AIDS patient care and STDs最新文献

Improving HIV outcomes for men who have sex with men (MSM) in sub-Saharan Africa requires addressing gaps in the HIV treatment cascade. This study examined these gaps among 71 treatment-naive MSM with HIV in the HIV Prevention Trials Network 075, a 1-year prospective biobehavioral cohort study (2015-2017) across four sub-Saharan African sites. Following a positive diagnosis, 86% of participants sought HIV care. Reasons for not having sought care or delays included a lack of perceived health issues and practical challenges. Most participants (80%) who engaged in care were prescribed antiretroviral therapy (ART). Although self-reported adherence was high, over one-third of those prescribed ART had no detectable antiretroviral drugs (ARVs) at the study's conclusion. ARV detection was significantly associated with study site, higher income, and experienced homophobia. The highest adherence rates were observed at the site offering direct, integrated treatment, underscoring the potential of "one-stop shop" services to mitigate intra-, interpersonal, and structural barriers. Despite a supportive study environment, gaps remain in linking MSM and transfeminine individuals to sustained HIV care and ART adherence. Given the urgency of addressing HIV among these populations, targeted interventions that promote engagement in care and adherence to treatment are critical.

In 2016, Botswana changed the policy to institute universal "test and treat" (UTT) in people with human immunodeficiency virus or HIV (PWH). It is unclear whether these policy changes have yielded any clinical benefits or harms. We conducted a retrospective cohort analysis of PWH aged ≥18 years to compare patient outcomes in individuals who received antiretroviral treatment (ART) under (1) the introduction of UTT and (2) rapid versus delayed ART start, at two clinics in Gaborone, Botswana, between 2014 and 2020. Multivariate logistic regression and propensity score models were used to control for potential confounding and selection bias. Of the 2008 participants who had a complete plasma HIV RNA at 1 year following ART initiation, 59 (2.9%) experienced virologic failure, and 665 (33.1%) were lost to follow-up (LTFU). Higher LTFU was recorded in UTT than in delayed ART period (43% vs 31%, p < 0.001); the same trend was upheld on further examination treating all LTFU as treatment failure (47% vs 37%, p < 0.001). In adjusted models, neither the UTT policy: odds ratio (OR) 1.91 [95% confidence interval (CI): 0.90, 3.56] nor rapid ART start: OR 1.31 (95% CI: 0.75, 2.34) was associated with viral failure. UTT was not associated with LTFU: OR 1.04, 95% CI (0.75, 1.45). Missed clinic visits were associated with viral failure regardless of policy period: OR 1.17 (95% CI: 1.03, 1.31) or rapid start: OR 1.20 (95% CI: 1.07,1.35). Neither UTT policy nor rapid ART start was associated with any one of the composite unfavorable outcomes. However, missing clinic visits was an independent risk factor for unfavorable outcomes.

Substance-using men who have sex with men (MSM), especially those in rural areas, face a heightened risk of HIV and sexually transmitted infections (STIs). Despite increased risk, uptake of HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), and doxycycline post-exposure prophylaxis (Doxy-PEP) remains low among rural MSM. The multi-domain factors influencing past-year use of oral PrEP, PEP, and Doxy-PEP among substance-using MSM in the rural southern US remain unknown. A cross-sectional study of rural substance-using MSM (n = 345) in the Southern US was conducted from February 29 to March 23, 2024. Three series of bivariate and multivariate logistic regression analyses were conducted. Past-year PrEP use was significantly associated with HIV-negative status (adjusted odds ratio [aOR] = 2.55, 95% confidence interval [CI]: 1.12-5.80, p = 0.025), past-year STI diagnosis (aOR = 2.23, 95% CI: 1.19-4.15, p = 0.012), past-year HIV testing (aOR = 3.40, 95% CI: 1.05-10.9, p = 0.040), and past-year STI testing (aOR = 10.09, 95% CI: 2.25-45.37, p = 0.003). Past-year PEP use was significantly associated with past-year STI diagnosis (aOR = 3.70, 95% CI: 1.33-10.32, p = 0.012) and oral sex (aOR = 0.09, 95% CI: 0.01-0.63, p = 0.015). Finally, past-year Doxy-PEP use was significantly associated with past year-STI diagnosis (aOR = 4.44, 95% CI: 2.03-9.71, p < 0.001). Results underscore the need for integrated care across primary care, pharmacy, and substance use treatment settings to improve screening, education, and prescription of HIV/STI preventative biomedical pharmaceuticals for substance-using MSM.

Men who have sex with men who use substances (SU-MSM) can benefit from pre-exposure prophylaxis (PrEP) for HIV prevention, especially in Southern US cities where HIV incidence is high; however, uptake remains low. Identifying barriers and facilitators is crucial for developing and implementing strategies to enhance uptake. Few studies of PrEP barriers and facilitators have focused on Southern SU-MSM, and most existing studies have not robustly measured such barriers and facilitators. In this study, 225 SU-MSM were recruited from community STI clinics, syringe services programs, or substance use treatment programs in eight Southern cities. Using structural equation modeling, we examined latent variable constructs of barriers and facilitators (i.e., affordability, burden, risk compensation, side effects, and stigma) and their associations with both willingness to take PrEP and length of PrEP use. Greater concern over affordability was robustly associated with more willingness to take PrEP under a variety of conditions. Risk compensation was associated with greater length of PrEP use, suggesting a major motivator to remain on PrEP was the perceived freedom to forego condoms during sex. Findings advance research on measurement of barriers and facilitators of PrEP willingness and uptake and highlight the importance of addressing affordability in PrEP implementation.

Early in the Mpox outbreak, individuals presenting for Mpox testing often did not receive comprehensive sexually transmitted infection (STI) screening upon presentation. This study aims to assess the impact of targeted outreach on linkage to STI and HIV screening and HIV pre-exposure prophylaxis (PrEP) counseling for individuals presenting for Mpox testing. Individuals who had tested for Mpox were contacted via an existing STI outreach team in Dallas, Texas, to engage in STI/HIV screening and other preventive services between June 2022 and March 2023. On retrospective chart review, 414 individuals were tested for Mpox with 203 PCR-confirmed cases. 238/414 (58%) were previously diagnosed with HIV. 76/176 (43%) of individuals with unknown HIV status were screened for HIV, and six new cases of HIV were identified. One-third (136/414) were also tested for other STIs (chlamydia, gonorrhea, or syphilis), with 45 new cases identified. 94/414 (23%) individuals were contacted for outreach after initial Mpox testing. Patients who received outreach were more likely to be tested for HIV (10/26 [38.4%]) compared with those who did not receive outreach (19/144 [13.3%]) (p < 0.001) and more likely to undergo additional STI testing (58/94 [62%] vs. 109/320 [34%]) (p < 0.001). More individuals in the outreach group were counseled on starting PrEP than in the non-outreach group (14/26 [53.8%] vs. 8/144 [5.6%]) (p = 0.0016). Targeted outreach increased screening for HIV and other STIs and counseling for PrEP among patients presenting for Mpox testing. Strategies to increase linkage to preventive services are needed to reduce coinfections of Mpox, HIV, and other STIs.

African immigrants in the United States experience increased HIV risk due to social and structural barriers such as language constraints, stigma, and cultural misconceptions. Despite this, research on effective pre-exposure prophylaxis (PrEP) messaging tailored to this population remains limited. This study examines how PrEP communication can be adapted to meet the needs of Ghanaian immigrants who represent a segment of the larger African immigrant population. Semistructured interviews were conducted, transcribed verbatim, and analyzed using NVivo 12. The analysis highlights key considerations for effective PrEP messaging, including the importance of cultural and linguistic relevance, the role of familiar and relatable messengers, and the need for clear and practical information. Participants emphasized the significance of addressing stigma and misinformation with factual, empathetic messaging and expressed a preference for ongoing community-based education about PrEP. Community leaders and health care professionals were identified as influential sources of information, capable of shaping attitudes and increasing uptake. These findings underscore the necessity of culturally tailored, community-driven approaches to PrEP messaging that bridge linguistic and cultural gaps. Integrating these insights into health communication strategies can improve awareness, acceptance, and utilization of PrEP among Ghanaian immigrants, ultimately contributing to more equitable HIV prevention efforts.

In 2022, cisgender women accounted for one in five HIV diagnoses in the United States. Existing structural, social, and behavioral factors impede women's engagement with HIV prevention strategies including Pre-Exposure Prophylaxis (PrEP) access, condom usage, and uptake of HIV testing. This study explores the perspectives of women living with HIV (WLWH) about factors that may contribute to HIV acquisition and their advice for women who may benefit from HIV prevention strategies. We conducted semistructured interviews with 40 WLWH who were diagnosed on or after January 1, 2000. Interviews were conducted via Zoom and lasted 45-60 min. Interviews were professionally transcribed, coded, and analyzed to identify themes. Guided by the AIDS Risk Reduction Model, this study uses qualitative findings to describe the steps for recognizing and reducing HIV vulnerabilities. The analysis revealed three themes: (1) recognizing HIV risk for oneself and partner, (2) commiting to decreasing HIV risk, and (3) enacting HIV risk reduction strategies. After recognizing the personal and partner characteristics associated with increased HIV risk and committing to reducing that risk through self-love, relationship assertiveness, and boundary setting, women will be better prepared to enact risk reduction strategies. The four most commonly discussed strategies by WLWH included HIV testing, condom usage, PrEP, and avoiding drug use. This study highlights the importance of understanding the experiences of WLWH to inform effective HIV prevention strategies. Insights from these women emphasized the need for increased awareness, empowerment, and accessible resources to support HIV risk recognition and reduction among women.

HIV pre-exposure prophylaxis (PrEP) is underutilized in the United States. Emergency departments (EDs) can be strategic locations for initiating PrEP; however, knowledge concerning patients' receptivity to ED PrEP programs is limited. This study explores ED patients' perspectives on PrEP service delivery and their preferences for implementation. Semi-structured qualitative interviews were conducted with 15 potentially PrEP-eligible ED patients to examine their receptiveness to PrEP services, preferences for delivery methods, and logistical considerations. Most participants were open to learning about PrEP in the ED, provided it did not delay care, occur during distress, or compromise privacy. Universal PrEP education was viewed as reducing stigma and increasing awareness, while targeted screening was considered efficient. Participants strongly preferred receiving information in person rather than via videos or pamphlets. Concerns included ensuring ED staff expertise and maintaining privacy during PrEP-related discussions. Opinions on initiating same-day PrEP versus prescriptions or referrals varied, with participants valuing flexibility and linkage to care. This first qualitative study of ED patients' perspectives on PrEP services highlights general receptiveness, with key concerns about privacy, expertise, and wait times. Patient-centered approaches, such as integrating services into ED workflows, offering flexible initiation options, and providing privacy, can address barriers and enhance the feasibility of ED-based PrEP programs.