AIDS and Behavior最新文献

The transition from adolescence to adulthood is a critical phase for young people living with perinatal HIV, who must navigate typical developmental milestones while managing a chronic illness and facing (fear of) societal stigma. This qualitative study explored the lived experiences of Dutch young adults (aged 20-30) with perinatal HIV, focusing on their transition to adulthood and from pediatric to adult care. Semi-structured interviews were conducted with 11 participants. While the findings are based on a small, self-selected sample and are not intended to be statistically representative, they offer in-depth insight into key challenges during transition. The findings highlight the profound impact of stigma and selective disclosure of HIV-status. Parental support was important but complex, especially when views on disclosure differed. Peer contact could provide a sense of connection, though many did not feel the need for ongoing involvement. Participants described challenges in social and professional contexts. Experiences with the transition to adult care varied, with more recent transfers being more positive. Valued key elements of transitional care included support from nurse specialists, meeting the adult provider beforehand, and a warm welcome in adult care. Despite stable medical management, the psychological burden of stigma and fear of disclosure remained significant. These findings underscore the need for tailored transition programs addressing medical, psychosocial and emotional needs, including psychological support, structured attention to family dynamics, pre-transfer meetings with adult providers, and peer support.

The Red Carpet Entry (RCE) program is an evidence-informed structural intervention to improve linkage to HIV care within 72 h of diagnosis. In this paper, we review a rigorous, novel approach for evaluating an implementation toolkit to support adoption and effective implementation of RCE. We fielded and evaluated an RCE implementation toolkit at two clinic sites over an 8-month period. We evaluated the toolkit by assessing implementation processes, contexts, and outcomes at each clinic site, and by surveying and interviewing key implementation staff (n = 9) to solicit their feedback on the toolkit routinely throughout program implementation. This study offers preliminary evidence that the toolkit can support effective implementation of RCE and bolsters evidence regarding the impact of RCE on linkage to care. Both clinics used the toolkit to implement the RCE program with a high degree of fidelity-clients received 85-100% of intended RCE services at the clinic sites. Moreover, as a result of implementing RCE, one site saw an improvement in linkage to care from 68% at baseline to 77% during the implementation period. Staff reported that toolkit components were well-designed for communicating key information but needed to be more succinct and easier to navigate to increase their utility for busy clinic staff. We refined the toolkit to incorporate key lessons learned from our evaluation. Toolkits, especially those that have been tested with program implementers and are informed by evidence regarding implementation and client outcomes, are a critical tool for supporting the integration of evidence-based practices into routine healthcare.

One of the key pillars of Ending the HIV Epidemic is ensuring adherence to oral HIV pre-exposure prophylaxis (PrEP). Men who have sex with men (MSM) who also have substance use disorders experience multiple challenges to maintaining PrEP adherence. We developed a digital pill system (DPS) linked to a personalized adherence intervention, PrEPSteps, to address barriers to PrEP adherence, and tested the feasibility and acceptability of this system, as well as its potential for an effect on PrEP adherence. We enrolled MSM with moderate to severe substance use disorder who were on oral PrEP in a two-arm pilot randomized controlled trial. Both arms received the DPS co-encapsulated with oral PrEP. Participants in the intervention arm also received "PrEPSteps" - a personalized cognitive-behavioral adherence intervention. Primary outcomes were feasibility and acceptability of DPS + PrEPSteps. To explore potential intervention effects, adherence changes from baseline to 3-month follow-up were compared across arms. At 6-month follow-up, adherence was assessed via self-report. Thirty-six participants were enrolled, 32, completed the run-in period, 28 were randomized, and 27 completed the 3-month intervention period. Of those, 26 completed six-month follow-up. Operation of the DPS and PrEPSteps was feasible, with consistent data recording throughout the 3-month intervention period. Qualitative interviews in the intervention arm at 3 months demonstrated PrEPSteps was acceptable. Intervention arm participants had 14% higher PrEP adherence (b = 13.67, 95%CI [.77-26.57], p = .039) at 3 month follow up. This effect persisted at six months, suggesting that PrEPSteps has the potential to improve PrEP adherence and help individuals sustain adherence benefits over time.Trial registration: www.ClinicalTrials.gov identifier: NCT03512418.

Despite Rwanda's progress in HIV prevention for key populations, female employees in alcohol-serving establishments (ASEs) remain underserved, with interventions often lacking attention to the contextual factors shaping their HIV risk and service uptake. Guided by the Exploration phase of the Exploration, Preparation, Intervention, and Sustainment (EPIS) framework, a qualitative study was conducted to identify contextual factors affecting HIV prevention uptake among young single mothers working in informal ASEs. In-depth interviews were conducted with 101 participants recruited through maximum variation purposive and snowball sampling. Data were analyzed thematically, with findings organized according to inner and outer EPIS contextual domains. Outer context findings revealed structural and socio-cultural barriers, including unaffordability of post-exposure prophylaxis and HIV self-testing kits, inconsistent condom availability, and gender norms limiting women's autonomy in sexual health decision-making. Inner context findings highlighted workplace-related challenges, such as limited support from establishment owners, absence of HIV prevention resources within venues, and the influence of male partners and clients on women's ability to negotiate safer sexual practices. Facilitators across both contexts included HIV risk awareness, fear of unintended pregnancy, and aspirations for improved economic and social futures for themselves and their children. By systematically examining contextual influences during the EPIS Exploration phase, this study addresses a critical gap in HIV prevention research among an underserved population. These findings can inform the development of context-responsive behavioral and structural interventions aimed at improving HIV prevention uptake and addressing workplace, social, and structural drivers of HIV vulnerability in ASEs.

Modern antiretroviral therapy (ART) regimens have increased life expectancy and improved quality of life in people with HIV (PWH). However, the necessity for lifelong ART use presents adherence and persistence challenges. Recent population-level data regarding such challenges with contemporary daily oral ART regimens are limited, particularly in the United States. This observational, retrospective, noncomparative cohort study used data from HealthVerity MarketPlace closed medical and pharmacy claims from PWH ≥ 18 years of age (treatment naive or treatment experienced) who were insured in the United States. Eligible PWH had ≥ 2 pharmacy refills for a Department of Health and Human Services (DHHS) guideline-recommended complete daily oral ART regimen between January 1, 2016, and November 30, 2023, with ≥ 365 days of continuous baseline enrollment and ≥ 180 days of follow-up. The index date was the date of the first recorded pharmacy claim for a complete ART regimen, regardless of prior treatment experience. Rolling adherence was measured using the Continuous, Multiple Interval Measure of Medication Acquisition method that compared the timing of prescription fills versus the number of days the prescription was intended to last, within blocks of 90 days. Suboptimal adherence was defined as proportion of days covered < 85%. Treatment interruption was defined as a gap in ART medication supply of > 90 days, followed by resumption of ART at any point, with combined treatment interruption/discontinuation defined as a > 90-day gap in ART medication supply, regardless of whether ART was restarted. Switching between DHHS guideline-recommended ART regimens and from DHHS guideline-recommended to nonguideline-recommended ART regimens was also evaluated. A total of 73,533 PWH were included in the study (60,062 [81.7%] treatment naive and 13,471 [18.3%] treatment experienced). The proportion of PWH on treatment for ≥ 1 year who remained adherent during all 90-day blocks decreased from 40.2% (95% confidence interval [CI], 39.6%-40.8%) by the end of Year 1, to 24.2% (95% CI, 23.7%-24.6%) at the end of Year 2, and to 17.7% (95% CI, 17.3%-18.1%) at the end of Year 3 when standardized by age group-sex-region. The standardized annual prevalence of suboptimal adherence remained relatively constant between 2017 and 2022 (46.7%-53.2%). The standardized proportion of PWH who persisted on daily oral ART without treatment interruption was 81.2% (95% CI, 80.8%-81.6%) after 1 year, 74.1% (95% CI, 73.7%-74.6%) after 2 years, and 70.6% (95% CI, 70.1%-71.1%) after 3 years. Switching between DHHS guideline-recommended daily oral ART regimens remained below 10% between 1 and 3 years of follow-up and was similar for switches from guideline-recommended to nonguideline-recommended daily oral ART regimens. The findings of this study suggest that suboptimal adherence to daily oral ART remains a challenge, even with the availability of modern regimens.

Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexually active TWTFP aged 15+. Recruitment occurred between 6/2022 and 10/2023 via social media advertisements for a cross-sectional online sexual health survey. Analyses included past-year PrEP naïve TWTFP with no prior HIV diagnosis (N = 1648). Participants reported LAI-PrEP willingness and ranked PrEP modality preferences; recent healthcare-related experiences were explored as correlates, using adjusted multivariable Poisson regression with robust variance estimation. Among respondents, 26.3% were willing to use LAI-PrEP (n = 433/1648). Among participants willing to use LAI-PrEP and another modality (n = 390/433; 90.1%), 45.6% (n = 178/390) preferred LAI-PrEP. Discussing sexual health with a healthcare provider (HCP) was associated with increased LAI-PrEP willingness (adjusted prevalence ratio [aPR] = 1.34; 95% confidence interval [CI] = 1.12-1.60; p = 0.001); use of oral prescription medication (non-hormonal) was associated with decreased LAI-PrEP willingness (aPR = 0.60; 95% CI = 0.38-0.93; p = 0.022). No significant associations were found between healthcare-related experiences and LAI-PrEP preference. Given that most TWTFP who were willing to use LAI-PrEP were also willing to use oral-PrEP, but nearly half preferred LAI-PrEP, offering multiple PrEP modalities is essential to meet their needs. Associations between sexual health discussions and increased LAI-PrEP willingness highlight the importance of HCP engagement; initiatives which encourage HCPs to initiate LAI-PrEP conversations in supportive ways are crucial. Associations between oral prescription use and decreased LAI-PrEP willingness, coupled with null findings related to injection use, highlight the need for further investigation.

We examined the association between educational attainment and HIV positivity among pregnant women in a high HIV-prevalence setting and assessed how this relationship varies by age to inform targeted prevention strategies. This cross-sectional study included 2003 pregnant women aged 21-44 years attending their first antenatal visit (<27 weeks' gestation) at four public health facilities in East London, South Africa, between March 2021 and May 2024. Educational attainment was categorized as pre-high school (< grade 10), high school (grades 10-12), diploma (post-high school), or degree (associate's or bachelor's). Age was categorized into four groups (21-24, 25-29, 30-34, and 35-44 years). HIV status was determined through routine antenatal testing. We used logistic regression to assess associations between educational attainment and HIV positivity, adjusting for age, partner's HIV status, and participant sexually transmitted infection (STI) status. Overall HIV prevalence was 31.0% (95% CI, 28.9%-33.0%). Compared with women with less than a high school education, the odds of HIV infection were lower among women who attained high school education (adjusted odds ratio [AOR], 0.59; 95% CI, 0.40-0.87), a diploma (AOR, 0.40; 95% CI, 0.24-0.67), or a degree (AOR, 0.21; 95% CI, 0.09-0.43). However, this inverse association was not observed among women aged 35-44 years. In conclusion, higher educational attainment was associated with lower HIV prevalence among pregnant women, but this protective association diminished with increasing age. HIV prevention strategies should account for both socioeconomic factors and age-related interpersonal dynamics influencing HIV vulnerability.