AIDS patient care and STDs最新文献

Bacterial sexually transmitted diseases (STDs) remain prominent in the United States among gay, bisexual, and other men who have sex with men (GBMSM). Doxycycline for post-exposure prophylaxis (DoxyPEP) is a regimen by which the antibiotic doxycycline is taken after sex to prevent bacterial STDs, such as, chlamydia, gonorrhea, and syphilis. Despite this, this study was conducted because there are a limited number of publications that describe GBMSM's knowledge of, and interest in, taking DoxyPEP and preferences regarding its implementation. We conducted a mixed-methods study between November 2023 and March 2024. Participants (N = 21) completed a semi-structured interview and survey and were eligible if they were a cisgender man who reported having anal sex with another man in the past year and lived in the greater Los Angeles area. Interviews were recorded and transcribed and were analyzed using thematic content analysis. The majority of participants identified as gay (90%) and a racial/ethnic minority (86%); 33% were living with HIV and 43% had been diagnosed with an STD in the prior year. Participants' mean age was 40 years (standard deviation [SD] = 15) and they reported an average of 4.5 (SD = 2.27) sexual partners in the past year. Interviews revealed that knowledge of DoxyPEP was low (28%), but most (81%) were interested in using DoxyPEP after learning about its potential. The vast majority were willing to pay $10-$20 for a 1-month supply but preferred that it be free or covered by insurance. Most preferred to get DoxyPEP from a medical provider or over-the-counter at a pharmacy. Others suggested sexualized venues, such as private sex parties, bathhouses, sex clubs, etc. The greatest concerns about its use included possible side effects, antibiotic resistance, or that it would lead to decreased condom use and increased number of sex partners. A common misconception was that DoxyPEP could prevent both a bacterial STD and HIV. DoxyPEP has strong potential as a widely accepted STD prevention method, but its successful adoption will require proactive strategies to increase GBMSM's knowledge. Implementation programs might consider nontraditional venues where sex between men is regularly occurring.

Community health workers (CHWs) play a significant role in supporting health services delivery in communities with few trained health care providers. There has been limited research on ways to optimize the role of CHWs in HIV prevention service delivery. This study explored CHWs' experiences with offering HIV prevention services [HIV testing and HIV pre- and post-exposure prophylaxis (PrEP and PEP)] during three pilot studies in rural communities in Kenya and Uganda, which aimed to increase biomedical HIV prevention coverage via a structured patient-centered HIV prevention delivery model. In-depth semi-structured interviews were conducted from November 2021 to March 2022 with CHWs (N = 8) and their clients (N = 18) in the Sustainable East Africa Research in Community Health (SEARCH) SAPPHIRE study. A seven-person multi-regional team coded and analyzed data using a thematic analysis approach. CHWs offered clients PrEP and PEP refills, adherence monitoring, counseling on medications, and phone consultations. Clients reported CHWs maintained close interpersonal relationships with clients, and demonstrated trustworthiness and professionalism. Some clients reported that community members trusted the authenticity of CHWs, while others expressed concerns about the CHWs' ability to maintain confidentiality, and felt that some community members would be uncomfortable receiving HIV services from them. CHWs valued the expansion of their role to include prevention services but expressed concerns about balancing competing demands of CHW responsibilities, income-generating activities, and family roles. CHWs were well accepted as HIV prevention service providers despite contextual challenges. CHWs need ongoing training support. Establishing structures for remunerating CHWs in health systems could improve their performance and retention.

Low engagement with HIV services persists among young men with harmful alcohol use in South Africa. We previously piloted a rural community-based HIV service delivery model to engage this key population. In the initial study, male nurses visited alcohol-serving venues to provide HIV testing and pre-exposure prophylaxis (PrEP) services. From November 1 to December 30, 2021, we conducted interviews with 17 of 34 male pilot participants to evaluate program barriers, facilitators, and suggestions. All interviewees were satisfied with HIV testing and PrEP services. Participants overcame testing avoidance through peer influence and enhanced privacy. Barriers for PrEP initiation were stigma (PrEP mistaken for HIV treatment) and complacency toward HIV, while facilitators included desire to mitigate alcohol-associated risks, social support, and comfort with male community nurses. Most participants self-reported good adherence due to daily routines, nurse follow-ups, and social support, with lapses due to travel and alcohol use. Post-pilot, only three participants transferred to clinics to continue PrEP due to inconvenient access, unwelcoming environment, and stigma of clinic attendance. All participants wanted to restart community-based PrEP due to convenience, preference for male nurses, and avoidance of stigma. A few participants reported privacy concerns regarding peer-pressure to disclose test results and pills or home visits being mistaken for HIV treatment. Future suggestions included school/church visits, unmarked vehicles, nurse assistance with facilitated PrEP disclosure, patient ambassadors, and injectable PrEP. Community-based PrEP services using male nurses at alcohol-serving venues can reach men who otherwise would not engage in HIV services.

Although literature regarding HIV prevention among transgender and nonbinary (TNB) people has grown considerably, important gaps remain, particularly in relation to the HIV pre-exposure prophylaxis (PrEP) care cascade. Additional research is needed to understand when and why TNB people exit the PrEP care cascade to inform interventions to better support these populations. Moreover, most studies have focused on transgender women, though transgender men and nonbinary people also experience a disproportionate prevalence of HIV relative to cisgender populations. This study addresses these gaps by exploring engagement in the PrEP care cascade among a statewide convenience sample of 659 transgender women, transgender men, and nonbinary people, and analyzing how gender identity impacts participant likelihood to continue along the cascade. Data come from the 2018 Michigan Trans Health Study and include self-report data on demographics, sexual behavior, and PrEP awareness, information receipt, referral, initiation, and retention. Participants who self-reported vaginal/front hole or anal sex and did not use barriers (n = 318) were considered eligible for PrEP. Only 21.13% of those eligible for PrEP received information about PrEP, 8.18% were referred to PrEP, and 1.57% initiated PrEP use. A significantly greater proportion of transfeminine and participants who identified with multiple/other genders reported receiving PrEP information than those who identified as transmasculine or nonbinary [χ² (3, n = 311) =11.34, p = .01]. No other significant gender differences were observed. Providers serving TNB individuals must recognize the diversity of individuals who qualify for information on PrEP, provide trans-affirming care when offering PrEP prescriptions, and consider situating PrEP opportunities in TNB serving spaces to reduce access barriers.

Personal and structural barriers to HIV pre-exposure prophylaxis (PrEP) care result in its underutilization and premature discontinuation. A home-based PrEP program comprised of telemedicine visits and/or self-administered lab testing may address some of these barriers. Our objective was to assess the acceptability and feasibility of a home-based PrEP program among stakeholders at an urban HIV and primary care clinic. We used the consolidated framework for implementation research to evaluate determinants of successful implementation of the program. We surveyed and interviewed PrEP patients and their health care team. In a baseline survey of PrEP users (n = 112) administered between May 2021 and August 2022, 65% expressed interest in switching to the home-based PrEP program. Seventeen patients over the course of follow-up through December 2023 started home-based PrEP, including 12 patients who completed both a telemedicine visit and a self-administered lab kit, and 5 patients who completed only a telemedicine visit. Of these, over 80% had positive feedback on the telemedicine visits. Survey results demonstrated excellent acceptability and feasibility of the lab kits. Patients indicated in interviews that the home-based PrEP program provided the strong advantage of convenience. Despite mixed feelings from PrEP providers on telemedicine visits (n = 5), most felt that the program made PrEP care delivery easier for patients and would encourage their patients to use the program if it were a good fit. Barriers to program success included shipping delays and staff turnover during program implementation. In conclusion, uptake of the home-based program was low but program participants expressed high acceptability.

This study evaluates the impact of an expanded HIV testing initiative, launched in June 2018 in Luzhou, Sichuan, China, on antiretroviral therapy (ART) initiation rates among people living with HIV (PLWH). Using an uncontrolled interrupted time-series design, we analyzed data from 11,040 PLWH between June 2016 and December 2022, extracted from 108 health facilities via the Center for Disease Control and Prevention's ART database. The primary outcome measures were ART initiation rates within 7 and 30 days of HIV diagnosis. Results showed a significant improvement in the 30-day ART initiation rate following expanded testing, increasing from 46.1% to 90.9% by the study's end. The 7-day initiation rate also improved but remained below 30%. The study found that expanded testing enhanced the role of primary health care institutions in ART initiation. However, the COVID-19 pandemic, beginning January 2020, negatively impacted ART initiation rates, with a slight effect on 30-day rates but a persistent negative impact on 7-day rates. Despite these challenges and an increased HIV burden, Luzhou's ART initiation rates surpassed the national average. This study emphasizes the effectiveness of expanded HIV testing in ensuring timely ART access, crucial for HIV epidemic control, and improved patient outcomes. It also reveals challenges in maintaining HIV services during public health crises, offering insights into health care system resilience. Future research should focus on evaluating long-term treatment outcomes and strategies to support ending the AIDS epidemic.