AIDS patient care and STDs最新文献

Black cisgender women in the Southern United States experience disproportionate human immunodeficiency virus (HIV) rates. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool but is underutilized in this population. We assessed PrEP cascade outcomes and correlates among Black women in the Southern United States. Between March and June 2022, we administered a cross-sectional online survey to Black cisgender women residing in the Southern United States who reported unprotected sex in the past 6 months and were negative for HIV by self-report. Participants provided information on sociodemographic characteristics, HIV knowledge, PrEP awareness and use, psychosocial factors, and health care access. We used descriptive statistics and multivariate logistic regression models to describe the sample and assess the correlates of PrEP outcomes, respectively. Participants included 491 Black women, with a mean age of 40.1 years (SD: 17.5); 53% had a college degree or lower, and 79% were single. PrEP awareness was 39.5%, willingness 25.7%, and current use only 5.5%. The factors associated with PrEP awareness included younger age (aOR = 1.02, 95% CI: 1.01-1.03), higher education (aOR = 1.68, 95% CI: 1.09-2.60), medical trust (aOR = 1.09, 95% CI: 1.03-1.15), binge drinking (aOR = 1.77, 95% CI: 1.06-2.94), and HIV testing in the past year (aOR = 1.55, 95% CI: 0.98-2.45). The PrEP willingness predictors included HIV testing in the past year (aOR = 1.80, 95% CI: 1.11-2.90) and HIV worry (aOR = 1.84, 95% CI: 1.09-3.09). HIV testing emerged as a key facilitator for both PrEP awareness and willingness, suggesting that testing encounters represent critical opportunities for PrEP integration. PrEP strategies should address both individual-level factors and structural barriers, particularly medical trust within health care systems.

In the United States, youth are disproportionately affected by HIV and have poorer health outcomes than adults. Health care transition (HCT) from pediatric/adolescent- to adult-oriented HIV care is associated with disruptions to youths' care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HIV-related HCT outcomes. Accordingly, our team designed and implemented the iTransition intervention to support youth and providers in navigating HIV-related HCT. We conducted a pilot trial of iTransition in two cities in the United States with four participant groups: (1) historical control group (n = 21), (2) youth intervention group (n = 33), (3) provider intervention group (n = 17), and (4) Transition Champions (i.e., staff members from each participating pediatric/adolescent and adult clinic designated to support iTransition implementation; n = 7). Analyses examined acceptability, feasibility, and preliminary efficacy. Youth, providers, and Transition Champions, who completed the assessments, generally assessed the feasibility and acceptability of the iTransition app and provider console favorably. Linkage to adult HIV care (defined as one adult HIV care appointment) was significantly higher in the youth intervention group, where 81.8% were linked compared with 47.6% in the historical control group (χ²= 6.96, p = 0.008). Rates of care linkage were not significantly different between app users and non-users (χ² = 1.09, p = 0.30). Notably, overall use of the app and the provider console was low. This study suggests that iTransition could serve as an important tool to support HCT for youth living with HIV in the United States; however, further work is needed to optimize implementation and improve uptake.

Leveraging community resources to address disparities in HIV and pre-exposure prophylaxis (PrEP) use across Black and Latino/a communities is of high importance, yet little is known about how community members utilize these resources. We explored the use of community resources and PrEP among Black and Latina women at high risk for HIV by conducting semistructured interviews with 18 Black and Latina women from May 2018 to November 2019 in Austin, Texas. Interviews were transcribed verbatim and analyzed using thematic content analysis. We found that the majority of participants used community resources, including shelters, domestic violence resources, counseling, and education/workplace resources. Several barriers to the use of community resources were intimate partner violence, financial and employment issues, and stigma. Most women were interested in PrEP use, and those who used community resources were more open to PrEP use than those who did not use community resources. Future work should focus on promoting PrEP through community resources.

People with criminal justice involvement (PCJI) face a heightened risk of HIV yet remain underserved by prevention strategies such as pre-exposure prophylaxis (PrEP). This systematic review synthesizes current evidence on PrEP utilization among PCJI, identifying key barriers and facilitators that influence uptake and adherence. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a comprehensive literature search and thematic analysis. Twenty-five studies met inclusion criteria, with most conducted in the Northeast and Southern United States, and few from the Midwest or West. Barriers to PrEP utilization included competing post-release priorities, unstable housing and transportation, stigma, medical mistrust, lack of social support, and fear of re-incarceration. Conversely, facilitators of PrEP engagement included streamlined prescription procedures, patient navigation services, and coordinated linkage to care during reentry. The findings underscore the need for targeted, multi-level interventions that not only address individual knowledge and behavior but also tackle broader structural determinants of health. These include improving housing stability, integrating PrEP into correctional and post-release care systems, and fostering collaborative partnerships between criminal justice agencies, health care providers, and community-based organizations. To our knowledge, this is the first systematic review to comprehensively examine PrEP utilization among PCJI. As the United States continues efforts to end the HIV epidemic, addressing the unique needs of justice-involved populations is essential. This review provides a critical foundation for public health professionals and policymakers to design more equitable, effective HIV prevention strategies tailored to this marginalized group.

Given the global burden of sexually transmitted infections (STIs) and the introduction of doxycycline post-exposure prophylaxis (doxy-PEP) as an effective biomedical prevention strategy, there is a need to re-evaluate and culturally tailor STI screening policies for better integration into prevention services. We assessed preferences for STI prevention services among gay, bisexual, and other men who have sex with men (GBMSM) in Taiwan in the context of doxy-PEP. An anonymous, self-administered, web-based survey was conducted between April and May 2025 via a geosocial app popular among Taiwanese GBMSM. A discrete choice experiment with a D-efficient design evaluated preferences across screening frequency, service integration, STI screening types, location, and out-of-pocket costs. Mixed logit models and latent class analysis (LCA) were used for analysis. Among 606 cisgender GBMSM (median age: 34; interquartile range: 30-40), half reported awareness of doxy-PEP, 18% had used it, and 42% were willing to use it in the next 6 months. Participants preferred fixed-interval screening, integrated prevention services (including doxy-PEP, STI screening, HIV pre-exposure prophylaxis or antiretroviral therapy, and vaccination), and lower costs. LCA identified two groups: "Cost-Conscious Pragmatists" (41%) prioritizing affordability and a simpler STI screening package (i.e., syphilis and gonorrhea), and "Comprehensive Care Self-Investors" (59%) willing to pay more for comprehensive, frequent STI screening. While GBMSM in Taiwan may favor routine, integrated services, cost strongly shapes uptake. A modular screening design with core essential services and optional add-ons could maximize accessibility and equitable access across beneficiaries with diverse financial capabilities.

The anatomical site of gluteal administration may influence the pharmacokinetics and tolerability of long-acting cabotegravir (CAB) plus rilpivirine (RPV), but direct comparisons between dorsogluteal (DG) and ventrogluteal (VG) injections are limited. In this prospective intra-individual crossover study, 152 adults with HIV receiving injectable CAB and RPV were switched from DG to VG administration. A total of 842 trough and 131 one-month postinjection plasma samples were analyzed. VG delivery was associated with higher one-month post-dose concentrations for both drugs (median CAB 1280 vs. 834 ng/mL, p < 0.001; RPV 148 vs. 126 ng/mL, p = 0.043). At trough, CAB concentrations were lower with VG injections (573 vs 664 ng/mL, p < 0.001), whereas RPV levels did not differ significantly (131 vs 123 ng/mL, p = 0.461). Although uncommon, a higher proportion (6.9% vs. 1.5%, p = 0.001) of CAB trough samples fell below the protein-adjusted inhibitory concentration 90 threshold in the VG group. VG administration resulted in lower variability in pooled CAB and RPV trough concentrations, both intra-patient (standard deviation ratio 0.92; p = 0.041) and inter-patient (0.80; p = 0.001), compared with DG injections. Detectable HIV-1 RNA (≥50 copies/mL) was rare and comparable between injection sites, with no confirmed virologic failures. Participants reported better tolerability with VG injections, which were associated with fewer local symptoms and were preferred by 67% of respondents. Ventrogluteal administration is associated with more consistent pharmacokinetics and improved tolerability, supporting its use as the preferred site for long-acting CAB/RPV. Although CAB trough levels were modestly lower and occasionally fell below predefined thresholds with VG injection, this did not impact virologic outcomes, reinforcing its clinical suitability in most settings.

The presence of chlamydia, gonorrhea, or syphilis infection is a significant risk factor for HIV acquisition and transmission and disproportionately impacts men who have sex with men (MSM) and transgender women. While HIV preexposure prophylaxis (PrEP) reduces HIV risk, its use may influence sexual behaviors, potentially increasing sexually transmitted infection (STI) exposure. Conversely, PrEP users are often more engaged in care, regularly screened and treated for STIs, and may access other prevention tools such as doxycycline postexposure prophylaxis. Studies on the relationship between PrEP use and STIs have shown mixed results. This cross-sectional analysis included 392 participants (381 cisgender MSM; 11 transgender women) enrolled in the US-based Multicenter AIDS Cohort Study/WIHS Combined Cohort Study between 2021 and 2024 who were sexually active in the year prior to STI testing and HIV negative at their most recent study visit. We assessed whether bacterial STI positivity (i.e., laboratory-confirmed chlamydia and gonorrhea at the urethral, pharyngeal, and/or rectal sites and/or current/past syphilis infection) differed by current PrEP use (yes/no). Multi-variable logistic regression models included sociodemographic and behavioral covariates that were associated with bacterial STI positivity at p < 0.05, with the most parsimonious models selected based on the lowest Akaike Information Criterion. Overall, 32.7% reported current PrEP use. Syphilis was the most prevalent STI (6.8%), followed by chlamydia (3.2%) and gonorrhea (2.1%); 11.7% of PrEP users tested positive for at least one STI, compared with 6.1% of non-PrEP users. Among PrEP users, 37.9% reported stopping or decreasing condom use, and 31.6% reported an increased number of sex partners after initiating PrEP. In both bivariate and multi-variable models, PrEP use was associated with higher odds of gonorrhea positivity (adjusted odds ratio = 4.70, 95% confidence interval [CI]: 1.10-20.04, p = 0.037) and greater odds of being positive for at least one STI (crude odds ratio = 1.94, 95% CI: 1.06-3.90, p = 0.041). No significant differences were observed for chlamydia and syphilis by PrEP use status. Overall, these findings suggest that current PrEP users (vs. non-PrEP users) have an increased odds of bacterial STI positivity, particularly gonorrhea, in a diverse, multi-city cohort of HIV negative, sexually active MSM and transgender women in the United States PrEP remains highly effective in preventing HIV, and our results underscore the importance of integrated sexual health services that support ongoing STI screening and prevention alongside PrEP use among sexual and gender minorities.

Evidence from real-world studies suggests that 3-monthly screening for asymptomatic chlamydia/gonorrhea is not reducing incidence and is driving increased antibiotic use and antimicrobial resistance (AMR). While some countries are recommending less screening, changes to guidelines require clinician buy-in. This study explored the views of Australian sexual health clinicians on changing practices around asymptomatic screening for chlamydia/gonorrhea in gay, bisexual, and other men-who-have-sex-with-men and attitudes to not automatically treating positive diagnoses. Between September and December 2024, we conducted thematic analysis of semi-structured interviews with 12 physicians (including 8 general practitioners) and 4 nurse practitioners working in sexual health centers, hospitals, Aboriginal health services, general practice, and nongovernmental organizations. Clinicians had variable knowledge about the limited effectiveness of asymptomatic screening. Many were open to reduced screening if provided supporting evidence. Given challenges in reducing medical interventions, they recommended public education to drive changes. While some clinicians supported patient dialogue in treatment decision-making, most felt uncomfortable not treating. Key concerns included ideas about their role as doctors, onward transmission (particularly to women), and complications/uncomfortable symptoms/patient psychological well-being. AMR considerations were less salient. While the "test and treat" paradigm is engrained, clinicians were open to reduced screening if provided with clear evidence but were generally reluctant to not treat. A flexible approach that supports patient empowerment in decision-making about screening frequency and choices around treatment could present a way forward. Changing practice requires education to shift patient/clinician mindsets around what it means to have a positive chlamydia/gonorrhea diagnosis.