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

Abstract: In Australia, nurse practitioners (NPs) provide care to people with HIV (PWH) in hospital and community settings. We describe a national audit evaluating NP care for PWH, assessing adherence to 2 HIV monitoring guidelines. Five NPs conducted a retrospective case note self-audit. Deidentified data were collected, pooled, and analyzed using Microsoft Excel and compared with HIV monitoring guideline targets. The review was undertaken for 212 NP patients, the majority being cisgendered men (86%), ages 45-49 years, identifying as gay (65%). The majority (95%) of PWH were on an appropriate HIV treatment, meeting the United Nations Programme on HIV/AIDS target of 95%. HIV viral load testing was current for 211 (99%) individuals. Of 138 individuals eligible for cardiovascular screening, 84 (60%) were screened, below a guideline target of 90%. Compliance with HIV monitoring guidelines exceeded targets in most areas. Our audit demonstrates that NPs provide effective and guideline compliant HIV care to PWH in Australia.

Abstract: HIV screening is not routinely offered to acutely ill, hospitalized patients. For some patients a hospitalization represents a crucial opportunity to identify undiagnosed HIV infection and interrupt HIV transmission chains. Among people who inject drugs, a hospitalization for infective endocarditis may be one of the only touchpoints they have with a health care provider. Nurse-led HIV screening initiatives in the acute care and emergency medicine settings are being trialed across the United States. Nurses and nurse practitioners are uniquely poised to establish universal, comprehensive HIV testing protocols for people who inject drugs hospitalized for the management of infective endocarditis.

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: Adolescent girls and young women ages 15-29 years (AGYW) living in Lesotho experience a disproportionate HIV burden. Using a household-based national survey in Lesotho, we conducted a three-step latent class analysis to identify typologies of AGYW most vulnerable to HIV infection. We first classified AGYW into HIV vulnerability groups based on self-reported sexual behaviors, then identified associations between typology and HIV diagnosis. HIV vulnerability behaviors included early sexual debut, condomless sex, multiple sexual partners in the past year, sex with partners they do not know the status of or are living with HIV, age disparate sex, use of contraceptives, and having children. Across all age groups, we found that HIV vulnerability typologies could be described as low vulnerability, high vulnerability, and parous. As AGYW age, they engage in more types of higher vulnerability sexual behaviors; interventions to reduce this risk should start at a younger age. Our findings emphasize the importance of implementing and scaling up biomedical strategies such as pre-exposure prophylaxis.

Abstract: People living with HIV (PLWH) may experience premature physical deficits, including walking, mobility, and balance problems. The purpose was to measure deficits in walking, mobility, balance, and dual tasking in PLWH. The secondary objective was to make recommendations regarding the use of rehabilitation outcome measures. CINAHL, PubMed, and SPORTDiscus databases were searched. Two independent reviewers screened titles/abstracts and full-text articles, extracted data, and performed a quality assessment. Fifty-six articles with 14,053 PLWH and 8,454 uninfected controls were included. A meta-analysis revealed significantly worse performance among PLWH on the five times sit to stand mobility test versus controls (Cohen d = 0.68, 95% confidence interval [CI 0.08-1.29], p = .03). Meta-analyses revealed no differences between PLWH and controls for usual gait speed (Cohen d = -0.47, 95% CI [-1.10 to 0.15], p = .14) and fast gait speed (Cohen d = -0.39, 95% CI [-0.87 to 0.08], p = .10). Ten of 12 studies comparing PLWH with controls found differences in balance outcomes. PLWH have significantly worse mobility than uninfected controls.

Abstract: The return of a migrant partner can negatively impact the sexual health of women who stayed in their communities. Understanding their sexual health needs is crucial for developing targeted interventions and support systems. Our study used a critical ethnographic approach in Agua Dulce, a rural community in Mexico, involving 50 key informants: women who stayed behind ( n = 20), returnees ( n = 12), community leaders ( n = 12), and health care professionals ( n = 6). We used participant observation, policy analysis, and interviews, using purposeful and snowball sampling methods. A gender-based thematic analysis revealed economic hardships and early separations affect the sexual well-being of women who stay behind. Infidelity, discovered through social media or calls, causes emotional distress and family disruptions. Male migrants spend an average of 8.85 years abroad, leading to fears of risky sexual behaviors. Our study highlights the urgent need for specialized support centers and comprehensive health interventions.

Abstract: Undetectable = Untransmittable (U=U) is a key message emphasizing that antiretroviral therapy suppresses HIV and prevents its sexual transmission. However, dissemination of U=U varies among health care providers, potentially leading to knowledge gaps among patients. Little research exists on the understanding of U=U among active duty men who have sex with men (MSM) in the U.S. military. Our cross-sectional, online study examines 222 active duty MSM to determine prevalence of accurate knowledge of U=U and demographic predictors of misinformation. Participants received a pre-exposure prophylaxis (PrEP) overview and were asked to indicate if the statement "Undetectable equals Untransmittable" was true or false. Although the majority accurately understood U=U (70%; n = 156), approximately 30% did not ( n = 66); a binary logistic regression revealed lower U=U understanding among White, bisexual, unmarried, and Marines/Navy participants. Standardized education on U=U is crucial for resolving knowledge gaps and combating stigmas surrounding HIV treatment.

Abstract: Stress and HIV disproportionately affect Latinx adults in the United States, contributing to numerous health inequities. Among people living with HIV (PLWH), increased stress is associated with decreased medication adherence, effectiveness, and higher rates of immunosuppression and comorbidities. Our study ( N = 126) examined the relationship between perceived stress and HIV-related health among Latinx ( n = 83) and non-Latinx White ( n = 43) PLWH. Latinx PLWH reported better HIV-related health outcomes than non-Latinx White PLWH, despite higher viral load (all p 's < .05). An interaction effect showed that higher perceived distress was associated with worse health outcomes and lower CD4+ T cell count only in Latinx PLWH ( p 's < .05). Our findings highlight the consequences of stress on HIV-related health. Notably, higher stress may be especially detrimental among Latinx PLWH, underscoring the need for more culturally tailored interventions in HIV-related care. Future research should include additional sociocultural factors and longitudinal assessment in a larger sample.

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: Older adults account for one in every five new HIV infections in the United States yet are often overlooked in tailored pre-exposure prophylaxis (PrEP) messaging. The aim of this study was to evaluate the original PrEP messaging source and its influence on PrEP use among a cohort of older adults. The Columbus Health Aging Project data (N = 794) were used to examine the initial PrEP information source and PrEP use in the past 6 months, adjusting for demographics and sexually transmitted infection (STI) status. Forty-six percent reported an STI, and 11.5% used PrEP. The main sources of PrEP information were peers (42.2%) and health care providers (40.2%); media (17.6%) sources were less common. Compared with those who received PrEP information from their health care provider, those informed by peers (adjusted odds ratio [aOR] = 0.58; 95% confidence interval [CI]: 0.34-0.99) or media (aOR = 0.17; 95% CI: 0.07-0.42) were less likely to use PrEP. Adjusting for STI-, media-informed remained less likely to have used PrEP compared with those informed by providers (aOR = 1.14; 95% CI: 0.55-2.35). These findings highlight the importance of tailored PrEP messaging for older adults for Ending the HIV Epidemic efforts. Media appears less impactful as a messaging approach for older adults.