is recommended, but compliance is poor. This study aims to identify determinants associated with non-compliance and the risk of high-grade intraepithelial lesions (HSIL) in WWH. The study assessed compliance with the national cervical screening guideline of the Dutch Association of HIV Practitioners (NVHB) in Dutch WWH. Data from the ATHENA National HIV cohort, including WWH from seven HIV centers registered from 2000 through 2021, were analyzed. Descriptive and logistic regression analyses were performed to examine the associations between determinants and guideline adherence, as well as the associations between these determinants and cervical smear results in the study population. The study included 1537 WWH, of whom 1007 (65.5%) had at least one cervical smear, resulting in a compliance rate of 0.28 per three patient-years. Among these 1007 women, 228 (22.6%, 23 per 1,000 p-y) had HSIL and 9 (0.9%, 0.9 per 1,000 p-y) developed cervical cancer. Compliance was associated with hormonal contraceptive use, limited alcohol consumption, a history of STDs (other than HIV), and pregnancy. Non-compliance was more common in WWH born in Africa and Western Europe compared to those born in the Netherlands and in those never treated with cART. HSIL was associated with younger age, drug use, high-risk HPV, low CD4 counts, and detectable viral load. Cervical screening compliance in WWH in the Netherlands is moderate to poor, with HSIL incidence twice as high as in the general population. These findings underscore the importance of cervical screening in this high-risk group. The results can guide the development of personalized strategies to improve screening adherence, leading to earlier HSIL detection and a reduced cervical cancer incidence.