AIDS and Behavior最新文献

Self-collected dried blood spot (DBS) samples may be useful in monitoring viral load (VL) in research studies or clinically given that they eliminate the need for participants to travel to study sites or laboratories. Despite this, little information exists about monitoring VL using DBS self-collected at home, and no information exists on DBS for this use among older rural people living with HIV (PLH), a population that could benefit from self-collection given difficulty accessing care. We report on the feasibility and acceptability of self-collected DBS samples, DBS VL results, concordance between self-reported and DBS VL, and factors associated with DBS detectable VL in a rural Southern U.S. sample of PLH aged 50 years and older. Between 2021 and 2022, 61 older rural PLH from 9 Southern U.S. states (M_age = 58, 25% female) completed survey measures and self-collected DBS specimens at home; 51 of these participants completed the same procedures at 3-month follow-up. Nearly all participants (96-98%) collected DBS specimens that could be successfully analyzed for VL, and participants found self-collection highly acceptable. Approximately one quarter of participants had quantifiable detectable VL (≥ 839 copies/mL) at each time point. Concordance between self-reported and DBS VL was 69% at baseline and 82% at follow-up; the majority of those with DBS detectable VL self-reported undetectable VL (86% at baseline and 60% at follow-up). Self-collection of DBS specimens for VL monitoring can add value to research conducted remotely, including research associated with the care of rural and/or older PLH.

Peer support from social networks of gay, bisexual, and other men who have sex with men (GBMSM) has been recognised as a critical driver of engagement with HIV prevention. Using data from an online cross-sectional survey of 1,032 GBMSM aged 18 or over in Australia, a latent class analysis was conducted to categorise participants based on social support, LGBTQ + community involvement, and social engagement with gay men and LGBTQ + people. Comparisons between classes were assessed using multivariable multinomial logistic regression. Participants were allocated into four classes: 'Gay men focused' (n = 293, 28.4%) with high levels of support from gay men, 'High and diverse' (n = 75, 7.3%) with high support from people with a range of gender and sexual identities, 'Moderate overall' (n = 177, 17.2%) who reported some support from all sources, and 'Low overall' (n = 487, 47.2%) who had low support. Lifetime HIV testing was lower in the 'Low overall' (78.0%) and 'Moderate overall' (81.9%) classes compared to the 'Gay men focused' (96.9%) and 'High and diverse' (93.3%) groups. Among non-HIV-positive participants (n = 971), lifetime PrEP use was lower in the 'Low overall' (28.9%) than the 'Gay men focused' group (56.2%) but similar in the 'High and diverse' (59.7%) and 'Moderate overall' (37.5%) groups. Greater levels of social engagement with gay men and LGBTQ + people were associated with higher levels of HIV testing and PrEP use. Interventions are needed to reach GBM who are less engaged with GBMSM networks or LGBTQ + communities.

Healthy aging is an important area of research across many populations, but less work has focused on this area among sexual and gender diverse individuals relative to the general population. On the whole, it is known that as the U.S. population ages, increasing attention is needed to understand the intersections between aging, health, and wellbeing. One area of consideration to address in regard to healthy aging is that of HIV prevention, in particular, pre-exposure prophylaxis (PrEP) use. For the current study we assessed these factors in a cross-sectional survey designed to assess disease status and related risk factors among a sample of individuals ≥ 50 years of age (N = 794, M_age = 58.5, range = 50-88) who resided in a metropolitan area in Ohio, USA. Results demonstrated that as overall age increased, general aging concerns decreased. Although HIV status was not related to general aging concerns, in additional models, lifetime PrEP use and six-month PrEP use were both related to greater aging concerns. When evaluating sexual orientation-specific aging concerns, we noted the opposite direction in terms of its relationship with age; as these concerns increased so did age. Further, cisgender women, transgender women, transgender men, and those identifying with a different identity each reported greater sexual orientation related aging concerns compared with cisgender men. Based on the current findings, additional research is needed to more fully understand aging related concerns for older individuals who identify as sexual orientation diverse.

Rapid antiretroviral therapy (ART) refers to initiating HIV treatment within seven days of diagnosis. Multidisciplinary teams that implement rapid ART protocols can be effective in addressing the holistic needs of HIV patients. The purpose of this study was to evaluate a multidisciplinary team's implementation of a rapid ART protocol through a retrospective pre and post study design among 627 patients referred to a local HIV clinic between January 2017 and December 2022. We observed a 46% difference in the median number of days from diagnosis to first visit (p < 0.001) between pre implementation ("pre") [median days = 13] and post implementation groups ("post") [median days = 7] and a 17% difference in median days from first visit to viral suppression (p < 0.05) between pre (median days = 63) and post groups (median days = 52). An adjusted Cox proportional hazards model showed a higher probability of having a first visit with a medical provider following diagnosis sooner in the post group compared to the pre group (hazard ratio [HR]: 1.53, p < 0.001). The post group also had a higher probability of achieving viral suppression sooner compared to the pre group (HR: 1.55, p < 0.01) where 98% achieved viral suppression in the post group within 12-months compared to 90% in the pre group. These results show that after the introduction of a rapid ART protocol implemented by a multidisciplinary team, there were significantly shorter days to first visit and greater viral suppression outcomes among the post group compared to the pre group.

This study aimed to examine shifts in the cost-savings threshold of a rural syringe services program (SSP) that resulted in the 12-months following the identification of the COVID-19 pandemic. We compared SSP operational costs during the 12-months immediately before and after identification of the COVID-19 pandemic using administrative data from the Cabell-Huntington Harm Reduction Program (CHHRP), which is operated by the Cabell-Huntington Health Department in West Virginia. Data included monthly counts of client encounters, sterile syringe distribution, and HIV testing. Cost-savings threshold analyses were conducted to estimate the number of HIV infections that would have to be averted for the CHHRP to be cost-saving in the 12-months before and after the identification of the COVID-19 pandemic. In the 12-months following identification of the COVID-19 pandemic, there was a 13.6% reduction in the number of client encounters and a 69.3% reduction in the number of HIV tests administered at the CHHRP. From the healthcare perspective, in the 12-months before and after the pandemic, the CHHRP cost $190,151 and $116,727, respectively. The number of averted HIV infections required for the CHHRP to be cost-saving was less than one across both time periods and for all estimates of lifetime HIV-related medical costs. There were shifts in the operational costs at the CHHRP after the identification of the COVID-19 pandemic; however, the costs of providing harm reduction services were significantly less than lifetime HIV treatment costs for a single person. Increasing investments in harm reduction is essential for eliminating HIV transmission.

Longitudinal patterns of engagement in care among women living with HIV (WHIV) during the perinatal period are poorly understood. We employed group-based trajectory modeling to (1) describe trajectories of HIV visit engagement; and (2) identify predictors of membership in suboptimal care trajectories. Data came from a prospective cohort study across five urban clinics in Lilongwe, Malawi conducted between February 2020 and August 2022. Participants were followed from entry into antenatal care (ANC) through 9 months postpartum. Trajectories were defined for 375 participants based on whether (1) ≥1 HIV care visit was attended; or (2) ≥1 HIV care visit was missed for each three-month interval during follow-up. Over a maximum of 15 months of follow-up, we identified two distinct trajectory groups for each HIV visit engagement outcome: "lower" (7%) vs. "consistently high" (93%) probability of attending a visit groups and "higher" (86%) vs. "consistently low" (14%) probability of missing a visit groups. Age <25 years (odds ratio (OR) = 3.82, 95% CI 1.25, 11.73) or >1 hour of travel time to the clinic (OR = 3.54, 95% CI 1.44, 8.69) were associated with membership in the "lower" probability of attending a visit trajectory group. Enrollment after the start of the COVID-19 pandemic (OR = 0.23, 95% CI 0.07, 0.74) and higher gestational age at enrollment (OR = 0.28, 95% CI 0.09, 0.86) were protective against membership in the "lower" probability of attending a visit and the "higher" probability of missing a visit trajectory groups, respectively. In settings where missed visits are common, visit attendance may be an important indicator of care engagement.

Transgender and gender-expansive young people, ages 13-24 years, experience disproportionate HIV risk yet are among those with the lowest US PrEP uptake rates (< 10%). Factors influencing PrEP outcomes for this population are poorly understood. This study examines the effects of gender minority stressors, gender affirmation, and heavy substance use on their PrEP outcomes using data from the CDC's 2018 START study (N = 972). A conceptual model integrating the gender minority stress and gender affirmation models was developed, mapping relevant START items onto it. Structural equation modeling (Mplus-8.9) was used to examine factors related to their PrEP intentions. Most participants were 18-24 (68%), trans-female (46%), white (45%), and reported heavy substance use (40%). Medical discrimination increased internalized transphobia (b = 0.097, SE = 0.034, p = 0.005) and perceived stigma (b = 0.087, SE = 0.034, p = 0.010). Family rejection increased perceived stigma (b = 0.181, SE = 0.032, p < 0.001) and heavy substance use (b = 0.260, SE = 0.053, p < 0.001). Perceived stigma also increased heavy substance use (b = 0.106, SE = 0.037, p = 0.004). Perceived stigma (b=-0.085, SE = 0.027, p = 0.002) and heavy substance use (b=-0.161, SE = 0.031, p < 0.001) decreased PrEP intentions, while gender affirmation increased them (b = 0.045, SE = 0.019, p = 0.020). A 1-point increase in gender affirmation reduced heavy substance use risk by -0.179 (SE = 0.030, p < 0.001) in the presence of family rejection and by -0.074 (SE = 0.041, p = 0.074) when perceived stigma was present. This study underscores heavy substance use as a potential barrier to PrEP uptake for transgender/gender-expansive youth. Future research could explore how gender affirmation acts as a protective factor against the negative impact of family rejection and perceived stigma on heavy substance behaviors among these populations.

Many men with HIV (MWH) want to have children and may encounter HIV- and infertility-related stigma experiences. Integration of reproductive health and HIV care for men is rare. When available, safer conception care focuses on HIV prevention but lacks fertility support. We conducted qualitative in-depth interviews in Uganda with 30 MWH who desired more children and self-reported no partner pregnancy after 12 or more months of conception attempts. We separately interviewed 10 female partners. Interviews explored stigma experiences and factors impacting engagement in HIV and reproductive care. We used vignettes to elicit responses to stories of couples experiencing challenges of HIV and subfertility. The study team discussed, coded, and analyzed data from individual participant interview transcripts, inductively identifying emergent themes. The following overarching themes emerged: (1) Reproductive goals often take priority over HIV prevention among HIV-affected couples in this context, influenced by multi-level subfertility stigma in society. (2) MWH may pursue behaviors that increase risk of HIV transmission to meet their reproductive goals. (3) Men and women are eager to maintain their primary partnerships, prevent HIV transmission, and meet their reproductive goals with guidance from healthcare providers. Further research is needed on the causes of subfertility and infertility among HIV-affected couples in East Africa to better support their conception goals. Additionally, studies on the intersection of HIV and infertility stigma in high-fertility, high-HIV prevalence areas are essential for designing interventions that meet couples' social, emotional, and medical needs.

Anal HPV infection is particularly prevalent among men who have sex with men (MSM). The purpose of this study was to understand the status and influencing factors of HPV infection in MSM in Urumqi, Xinjiang, in order to provide suggestions for policy formulation. A prospective cohort study was conducted among HIV-negative MSM in Urumqi Xinjiang between April 2016 and June 2023. 824 MSM were recruited. Data were collected anal swab results from self-administered questionnaires and laboratory tests. A Cox regression model was employed to analyze factors associated with HPV infection. The prevalence rates of high-risk HPV and low-risk HPV were 37.99% and 25.97%. Receptive anal intercourse is a well-established risk factor for both incident and persistent HPV infections among MSM. For new high-risk HPV infections, the adjusted hazard ratio is 1.55 (95% CI: 1.28-1.89), and for persistent high-risk HPV infections, the aHR is 1.95 (95% CI: 1.48-2.57). Similarly, for low-risk HPV, receptive anal intercourse increases the risk of incidence (aHR = 1.34, 95% CI: 1.07-1.67) and persistent infection (aHR = 1.64, 95% CI: 1.18-2.29). Seeking sexual partners in bathhouses raised the risk of low-risk HPV infections (aHR = 1.36, 95% CI: 1.05-1.76). Young MSM may face a higher risk of HPV infection. Implementing targeted HPV vaccination catch-up programs for the MSM population in Urumqi could offer significant societal benefits.

Military members and female sex workers (FSWs) may be more likely to acquire or transmit HIV. Mapping HIV transmission across these high-risk populations and identifying behaviors associated with sexual network clustering are needed for effective HIV prevention approaches. A cross-sectional study recruited participants newly diagnosed with HIV among militaries, civilians, and FSWs in Zambia, Senegal, and Democratic Republic of the Congo (DRC). Participants were interviewed on behaviors and provided blood samples for HIV-1 partial pol sequencing. Genetic-distance based network analyses inferred putative relationships between HIV-1 partial pol sequences. Bivariate logistic regression models identified variables associated with clustering in a sexual network. 908 participants were included (n = 313 FSWs, n = 297 military, n = 298 civilians). 311 blood samples were sequenced and had survey data, of which 93 (29.9%) were genetically linked, forming 36 transmission clusters. All but one cluster were comprised of participants from the same country, including one large cluster (n = 12; 9 FSWs and 3 civilians) from DRC. A large mixed-country cluster (n = 9) including 7 men (4 civilians, 3 military) and 2 FSWs was observed. The odds of clustering in a sexual network were elevated for DRC participants, FSWs, and those cohabitating with a sexual partner. Findings underscore the importance of identifying linkages in high-risk populations to develop tailored HIV prevention strategies. Linkages across risk groups and countries illustrate the potential role of mobile populations in HIV transmission and acquisition. Larger studies including HIV recency testing may better elucidate biological and behavioral interactions between military, civilians, and FSWs.