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

Abstract: Men who have sex with men (MSM) experience intimate partner violence (IPV) and are at an elevated risk of HIV acquisition. Preexposure prophylaxis (PrEP) is an effective preventative measure against HIV. However, its adoption and consistent use among MSM, especially those experiencing IPV, is low. This scoping review summarizes literature relevant to HIV PrEP, focusing on MSM who experience IPV. Of the 110 studies identified, eight eligible studies met the inclusion and exclusion criteria. Most of these were conducted in the United States, focusing exclusively on adult MSM. Most studies evaluated daily oral PrEP. The studies assessed the impact of IPV on respondent's knowledge, willingness, preference, and PrEP use and revealed varying levels of association between IPV and PrEP. Future research is essential to develop practice guidelines and policy to enhance PrEP uptake in this vulnerable population.

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: Adherence to preexposure prophylaxis (PrEP) is lower among high-risk populations, including youth experiencing homelessness (YEH). This study determined the feasibility of urine PrEP adherence biomarker testing and examined the barriers and facilitators to PrEP uptake and adherence among YEH. YEH were recruited from a randomized control trial conducted in a large urban setting in southern United States. Interviews ( N = 40) were conducted to identify barriers and facilitators to PrEP uptake and adherence. PrEP urine-based adherence testing feasibility was conducted among those who started on PrEP. Twenty-two participants obtained a prescription and 15 youth completed at least one adherence test. Facilitators and barriers were categorized as individual, interpersonal and community, and structural among PrEP starters and nonstarters. PrEP uptake and adherence were low for eligible YEH. Enriching the understanding of the challenges and facilitators experienced with accessing PrEP for YEH can improve engagement in HIV prevention among YEH.

Abstract: Despite a global decrease in HIV cases and efforts to reduce HIV incidence in the country, the Philippines has an increasing HIV incidence rate, which is the highest in the Asia-Pacific region. A multiplicity of factors is driving the HIV epidemic in the Philippines. Our scoping review aims to describe the current literature about factors influencing the Philippine HIV landscape. The available literature shows that individual, sociocultural, environmental, educational, environmental, and biological factors fueled the HIV epidemic in the Philippines. Specifically, low levels of HIV knowledge, low testing rates, high-risk sex behaviors, stigma, lifestyle, location, lack of HIV education in schools, conservative society, and restrictive policies are contributing factors. Our findings provide direction for designing comprehensive targeted interventions, increasing public awareness, advocating for policy formulation, and developing a dedicated HIV research program to guide HIV preventive programs and research in the country.

Abstract: Pre-exposure prophylaxis (PrEP) has been an essential tool in our progress to End the HIV Epidemic. Nurses continue to be essential to the education, provisioning and advocacy for continued use of and accessibility of PrEP. ANAC aligns with the science and supports continued biomedical innovation, swift implementation, and equitable access. ANAC also presses our policymakers to support expnded access to this life saving medication.

Abstract: Our qualitative study explores meaning making and motivation for preexposure prophylaxis (PrEP) adherence and engagement among gay, bisexual, and other sexual minoritized men (GBSMM) who misuse alcohol. Nineteen interviews with 10 participants who screened positive for harmful alcohol consumption (Alcohol Use Disorders Identification Test scores > 8) indicated that PrEP meaning making contributes to mental well-being, serving as a stabilizing ritual. Motivation for engagement included a commitment to proactive health management and personal and community safety. In the analysis, meaning making and motivation converged through themes of (a) identity affirmation, (b) accountability for self-care, (c) peace of mind, and (d) agency. Complementary themes included relationship dynamics and strategies for adherence. Participants' alcohol use was also explored, examining its intersections with the themes and understandings of PrEP and social well-being. Recommendations include integrating motivational enhancements into the care continuum to increase PrEP adherence and engagement with clinical care and community support among patients misusing alcohol.

Abstract: Young Black and Latino men who have sex with men are disproportionately affected by the U.S. HIV Epidemic, yet pre-exposure prophylaxis (PrEP) uptake remains low. To understand barriers and facilitators to PrEP uptake and persistence, we used a concurrent mixed methods design (quantitative: online surveys, n = 19; qualitative: individual interviews, n = 15) from providers (e.g., nurse practitioners, clinicians, and social workers) at 4 clinics providing PrEP services in Birmingham, Alabama and New York City. Although all providers were comfortable prescribing daily oral PrEP, they had concerns about on-demand PrEP (e.g., complex dosing schedule) and injectable PrEP (e.g., insurance barriers). Provider training is needed to address barriers to providing PrEP modalities beyond daily oral PrEP and increase uptake among young Black and Latino men who have sex with men. Additionally, in order to increase uptake of injectable PrEP, rising PrEP costs due to changes in the 340B Drug Pricing Program will need to be addressed.

Abstract: Our study was designed to update the HIV Knowledge Questionnaire by incorporating pre-exposure prophylaxis (PrEP) knowledge questions, as previous HIV knowledge tools lack this focus. Four rounds of Delphi surveys were conducted with 47 expert participants, each with extensive HIV-related expertise (mean experience: 18.94 years). Expert participants rated item relevance on a scale of 0-3 and provided feedback. An item was removed if over 70% scored it two or less. The process continued until consensus was reached, defined as 80% of items scoring above two by more than 70% of expert participants, with no new suggestions. The final measure included 31 items covering general HIV knowledge, transmission modes, treatment, risk, and PrEP definitions, types, and dosages. Future research is essential to validate this tool for research and clinical settings, ensuring it accurately measures patients' diverse knowledge levels.

Abstract: Supportive relationships between people living with HIV (PLWH) and their health care providers are crucial for treatment adherence and communication about health needs. This study explored key elements of patient-provider relationships (PPRs) among PLWH in a predominantly rural, Mountain West state with a low HIV prevalence. We analyzed in-depth interviews conducted with 17 PLWH. We identified 4 key themes related to PPR: (a) providers' limited competencies in HIV and lesbian, gay, bisexual, transgender and queer issues, (b) patients' desire for empathetic and nonjudgmental care, (c) patients' experiences of dismissal or dehumanization by providers or the health care system, and (d) experiences and fear of stigma. Our findings underscore the role that PPR plays in addressing or exacerbating barriers for PLWH in rural areas, emphasizing the need for both interpersonal (e.g., provider-focused) and structural interventions to increase providers' HIV knowledge, decrease stigma, and foster positive PPR.