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

Despite its benefits, partner notification (PN) for HIV faces multiple barriers. This study explores HIV PN experiences, barriers and enabling factors in Rotterdam, the Netherlands, between November 2019 and February 2022. Semi-structured interviews were conducted with 19 recently HIV diagnosed individuals (<2 years; indexes), 11 notified partners and 10 key persons, alongside two focus groups with 10 peers. Data collection was iterative, and analysis was guided by the social-ecological model of McLeroy et al. The findings showed that most indexes were surprised by their diagnosis and had limited knowledge of HIV. PN was often supported by healthcare providers and conducted through digital platforms such as WhatsApp or anonymous online PN tools. Motivations for disclosure included moral responsibility and protecting partners, while barriers included fear, stigma, emotional distress, lack of contact details and perceived illness. Empathic support from providers and peers was a key enabling factor. Most interviewed notified partners underwent testing, often for the first time, and none tested positive. Participants emphasised the need to normalise HIV testing, promote undetectable = untransmittable messaging, improve PN tools, expand testing access and strengthen public awareness. In conclusion, PN is shaped by intersecting personal, social and structural factors, requiring flexible, context-specific interventions.

Oral pre-exposure prophylaxis (PrEP) is a highly effective and safe way to prevent HIV acquisition among men who have sex with men (MSM). PrEP became available to MSM in Sweden in 2018, but there have been challenges in its accessibility. The aim of this study was to gain an improved understanding of the lived experience of MSM enrolled in a PrEP program in Sweden. Data were collected through in-depth interviews with 16 MSM enrolled in the Uppsala PrEP program, which was the first PrEP program in Sweden. After being transcribed verbatim, data were analyzed using qualitative content analysis with an inductive approach to explore both the manifest and latent meanings of the interviews. The analysis resulted in an overarching theme: Transforming the sexual health landscape through PrEP, based on three descriptive sub-themes representing the perceptions and experiences among the participants: Constructing the "deserving" PrEP user, Being in the process of re-defining HIV, and Becoming a new sexual being. The results suggest that while several benefits, such as reduced HIV anxiety and sexual freedom, are experienced by PrEP users, continued HIV worry, risks of bacterial STIs and negative experiences of stigma and control are challenges that need to be addressed further.

Durable HIV viral suppression is the primary goal of initiatives aimed at ending the HIV epidemic. This study (1) identified viral suppression patterns over a four-year period, and (2) determined the association of viral suppression patterns with demographic characteristics. This study was a retrospective observational analysis of insurance claims data of 2,677 members of a New York City managed care plan who were living with HIV (PLWH). Using cluster analysis, five distinct viral suppression patterns were identified: consistently unsuppressed (15%), became unsuppressed (12%), fluctuated (16%), became suppressed (12%), and consistently suppressed (45%). Adults aged 18-29 were more likely to be consistently unsuppressed than older individuals. Compared to non-Hispanic White individuals, PLWH who were non-Hispanic Black had greater odds of becoming suppressed or becoming unsuppressed, and to be consistently unsuppressed. Hispanic PLWH also had greater odds of being consistently unsuppressed. Transgender or gender diverse PLWH had greater odds of being in the fluctuated viral load group than their cisgender peers. Thus, demographic characteristics are useful in identifying groups at-risk for viremia, reflecting the association of these factors with social determinants of health. Future research should examine how to reduce barriers to healthcare and increase care engagement for these populations.

This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) in enhancing happiness among women living with HIV in Ahvaz, Iran. A randomized controlled trial assigned 92 eligible women to either an MBCT group (n = 46) or a control group (n = 46). The MBCT group participated in eight 90 min sessions, while the control group received no intervention. Data were collected using demographic questionnaires, the Oxford Happiness Inventory, and Beck Depression Inventory-II. Statistical analyses included chi-square, t-tests, Mann-Whitney U, and repeated measures ANOVA (p < 0.05). Post-intervention, the MBCT group showed a significant increase in happiness (30.9 ± 7.1 to 40.5 ± 4.9) compared to minimal change in controls (32.8 ± 7.1 to 33.9 ± 7.0, p < 0.001). Subscale improvements included self-esteem (2.1 ± 1.4 to 3.3 ± 1.0), mood (8.8 ± 2.9 to 11.0 ± 2.5), self-efficacy (3.4 ± 1.7 to 4.8 ± 1.7), health perception (6.8 ± 2.1 to 9.2 ± 1.6), and life satisfaction (11.7 ± 3.4 to 14.7 ± 2.5) (all p < 0.01). Depression scores decreased significantly (16.6 ± 4.9 to 11.9 ± 3.1, p < 0.001). Findings indicate MBCT effectively enhances happiness and related psychological factors in women with HIV, supporting its role in improving mental well-being.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20231004059614N1.

Telemedicine offers a patient-centered approach to chronic care, including HIV. However, its uptake depends on the users' perceptions of its benefits and challenges. We explored patients' and providers' knowledge, perceptions, benefits, challenges, and resource needs for integrating telemedicine into routine HIV care. We conducted a qualitative study involving eight gender-stratified focus group discussions and 23 key informant interviews with people with HIV (PWH) and their healthcare providers (HCPs) recruited from four government facilities. Transcripts were coded and analyzed using framework analysis. The themes identified in the study included knowledge of telemedicine, perceived benefits and challenges, and implementation requirements. PWH and HCPs viewed telemedicine as enhancing access, reducing clinic congestion, and lowering travel and opportunity costs. Other benefits include improved retention, reduced stigma, and decreased provider workloads. However, they identified challenges, such as limited physical examinations, privacy concerns, and the need for user training. To implement the telemedicine intervention, they identified key resource needs such as reliable technology, electricity, internet, and confidentiality training. Rethinking scheduling workflows to adequately cater for tele-visits of patients is critical for success. Telemedicine is a viable, patient-centered addition to in-person HIV care. Addressing technological, privacy, and infrastructure barriers is essential for effective integration in resource-limited settings.

The Ryan White HIV/AIDS program (RWHAP) is governed by legislative and programmatic guidelines that ensure comprehensive services are provided to persons with HIV (PWH) across the United States. Comprehensive training and skill building opportunities for programmatic staff are rare. RWHAP funding recipient organizations may struggle to acquire and retain essential program-specific knowledge, with downstream impact on patient care and treatment.We designed a comprehensive 11-session videoconference learning series to improve program staff's confidence and competence with RWHAP fundamentals. Quantitative pre-vs-post session data were analyzed using Wilcoxon Signed-Rank tests, and qualitative data using thematic analysis.We enrolled 136 staff from 23 organizations in the southeastern United States with ≥1 ending the HIV Epidemic (EHE) jurisdiction; 94.1% (n = 128) worked in Kentucky. We observed post-session improvement in self-reported knowledge, confidence in ability to apply knowledge and perform job functions, and skill after each session. Post-session and end-of-series survey responses indicated that participants were satisfied with the series (mean 8.5/10.0), and that it met their learning needs.This program allowed participants to gain comprehensive understanding of the RWHAP programmatic and legislative guidelines, promoted effective and compliant program management, supported staff's learning needs, and will equip participating organizations to optimize service delivery and patient outcomes.

Frontline healthcare providers (HCPs) are critical to the paediatric-adolescent HIV response in Africa, yet their mental health and workplace wellbeing remain underexplored. We conducted a mixed-methods study with 617 frontline HCP who provide HIV services to children and adolescents in 12 high-prevalence African countries. Participants completed a cross-sectional survey assessing depression, work-related quality of life, empowerment, job satisfaction, and role overload. We examined differences in depression scores by age, gender and occupation. Twenty-one focus groups explored workplace experiences, challenges and their relationship to mental health and well-being. Thirty-nine per cent (n = 242) of participants reported at least mild depressive symptomatology. Prevalence was highest among younger HCPs: 55% among 18-29-year-olds, 39% among 30-45-year-olds and 27% among 45 + year-olds. Depression was more common in psychosocial support roles: 64% among peer supporters, 50% among community health workers and 44% among counsellors. Biomedical providers (nurses, doctors, and pharmacists) reported significantly lower depression scores than psychosocial support positions (p = 0.018). Work-related quality of life was significantly inversely associated with depression (p < 0.001). Participants described feeling overburdened and burnt out, linking mental health challenges to workplace conditions and calling for urgent improvements in work environments and well-being support for frontline HCP who provide HIV services to children and adolescents in Africa.

Although pre-exposure prophylaxis (PrEP) is an effective way to prevent HIV infection, PrEP uptake and adherence remain low in transgender and nonbinary (TGNB) communities. This qualitative study explored perspectives on the community-developed PrEP Well program that implemented PrEP services in a TGNB community center. Clients completed an interview approximately 90 days after program enrollment about factors that influenced their participation and suggestions for program improvement. Interviews were audio-recorded, transcribed, translated to English (if conducted in Spanish), de-identified, and analyzed using inductive thematic analysis. Twenty-five participants completed exit interviews. We identified eight themes. Positive experiences included (1) TGNB-centered program (subthemes: program coordinator, environment), (2) improved health, (3) program structure, and (4) improved financial status. Factors that negatively impacted engagement included (5) concerns about PrEP-related side effects and (6) inconvenient program logistics. Suggestions for improvement included (7) a one-stop shop model to reduce client burden and (8) program expansion. TGNB clients found PrEP Well to be acceptable and particularly appreciated that it was TGNB-centered. Future community-led PrEP programs should incorporate all services in one physical location and expand program components and duration in accordance with client needs.

ABSTRACTKnowing one's HIV status is associated with better outcomes for children and adolescents living with HIV (CALHIV). The World Health Organization (2021) recommends that adolescents be counselled about the potential benefits and risks of disclosing their HIV status. CALHIV who are fully disclosed to by an appropriate age have better retention in care and better psychosocial outcomes. Most disclosures occur in health system settings, with healthcare providers playing a key role in the disclosure process. This study draws on insights from participants in the Paediatric-Adolescent Treatment Africa (PATA) Summit - a convening of healthcare providers caring for CALHIV. The study explores disclosure-related experiences under three primary themes: (1) perspectives on managing patients and families; (2) healthcare provider skills in facilitating disclosure; and (3) foundations for healthy disclosure. Cross-cutting issues included the importance of developmentally appropriate communication, balancing risks and benefits, addressing stigma, and strengthening pre- and post-disclosure support. Findings were mapped onto a socioecological model that identified barriers and facilitators at the child/adolescent, caregiver/family, healthcare provider, and community levels. Stigma and the temporal nature of disclosure were cross-cutting across all levels. Findings highlight the multifaceted nature of disclosure and the necessity for a coordinated, multisectoral approach that extends beyond health facilities.

We compared the levels of psychosocial and sexual experiences of adolescents aged 10-19 years who were living with (ALHIV) and affected by HIV who resided in HIV-affected homes of Uganda. Data were collected using a questionnaire that was validated using factor analysis. The levels of psychosocial and sexual experiences of these adolescents were compared using variance and Kruskal-Wallis tests. Results showed that whereas these adolescents were exposed to each observed factor, the ALHIV were significantly more vulnerable to lower education levels, living with sick people, death of both parents, changing homes, living with caregivers who were relatives or alcohol users, negative peer influence, poverty, personal and interpersonal problems, distress, sexual risk behaviour, and negative coping methods, compared to those not living with HIV or unaware of their HIV status. Hence, despite the higher primary education achievement and access to HIV services, ALHIV face a lesser sense of belonging, a higher burden of caring for their family members' sicknesses, higher vulnerability to sexually transmitted diseases, and poorer coping abilities compared to the other adolescents in the same home. Interventions are needed from families, schools and agencies to address the risk and protective factors among these adolescents.