Janac-Journal of the Association of Nurses in Aids Care最新文献

Abstract: Older women living with HIV are uniquely situated at multiple marginalized intersections because of their gender, age, and HIV status. However, research into how gender-based stigma (GBS) affects HIV prevention and care for older women is sparse. We conducted a scoping review to explore the relationship between GBS and HIV-related psychosocial, behavioral, and well-being outcomes among older women. Our systematic search yielded 25 articles describing 22 unique studies. We identified five main themes highlighting how GBS exists at individual, interpersonal, and societal levels to adversely affect HIV prevention and treatment among older women: (a) relationship power, safe sex practices, and intimate partner violence; (b) stigma, discrimination, and harmful stereotypes; (c) quality of care; (d) caregiving roles and responsibilities; and (e) psychological and physiological manifestations. Outstanding questions remain on best methods for measuring and conceptualizing GBS in HIV research and ways to translate research findings to public health practice.

Abstract: HIV-related stigma remains a significant challenge for older people living with HIV (PLWH), particularly during routine health care visits. Our qualitative study explores the perceptions and experiences of stigma among 12 older PLWH in Wuxi, China, through semi-structured interviews. Using Braun and Clarke's thematic analysis, 4 primary themes emerged: (a) self-psychological emotional experiences, including both negative and positive encounters; (b) personal stigma-related medical behaviors, such as voluntary disclosure and seeking care for non-HIV-related conditions; (c) medical expectations regarding HIV treatment and health care providers; and (d) insufficient medical support, including digital divide and economic constraints. Participants faced diverse challenges, highlighting the need for comprehensive strategies to address stigma in health care visits for older PLWH.

Abstract: Retaining people with HIV (PWH) in medical care is crucial to ending HIV as an epidemic. Many PWH in Baltimore also experience high rates of substance use, mental health disorders, and homelessness, making it difficult to locate and engage them in care. In our hospital-to-community transitional care program for PWH, 50% of clients were lost to follow-up. To increase the percentage of engaged patients, we developed a locator tool and protocol detailing patient's social and personal information, to be used when clients could not otherwise be located. We obtained completed locator tools on 85% of our 20-client sample, and 76% of these were active at 60 days. Of these, 53% were active at 90 days. The locator tool and protocol were acceptable and feasible in locating and retaining hard-to-reach clients. Widespread, consistent use of the locator tool and protocol may be an effective intervention toward ending the HIV epidemic.

Abstract: Before the COVID-19 pandemic, Kenya had seen a significant decline in new HIV infections among most age groups except for young people aged 15-24 years. Young women residing in urban areas are significantly affected by gender-based violence. Guided by the theory of gender and power and postcolonial theory, our descriptive qualitative study sought to understand young women's experiences with HIV risk and the impact of sexual violence before the COVID-19 pandemic. We conducted individual and focus group interviews with 73 young women residing in Kibra, Kenya. Using thematic analysis, interviews were recorded, transcribed, and coded. We identified six themes: financial insecurity, drug use, peer pressure, fear of condom use, physical environment, and disco matanga traditions. Findings revealed structural factors such as poverty and gender norms affect young women. Strategies for HIV risk prevention focused on young women in Kenya should include efforts for protecting young women from sexual violence.

Abstract: Parents living with HIV (PLWH) are often affected by co-occurring trauma, substance use, and mental health concerns. These complex challenges may contribute to intergenerational transmission of health risk, yet few studies have examined how these challenges affect family well-being in HIV-affected families. HIV care providers' insights can inform prevention efforts. Our study used qualitative focus group methods in two Southeast U.S. cities to explore providers' perceptions of PLWH's challenges navigating parenting and HIV-related concerns and strengths supporting positive adaptation. Six themes emerged: PLWH's challenges; strengths; COVID-19 impacts; impact of trauma, mental health, and substance use; supports needed; and engagement strategies. Providers highlighted trade-offs between parents' self-care and parenting and that parents often draw strength from their children. Challenges identified were both common to parenting and unique to living with HIV. Results underscore the need for multilevel prevention, including addressing basic needs; integration of mental health and medical services; and increased family services.

Abstract: In Chile, little research exists depicting how a person-centered care (PCC) model is translated into clinical practice. A multiple-source qualitative case study design was used to analyze which elements of PCC are implemented in care for people living with HIV (PLWH). Data collection included documentary analysis of national governance documents and semi-structured interviews conducted within two public hospitals in Chile with health care providers (HCPs) and PLWH. Data analysis identified five key elements PCC used in HIV clinical practice in Chile. Participants and governance documents highlighted "access to care" as a key element in PCC care. "Patient safety" was highly represented in governance documents. For HCPs and PLWH, "essential characteristics of HCPs" and "trusting relationship" were the main elements in HIV care. Simultaneously, "access to care," "essential characteristics of HCP," "adequate communication," and "patient safety" have a considerable margin of improvement. Challenges associated with fitting HIV as a chronic condition persist.

Abstract: Malnutrition is a critical issue for people living with HIV (PLWH), affecting their immune function, health outcomes, and response to antiretroviral therapy. This meta-analysis assessed the prevalence of malnutrition among PLWH and explored key moderating factors across countries. A systematic search of six databases-Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest, PubMed, Scopus, and Web of Science, included 103 studies involving 240,879 PLWH. The pooled prevalence of malnutrition was 16.6% (95% confidence interval = 14.1-19.5). Subgroup analysis revealed higher prevalence in Southeast Asia (31.1%), PLWH with primary education (37.7%), those on antiretroviral therapy for over a year (51.7%), and World Health Organization Stage 3 (36.4%). Meta-regression identified alcohol consumption, smoking, hepatitis, and tuberculosis as significant moderators. The prevalence of malnutrition among PLWH is substantial, with several moderating factors identified. Addressing malnutrition among PLWH requires routine nutritional assessments and targeted interventions to improve health outcomes and quality of life for PLWH globally.

Abstract: Pre-exposure prophylaxis (PrEP) is the administration of antiretroviral medications before HIV exposure to prevent HIV infection. PrEP or biomedical prevention is an essential part of the ending the HIV epidemic strategy. Currently, there are 4 guideline-approved dosing approaches to PrEP, which include 2 oral formulations and 1 long-acting injectable. Unfortunately, most individuals who would benefit from PrEP do not receive a prescription, and even fewer initiate and continue PrEP. Barriers to PrEP uptake and persistence are complex and extend along a socio-ecologic framework from individual through structural. In this article, we highlight the barriers to PrEP care among priority populations, discuss evidence-based solutions, and offer multilevel considerations for clinicians, researchers, and community members to increase access, uptake, and persistence in PrEP care for all.

Abstract: Leveraging patient preferences can improve patient satisfaction and engagement in intentional health services. We explored desired health services preferences of marginalized populations accessing HIV-related care engagement to inform the implementation of an HIV prevention and treatment mobile clinic model. We conducted a maximum-difference survey with 154 people at community events and homeless encampments in Oakland, CA. Participants ranked 32 items in differentials of importance on a tablet, which were analyzed with Hierarchical Bayesian modeling. Fourteen services were prioritized, including housing, mental health counseling and screening, drug overdose prevention, personal hygiene, and food assistance. Participants indicated preferences for services that address basic physiological and safety needs (i.e., housing services, food, personal hygiene supplies, drug overdose treatment, and mental health support and engagement), physical examinations, screenings, and medication refills. Incorporating community-informed preferences into the development of services may improve engagement in care alongside a syndemic approach toward ending the HIV epidemic.