AIDS and Behavior最新文献

South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program provides community-based medication delivery for clinically stable people with HIV (PWH) on antiretroviral therapy (ART). To evaluate CCMDD implementation, we conducted semi-structured interviews with 60 PWH enrolled in CCMDD for at least 12 months. In a directed content analysis based on the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework, key themes were compared with qualitative data collected from PWH enrolling in CCMDD at an earlier time-point. Results indicated consistently positive views of CCMDD, primarily attributed to convenient and smooth medication pick-up. At the later (vs. earlier) time-point, participants discussed less clinic crowding, mentioned few medication errors, and noted improved communication around refills. Community HIV stigma was a persistent challenge, as was nurses' judgmental communication style. To ensure CCMDD's success, continued focus is needed on decreasing HIV stigma beyond the clinic context and improving provider-patient relationships.

After a decade of implementation in the US, PrEP uptake remains underutilized by communities that would greatly benefit from it. Event-Driven (ED) PrEP is a potential avenue to increase uptake, however very little is known about its use in the US. We analyzed data derived from Together 5000, an internet-based U.S. national cohort of Sexual and Gender Minority (SGM) individuals aged 16-49 years and at risk for HIV. First, we looked at predictors of ED PrEP use using a framework based on current US-based PrEP implementation-related variables. Then, we explored whether experiencing certain types of barriers were associated with choice of ED PrEP over daily PrEP using logistic regression analysis. Our findings showed that variables related to education and sexual behaviors were associated with ED PrEP choice, while experiencing barriers to daily PrEP had no effect. We found a gradient effect with education, where individuals who reported having some college had 3 times the odds of taking ED PrEP, those reporting a bachelor's degree had 3.25 times the odds, and those with graduate school education had 7.56 times the odds of choosing ED PrEP compared to those with a high school diploma or less. Individuals who reported having 2 or more hours of lead time for sex had 3.35 times the odds of using ED PrEP (aOR = 3.35, 95% CI 2.23-5.47). Participants who reported having an STI within the last 6 months had 60% lower odds of using ED PrEP (aOR = 0.4, 95% CI 0.2-0.72). The use of ED PrEP is a promising pathway for expanding PrEP due to its success and protection levels. Our studies indicated that educational background and behavior influence PrEP choice. Ensuring PrEP candidates and users have access to information about new PrEP types may increase uptake and support implementation efforts.

To improve the quality of life for people living with HIV (PLWH), it is vital their treatment plans closely follow the HIV care continuum. However, many barriers, such as mental health disorders (MHD), can complicate treatment. Patients being treated for HIV with comorbid MHD are more likely to not be retained in care and maintain an unsuppressed viral load. As PLWH and people vulnerable to acquiring HIV are more commonly diagnosed with MHD in comparison to the general population, it is important that steps to mitigate the possible effects of MHD are addressed during treatment. This study examines how minimal mental health care in a safety-net hospital system in the U.S. South can show benefits in retaining patients throughout their treatment of HIV. The results showed that older individuals retained a higher level of viral suppression when they followed up regularly with a mental health care provider during treatment. In addition, regardless of age, the higher the number of mental health care visits a patient attended during treatment, the higher the likelihood of viral suppression. By incorporating mental health care into the HIV treatment plan, the patients who met at least one of these criteria had better treatment outcomes and progressed further along the HIV care continuum.

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk environment framework, this case study adopted a mixed-methods design spanning two rapid assessment studies with PWUD in Lowell (n = 90) and Lawrence (n = 40), Massachusetts, during an HIV outbreak (2017, Study 1) and following the outbreak (2019, Study 2). Survey responses (n = 130) were summarized by computing descriptive statistics, ethnographic field notes were reviewed, and qualitative interviews (n = 34) were thematically analyzed to contextualize quantitative findings. Study 1 participants reported constrained syringe access, high injecting frequency, syringe reuse, and unsafe syringe disposal practices, and uncovered entrenched social and structural factors exacerbating existing substance use and HIV risks: housing instability, limited harm reduction supplies and services (e.g., MOUD access), and tensions between law enforcement and PWUD. Following the outbreak and substantial local investments in harm reduction and treatment infrastructures, Study 2 participants indicated lower injection risk reporting fewer syringe reuse episodes, improved syringe disposal practices, high frequency of naloxone administration at recent overdoses, frequent testing for HIV and HCV, and greater engagement with syringe services programs. A rapid assessment approach to fentanyl's emergence and a concomitant HIV outbreak provided time-sensitive, critical insights and identified needed and local response strategies. However, unless social and structural risk factors are also addressed, community vulnerability to future HIV outbreaks remains.

Behavioral economics research suggests poverty may influence behavior by reducing mental bandwidth, increasing future discounting, and increasing risk aversion. It is plausible these decision-making processes are further impaired in the context of HIV or pregnancy. In this cross-sectional study of 86 low-income women in Philadelphia, HIV was associated with lower mental bandwidth (one of two measures) and lower risk aversion. Pregnancy was not associated with any decision-making factors. In secondary analyses, viral suppression was associated with greater mental bandwidth (one of two measures), and antenatal clinic attendance with lower future discounting. Anti-poverty interventions may be beneficial to improve HIV-related health behaviors.

Recent studies have demonstrated the efficacy of doxycycline as post-exposure prophylaxis (doxy-PEP) for sexually transmitted infection (STI) prevention, but little is known regarding patient beliefs and interest in doxy-PEP. We conducted a cross-sectional survey of adults (≥ 19 years) receiving care for HIV treatment (PWH) or prevention (pre-exposure prophylaxis, PrEP) between May-October 2023. The 32-question survey was organized into three parts: doxy-PEP awareness/beliefs/interest/concerns, sexual history, and demographics. Fishers Exact and Wilcoxon rank sum tests were used to compare responses between groups. Multivariate logistic regression identified predictive factors for doxy-PEP interest and concern(s). 166 participants completed the survey. Mean age was 43 years, 83% were male, 22% Black, and 13% Hispanic. Forty-one participants (25%) were on PrEP. Most respondents (75%) were unaware of doxy-PEP. Factors associated with doxy-PEP interest were respondents prescribed PrEP (aOR 2.67; 95% CI, 1.15-6.21) and belief of high risk for STI (aOR, 4.50; 95% CI, 2.24-9.07). Higher doxy-PEP concerns were associated with age ≤40 years (aOR, 3.10; 95% CI, 1.47-6.52), > high school education (aOR, 3.47; 95% CI, 1.64-7.33), and belief of high risk for STI (aOR, 2.58; 95% CI, 1.21-5.50). In this single-site cohort survey study, most respondents were unaware of doxy-PEP but expressed interest and low levels of overall concern. Clinicians should offer doxy-PEP access to all patients at high risk for STIs or requesting the treatment after shared decision-making discussions.

With earlier initiation and more effective antiretroviral therapy regimens, people with HIV (PWH) are achieving longer lifespans but with high rates of chronic disease and physical function impairment. Regular exercise can reduce disease burden, but older adults with HIV may experience unique barriers to exercise. Exercise self-efficacy (ESE) is an important component of initiation and continuation of exercise, and ESE measurement may illuminate barriers to exercise. Our goal was to evaluate differences in ESE between older PWH and seronegative participants (controls) prior to exercise initiation and over 24-weeks of a supervised resistance and endurance exercise intervention. Virally suppressed PWH and controls completed 12 weeks of moderate-intensity exercise, followed by randomization to 12 weeks of moderate- or high-intensity exercise. The Self-Efficacy for Exercise survey was completed at weeks 0, 12, and 24. Enrolled participants (PWH = 32, controls = 37) had a median age of 56 years [interquartile range: 52, 62]; 63 (91%) were male, and 23 (33%) identified as ethnic or racial minorities. ESE scores differed by serostatus prior to exercise initiation (PWH: 61.3 [95% confidence interval: 54.5, 68]; controls: 73.8 [67.6, 80.1]; p = 0.01; t = - 2.7). ESE scores did not change over the initial 12 weeks in PWH (4.8 [- 2.1, 11.8]; p = 0.17; t = 1.4) or controls (- 2.3 [- 8.9, 4.4]; p = 0.50; t = - 0.7) or between weeks 13 and 24 (pooled serostatus: - 4.8 [- 9.7, 0.2]; p = 0.06: t = - 1.9). Future interventions should incorporate additional strategies to improve ESE, such as text messaging support, coaching, or external rewards.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Among persons with HIV (PWH), unhealthy alcohol use and polypharmacy contribute to bothersome symptoms (e.g., fatigue, dizziness, memory loss). However, effective risk communication targeting these associations is challenging. The HIV and Alcohol Research center focused on Polypharmacy (HARP) is conducting a pilot study that will generate feasibility and acceptability data on a clinical pharmacist-delivered counseling intervention targeting the modification of unhealthy alcohol use and polypharmacy in PWH. Counseling is guided by the Information-Motivation-Behavioral Skills-Motivational Interviewing (IMB-MI) model. Herein, we describe the study protocol. This pilot uses a one-group pre-test/post-test design. We will recruit 50 participants from those who participated in the consented cohort of the Veterans Aging Cohort Study. Participants must be prescribed ≥ 5 long-term medications, have a self-reported Alcohol Use Disorders Identification Test score > 0, and be living with HIV. We will exclude those with moderate-severe alcohol use disorder as identified by an Alcohol Symptom Checklist score ≥ 4. Data are collected using three self-administered surveys (baseline, immediately after booster intervention, and 30-days post-intervention), two PEth blood tests (baseline, 30 days post-intervention), and medication data from the electronic health record (baseline). The intervention includes a 60-minute IMB-MI-based counseling session followed by a booster session 2 weeks later. Some participants will also be asked to participate in a qualitative interview to provide feedback on the intervention. The pilot investigates the impact of an intervention on alcohol consumption and the use of multiple medications among PWH, exploring how best to reduce bothersome symptoms, communicate risk, and support behavior change in this population.