AIDS patient care and STDs最新文献

The co-occurrence of HIV and substance use disorders (SUDs) presents significant challenges for engagement in HIV care, with an estimated 48% of people living with HIV (PLWH) also having an SUD. This qualitative substudy of the BASE clinical trial employed constructivist grounded theory methodology to understand factors influencing engagement in HIV care among PLWH with ongoing SUDs. Fifteen participants who completed the BASE study participated in semistructured interviews about their experiences with HIV care engagement. Median age was 40 (range 21-61), 80% male sex, 27% Black, and 27% Hispanic. The analysis resulted in a model centered on three intrapersonal factors: motivation for care, capacity to remember care behaviors, and ability to engage in care. These factors existed within a broader context of stigma, ongoing substance use, and financial insecurity, which created significant barriers to care engagement. However, participants identified interpersonal relationships and clinic interventions as important facilitators that helped them maintain engagement in care. The study provides novel insights by developing a model directly from patient perspectives, conceptualizing engagement as existing on a spectrum, and identifying varied ways participants accessed motivation through relationships. These findings could inform the development of more effective interventions that account for the specific needs of people living with both HIV and SUDs.

Qualitative studies suggest stigma is a barrier to pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in sub-Saharan Africa, but there are few quantitative data or validated measures available. This study sought to develop and validate a scale to measure PrEP stigma among AGYW in western Kenya. An initial scale was developed, then pilot tested with 200 AGYW taking PrEP. The final scale was used in a longitudinal study with 250 AGYW to assess the prevalence and sources of PrEP stigma and to test whether PrEP stigma is associated with PrEP adherence, measured by hair tenofovir levels. The pilot testing resulted in the final 17-item Young Women's PrEP Stigma Scale (YW-PSS) with subscales for perceived, anticipated, experienced, and internalized PrEP stigma, high internal consistency (Cronbach's alpha = 0.81), and evidence of divergent and construct validity. In the longitudinal study, 72% of participants reported any perceived PrEP stigma, 64% any anticipated stigma, 35% any experienced stigma, and 15% any internalized stigma. The most commonly reported stigma perpetrators were friends, male partners, and men and women from the community. Participants with higher total, perceived, or experienced PrEP stigma scores were significantly less likely to have high PrEP adherence, while anticipated and internalized stigma were not associated with PrEP adherence. Findings from this study support the validity and reliability of the YW-PSS among AGYW in Kenya and suggest that PrEP stigma is highly prevalent and predicts poor PrEP adherence. Stigma reduction interventions are needed to support PrEP adherence and well-being in this population.

The New York City "Data-to-Suppression" (D2S) initiative was launched to improve HIV viral suppression among Ryan White HIV/AIDS Program Part A (RWPA) clients through a combination of surveillance-based, client-level reporting and capacity-building activities with RWPA housing and behavioral health service providers. This study qualitatively examines provider perspectives on its implementation. Drawing from 8 RWPA-funded agencies participating in D2S, we conducted semistructured interviews with 24 purposively sampled providers from 8 RWPA-funded agencies participating in D2S, including patient navigators engaged in D2S outreach, patient navigator supervisors, and administrators. Interviews were conducted between August and November 2022. The interviews explored four topics: (1) D2S workflow and benefits, (2) implementation facilitators, (3) implementation barriers, and (4) areas for improvement. Providers reported that D2S was easy to implement and identified clients in need of additional support. Suggestions for improvement included issuing more timely reports, adding more detailed data to reports, and focusing the intervention on agencies where behavioral health and housing program staff do not already have access to clients' HIV care and viral suppression status. Providers described barriers such as organizational capacity constraints (e.g., hiring and retaining staffing levels) and clients' difficulty with maintaining viral suppression due to competing needs. Qualitative feedback from the providers responsible for delivering an intervention is critical to identifying refinements that could strengthen engagement in intervention implementation and thus critical to achieving and sustaining the intended impact.

Adolescents frequently demonstrate limited knowledge about HIV/AIDS, contributing to persistent stigma, misconceptions, and risky behaviors. These knowledge gaps and stigmatizing attitudes hinder effective HIV prevention and health outcomes. Understanding the sources of adolescents' HIV knowledge and identifying demographic disparities can inform targeted educational interventions. We conducted a cross-sectional, anonymous survey with 2110 adolescents aged 14-18 in Munich, Germany, prior to an extracurricular sexual health lecture between November 2023 and February 2024. The questionnaire assessed sociodemographics, HIV knowledge, sources of information, attitudes toward people living with HIV (PLHIV), and risk perceptions. Data were analyzed using descriptive and inferential statistics to identify knowledge gaps and demographic trends. Significant misconceptions about HIV transmission and prevention were observed, with 40.9% of students uncertain about transmission routes. Male students and those in nonacademic school tracks exhibited higher rates of uncertainty and misinformation. Social media, particularly TikTok, emerged as a major but inconsistent source of HIV information, alongside schools. Stigmatizing attitudes, such as discomfort with PLHIV, were linked to knowledge gaps and misinformation. Demographic factors, including gender and educational background, significantly influenced both knowledge and attitudes. These findings underscore the need for targeted, inclusive educational interventions to bridge HIV knowledge gaps and reduce stigma among adolescents. Leveraging both traditional school-based education and reliable digital platforms can address misconceptions and promote empathy toward PLHIV. Efforts to standardize comprehensive sexual health curricula and develop accurate online resources are critical to improving adolescent health literacy and fostering inclusive attitudes.

Electronic health record (EHR)-based models to identify individuals who may benefit from pre-exposure prophylaxis (PrEP) outperform traditional risk scores and may alleviate challenges associated with PrEP initiation. Pre-implementation work is critical to ensure algorithms are optimized for the local context, particularly given regional differences in the US HIV epidemic. To inform the derivation and implementation of EHR-based models within health systems in New Orleans and Baton Rouge, Louisiana, we conducted focus group discussions (FGDs) with community advocates and in-depth interviews (IDIs) with emergency department, primary care, and HIV-trained clinicians. We asked about their perspectives on HIV epidemiology and PrEP uptake and sought suggestions for locally relevant variables to optimize model performance. FGDs and IDIs were audio-recorded and analyzed using thematic analysis. From January to March 2023, FGDs were conducted with 18 community advocates and IDIs with 12 clinicians. Community advocates did not believe that PrEP had reduced local HIV incidence, primarily due to a lack of inclusive marketing. Clinicians noted that improving PrEP uptake would require better access to education, PrEP providers, and affordable medication. Community advocates suggested adding sexual assault history and number of pregnancies to the model; clinicians suggested adding hepatitis B, more sexually transmitted infection treatment modalities, incarceration history, and opiate use. To optimize model implementation, community advocates emphasized the need to convey model output respectfully and compassionately, and clinicians suggested involving ancillary staff in PrEP discussions. Although evidence supports the use of EHR-based models to identify PrEP candidates, local stakeholders can provide unique insight into optimizing model performance and implementation.

Little is known about long-acting HIV treatment implementation with trans women. We piloted and evaluated the implementation of novel strategies to increase uptake and use of long-acting HIV treatment among trans women in San Francisco. In 2022, qualitative formative nominal groups (n = 8) and in-depth interviews with providers (n = 11) were conducted to elicit facilitators and barriers to long-acting HIV treatment delivery among trans women living with HIV and to inform a pilot delivery model. Between August 2023 and August 2024, participants were enrolled into the program. Sequential mixed methods were used to evaluate formative and implementation data to understand barriers to starting long-acting treatment. Barriers for trans women were concerns about side effects, fear of needles, and difficulty adhering to bi-monthly injections. They were also concerned about missed injections from lack of transportation and incarceration and medical mistrust. Providers were most concerned with participant adherence due to social determinants (e.g., housing) and behavioral health challenges (e.g., methamphetamine use, mental health disorders). Buttock fillers and implants, patient worries about interactions with hormones, clinical barriers (e.g., availability of genotyping data), insurance, and managing prescriptions were also potential barriers. A significant barrier to implementation was the burden on referring clinic providers for eligibility screening and many trans women who were referred declined participation or were not eligible due to contraindicated clinical histories. Our study identified barriers to implementing long-acting HIV treatment among trans women living with HIV and provides novel implementation insights for clinics and interventions serving this community.

Youth living with human immunodeficiency virus (YHIV) aged 13-25 often struggle with adherence to daily oral antiretroviral treatment (ART) regimens. Recently approved intramuscular injectable long-acting ART (LA-ART) may promote adherence and improve longitudinal health outcomes. The study explores the willingness to use LA-ART strategies among YHIV. This cross-sectional pilot study included a telephone-based survey embedded into a randomized controlled trial of an intervention (NCT03600103) designed to enhance viral suppression among YHIV with baseline adherence challenges and detectable viremia. Participants completed 34-item telephone surveys between October 2021 and February 2022 to evaluate preferences and willingness to use four LA-ART delivery alternatives [intramuscular injection (IM), subcutaneous injection (SC), subdermal implant (SDI), and LA-ART pills] compared with daily oral ART. Long-acting pills were most preferred (84%, 16/19), while 79% of participants (15/19) expressed willingness to try IM, 79% (15/19) SC, and 74% (14/19) SDI. However, when asked to choose only one method, most (58%, 11/19) selected IM as the method that would work best. The arm was the preferred injection site (73% [8/11]) compared with the thigh (18% [2/11]). Willingness to use LA-ART was higher with less frequent injections, e.g., for IM LA-ART, 47% (9/19) were willing to try weekly vs. 79% (15/19) were willing to try every three-month injections. YHIV experiencing adherence challenges are willing to use novel LA-ART delivery methods. Addressing concerns around LA-ART methods and educating YHIV on their efficacy could help increase uptake, which could reduce rates of non-adherence in YHIV.

Black women bear a disproportionate burden of the US HIV epidemic, compared with women of other racial groups. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to communication and shared decision-making with health care providers. Using an institutional review board-approved questionnaire, we surveyed 186 adults (83% Black; 9% White; 3% American Indian/Alaskan Native; 4% Other) who were PrEP eligible, HIV seronegative, cisgender women in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction. Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months [index = -0.3093, standard error (SE) = 0.1886, 95% confidence interval (CI; -0.7455, -0.0122)] and 12 months [index = -0.3248, SE = 0.1987, 95% CI: (-0.7827, -0.0040)] through an anticipated discussion with a provider. When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity. This study was limited by the low number of non-Black participants (17%) as well as the requirement that subjects be English-speaking only.