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Specialty Care Referral for Underrepresented Minorities Living with HIV in the United States: Experiences, Barriers, and Facilitators. 美国代表性不足的少数民族艾滋病毒感染者的专科转诊:经验、障碍和促进因素。
IF 3.4 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-06-13 DOI: 10.1089/apc.2024.0066
Charles Muiruri, Carrie Dombeck, Teresa Swezey, Sarah Gonzales, Morgan Lima, Shamea Gray, Joseph Vicini, April C Pettit, Chris T Longenecker, Eric G Meissner, Nwora Lance Okeke, Gerald S Bloomfield, Amy Corneli

The increased incidence of chronic diseases among people with HIV (PWH) is poised to increase the need for specialty care outside of HIV treatment settings. To reduce outcome disparities for HIV-associated comorbidities in the United States, it is critical to optimize access to and the quality of specialty care for underrepresented racial and ethnic minority (URM) individuals with HIV. We explored the experiences of URM individuals with HIV and other comorbidities in the specialty care setting during their initial and follow-up appointments. We conducted qualitative interviews with participants at three large academic medical centers in the United States with comprehensive health care delivery systems between November 2019 and March 2020. The data were analyzed using applied thematic analysis. A total of 27 URM individuals with HIV were interviewed. The majority were Black or African American and were referred to cardiology specialty care. Most of the participants had positive experiences in the specialty care setting. Facilitators of the referral process included their motivation to stay healthy, referral assistance from HIV providers, access to reliable transportation, and proximity to the specialty care health center. Few participants faced individual, interpersonal, and structural barriers, including the perception of individual and facility stigma toward PWH, a lack of transportation, and a lack of rapport with providers. Future case studies are needed for those URM individuals with HIV who face barriers and negative experiences. Interventions that involve PWH and health care providers in specialty care settings with a focus on individual- and structural-level stigma can support the optimal use of specialty care.

随着艾滋病病毒感染者(PWH)慢性病发病率的增加,他们对艾滋病治疗机构以外的专科护理的需求也将增加。为了减少美国艾滋病相关并发症的治疗效果差异,优化代表性不足的少数种族和少数民族(URM)艾滋病感染者获得专科治疗的机会和专科治疗的质量至关重要。我们探究了感染艾滋病毒和其他合并症的少数民族患者在专科医疗机构初次就诊和复诊时的经历。我们于 2019 年 11 月至 2020 年 3 月期间在美国三家拥有综合医疗服务体系的大型学术医疗中心对参与者进行了定性访谈。我们采用应用主题分析法对数据进行了分析。共采访了 27 名感染艾滋病毒的乌拉圭移民。其中大多数人是黑人或非裔美国人,并被转介到心脏病专科治疗。大多数参与者在专科医疗机构都有积极的经历。转诊过程中的促进因素包括他们保持健康的动力、艾滋病提供者提供的转诊协助、可靠的交通工具以及距离专科医疗中心较近。少数参与者面临个人、人际和结构性障碍,包括个人和医疗机构对艾滋病感染者的偏见、交通不便以及与医疗服务提供者缺乏默契。未来还需要对那些面临障碍和负面经历的少数民族艾滋病毒感染者进行案例研究。让残疾人和医疗服务提供者参与到专科护理环境中,重点关注个人和结构层面的污名化问题,这样的干预措施可以支持专科护理的最佳利用。
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引用次数: 0
Perspectives Among Health Care Providers and People with HIV on the Implementation of Long-Acting Injectable Cabotegravir/Rilpivirine for Antiretroviral Therapy in Florida. 医疗服务提供者和艾滋病病毒感染者对佛罗里达州实施长效注射卡博特拉韦/利匹韦林抗逆转录病毒疗法的看法。
IF 3.4 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-04-30 DOI: 10.1089/apc.2024.0067
Rebecca J Fisk-Hoffman, Sashaun S Ranger, Abigail Gracy, Hannah Gracy, Preeti Manavalan, Maya Widmeyer, Robert F Leeman, Robert L Cook, Shantrel Canidate

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.

用于抗逆转录病毒疗法(ART)的长效注射剂卡博替拉韦/利匹韦林(CAB/RPV)可使许多艾滋病病毒感染者(PWH)受益。然而,其影响在很大程度上取决于医疗服务提供者是否愿意开具处方以及感染者是否愿意服用。本研究探讨了佛罗里达州高感染率地区的 PWH 和 HIV 护理提供者在实施 LAI CAB/RPV 过程中感知到的障碍和促进因素。研究人员用英语对全州 16 名艾滋病感染者(50% 为非西班牙裔白人,50% 为顺式男性,94% 接受口服抗逆转录病毒疗法)和 11 名提供者(27% 为非西班牙裔黑人,27% 为西班牙裔,73% 为顺式女性,64% 开具 LAI CAB/RPV 处方)进行了半结构化定性访谈。招募工作于 2022 年 10 月至 2023 年 10 月期间在艾滋病诊所进行。对访谈进行录音、专业转录,然后使用主题分析法进行双重编码。实施研究综合框架为访谈指南和编码提供了指导。虽然 PWH 认为 LAI CAB/RPV 是有效的,但主要的障碍包括通过注射进行管理、参加更多门诊的挑战,以及感觉这使 HIV 成为个人生活的中心。此外,医疗服务提供者还对整合酶耐药性的产生表示担忧。公共卫生人员和医疗服务提供者指出的诊所外的障碍包括交通、污名化、就医不公平和付款人问题。在诊所内部,医疗服务提供者认为需要额外的人员配备和增加现有工作人员的负担是障碍。这些障碍降低了 PWH 和医疗服务提供者对 LAI CAB/RPV 的认知需求,尤其是在口服抗逆转录病毒疗法非常有效的情况下。许多已发现的障碍发生在诊所之外,可能也适用于其他新型长效抗逆转录病毒疗法。
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引用次数: 0
Facilitators, Barriers, and Opportunities to Implementing Sexual History Screening and Human Immunodeficiency Virus Pre-Exposure Prophylaxis at a Federally Qualified Health Center. 在联邦合格卫生中心实施性史筛查和人类免疫缺陷病毒暴露前预防的促进因素、障碍和机遇。
IF 3.4 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-05-01 Epub Date: 2024-04-26 DOI: 10.1089/apc.2024.0026
Kelly W Gagnon, Robert W S Coulter, James E Egan, Ken Ho, Mary Hawk

Sexual history screening (SHS) is recommended to determine risk for acquisition of human immunodeficiency virus (HIV) and eligibility for pre-exposure prophylaxis (PrEP). SHS and PrEP are underutilized, sequential screening, and prevention practices. This study aimed to understand factors impacting the implementation of SHS and PrEP at a multi-site federally qualified health center (FQHC) in Connecticut. Guided by the Consolidated Framework for Implementation Research, semistructured interviews were conducted on Zoom with primary care providers (PCPs), medical assistants, clinical leadership, and PrEP navigators. Convenience and purposive sampling took place via email until thematic saturation was achieved. Thematic analysis was conducted. Twenty-two participants were interviewed for this study. PCPs lacked knowledge and reported limited or no use of SHS to determine patients' level of HIV risk, which may explain why most PCPs relied on patients to request PrEP. While PCPs perceived organizational support to prescribe PrEP, clinical staff were unaware of structural resources. Lastly, participants described a vertical trajectory of influence from external sources (policies and insurance) to time allocated to appointments that limits their ability to implement SHS and PrEP, further complicated by the electronic health record and disparities in structural resources across clinical sites. This study provides foundational evidence for future research on implementation strategies to improve HIV prevention through universal, comprehensive SHS to identify patients for PrEP. Overcoming barriers to SHS and PrEP, particularly in clinical settings such as FQHCs that care for vulnerable populations, may improve identification, prevention, and treatment of HIV and aid in ending the HIV epidemic.

建议进行性史筛查 (SHS),以确定感染人类免疫缺陷病毒 (HIV) 的风险和接受暴露前预防 (PrEP) 的资格。性史筛查和 PrEP 是未得到充分利用的连续性筛查和预防措施。本研究旨在了解影响康涅狄格州一家多站点联邦合格医疗中心 (FQHC) 实施 SHS 和 PrEP 的因素。在 "实施研究综合框架"(Consolidated Framework for Implementation Research)的指导下,对初级保健提供者 (PCP)、医疗助理、临床领导和 PrEP 引导员进行了半结构化访谈。在达到主题饱和之前,通过电子邮件进行了便利性和目的性抽样。进行了专题分析。本研究对 22 名参与者进行了访谈。初级保健医生缺乏相关知识,并报告说他们很少或根本没有使用 SHS 来确定患者的 HIV 风险水平,这或许可以解释为什么大多数初级保健医生依赖于患者来申请 PrEP。虽然初级保健医生认为组织支持开具 PrEP 处方,但临床工作人员并不了解结构性资源。最后,参与者描述了从外部来源(政策和保险)到预约时间分配的垂直影响轨迹,这种轨迹限制了他们实施 SHS 和 PrEP 的能力,而电子健康记录和不同临床地点的结构性资源差异使情况更加复杂。这项研究为今后研究实施策略提供了基础性证据,以便通过普及、全面的社会健康服务来识别 PrEP 患者,从而改善艾滋病预防工作。克服 SHS 和 PrEP 的障碍,尤其是在照顾弱势人群的临床环境中,如 FQHC,可改善 HIV 的识别、预防和治疗,并有助于终止 HIV 的流行。
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引用次数: 0
Prevalence of Diagnosed and Undiagnosed Depression Among US Adults with Human Immunodeficiency Virus: Data from the Medical Monitoring Project. 美国成人人类免疫缺陷病毒感染者中确诊和未确诊抑郁症的患病率:医疗监测项目数据。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-25 DOI: 10.1089/apc.2024.0031
Linda Beer, Linda J Koenig, Y. Tie, Xin Yuan, Jennifer Fagan, Kate Buchacz, Kamal Hughes, John Weiser
People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.
人类免疫缺陷病毒感染者(PWH)受抑郁症的影响尤为严重,但目前还缺乏对美国 PWH 的最新全国性估计,包括当前症状和临床诊断,以评估漏诊和症状缓解不足的情况。我们利用美国疾病预防控制中心医疗监测项目(MMP)的数据,报告了美国成年残疾人中已诊断和未诊断抑郁症的全国代表性估计数据。在 2021 年 6 月至 2022 年 5 月期间,MMP 收集了 3928 名残疾人病历中与重度或其他抑郁症状相符的症状以及抑郁症诊断的访谈数据。我们报告了加权百分比和患病率比 (PR),以量化不同群体在主要社会和健康因素方面的差异。总体而言,34% 的残疾人患有任何抑郁症(诊断或患者健康问卷-8);其中 26% 有症状但无诊断(未确诊抑郁症),19% 既有诊断又有症状,55% 有诊断但无症状。在抑郁症患者中,残疾人(PR:1.52)和食物无保障者(PR:1.67)更有可能未被诊断。失业者(PR:1.62)、残疾者(PR:2.78)、食物无保障者(PR:1.46)或在人类免疫缺陷病毒(HIV)护理中受到歧视者(PR:1.71)更有可能被诊断为有症状的抑郁症。有症状(未诊断或已诊断)的患者不太可能坚持抗逆转录病毒疗法(ART)剂量(PR:0.88;PR:0.73)或持续抑制病毒(PR:0.62;PR:0.91),也更有可能对心理健康服务的需求未得到满足(PR:2.38;PR:2.03)。三分之一的 PWH 患有抑郁症,其中近一半未经诊断或仍有临床相关症状。扩大对抑郁症的筛查和有效治疗可提高生活质量和艾滋病的治疗效果。
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引用次数: 0
Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus. 患有人类免疫缺陷病毒的西班牙裔/拉美裔老年人在代谢综合征和神经认知功能方面的差异。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-25 DOI: 10.1089/apc.2024.0043
M. Marquine, L. Kamalyan, Z. Zlatar, D. Yassai-Gonzalez, A. Perez-Tejada, A. Umlauf, Tala Al-Rousan, Verónica González, Jordana Breton, Lesley A Guareña, Lilla A Brody, M. Cherner, Ronald J Ellis, M. L. Zúñiga, D. Mungas, Raeanne C Moore, David J Moore, Valerie Wojna, Rasheeda K Hall, Donald R. Franklin, Robert K. Heaton
Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.
神经认知障碍和代谢综合征(MetS)在艾滋病病毒感染者(PWH)中十分普遍。我们研究了西班牙裔和非西班牙裔白人老年艾滋病感染者在与艾滋病相关的神经认知功能方面的差异,以及 MetS 在解释这些差异方面的作用。参与者包括参加加利福尼亚州南部一项队列研究的 116 名年龄在 50-75 岁之间、居住在社区的艾滋病感染者[58 名西班牙裔(53% 讲西班牙语)和 58 名年龄相当的非西班牙裔白人;总体组别:年龄:男 = 57.9,标准差 (SD) = 5.7;教育程度(年):男性占 83%,58% 患有艾滋病,94% 正在接受抗逆转录病毒治疗]。总体神经认知能力是根据 10 项认知测试的 T 分值,并根据人口统计学特征(年龄、教育程度、性别、种族、语言)进行调整后得出的。MetS是通过考虑中心性肥胖、空腹甘油三酯升高、高密度脂蛋白胆固醇偏低和血糖升高,或对这些情况进行药物治疗的标准标准来确定的。研究的协变量包括社会人口学、精神病学、药物使用和艾滋病毒疾病特征。与非西班牙裔白人相比,西班牙裔人的整体神经认知功能较差(Cohen's d = 0.56,p < 0.05),MetS 患病率较高(38% 对 56%,p < 0.05)。包括种族和重要协变量在内的逐步回归模型显示,西班牙裔是唯一能显著预测整体神经认知功能变差的因素(B = -3.82,SE = 1.27,p < 0.01)。包括 MetS 在内的一个模型显示,西班牙裔(B = -3.39,SE = 1.31,P = 0.01)和 MetS(B = -2.73,SE = 1.31,P = 0.04)都与神经认知的恶化独立相关。总之,研究结果表明,在西班牙裔和非西班牙裔白人老年残疾人中,MetS 的增加与神经认知功能的恶化有关,但并不能解释神经认知差异。MetS仍然是改善不同老年残疾人神经认知功能障碍的重要干预目标。
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引用次数: 0
A Call for Youth Voice to Support Engagement in Care for 18- to 29-Year Olds Living with HIV in the US South. 呼吁青年发出声音,支持美国南部 18 至 29 岁艾滋病病毒感染者参与护理。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-25 DOI: 10.1089/apc.2024.0006
Catherine Johnson, Autumn B. Chidester, Divya Chandramohan, Hueylie Lin, Nhat Minh Ho, Anna Taranova, A. Nijhawan, Susan Kools, Karen Ingersoll, Rebecca A. Dillingham, Barbara S Taylor
Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.
感染艾滋病病毒的青少年(YWH)在实现病毒抑制方面面临着挑战,尤其是在美国南部地区,因此欢迎采取符合社区需求的新型干预措施。计划行为理论 (TPB) 描述了影响行为改变的因素,而积极青年发展 (PYD) 则支持以青年为重点的项目设计。我们运用计划行为理论和积极青年发展理论来探讨支持南得克萨斯州青年妇女之家参与护理的因素和面临的挑战。我们对青年福利院进行了 14 次半结构式访谈,并与 26 位利益相关者进行了 7 次焦点小组讨论,这些访谈和讨论都参考了主题为本理论、PYD 和青年咨询委员会 (YAB) 的主题。研究小组和青年咨询委员会对新出现的主题进行了审查,并根据反馈意见对访谈指南和编码手册进行了反复修订。主题分析按受访者类型、主题规划和青年发展进行了代码族比较。所有研究方法均通过了 UT Health San Antonio 和 University Health 机构审查委员会的审查。与参与护理相关的新主题包括:对 HIV 诊断的不同反应,从接受到恐惧/悲伤;财务、保险和心理健康方面的挑战;创伤史;高自我效能感;渴望独立;以及希望与同年龄组的诊所工作人员接触。利益相关者认为 YWH 的生活方式,包括聚会和使用药物,是护理的障碍。与此相反,"青年妇女健康 "将 "聚会 "视为不受欢迎的刻板印象,而护理障碍则包括多重工作和家庭责任。在PYD中捕捉到而在TPB中没有捕捉到的两个关键主题是青少年的声音在项目设计中的重要性和护理的结构性障碍(如保险、交通)。基于这些发现,我们为那些寻求设计更有效的以青年为中心的艾滋病护理参与干预措施的人提供了重要的相关指导。通过在项目设计中考虑青年妇女与艾滋病患者的观点并结合PYD框架,利益相关者可以更好地满足青年妇女与艾滋病患者对代表权和代理权的渴望。我们的研究结果为那些寻求为青年女性设计更有效的艾滋病关怀参与干预措施的人提供了重要的相关指导。
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引用次数: 0
Long-Acting Injectable ART in Practice: A Mixed Methods Implementation Study Assessing the Feasibility of Using LAI ART in High Risk Populations and At Alternative Low Barrier Care Sites. 长效注射抗逆转录病毒疗法在实践中的应用:一项混合方法实施研究,评估在高风险人群和其他低障碍护理场所使用 LAI ART 的可行性。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-24 DOI: 10.1089/apc.2024.0048
Laura Fletcher, S. Burrowes, Lora L Sabin, Nicole McCann, Ghulam Karim Khan, Glorimar Ruiz-Mercado, Samantha Johnson, Simeon D Kimmel, Cassandra M Pierre, M. Drainoni
Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to change the lives of people living with HIV (PLWH). To ensure equitable access to new treatment modalities, we examined the feasibility and acceptability of administering Cabotegravir Rilpivirine Long Acting (CAB/RPV LA) to individuals who experience challenging social determinants of health (SDoH) and struggle with adherence to traditional oral ART. Quantitative and qualitative data were used to assess feasibility of utilizing ART at alternative clinic. Data were collected on individuals eligible to receive CAB/RPV LA at an alternative street-based clinic and on individuals receiving CAB/RPV LA at a traditional HIV clinic. After 6 months, participants were interviewed about their experience. Providers involved in the implementation were also interviewed about their experiences. Only one participant (out of 5) who received CAB/RPV LA at the alternative clinic received consistent treatment, whereas 17 out of 18 participants receiving CAB/RPV LA at the traditional clinic site were adherent. Participants and providers believed that LAI had potential for making treatment adherence easier, but identified several barriers, including discrepancies between patients' desires and their lifestyles, impact of LAI on interactions with the medical system, risk of resistance accompanying sub-optimal adherence, and need for a very high level of resources. While LAI has major potential benefits for high-risk patients, these benefits must be balanced with the complexities of implementation. Despite challenges that impacted study outcomes, improving treatment outcomes for PLWH requires addressing SDoH and substance use.
长效注射抗逆转录病毒疗法(ART)有可能改变艾滋病病毒感染者(PLWH)的生活。为了确保公平地获得新的治疗模式,我们研究了为那些健康社会决定因素(SDoH)具有挑战性且难以坚持传统口服抗逆转录病毒疗法的人注射卡博替拉韦瑞匹韦林长效注射剂(CAB/RPV LA)的可行性和可接受性。定量和定性数据用于评估在替代诊所使用抗逆转录病毒疗法的可行性。我们收集了有资格在替代性街头诊所接受 CAB/RPV LA 治疗的患者以及在传统艾滋病诊所接受 CAB/RPV LA 治疗的患者的数据。6 个月后,对参与者进行了访谈,了解他们的经历。参与实施工作的医疗服务提供者也接受了采访,讲述了他们的经历。在替代诊所接受 CAB/RPV LA 的参与者(5 人中)中只有一人坚持治疗,而在传统诊所接受 CAB/RPV LA 的 18 名参与者中有 17 人坚持治疗。参与者和医疗服务提供者认为,LAI 有可能使坚持治疗变得更容易,但也发现了一些障碍,包括患者的愿望与他们的生活方式之间的差异、LAI 对与医疗系统互动的影响、次优坚持治疗带来的抗药性风险,以及需要非常多的资源。虽然LAI对高危患者有很大的潜在益处,但这些益处必须与实施的复杂性相平衡。尽管存在影响研究结果的挑战,但改善 PLWH 的治疗结果需要解决 SDoH 和药物使用问题。
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引用次数: 0
Perspectives on Injectable HIV Pre-Exposure Prophylaxis: A Qualitative Study of Health Care Providers in the United States. 关于注射式艾滋病暴露前预防的观点:对美国医疗服务提供者的定性研究。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1089/apc.2024.0001
Jacob Bleasdale, Meghan McCole, Kenneth Cole, Amy Hequembourg, Gene D Morse, S. Przybyla
The introduction of injectable HIV pre-exposure prophylaxis (PrEP) has the potential to significantly change the biomedical HIV prevention landscape. However, effective implementation will require health care providers to adopt, prescribe, and administer injectable PrEP within clinical settings. This study qualitatively examined challenges and benefit of injectable PrEP implementation from the perspective of health care providers. From April to August 2022, we conducted 19 in-depth interviews with current PrEP-prescribing health care providers in New York State, including 3 physician assistants, 5 physicians, and 11 nurse practitioners. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to report semantic-level themes regarding injectable PrEP implementation. More than half of participants (61%) were aware of injectable PrEP; only 21% had experience prescribing it. Qualitative findings highlighted five themes. Three themes represented implementation challenges, including speculative concerns about side effects, appointment compliance, and practical and logistical considerations. The remaining two themes described benefits of injectable PrEP relative to oral PrEP, which included greater convenience and enhanced privacy. Findings from this qualitative study make significant applied contributions to the sparse knowledge on health care provider perspectives of injectable PrEP post-US Food and Drug Administration approval and their concerns and considerations regarding implementation in real-world clinical settings.
可注射的艾滋病暴露前预防疗法(PrEP)的引入有可能极大地改变生物医学艾滋病预防的格局。然而,要有效实施该疗法,需要医疗服务提供者在临床环境中采用、开具处方并实施注射式 PrEP。本研究从医疗服务提供者的角度出发,对注射式 PrEP 的实施所面临的挑战和益处进行了定性研究。2022 年 4 月至 8 月,我们对纽约州目前开具 PrEP 处方的医疗服务提供者进行了 19 次深入访谈,其中包括 3 名医生助理、5 名医生和 11 名执业护士。我们对访谈进行了录音、逐字转录和主题分析,以报告有关注射 PrEP 实施情况的语义级主题。超过一半的参与者(61%)知道注射 PrEP,但只有 21% 的参与者有过开具处方的经验。定性分析结果突出了五个主题。三个主题代表了实施过程中的挑战,包括对副作用、预约依从性的猜测性担忧,以及实际和后勤方面的考虑。其余两个主题描述了注射式 PrEP 相对于口服 PrEP 的好处,包括更加方便和隐私性更强。这项定性研究的结果为医疗服务提供者对美国食品药品管理局批准后注射 PrEP 的看法,以及他们对在实际临床环境中实施注射 PrEP 的担忧和考虑做出了重要的应用贡献。
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引用次数: 0
Understanding Attitudes of Postpartum Cisgender Women Toward Integration of HIV Prevention Services into Routine Prenatal and Postpartum Sexual Health Discussions. 了解产后同性妇女对将 HIV 预防服务纳入常规产前和产后性健康讨论的态度。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1089/apc.2023.0307
Caroline E Mullis, Alison J. Goldberg, Karina Avila, Bianca Hall, Sarit A Golub, Marla J Keller
Oral pre-exposure prophylaxis (PrEP) is an effective, user-controlled method for HIV prevention. However, awareness, uptake, and adherence to PrEP remain low among cisgender women (CGW). The prenatal and postpartum periods present an opportunity for delivery of comprehensive sexual health services that include HIV prevention education and services. However, little is known about postpartum CGW's attitudes toward integration of HIV prevention education and services into obstetric care in the US. We conducted semistructured interviews with 20 postpartum CGW in the Bronx, NY from July to November 2022 to explore their experiences with prenatal and postpartum sexual health care, examine their attitudes toward integration of HIV prevention services into obstetric sexual health care, and identify components of future implementation strategies. Transcripts were analyzed thematically using a framework approach. Among CGW interviewed, fewer than half reported prior knowledge of PrEP. Ten participants preferred long-acting injectable PrEP relative to six who preferred daily oral PrEP. Most participants reported no discussion of sex with their provider during pregnancy, and when discussions occurred, they focused on permission or prohibition of sexual activity. Participants described a reliance on providers to lead prenatal sexual health discussions. Even when not perceived as personally relevant, most respondents valued education on HIV prevention and PrEP services. In the postpartum period, sexual health discussions were similarly limited despite participants describing complex experiential sexual health concerns. This study supports the potential for integration of HIV prevention education and services into routine prenatal and postpartum sexual health discussions in an area of high HIV prevalence in the US.
口服暴露前预防疗法(PrEP)是一种有效的、由用户控制的艾滋病预防方法。然而,顺性别女性(CGW)对 PrEP 的认知度、接受率和坚持率仍然很低。产前和产后是提供包括艾滋病预防教育和服务在内的全面性健康服务的好时机。然而,在美国,人们对产后 CGW 对将 HIV 预防教育和服务纳入产科护理的态度知之甚少。2022 年 7 月至 11 月,我们对纽约布朗克斯区的 20 名产后 CGW 进行了半结构式访谈,以探讨她们在产前和产后性健康护理方面的经验,研究她们对将 HIV 预防服务纳入产科性健康护理的态度,并确定未来实施策略的组成部分。我们采用框架法对记录誊本进行了专题分析。在受访的 CGW 中,不到一半的人表示事先了解 PrEP。10 名参与者倾向于长效注射 PrEP,而 6 名参与者倾向于每日口服 PrEP。大多数参与者表示在怀孕期间没有与医疗服务提供者讨论过性问题,即使讨论过,也主要集中在允许或禁止性活动上。据参与者描述,他们依赖于医疗服务提供者来引导产前性健康讨论。即使认为与个人无关,大多数受访者也重视有关 HIV 预防和 PrEP 服务的教育。在产后,尽管参与者描述了复杂的性健康问题,但性健康讨论同样有限。本研究支持在美国 HIV 高发地区将 HIV 预防教育和服务纳入常规产前和产后性健康讨论的可能性。
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引用次数: 0
Rapid Initiation of Antiretroviral Therapy Under the Treat-All Policy Reduces Loss to Follow-Up and Virological Failure in Routine Human Immunodeficiency Virus Care Settings in China: A Retrospective Cohort Study (2016-2022). 在 "全治疗 "政策下快速启动抗逆转录病毒治疗可减少中国常规人类免疫缺陷病毒治疗中的随访损失和病毒学失败:回顾性队列研究(2016-2022 年)》。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1089/apc.2024.0045
Huan Xia, Lei Li, Yue Wu, Liying Gao, De-fa Zhang, Ping Ma
Following the World Health Organization's guidelines for rapid antiretroviral therapy (ART) initiation [≤7 days after human immunodeficiency virus (HIV) diagnosis], China implemented Treat-All in 2016 and has made significant efforts to provide timely ART since 2017. This study included newly diagnosed HIV adults from Tianjin, China, between 2016 and 2022. Our primary outcome was loss to follow-up (LTFU) at 12 months after enrollment. The secondary outcome was 12-month virological failure. The association between rapid ART and LTFU, as well as virological failure, was assessed via Cox regression and logistic regression. A total of 896 (19.1%) of 4688 participants received ART ≤7 days postdiagnosis. The rate of rapid ART has increased from 7.5% in 2016 to 33.3% by 2022. The rapid ART group had an LTFU rate of 3.3%, as opposed to 5.0% in the delayed group. The rapid ART group had a much reduced virological failure rate (0.6% vs. 1.8%). Rapid ART individuals had a reduced likelihood of LTFU [adjusted hazard ratio: 0.65, 95% confidence intervals (CI): 0.44-0.96] and virological failure (adjusted odds ratio: 0.35, 95% CI: 0.12-0.80). The real-world data indicated that rapid ART is practicable and beneficial for Chinese people with HIV, providing evidence for its widespread implementation and scaling up.
根据世界卫生组织关于快速启动抗逆转录病毒疗法(ART)的指南[人类免疫缺陷病毒(HIV)确诊后≤7天],中国于2016年实施了 "全人群治疗",并自2017年起为及时提供抗逆转录病毒疗法做出了巨大努力。本研究纳入了 2016 年至 2022 年期间中国天津新确诊的艾滋病成人患者。我们的主要结果是入组后 12 个月的随访损失(LTFU)。次要结果是 12 个月的病毒学失败。通过考克斯回归和逻辑回归评估了快速抗逆转录病毒疗法与LTFU以及病毒学失败之间的关系。在 4688 名参与者中,共有 896 人(19.1%)在确诊后 7 天内接受了抗逆转录病毒疗法。快速抗逆转录病毒疗法的比例从2016年的7.5%增至2022年的33.3%。快速抗逆转录病毒疗法组的LTFU率为3.3%,而延迟组为5.0%。快速抗逆转录病毒疗法组的病毒学失败率大大降低(0.6% 对 1.8%)。快速抗逆转录病毒疗法组患者发生 LTFU [调整后危险比:0.65,95% 置信区间 (CI):0.44-0.96] 和病毒学失败(调整后几率比:0.35,95% CI:0.12-0.80)的可能性较低。真实世界的数据表明,快速抗逆转录病毒疗法对中国艾滋病感染者是可行且有益的,为其广泛实施和推广提供了证据。
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AIDS patient care and STDs
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