AIDS patient care and STDs最新文献

High HIV incidence in the US South disproportionately affects adolescents, young adults, and Black women. Using a community-engaged approach and intervention mapping, we developed PrEP-Pro, an intervention to support family medicine physician-trainees to elicit a sexual history from and provide pre-exposure prophylaxis (PrEP) to adolescents, with special emphasis on engaging with Black adolescent girls and young women (AGYW). Intervention content includes PrEP curricula, adaptations to the Centers for Disease Control and Prevention (CDC)'s sexual history tool, and a PrEP Champion training program. Two community advisory boards (CABs)-one consisting of PrEP Champions and physicians, the other of AGYW-and two focus group discussions with physicians (N = 7) informed intervention content. We pretested PrEP-Pro at two sites over 3 months and assessed acceptability, appropriateness, feasibility. The provider CAB advised multiple training strategies: (1) locally informed sexual history videos; (2) HIV epidemiology review; (3) quick-reference badge and pocket cards on PrEP and eliciting sexual histories; (4) didactic, case-based content; (5) web-based content. The AGYW CAB informed development of (6) a sexual history screener and (7) clinic posters emphasizing confidentiality for adolescent clients. Across two family medicine residency programs, eight physicians participated in the 3-month pretest of the intervention. Acceptability (mean = 4.16/5 [standard deviation (SD) = 1.36]), appropriateness (4.16/5 [1.36]), and feasibility (4.19/5 [1.37]) were high. Six physician interviews informed adaptations including fostering a community of practice, increased case-based learning, and quick-reference card content modifications. We combined theory-driven and evidence-informed components to adapt and pilot PrEP-Pro to support physicians in discussing PrEP with adolescents. The adapted intervention was piloted across clinics to inform a future trial.

People living with HIV (PLWH) continue to experience longer life expectancy due to effective antiretroviral therapy (ART). However, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Despite improved HIV care, major adverse cardiovascular events (MACE) remain prevalent, with limited data from long-term cohorts. This study aimed to determine the incidence, risk factors, and predictors of MACE in long-term ACTHIV-IST cohort of PLWH in Istanbul. We conducted a retrospective analysis of 1059 patients followed for at least 10 years. Patients with prior MACE or noncardiac mortality were excluded. Traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities were analyzed using Cox proportional hazards regression. MACE incidence was 7.55% (80/1059) with a cumulative rate of 11.1%. The most frequent events were ischemic heart disease (30.4%), myocardial infarction (27.6%), and sudden cardiac death (18.6%). Among those without traditional CVD risk factors, a CD4⁺ count <200 cells/mm³ at diagnosis was associated with a 4.5-fold increased MACE risk. Hypertension (hazard ratio [HR]: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031/year) were the strongest independent predictors (p < 0.05). Patients who should have used statins but did not were at higher risk of developing MACE (34% vs. 17%) compared to those who did (p < 0.05). Twenty-one statin users of those who had MACE were before the event. A significantly higher MACE rate was observed in patients who used protease inhibitor (PI) compared to those who did not (p = 0.002). Low baseline CD4⁺ T-cell count, prolonged HIV duration, comorbidities (e.g., hypertension, CAD, and dyslipidemia), PI experienced, and older age at HIV diagnosis significantly increase MACE risk. Early diagnosis, continuous cardiovascular monitoring, start statins if indicated, and individualized ART strategies are essential to reduce MACE-related morbidity and mortality in PLWH.

As HIV outcomes continue to improve, disparities in viral suppression and care engagement persist, exacerbated by socioeconomic inequities, mental health stressors, systemic racism, HIV-related stigma, and other forms of discrimination. HIV care coordination programs address structural and psychosocial barriers to care and treatment, but these interventions must adapt to the evolving circumstances and perspectives of those expected to participate in them to achieve and sustain maximal impact. In 2009, the New York City Department of Health implemented a Ryan White-funded HIV Care Coordination Program (CCP). The CCP has demonstrated effectiveness, particularly among those newly diagnosed with HIV and those out of care or unsuppressed in the prior year. However, implementation challenges prompted a 2018 redesign to increase provider and client engagement. We conducted 30 semi-structured interviews with providers from six agencies delivering the revised CCP to examine barriers and facilitators to implementation. Providers highlighted the revised CCP's flexible, client-centered approach as a strength, allowing for personalized care plans and improved client engagement. Additionally, they emphasized the contributions of driven, committed staff. However, providers noted several barriers associated with the revised model or its implementation context, including increased paperwork burden, unrealistic service expectations, understaffing, and burnout from uncompensated emotional labor. Our findings suggest the value of retaining a client-centered model while streamlining administrative processes, enhancing training and support for providers, and increasing staff-client ratios. Adjustments based on providers' experience with a complex intervention can improve the fit of the intervention to its intended delivery settings and promote sustainability.

Delivering HIV testing and pre-exposure prophylaxis (PrEP) in community pharmacies can expand access to HIV services for populations with limited access to care. However, few pharmacies in the United States have successfully implemented these services. We investigated implementation barriers and facilitators of pharmacy-based HIV testing and PrEP initiation in Philadelphia, an Ending the HIV Epidemic priority jurisdiction with high rates of HIV and bacterial STIs, located in a state with relatively restrictive laws governing pharmacy scope of practice. Using a sequential, exploratory mixed-methods study design, we conducted 15 in-depth interviews with pharmacists and key implementing partners, followed by an online survey of pharmacists, pharmacy students, and technicians (n = 59). Interviews and surveys were analyzed using the Consolidated Framework for Implementation Research. Data were collected from October 31, 2023, to October 17, 2024. Interviewees representing three pharmacy sites had initiated HIV testing, but no sites had yet successfully implemented pharmacy-based PrEP. The primary barriers to delivering HIV testing were based on inner setting barriers (existing work burden, overly complex protocols). Legal restrictions and reimbursement concerns were the primary barriers to implementing pharmacy-based PrEP. Participants described potential solutions and mitigating strategies to these barriers, such as collaborative practice agreements and developing standing orders with medical providers, integration with telePrEP models, streamlined blueprints and protocols, and practice-based champions. Survey respondents indicated high levels of acceptability but lower levels of perceived implementation feasibility. To optimize implementation sustainability and success, implementation strategies need to adequately address legal barriers and reimbursement concerns and be integrated into the pharmacy workflow.

Injectable antiretroviral options for the treatment of HIV-1 infection have demonstrated the potential to reduce pill fatigue, improve medication adherence, increase patient satisfaction, and reduce stigma compared to oral antiretroviral therapy. In a recent non-randomized observational study, we previously examined safety and efficacy outcomes for participants who chose where to receive long-acting cabotegravir/rilpivirine over a 12-month period. This study demonstrated that at-home administration of long-acting cabotegravir/rilpivirine by a home health provider was comparably safe, effective, and associated with high satisfaction compared to in-clinic administration. To further understand the experience and impact of this intervention from the perspective of study participants, we analyzed quantitative end-of-intervention surveys and qualitative exit interviews offered to study participants after completion of the intervention. Using a grounded theory approach to analyze exit interviews, we conducted an iterative process of establishing codes, grouping the codes into key concepts, and organizing concepts into broader themes. We identified six broad themes related to the participant experience that involved (1) strengths of injectable therapy, (2) negatives of injectable therapy, (3) treatment setting preference, (4) reasons for preferring injectable therapy at home, (5) reasons for preferring injectable therapy in the clinic, and (6) general impressions related to injectable therapy. This work provides insight into patient perceptions and preferences regarding injectable HIV therapy, perspectives that will be important to consider for efforts designed to enhance accessibility of injectable HIV therapy and optimize the patient experience.

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.