AIDS patient care and STDs最新文献

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.

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.