AIDS patient care and STDs最新文献

Over 7000 youth ages 13-24 are diagnosed annually with HIV-1 in the United States despite the 2018 approval of oral pre-exposure prophylaxis (PrEP) for adolescents, highlighting the need for more research on provider prescribing practices in pediatric populations. Prior research chiefly focuses on patient barriers to accessing PrEP, and thus, our study explored provider barriers. From August to December of 2023, we conducted a survey of medical providers in pediatrics, family medicine (FM), and internal medicine (IM)/pediatrics. A 5-point Likert scale (0-4) assessed comfort in providing adolescent sexual health care and potential barriers to PrEP prescription, including discussions around sexual activity, gender identity, sexual orientation, sexually transmitted infections, and PrEP. In total, 158 responses were received. FM providers were more familiar with PrEP (3.4 to 1.5, 76.4% difference) and with prescribing PrEP (3.4-0.7, 131.2%) than pediatric providers. Logistic regression analysis found that FM providers were 32 times more likely to prescribe PrEP than pediatric providers. Pediatric providers were 3.4 times more likely than FM providers to identify barriers to PrEP prescription, notably "lack of time to counsel on risk reduction", "lack of capacity for follow-up", "lack of knowledge," and "lack of comfort" and non-prescribers were 2.7 times more likely than prior prescribers to identify barriers, notably "lack of knowledge" and "lack of comfort". This study highlights the crucial need for educational interventions for pediatric providers around PrEP provision, but also adolescent sexual health care more widely.

Cisgender women face significant HIV risks in the United States yet retention in prevention research is challenging. The same factors that increase HIV vulnerability also create barriers to research participation. This qualitative study explored multilevel barriers and facilitators to retaining cisgender women with increased HIV prevention needs in research using the social ecological model (SEM). Semi-structured interviews were conducted from August 2023 to February 2024 with 114 participants across three groups: HIV-negative cisgender women with increased HIV prevention needs (n = 34), cisgender women living with HIV (n = 40), and HIV prevention/treatment stakeholders (n = 40). Participants were recruited nationally through convenience sampling via social media and organizations. Directed content analysis was used to identify retention factors across individual, environmental, intervention, and structural levels. Barriers included substance use affecting contact maintenance, concerns about study time commitments, frustrations with unclear study procedures, poor staff rapport, safety concerns around intimate partner violence, historical research mistrust, and systemic vulnerabilities like housing instability. Facilitators included creating affirming environments that fostered purpose, flexible scheduling with incremental compensation, clear study expectations and health education/support, authentic staff relationships, discrete communication methods, transparent study procedures and approaches, virtual visit options, and availability of multiple contact methods. Findings corroborated a key paradox: those most vulnerable to HIV acquisition may be least likely to complete longitudinal studies due to structural barriers. Successful retention requires flexible approaches that address barriers at all SEM levels. These findings provide strategies for researchers to improve retention among cisgender women with increased HIV prevention needs, strengthening research representativeness and effectiveness.

Young Black sexual minority men living with HIV (YBSMM+) consistently report reduced engagement in the HIV care continuum. YBSMM+ are also highly burdened by depressive symptoms, which are strongly associated with suboptimal HIV care outcomes. Yet, little is known about the processes that drive depression-related disparities among YBSMM+. Informed by Minority Stress Theory, we examined three indirect effects, assessing whether the associations between experiences of racism, heterosexism, and HIV-related discrimination and depressive symptoms were mediated by three corresponding forms of internalized stigma. Participants included 216 YBSMM+ from the Southern United States who were assessed at three consecutive time points (longitudinal analyses), as well as 172 YBSMM+ who completed a fourth assessment (cross-sectional analysis). Data were collected from November 2016 to October 2022. Multiple regression analyses revealed that more frequent HIV-related discrimination at baseline significantly predicted greater internalized HIV stigma at the subsequent assessment, and that greater internalized racism at the fourth visit was significantly associated with more frequent depressive symptoms. No indirect effects achieved statistical significance, although recall bias due to long follow-up intervals may have affected the findings. These results suggest that, compared with internalized heterosexism and HIV stigma, internalized racism may be uniquely related to depressive symptoms, emphasizing the importance of exploring the impact of distinct forms of stigma on mental health. Future research may benefit from employing shorter time intervals to capture more nuance, assessing how ingrained internalized stigma has become, and considering the salience of internalized negative attitudes to core self-conceptions in similar longitudinal models.

The Rio Grande Valley (RGV) comprises counties with some of the highest prevalence of HIV in Texas. The predominantly Latino population also faces socioeconomic challenges, including high poverty rates, low health literacy, and transiency, contributing to increased risk of advanced HIV disease. AHORA was a real-world mixed-methods study evaluating viral control and immune reconstitution in a Latino population with advanced HIV disease, who were enrolled in a rapid start treatment program with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) at two clinics in the RGV. To explore reasons for late diagnosis and experiences of rapid antiretroviral therapy (ART) initiation, document analysis and 27 in-depth semi-structured interviews were conducted with 18 individuals receiving treatment and 9 clinic staff. Median time to an HIV-1 RNA level <200 copies/mL was 5.3 weeks, with 90.5% (19/21) achieving this by Week 24. There were statistically significant differences in mean HIV-1 RNA levels, CD4% and CD4 counts between baseline and Week 24. Strategies to maximize ART engagement were grounded in person-centered care and included regular appointment reminders and transportation assistance. Common barriers to accessing care included limited HIV knowledge and financial constraints. These were addressed through education and financial support, including the provision of treatment samples at no cost, independent of insurance status. The AHORA study effectively showcases the benefits of rapid B/F/TAF initiation for individuals with advanced HIV in the RGV, facilitating early viral suppression and improved health outcomes. It also emphasizes the critical role of person-centered care and tailored support services in overcoming health care access barriers.

The recent rise in HIV incidence among people who inject drugs in the United States highlights an urgent need to improve HIV testing, treatment linkage, and pre-exposure prophylaxis access in this group. Syringe services programs (SSPs) play a critical role by offering or linking clients to these services, yet little is known about how such care is delivered. Informed by the Consolidated Framework for Implementation Research, we conducted qualitative interviews with 41 representatives from 27 SSPs across the United States to characterize the current service delivery landscape, identify barriers to care, and explore modifiable implementation determinants. Rapid qualitative analysis revealed four primary HIV service delivery models: "one-stop shop" offering integrated, on-site HIV testing and follow-up care provided by the SSP; "test and refer" with integrated, on-site testing services followed by referrals to external partners for follow-up care; "co-located services" with SSPs relying on external partner organizations to provide HIV testing (and additional services) on-site; and "hand-off" involving referrals to off-site, external partners for HIV testing and follow-up care. SSPs faced varied implementation challenges, including staffing, funding, and space constraints; competing priorities; availability and accessibility of local partnerships; as well as SSP culture, which values participant autonomy (recipient-centeredness). These contextual factors influenced the feasibility and acceptability of HIV services and why SSPs adopted a particular service delivery model. To strengthen HIV prevention and care in SSPs, tailored implementation strategies are needed that account for programs' unique constraints and capacities.

Structural inequities significantly shape disparities across the HIV care continuum, yet few validated tools exist to quantify HIV-specific structural vulnerability at the population level in the United States. This study introduces and validates the HIV-Specific Social and Structural Determinants of Health Index (HIV-SSDI), a multi-dimensional, state-level index designed to capture structural disadvantage relevant to HIV prevention and care. Using publicly available state-level index (2008-2023) spanning nine structural domains, we developed the HIV-SSDI through exploratory factor analysis with three extraction methods: principal component analysis, maximum likelihood, and minimum residual. We constructed HIV-SSDI scores based on normalized factor loadings and evaluated their associations with HIV care continuum outcomes, using cross-sectional and longitudinal linear regression models. Three consistent latent factors emerged across methods: (1) socioeconomic and health care disadvantage, (2) HIV service infrastructure and urban density, and (3) structural/legal context. Higher HIV-SSDI scores were significantly associated with HIV prevalence, mortality, preexposure prophylaxis (PrEP) use, and testing rates but not with linkage to care or viral suppression. Longitudinally, the strength of association between SSDI and diagnosis rates declined between 2008 and 2022, while SSDI associations with PrEP use and PrEP-to-Need-Ratio increased sharply from 2012 to 2023. These trends were robust across factor extraction methods and model specifications. The HIV-SSDI is a validated, multi-dimensional metric that captures structural disadvantage relevant to HIV vulnerability and prevention. Its growing association with prevention outcomes over time supports its utility as a policy-relevant tool for identifying high-need states, guiding equitable resource allocation, and monitoring progress toward HIV-related health equity.

Rapid start of antiretroviral therapy (ART) has been recommended by the World Health Organization since 2017 and is an important approach toward optimizing HIV care. Our objective was to understand the experiences of people with HIV (PWH) undergoing rapid start and to synthesize lessons learned to improve our program. This mixed-methods study recruited newly diagnosed patients establishing care at an urban safety-net clinic in Dallas, TX, between 2021 and 2022. Eligible PWH were ART-naïve and diagnosed with HIV within 12 months prior to the rapid start visit. Participants completed baseline and follow-up surveys 3-12 months after enrollment. A subset of participants completed semi-structured interviews to capture their experiences with HIV and elucidate barriers and facilitators to rapid start. Interviews were evaluated using thematic analysis. Qualitative and quantitative findings were integrated to develop best practices. In total, 199 participants (35.5 ± 11.6 years; 73.9% men; 39.7% Black; 48.7% Hispanic; 38.2% heterosexual risk transmission of HIV) participated in the study. Completed surveys and interviews (n = 20) centered around five themes: (1) social and emotional needs, (2) patient-centered approach, (3) cultural competence, (4) structural navigation, and (5) longitudinal support. Key elements of a rapid start program include evaluating and fostering support networks; emphasizing patient-centered care like tailored education on HIV; acknowledging distinctive cultural values and behaviors of the patients; improving structural factors, including support for insurance issues; and strengthening longitudinal support past the rapid start visit. Such lessons can serve as a blueprint for other practices, particularly in the US South, looking to establish or strengthen rapid start programs.

Limited research exists on HIV pre-exposure prophylaxis (PrEP) interest among female university students in high-HIV-prevalence African settings. This study sought to establish the relationship between epidemiological and perceived HIV risk and PrEP intention among young women in higher education in Zambia. We recruited female students at an urban university to complete an online survey on intention to use PrEP in the next year (primary outcome); PrEP knowledge, attitudes, and behaviors; demographics; epidemiological HIV risk; and risk perception. Descriptive statistics, regression, and mediation analyses were used. Of the 454 sexually active participants, 118 (26%) reported PrEP intention. Actual PrEP use was rare (<5%). The odds of PrEP intention increased for those with perceived high HIV risk [adjusted odds ratio (aOR) = 3.08; 95% confidence interval (CI): 1.71-5.55] and with each year at university (aOR = 1.47; 95% CI: 1.21-1.80) but decreased with higher PrEP stigma (aOR = 0.91; 95% CI: 0.86-0.96) and more negative PrEP perceptions (aOR = 0.91; 95% CI: 0.85-0.97). More epidemiological risk factors were originally associated with PrEP intention (aOR = 1.24; 95% CI: 1.01-1.53 for each risk factor), though this relationship weakened after adjustment for perceived HIV risk, which mediated 69% of the relationship between epidemiological HIV risk and PrEP intention. Only 23% of high-risk participants recognized their high epidemiological HIV risk (3+ risk factors). Along with PrEP education and stigma reduction, there is a need for approaches that help female university students in Zambia accurately identify their HIV risk to make informed decisions about PrEP use.