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

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.

The secondary distribution of HIV self-testing (HIVST) kits has the potential to improve access and uptake of HIV testing. This study assessed the acceptability of secondary distribution of HIVST by people living with HIV (PLHIV) to their sexual partners in Central Kenya and explored the broader perspectives on this strategy. Conducted between November 2019 and April 2023, the study was nested within an interventional study that implemented two approaches to encourage HIV testing among sexual partners of PLHIV: (1) Invitation by PLHIV for clinic-based testing, and (2) distribution of HIVST kits to their sexual partners. One-time in-depth interviews (IDIs) were conducted with PLHIV (n = 21), sexual partners (n = 17), and healthcare providers (n = 10) to assess the acceptability of the HIVST distribution strategy from multiple perspectives. Participants generally perceived the HIVST strategy as acceptable, feasible, and convenient, as it saved both time and cost. However, some participants highlighted the potential for conflict and the lack of counseling services with HIVST, while others were concerned about the accuracy of HIVST. Future research should explore HIVST strategies that integrate user-centred counseling services while also addressing safety concerns related to relationship dynamics and the perceived effectiveness of HIVST kits.

Community-based HIV testing can identify high-risk adolescents and young adults living with HIV (AYALH), but data on long-term outcomes of AYALH identified via community-based testing is limited. We compared outcomes among AYALH 15-24 years identified in community-based campaigns to those who self-presented to an HIV clinic in Haiti. We measured retention 12-months after antiretroviral therapy (ART) initiation and factors associated with retention including time to ART initiation, assessed as a binary variable: immediate (≤7 days from HIV diagnosis) or delayed (>7 days from HIV diagnosis). Focus group discussions with providers highlighted AYALH's experience of entering care via both routes and recommendations for improving outcomes. 606 AYALH tested HIV-positive: 191 community-testers and 415 clinic-testers. Sociodemographic characteristics differed between groups: mean age 21 vs. 22 (p < 0.01), 88% vs. 74% female (p < 0.01), and 90% vs. 74% reported no income (p < 0.01). 12-month retention was 57% among community-testers and 68% among clinic-testers (p = 0.05). Those who immediately initiated ART had higher odds of non-retention (aOR, 1.62; 95%CI: 1.04-2.54; p = 0.03). Qualitative data suggested community-testers lack social support and were less emotionally prepared for diagnosis. Community-testers who immediately initiated ART were at highest risk of non-retention and are in need of enhanced psychosocial and clinical support to optimize outcomes.

We conducted a participatory workshop with pregnant or parenting young women to co-create innovative PrEP delivery strategies informed by their lived experiences. Nine pregnant or parenting young women (n = 6 aged 18-24; n = 3 aged 25-28) were recruited from the FastPrEP study, an implementation project in South Africa. Participants ranked barriers to PrEP access and use, with early clinic closures listed as the biggest challenge, followed by community PrEP-related stigma, pill burden, side effects, partner resistance, and missed appointments. Their proposed solutions included after-hours clinic opening times and alternative delivery models such as mobile clinics, home courier delivery, locker pick-up, and pharmacy access; community education led by providers and peers; long-acting PrEP (particularly injectables); side-effect remedies and lower-toxicity options like vaginal rings; co-packaging of PrEP and condoms with educational materials; and appointments reminders. Participants also designed their "dream PrEP delivery package." Participants wanted discreet packaging, convenient delivery platforms, and bundled access to sexual and reproductive health products, including PrEP, condoms, self-test kits, and menstrual hygiene items. Engaging pregnant or parenting young women as co-designers of PrEP delivery strategies is feasible and generates practical, user-driven solutions. Their insights underscore the importance of stigma-free, community-based, convenient, differentiated, and person-centred PrEP delivery.