AIDS and Behavior最新文献

The COVID-19 pandemic substantially disrupted healthcare services worldwide, and its impact on the identification and reporting of HIV and AIDS cases has become a critical concern. This study evaluated the effects of the pandemic on HIV/AIDS surveillance in Peru through a natural experiment using interrupted time series analysis of national surveillance data. Analysis of trends from 1985 to 2023 for HIV and from 1983 to 2023 for AIDS revealed consistent pre-pandemic increases, with an average annual growth of 27.02% for HIV cases and 20.48% for AIDS cases. However, the onset of the pandemic in 2020 was associated with significant immediate declines, with reductions of 1,609.86 HIV cases (95% CI: -3,147.26 to - 72.46) and 1,187.68 AIDS cases (95% CI: -1,560.10 to - 815.26). Furthermore, comparisons against ARIMA forecasts (HIV accuracy = 84.80%, AIDS accuracy = 85.45%) indicated substantial underreporting during the 2020-2023 period-estimated at 15.77% for HIV and 29.03% for AIDS cases. These results underscore the adverse effect of the COVID-19 crisis on ongoing HIV/AIDS case detection and reporting in Peru. They also highlight the urgent need for robust strategies-such as expanding telemedicine, enhancing self-testing, and reinforcing community-based interventions-to ensure continuous access to diagnosis and treatment during public health emergencies.

Understanding positive psychological factors (PPFs; internal strengths, socioemotional support) that promote optimal health outcomes among people with HIV (PWH) is increasingly important. 122 PWH and 98 people without HIV (PWoH) were included in multivariable regressions, testing interactions between HIV status and PPFs on 7 cognitive domains and 2 daily functioning outcomes, controlling for depressive symptoms. Overall, higher internal strengths were related to better learning and memory, whereas higher socioemotional support was related to better processing speed and psychomotor speed. PWH had a stronger positive relationship between PPFs and verbal fluency than PWoH. Overall, higher internal strengths were associated with fewer daily functioning impairments; however, only PWoH showed fewer functional declines with higher socioemotional support. PWH may require greater socioemotional support to accommodate an increased burden of comorbidities leading to functional difficulties. Among PWH, bolstering PPFs may improve cognition; however, internal strengths may particularly benefit daily functioning.

Long-acting injectable antiretroviral treatment (LAI ART) has the potential to transform HIV care and reduce HIV-related health inequities in achieving and maintaining viral suppression. However, without a plan for equitable roll-out of LAI ART, new pharmacological innovations in HIV treatment and prevention risk further deepening health disparities. This study delineates a process for providing universal LAI ART education to people with HIV (PWH) at an urban outpatient infectious disease clinic and documents the outcomes of these efforts. We compared the number and proportion of patients with HIV educated about injectable cabotegravir-rilpivirine (iCAB/RPV) and, among those educated, the number and proportion of patients interested in learning more about iCAB/RPV under a selective education model compared to a universal education model, disaggregated by race/ethnicity, sex, and age. We used a Chi-sq test to estimate p-values for the difference in proportions. The universal compared to selective education approach resulted in a larger proportion of clients educated and a greater proportion of people educated reporting interest in LAI ART. Slight differences observed between those never versus ever educated in the selective education were absent after the adoption of a universal education approach. Reasons for disinterest -- including fear of injections, not interested in more frequent clinic visits, and content with oral ART regimen -- did not differ across educational approaches. Our programmatic data offers preliminary evidence that a universal education approach can support and enhance equitable roll-out of LAI ART. Most patients with HIV are interested in learning more about LAI ART.

Young People Living with HIV (YPLHIV, 15-24 years) are an important demographic of Persons Living with HIV (PLHIV) globally and in Southern Africa. However, YPLHIV experience poor outcomes across the HIV diagnostic and treatment cascade due to multiple factors. We estimated the prevalence and determinants of HIV viral suppression in YPLHIV on antiretroviral therapy (ART) in selected Southern African countries. We used publicly available data from Malawi, Zimbabwe, Mozambique, Lesotho, and Eswatini collected during the Population-based HIV Impact Assessments (PHIAs) of 2020 to 2021. Weighted proportions, and 95% confidence intervals (CI) were computed to estimate the prevalence of viral suppression (< 1000c/ml) and bivariate and multivariate analyses were conducted to identify determinants of viral suppression. A total of 855 records of YPLHIV on ART were included in the analysis. The prevalence of viral suppression in YPLHIV on ART was 82.4% (95% CI: 76.7, 86.9). Residing in Mozambique and duration on ART were inversely associated with viral suppression; adjusted odds ratios (AORs) of 0.37 (95% CI: 0.14, 0.95), and 0.87 (95% CI: 0.80, 0.94), respectively. A negative result in the depression screen, being married/cohabitating, and ever switching an ART regimen were positively associated with viral suppression: AORs of 5.78 (95% CI: 2.21, 15.11), 3.72 (95% CI: 1.44, 9.63), and 3.44 (95% CI: 1.69, 7), respectively. YPLHIV had suboptimal viral suppression lower than the UNAIDS 95% targets and may benefit from further research and tailored interventions addressing modifiable factors associated with viral suppression such as depression.

As people with HIV (PWH) have an immunocompromised status and face potential complications from a COVID-19 infection, there are alternate, more expansive, vaccination schedules recommended for PWH. As the pandemic evolves and prevention fatigue rises, the vaccination sentiments and hesitancy of PWH require attention amid continued recommendations for boosters. Situated within South Carolina, this study aims to illustrate PWH's vaccination sentiments, as well as barriers and facilitators to vaccination. Semi-structured interviews were conducted online between March and August of 2023, among 24 PWH who were snowball and purposively sampled at a local AIDS Service Organization. An abductive approach was employed. All interviews were recorded, transcribed, and coded using an inductive, thematic analysis approach to identify and analyze emergent themes, which were then deductively categorized into the socioecological model. At the individual level, the need to protect oneself and others, prioritization of vaccination due to HIV status, and a positive personal history of vaccination facilitated uptake while a negative personal history acted as a barrier. Within the interpersonal and institutional level, family and friends as well as healthcare providers were found to serve as both positive and negative vaccine messengers. At the structural level, vaccine requirements and mandates (e.g., employer, travel) facilitated uptake while misinformation, misunderstanding, and skepticism (e.g., pace and process of vaccine development) acted as barriers to uptake. Tailored vaccination education and enhanced trust between providers and PWH may improve vaccination sentiments and mitigate hesitancy, as additional doses continue to be recommended.

Johannesburg, South Africa is a major destination for men moving from within and outside the country. Mobile men face challenges across the HIV care continuum. From March to May 2023, we conducted in-depth interviews with 29 mobile men and focus groups with 12 healthcare providers to explore factors influencing HIV prevention and care for mobile men. We used semi-structured guides, recorded and transcribed interviews, and analyzed data using inductive and deductive thematic analysis. Participants had a median age of 34. They described how relocating to Johannesburg created stress that deprioritized healthcare. They reported barriers at five key stages of status-neutral HIV care: awareness, decision to access care, experience of care, uptake of PrEP/ART, and adherence. Socio-economic needs, mobility, and masculine norms influenced men's engagement, and providers highlighted language barriers. Interventions to improve service uptake should address poverty, offer peer support, facilitate clinic transferability, and accommodate multiple languages to strengthen HIV services.

Poverty fuels risky sexual behaviors associated with HIV infection among youth. Interventions like cash transfers may mitigate HIV risk. We explored the role of broader social protection (including food, educational, and social transfers) in reducing HIV risk among 15-24-year-olds in Southern Africa. We analyzed Population-based HIV Impact Assessment surveys data from 31,317 youth in eSwatini, Lesotho, Malawi, Namibia, Zambia, and Zimbabwe (2015-2017). Using inverse probability-weighted multivariable logistic regression, we examined associations between types of social protection and condomless sex, multiple partnerships, and high-risk sexual behaviors. Food support was associated with reduced odds of condomless sex (OR 0.71 [95% CI 0.61-0.82]), multiple partnerships (0.77 [0.63-0.95]), and high-risk sex (0.70 [0.60-0.82]). Educational support was associated with reduced odds of condomless sex (0.57 [0.46-0.59]) and high-risk sex (0.59 [0.47-0.73]). Social transfers were associated with reduced odds of condomless sex (0.62 [0.54-0.70]) and high-risk sex (0.50 [0.44-0.56]). The benefits of social protection varied across countries. Educational support was associated with reduced odds of any HIV risk factors in eSwatini, Zambia, and Zimbabwe. However, the protective effect of social transfers was only observed in eSwatini, and the benefit of food support was only significant in Namibia. Furthermore, protective associations were more pronounced among females than males. This study underscores the potential of social protection to strengthen HIV prevention efforts by mitigating poverty-related risk factors, particularly for adolescent girls and young women in Southern Africa. The impact of specific programs appears context-dependent, highlighting the need for tailored interventions.

Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) are disproportionately affected by HIV. Despite the effectiveness of oral pre-exposure prophylaxis (PrEP) in preventing HIV, uptake and effective utilisation among AGYW remain suboptimal. This scoping review maps research on PrEP delivery outside clinical trials to AGYW in SSA. Quantitative and qualitative data were extracted from 58 studies on the facilitators and barriers to PrEP uptake and utilisation (including initiation, persistence, and adherence), and recommendations for effective PrEP delivery from AGYW and PrEP providers. Only studies on oral PrEP met the inclusion criteria. Facilitators of effective PrEP utilisation included social support with strong familial and peer networks positively influencing PrEP adherence and persistence. Healthcare provider interactions were pivotal in promoting PrEP uptake through dissemination of accurate information and ongoing support. Studies reported consistent barriers to PrEP uptake and utilisation including anticipated or experienced stigma, pill burden, and side effects. Addressing identified barriers and leveraging facilitators can enhance future effectiveness for PrEP delivery. There is a lack of strategies to support AGYW in long-term persistence and engagement with PrEP services. Our findings emphasise the urgent need for people-centred and localised, context-specific strategies to improve PrEP delivery among AGYW in SSA. Effective PrEP delivery strategies should include differentiated service delivery models, innovative approaches such as digital health, and integration with existing services such as antenatal care for pregnant and breastfeeding AGYW. More data is needed for PrEP delivery among AGYW across the region, including other PrEP modalities as they roll out.

Chronic pain is common among people living with HIV (PLWH) who engage in heavy drinking and both pain and heavy drinking influence quality of life, functioning, and HIV-outcomes. The purpose of this study was to: (1) test the acceptability and feasibility of a cognitive behavioral telehealth intervention (INTV) to reduce pain and heavy drinking among PLWH, (2) evaluate methods to implement a randomized controlled efficacy trial, and (3) provide preliminary information about its potential value. Forty-eight PLWH with chronic pain who engaged in heavy drinking were recruited from HIV-health clinics and social media. Following baseline assessment, participants were randomized to INTV or treatment-as-usual control (CTL). Participants completed outcome assessments at 3- and 6-months post-baseline. Results indicated that participants experienced high levels of satisfaction and showed strong intervention engagement. Over 85% of follow-up visits were completed across the two time-points. Condition comparisons showed small to moderate effects of the intervention on pain severity at 3-months (f² = 0.05) but not at 6-months (f² = 0.01). Effect sizes were consistent with less heavy episodic drinking for those in the INTV across timepoints (3-month aIRR = 0.72, 95% CI: [0.22, 2.41], 6-month aIRR = 0.71, 95% CI: [0.17, 2.96]) but only at 3-months for drinking quantity (3-month aIRR = 0.77, 95% CI: [0.29, 2.04]; 6-month aIRR = 1.00, 95% CI: [0.43, 2.29]). Results indicate that this is a feasible and acceptable approach for reducing chronic pain and heavy drinking among PLWH and that study methods may be useful for conducting a future efficacy trial. TRN: NCT03982433; Date of registration: 5/14/2019.