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

Abstract: Timely and accurate return of viral load (VL) results to adolescents living with HIV (ALHIV) is essential for early detection of adherence challenges and treatment failure. Our cross-sectional study evaluated VL data of ALHIV, ages 15-19 years, enrolled in six care facilities in Kiambu and Nakuru Counties in Kenya. We summarized the proportion of results available in both the electronic medical record (EMR) and the national database. Modified Poisson regression models assessed the relationship between ALHIV characteristics and knowledge of VL results. Of 20% (n = 207) of the charts that were randomly selected, 86% (n = 179) matched the national database source; however, 7% (n = 14) of VL results were missing from the clinic-EMR, and 8% (n = 17) were incongruent between the national database and EMR. Only half (52%) of the surveyed ALHIV (n = 132) reported receiving their last VL result, with older ALHIV more likely to receive VL results than younger (Prevalence ratio: 1.46, p = .02). Missing or incorrect data records suggest gaps need to be addressed in addition to increasing the proportion of ALHIV who receive accurate VL results to optimize care and management.

Abstract: The COVID-19 pandemic disrupted health care systems and resulted in some delays of care, challenging health care engagement among people living with HIV (PLWH). Using in-depth interviews, we explored the experiences of PLWH during the pandemic and identified barriers to and facilitators of care engagement. We recruited 40 participants from a managed-care Medicaid plan in New York City and conducted phone interviews during fall 2023. Thematic analysis identified 5 themes related to care engagement during the pandemic: (a) health care system strains led to some delays in care; (b) patient-provider connections suffered; (c) the pandemic led to personal crises and challenges to care engagement; (d) strong communication and connection reduced disruption and stress; and (e) the pandemic had a lasting effect on interpersonal connections. These findings highlight ways to help maintain care engagement among PLWH even during social and public health crises and contribute to ending the epidemic.

Abstract: Although exercise supports the physical function and health of older people living with HIV (PLWH), less than half of PLWH globally achieve recommended levels of activity. A qualitative descriptive design was used to determine what motivates sedentary PLWH, 50 years and older, to participate in an exercise trial. Interviews were conducted with PLWH who participated in an exercise trial ( n = 30) and PLWH who declined enrollment in the same exercise trial ( n = 4). The theory of planned behavior (TPB) guided a directed content analysis of the interviews. Data analysis identified four themes: (a) intention or motivation (perceived benefits, maintaining the exercise behavior over time), (b) attitudes (goals and preferences), (c) perceived behavioral control (barriers, facilitators, and self-efficacy), and (d) subjective norms (pressure from health care providers and social networks). Findings from our study contribute to informing the development of future exercise interventions or trials and to planning care to encourage a physically active lifestyle.

Abstract: Chronic diseases such as osteoporosis and low bone mineral density (BMD) are significant public health concerns for people living with HIV (PLWH), especially with the increased life expectancy because of antiretroviral therapy (ART). This study evaluated the prevalence and associated factors of low BMD among 94 PLWH in Kerman, Iran, from September 2021 to February 2022. Using dual-energy X-ray absorptiometry, BMD was measured, with low BMD defined by specific T-scores and Z-scores. Predictors were assessed through interviews, medical records, and blood tests. Bivariable and multivariable logistic regression models identified associations between low BMD and various factors. The study found a 51.1% prevalence of low BMD, with significant associations with hypogonadism (adjusted odds ratio [aOR]: 3.19), longer ART duration (aOR per month: 1.02), and lower body mass index (aOR per unit: 0.83). The findings highlight the need for regular screening and timely intervention for low BMD among PLWH, particularly with prolonged ART use.

Abstract: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in people with HIV (PWH) and increases the risk of hepatic fibrosis and hepatocellular carcinoma. We sent an online survey to providers of the American Academy of HIV Medicine. Of respondents ( n = 214, 8% response rate), 65% reported screening for NAFLD in PWH, with 28% routinely screening all patients. Most respondents refer patients to hepatology if workup suggests another coexisting liver disease or cirrhosis, with the primary goals of referral being additional diagnostic testing (60%) or specific treatments (75%). The most common barriers to screening were feeling unsure of what tests to order (28%) and how to conclusively diagnose NAFLD (29%). Most respondents were interested in society guidelines (73%) and NAFLD education for patients (57%) and providers (55%). Our findings support the development of NAFLD clinical practice guidelines for HIV providers and the inclusion of PWH in clinical trials of novel agents.

Abstract: Well-established, regular exercise interventions for older people living with HIV (OPLWH) are beneficial. However, the fundamental principles of exercise prescription for this population have not been sufficiently explored. An expert panel of health care professionals engaged in a modified Delphi technique to explore their perceptions of, and gain their consensus on, an exercise prescription framework for OPLWH in a resource-poor South African setting. A high level of agreement among participants was determined using a priori threshold of 80% agreement and an interquartile range of ≤ 1. Expert consensus was reached on a structured, multifaceted exercise prescription and also fundamental principles, such as multidisciplinary engagement and team collaboration, pre-exercise health screening, and exercise supervision. These were viewed as necessary components of a framework to improve the integration of exercise rehabilitation in the treatment, care, and support for OPLWH.

Abstract: Effective antiretroviral treatment means that people with HIV are living for longer. This includes Black African women, who represent a large proportion of people aging with HIV in the United Kingdom. Despite this, the impact of living and aging with HIV on the well-being of Black African women aging with HIV has not been investigated. Interpretative phenomenological analysis of interviews with eight Black African women ages 50 years and older living with HIV developed six superordinate themes. Findings demonstrated how experiences of HIV-related stigma negatively affected social, occupational, and psychological well-being. Perspectives on living and aging with HIV into the future included experiences of acceptance, uncertainty, anxiety, and hope. Recommendations are made, including developing clinical practice to consider needs relating to social and psychological well-being, as well as physical well-being, for women aging with HIV.

Abstract: The aims of this study were to determine if HIV symptoms among sexual minority men formed clusters and to examine the sociodemographic and clinical characteristics that are associated with these clusters. We analyzed cross-sectional data from Ghanaian sexual minority men ( N = 225) living with HIV. We used both principal component analysis and multivariable linear regression. Our findings indicate that sadness (64.0%) and headache (62.7%) were the most prevalent symptoms among our sample. Seven symptom clusters were identified: neurological symptoms, psychological symptoms, gastrointestinal symptoms, dermatological symptoms, self-concept/self-esteem, weight/diet-related symptoms, and sleep quality and potential disturbances. Late HIV diagnosis was significantly associated with higher distress scores for all symptom clusters except for the self-concept/self-esteem and gastrointestinal symptoms clusters. The findings emphasize the importance of early HIV symptom identification.