AIDS and Behavior最新文献

Despite freely available oral HIV pre-exposure prophylaxis (PrEP), HIV incidence among young men in South Africa remains high. This study explores the impact of alcohol use on PrEP initiation and continuation among South African men. We performed a secondary data analysis from a trial involving men aged 16-29, randomly selected in KwaZulu-Natal. Participants were referred to sexual health services, and those who were HIV negative and sexually active were offered oral PrEP. Alcohol consumption was categorized using AUDIT-C criteria as no/low risk (0-3) and hazardous alcohol use (4-12). Primary outcomes were PrEP initiation and continuation, defined as refilling prescriptions for ≥ 4 months. Logistic regression models adjusted for clinical and demographic confounders estimated relationships between PrEP initiation/continuation and alcohol use. Among 325 men analyzed, average age was 22.9 years (SD 3.6), with 146 (45%) reporting hazardous alcohol consumption. PrEP initiation was greatest among the hazardous/very-high risk group (40%), with the lowest uptake among men who do not use alcohol (17%). In multivariate analyses, those with hazardous alcohol use remained more likely to initiate PrEP compared to those with no/low risk alcohol use (aOR 1.96, 95%CI 1.13-3.40; p-value = 0.017). Only 27% (24/88) remained on PrEP at 4 months, with continuation similar between alcohol use groups (aOR 1.56, 95%CI: 0.47-5.12, p = 0.47). Hazardous alcohol use is prevalent among men in rural South Africa and associated with increased PrEP initiation. However, overall PrEP continuation was low and consistent across alcohol use levels. Hazardous alcohol use should not deter PrEP implementation efforts to engage young men.

Most research assessing human immunodeficiency virus (HIV) anxiety relies on single-item measures or psychometric measures that are outdated in terms of concepts and language. There is a critical need for a robust, reliable, and contemporary measure to identify populations at risk of avoiding HIV testing, treatment, and prevention, thereby supporting global HIV eradication goals. Focus groups informed the initial development of the HIV Anxiety Scale (HAS), revised through expert feedback. The factor structure was assessed in two studies. In Study 1, an Exploratory Factor Analysis (EFA) was conducted with 251 participants. In Study 2, a Confirmatory Factor Analysis (CFA) with 200 participants was performed alongside validity, internal consistency, and measurement invariance assessments. Studies 1 and 2 elicited a 3-factor model, resulting in a 16-item measure with the following subscales: Psychosocial Implications of HIV, Lifestyle Implications of HIV, and HIV Testing Anxiety. The HAS demonstrated a good factor structure, acceptable validity and excellent internal consistency across diverse groups in Study 2. The HAS provides a contemporary, robust measure of HIV anxiety, addressing limitations of previous tools and contributing to efforts to identify and support populations at risk of HIV avoidance behaviours. We recommend that future research continue to validate and test this new measure, but it offers a standardised tool to inform targeted interventions for HIV testing, prevention, and treatment.

Human immunodeficiency virus (HIV) is still an important global health burden and remains a common sexually transmitted infection (STI). Voluntary Counselling and Testing points (VCTs) in Poland allow free and anonymous access to HIV testing among the adult population. The aim of the study was to investigate whether there is an increased occurrence of HIV infection among individuals who identify as homosexual and to profile three distinct groups among VCTs clients: the most common patient coming for testing, the most frequent HIV-positive individual, and the most typical Pre-Exposure Prophylaxis (PrEP) user. Data obtained from 29 VCT points in Poland between 2015 and 2023 were retrospectively analyzed. The prevalence of HIV infection in this cohort was calculated and a model for HIV infection risk among various populations was built. 295,556 patient reports revealed that heterosexual men aged 25-34 years (13.43%) tested most frequently. In total, the average prevalence of HIV-positive patients amounted to 1.36%. Among the tested population, HIV infection was the most prevalent among homosexual men aged 25-34 (0.34%). Moreover, we showed that the risk of receiving a positive HIV result was almost five times higher among homosexual and bisexual patients than among heterosexual individuals. The findings highlight the urgent need for targeted HIV prevention efforts, particularly among homosexual and bisexual men. Ongoing monitoring and education are necessary even among PrEP users to prevent new infections.

This study aimed to decrease viral load (VL) to increase viral suppression (VS) among youth living with HIV (YLH) ages 12-24. This study was a stepped care randomized controlled trial. Sixty-eight YLH with established infection, without VS, and with at least two follow-ups (N = 68) were randomized to a control condition (n = 25) or a stepped care intervention (n = 43), and repeatedly assessed for up to 24 months. Both conditions received referrals for health services and a daily automated text-messaging and monitoring intervention (AMMI). YLH in stepped care who were unsuppressed at 4-month assessments stepped up to peer support and later to coaching. Random effects regressions examined VL trajectories over time as well as trajectories of secondary outcomes. There was significant evidence suggesting a different longitudinal trajectory of VLs for the two conditions. The control condition had improved VLs at about 12 months and then started to return to higher VLs. The stepped-care condition improved over the same time period and remained relatively stable. We estimated that the average VL was lower in the stepped care condition at 24 months, but we cannot claim a statistically significant difference between conditions. Both intervention groups appeared to have positive intervention impacts suggesting some benefits of the AMMI intervention. The improvement in VL at 24 months for stepped care compared to the control condition are suggestive of a viable intervention strategy that warrants further study.

This study evaluated the usability of a mobile health application for persons with HIV (PWH) in the District of Columbia (DC) area in preparation for a pragmatic cluster randomized efficacy trial of the PositiveLinks (PL) app. Fourteen participants from the DC Cohort, a multi-site longitudinal prospective HIV cohort study, participated in Think-aloud usability testing. Participants viewed a demonstration version of the PL app and narrated their thoughts, impressions, navigation, and comments as they moved through the app functions. A second set of fourteen DC Cohort participants used the PL app for a one-month period of Beta testing to identify any bugs or glitches, then completed an in-depth interview and System Usability Survey (SUS). A majority of participants identified as male and non-Hispanic Black. Qualitative data from the Think-alouds and Beta testing interviews were audio recorded, transcribed and analyzed in Dedoose using an iterative approach. Think-aloud and Beta testing showed that users viewed the app positively and considered it to be user- friendly. Participants particularly liked the daily reminders and ability to communicate with peers with HIV and their HIV care team. Although most participants reported no dislikes, they requested more customization and more resources. The app achieved a high mean SUS score of 76 and high response rates for app features. No bugs or glitches were identified. The version of PL to be used by participants in the DC Cohort was well liked and highly usable, and participant input informed optimization of the app prior to launching the efficacy trial.

Sexually transmitted infections (STIs) are a global health concern. Blood donation centres employ comprehensive screening measures to identify donors with STIs, such as HIV, HBV, HCV, and syphilis, which can also transmitted through blood transfusions. Herein, we investigated the seroprevalence of STIs and demographic determinants related to multiple infections among rejected blood donors at the National Blood Transfusion Service (NBTS) in Angola. This was a cross-sectional study conducted with 1885 rejected blood donors serologically screened for anti-HBsAg, anti-HCV, anti-HIV, and anti-TP during pre-donation screening at the NBTS, located in Luanda, the capital city of Angola, between March 2022 to July 2023. Overall, HIV (11.2%), HBsAg (71.7%), HCV (9.30%), and Syphilis (8.80%) were detected. The multiple infection rate was 2.30%. HIV and syphilis were associated with age (p < 0.05). HBV was related to age, areas of residence, and occupation (p < 0.05). HCV was related to areas of residence and educational level (p < 0.05). No relationship was observed between demographic characteristics with multiple infections (p > 0.05). Individuals aged over 40 years (OR: 2.48, p = 0.393), males (OR: 1.33, p = 0.639), non-urbanized regions (OR: 1.18, p = 0.594), low educational level (OR: 3.46, p = 0.222), and employed (OR: 1.34, p = 0.423), were more likely to have multiple infections. Our results demonstrate a high rate of circulation of STIs among blood donation candidates in Luanda. HBV was the main reason for the rejection of candidates. However, nucleic acid-based screening techniques should be considered to ensure better quality screening for occult infections in blood donor candidates.

Female Sex Workers (FSW) and men who have sex with men (MSM) in Kenya remained disproportionately burdened by HIV. Our study aims to estimate trends in HIV incidence and identify characteristics associated with the rate of infection among these populations over the past decade. Data were collected at Sex Workers Outreach Program (SWOP) in Nairobi County from 2009 to 2021. We included records of 3,595 FSW and 581 MSM with a negative HIV test at enrolment and at least one follow-up test. We compared survival time between MSM and FSW using the Kaplan Meier log-rank test and used multiple Poisson regression to estimate incidence rate ratios. A steady decline in HIV infection was observed from 2009 to 2019 but increased in 2020 and 2021. The crude incidence rate was 1.46 (95% CI: 1.29-1.65) cases per 100 person-years. The incidence rate among MSM was 8.08 (6.73-9.69) per 100 person-years and 0.8 (95% CI: 0.7-1.0) per 100 person-years of follow-up among the FSW. In multivariate analysis, MSM had 16.14 times the risk of HIV infection compared to FSW (95% CI: 9.20-28.32), with relative risk declining in older age groups until over 50, where MSM and FSW experienced similar risk. For every successive year since 2009, the risk of HIV infection declined (annual IRR:0.73, 95% CI: 0.71-0.75). Continued and accelerated efforts targeted at MSM and FSW are needed to ensure the observed decline in HIV incidence continues in line with the UNAIDS-2030 global targets.

Human immunodeficiency virus (HIV) remains a public health issue in the U.S., affecting approximately 1.2 million individuals, many of whom are unaware of their infection status. This study reviews predictors and the performance of HIV risk prediction models. We analyzed 18 studies published since 2010, which featured logistic regression, survival analysis, and machine learning techniques. These studies focused on diverse populations, including men who have sex with men, emergency department visitors, and the general population. Key predictors of HIV risk included demographics (age, sex, race) and behavioral factors (sexual practices, drug use). Electronic health records (EHR) documenting diagnoses of sexually transmitted infection (STI) were significant in all models. Behaviors like condomless sex, multiple sexual partners, and drug use were also strongly linked to increased risk scores. However, we noted a lack of social determinants of health in risk models, and a gap in studies focusing on cis female and transgender populations.

HIV cluster detection and response (CDR) provides a framework for identifying rapid HIV transmission and guiding implementation of proven HIV prevention and care strategies. Characterizing the relative benefits of CDR is important for guiding policy makers in resource allocation for HIV prevention. We sought to understand how many HIV infections would need to be averted by CDR activities to achieve various return-on-investment (ROI) thresholds. We conducted an ROI analysis of CDR in 2022, incorporating costs and benefits across US jurisdictions funded for HIV surveillance and prevention. Setting ROI thresholds between 1 and 5, we estimated the number of HIV infections that would need to be averted annually by CDR activities to reach ROI thresholds. A scenario was considered cost saving if the ROI > 1. Based on the number of people in national priority molecular clusters and estimated transmission in these clusters, we determined the percent reduction in transmission within these clusters that would be required to achieve the threshold number of HIV infections averted. The number of HIV infections needing to be averted annually ranged from 19 infections (ROI = 1) to 94 infections (ROI = 5). Among 657 HIV transmissions within national priority molecular clusters, the percent reduction in HIV transmission needed to meet ROI thresholds ranged from 2.9% (ROI = 1) to 14.3% (ROI = 5). In conclusion, CDR activities would need to avert a minimal number of HIV infections nationally to achieve cost savings.

Russia has an estimated 1.3-1.8 million people who inject drugs (PWID). In recent years concomitant decline of opioid use and rise of new psychoactive substances (NPS) use was observed. We conducted secondary analysis of survey data collected in 2019-2021 by a harm reduction organization in Saint-Petersburg, Russia (n = 978). Older PWID group (30+) was significantly more likely to use opioids (87.5% vs. 32.4%) than young PWID; young PWID used NPS four times more frequently than older ones (79.9% vs. 21.5%). The odds ratio of being an exclusive stimulant user but not an opioid user among younger cohorts is more than forty-five times higher than among older cohorts all else being equal (AOR = 47.38; 95% CI 21.90-102.53; p < 0.001). The younger respondents were more than four times less likely to be HIV-positive than older participants (8.4% vs. 36.7%) and more than three times less likely to be HCV-positive (23.5% vs. 80.6%). Young PWID were significantly more prone to risk behaviors (syringes sharing in past month; having overdose in the last 12 months; and inconsistent condom use during past 3 months) than older PWID, which renders them vulnerable to rapid HIV and HCV transmission both by parenteral and sexual routes. It is possible that currently we are observing two epidemics- an "old" opioid epidemic among older generations of PWID and a new synthetic cathinones epidemic among younger generations of PWID. New forms of harm reduction tailored to the needs of NPS users along with expansion of existing harm reduction programs for opioid users are urgently needed.