AIDS patient care and STDs最新文献

Indonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals' decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiving and holding fatalistic beliefs was linked to postponed ART initiation. Conversely, perceiving religion as loving and forgiving, seeking forgiveness through religious practices, viewing ART intake as a "collaborative" effort with God, and engaging in righteous deeds facilitated ART initiation. These findings indicated that religion, faith, and spirituality can serve as both barriers and facilitators to ART initiation, depending on individuals' faith-based practices and perceptions of religion, whether punishing or forgiving. We recommend that people with HIV and health care providers better recognize the role of religion, faith, and spirituality in coping with shame, guilt, and stigma after an HIV diagnosis. This recognition can facilitate informed decisions regarding ART initiation, ultimately improving health outcomes for individuals with HIV in Indonesia.

Homelessness adversely impacts continuity of care for people with HIV (PWH). The POP-UP program is a low-barrier drop-in care model embedded within an HIV clinic in San Francisco and is designed to serve PWH experiencing homelessness. We conducted a pilot study of mobile outreach for PWH in POP-UP who remain out-of-care despite the drop-in program. We conducted a mixed-methods study to evaluate the effectiveness of mobile outreach through a retrospective cohort of PWH eligible for this outreach and semistructured interviews. Patients with POP-UP were eligible for outreach if they had (1) HIV viral load ≥200 copies/mL and no visit in ≥30 days, (2) no clinic visit in ≥180 days, or (3) urgent re-engagement need identified by the clinic team. We report the proportion of patients re-engaging in clinic-based care within 30 days and thematic findings from semistructured interviews with patients who experienced mobile outreach. Of 74 patients eligible for outreach, 55 were outreached, 48 located, and 30 returned to clinic within 30 days. Most were currently housed in a single-room occupancy hotel (39%) or permanent supportive housing (25%), 87% had a substance use disorder, and 51% had a mental health diagnosis. Qualitative findings highlighted the value of mobile outreach in terms of interpersonal relationships with the clinical team and the perception that outreach was a helpful nudge to return to clinic. Among PWH with housing instability who are out-of-care despite access to drop-in clinic-based services, mobile outreach was acceptable and promising for locating patients and facilitating care re-engagement.

This mixed-methods study explored self-image among people with HIV participating in an HIV cure-related study involving analytical treatment interruptions (ATIs). Using both quantitative and qualitative approaches, we described how self-image emerged across study participation, focusing on internalized stigma, emotional strengths, and the psychosocial dimensions of study participation. Data come from the SCOPE-ATI substudy (NCT00187512) of the University of California San Francisco SCOPE cohort (NCT04359186). Quantitative data were collected at three timepoints: pre-ATI (n = 15), post-ATI (n = 12), and end of the study (n = 14). We observed a general decline in self-image scores over time. However, participants maintained a moderately high agreement with statements about contributing to reducing HIV stigma through their involvement in the study. Qualitative interviews were collected pre-ATI (n = 11), during ATI (n = 8), and post-ATI (n = 6). Qualitative findings revealed two major themes shaping self-image: (1) experiencing and reconciling internalized HIV stigma and (2) self-evaluations in relation to life purpose. Many participants expressed disappointment at having to resume antiretroviral therapy, viewing it as a reminder of their HIV status and its associated stigma. Nevertheless, some found purpose and pride in their participation, motivated by altruistic contributions to improving future HIV control options. The findings highlight the emotional complexities of participating in HIV cure research and underscore the need for psychosocial support throughout ATI studies. While most participants experienced a decline in self-image, some derived meaning and empowerment from their involvement. This study suggests that addressing emotional well-being and reinforcing participants' contributions to science can enhance their experience in future research.

Interventions that leverage telehealth technologies have the potential to improve health outcomes among people with HIV who experience multiple complex barriers to care. To assess the current state of knowledge on telehealth interventions for people with HIV in the United States, we searched the literature for recent (2019-2023) telehealth interventions designed to improve outcomes along the HIV care continuum, including linkage to care, retention in care, antiretroviral therapy adherence, and viral suppression. Our search identified 23 interventions. Text messaging was the most common telehealth delivery mode, followed by videoconferencing, commercially available applications, and novel applications. Nine interventions used more than one delivery mode. Common features across interventions to address barriers along the HIV care continuum included: HIV care self-management and monitoring tools; HIV treatment and adherence education; resources and referrals provision; live messaging for ongoing support or urgent issues; videoconference-based coaching, counseling, case management, or care; online peer-to-peer support; ecological momentary assessments to monitor and address barriers; and game-based elements to increase engagement. Interventions were reported as acceptable and feasible, with several showing an effect on antiretroviral therapy adherence. Further research is needed to fully leverage the potential of telehealth for ending the HIV epidemic in the United States.

This study aims to investigate the mediating role of positive coping in the relationship between physical activity and psychological distress (PD) among people living with HIV/AIDS (PLWHA) in Henan, China, and to explore the moderating factor regarding this relationship. A cross-sectional study was conducted among 517 PLWHA, recruited from four cities in Henan province. Path analysis was employed to examine the mediating effect of positive coping in the link between physical activity and PD. Additionally, a moderated mediation analysis was performed to assess the moderated effect on this relationship. The indirect effect of physical activity on PD via positive coping was statistically significant (β = -0.02, SE = 0.01, 95% confidence interval (CI) [-0.04, -0.01], p < 0.05), confirming partial mediation. The total effect of physical activity on PD was significant (β = -0.10, SE = 0.03, 95% CI [-0.16, -0.04], p < 0.05). Infection duration moderated the mediation effect, with a stronger impact of positive coping on reducing PD observed in participants with an infection duration of less than 10 years (β = -0.52, SE = 0.16, p < 0.001 for <5 years; β = -0.38, SE = 0.12, p < 0.001 for 5-10 years). Physical activity plays a pivotal role in reducing PD among PLWHA by promoting positive coping mechanisms. These findings highlight the importance of incorporating physical activity interventions early in the disease progression, as this may enhance coping skills and mitigate PD.

The Centers for Disease Control and Prevention recommends universal human immunodeficiency virus (HIV) screening in emergency departments (EDs) for patients (above 13 years). In 2017, Jackson Health System (Miami, FL) established a successful adult ED-based universal opt-out HIV screening program. However, when expanded to its affiliated pediatric ED (PED) as an opt-in protocol, only 1.3% of all adolescents received universal screening (only 1.7% were tested based on their chief complaints). We explore barriers to PED testing by comparing the attitudes of providers, patients, and caregivers. Institutional review board-approved surveys were administered anonymously to each group. Raw aggregate data were analyzed for trends. Providers' responses were stratified by role and responses were compared via a Mann-Whitney test. Twenty-four providers responded; they agreed that testing is warranted (x = 3.58 σ 1.32) and not time-consuming (x = 2.33 σ 1.05). There was no agreement on the perceived role of providers to perform testing. Attendings reported a high chance of breaching patients' confidentiality (x̄ = 3.27 σ 1.35), while nurses did not (x̄ = 2.33 σ 1.51). Of the 62 patient responses, 62.9% were amenable to testing, 69.4% would consent to 4th-generation serum testing if less invasive options (e.g., oral swabs) were unavailable, and 77.4% would inform caregivers of results. Of the 37 caregiver responses, 91.9% felt comfortable with their child consenting to testing. In this population, patients and caregivers appear amenable to universal screening. Low testing rates may be explained by providers' disagreement on their role to perform testing and concerns about confidentiality. Future studies should further explore protocol-based flaws and providers' views.

As HIV diagnoses continue to decrease and rates of viral suppression increase in the United States, key populations of underserved individuals represent a disproportionate share of those left undiagnosed, unengaged in care, and not virally suppressed. In 2021, the Health Resources and Services Administration's HIV/AIDS Bureau funded 20 HIV care organizations across the United States to implement seven innovative evidence-based interventions to engage individuals in the following four focus areas: LGBTQ+ youth, people with substance-use disorder, individuals with incarceration experience, and those for whom telehealth may reduce barriers to care. This article explores themes of implementer experiences common across interventions serving the four focus areas. Data sources include key informant interviews (n = 94) with members of the implementation teams, observation, and document review. Thematic analytic methods were first inductive, identifying semantic themes from observation and document review, then deductive, selecting coded interview data for analysis of latent themes present and salient across focus areas. We identified three main themes as follows: (1) challenging by design, (2) enhanced client-centered care, and (3) leveraging relationships. We present these themes as distinct concepts and discuss how they operate in relation to one another using the Exploration, Preparation, Implementation, Sustainment framework. Teams implementing interventions to engage people with HIV who remain out of care may benefit from adopting the following: an enhanced client-centered orientation with a focus on understanding the context of clients' lives; a high level of organizational and programmatic flexibility; an individualized, trauma-informed approach to enrollment and intervention delivery; and thoughtfully cultivated relationships among implementers, clients, and organizational partners.

Bacterial sexually transmitted diseases (STDs) remain prominent in the United States among gay, bisexual, and other men who have sex with men (GBMSM). Doxycycline for post-exposure prophylaxis (DoxyPEP) is a regimen by which the antibiotic doxycycline is taken after sex to prevent bacterial STDs, such as, chlamydia, gonorrhea, and syphilis. Despite this, this study was conducted because there are a limited number of publications that describe GBMSM's knowledge of, and interest in, taking DoxyPEP and preferences regarding its implementation. We conducted a mixed-methods study between November 2023 and March 2024. Participants (N = 21) completed a semi-structured interview and survey and were eligible if they were a cisgender man who reported having anal sex with another man in the past year and lived in the greater Los Angeles area. Interviews were recorded and transcribed and were analyzed using thematic content analysis. The majority of participants identified as gay (90%) and a racial/ethnic minority (86%); 33% were living with HIV and 43% had been diagnosed with an STD in the prior year. Participants' mean age was 40 years (standard deviation [SD] = 15) and they reported an average of 4.5 (SD = 2.27) sexual partners in the past year. Interviews revealed that knowledge of DoxyPEP was low (28%), but most (81%) were interested in using DoxyPEP after learning about its potential. The vast majority were willing to pay $10-$20 for a 1-month supply but preferred that it be free or covered by insurance. Most preferred to get DoxyPEP from a medical provider or over-the-counter at a pharmacy. Others suggested sexualized venues, such as private sex parties, bathhouses, sex clubs, etc. The greatest concerns about its use included possible side effects, antibiotic resistance, or that it would lead to decreased condom use and increased number of sex partners. A common misconception was that DoxyPEP could prevent both a bacterial STD and HIV. DoxyPEP has strong potential as a widely accepted STD prevention method, but its successful adoption will require proactive strategies to increase GBMSM's knowledge. Implementation programs might consider nontraditional venues where sex between men is regularly occurring.