AIDS and Behavior最新文献

Type 2 diabetes (T2DM) and depressive symptoms frequently co-occur among people with HIV (PWH). Depression may impact diabetes management in PWH. This study evaluated the prevalence of concurrent T2DM and depression among PWH and the impact of depression and HIV symptoms on glycemic outcomes (hemoglobin A1c [A1c], blood glucose [BG]) among people with both HIV and T2DM. We conducted a secondary analysis in the CFAR Network of Integrated Clinical Systems, a multisite clinical cohort including a diverse population of PWH in care from July 2005 through July 2023. Linear regression and linear mixed models were used to estimate the association between depression, HIV symptoms, and glycemic outcomes (A1C, BG) at baseline and over time. Of the 18,562 PWH, 2,945 (16%) also had T2DM. PWH with T2DM were older (56 vs. 49 years) and more often non-Hispanic Black and cis-gender men. The prevalence of depression was not significantly different between PWH with or without T2DM (20% vs. 21%) although more PWH with T2DM received antidepressant medications. Among people with both HIV and T2DM, HIV baseline symptoms and depression were not associated with a change in A1c. Increases in time-updated HIV symptom scores were associated with random (non-fasting) BG levels, with each additional HIV symptom resulting in 0.8 mg/dL increase in random BG level (95% CI: 0.04-1.60, p = 0.04). The prevalence of T2DM was higher among PWH than in the general population. Although depression appears to be well managed, other factors impacting glycemic outcomes among people with both HIV and T2DM require further study.

Financial incentives have demonstrated effectiveness in improving outcomes for people living with HIV; however, little is known about their impact on intimate partner violence (IPV) in this vulnerable population. A cluster-randomized trial investigating financial incentives and viral suppression was conducted in the Lake Zone of Tanzania (clinicaltrials.gov: NCT0420135). Between May 2021-March 2022, 32 clinics were randomized 1:1 to receive the standard of care (SOC) or to offer 22,500 TZS (~$10 USD) to individuals initiating antiretroviral therapy monthly for up to 6 months, conditional on clinic attendance. An intention-to-treat analysis was conducted to examine the effect of financial incentives on IPV among partnered women at 6 months (n = 494), with prevalence differences (PD) and 95% confidence intervals (CI) estimated using generalized estimating equations. Subgroup analyses were conducted among women partnered at 6 months only and women partnered at both baseline and 6 months. Past 6-month IPV was reported by 241 (48.8%) partnered women. Emotional IPV was the most common form of violence (47.8%), followed by physical (7.5%) and sexual IPV (5.1%). There were no significant differences in past 6-month IPV between arms in the primary (49.6% SOC vs. 48.1% incentive, PD: -0.02, 95% CI: -0.18, 0.15) or subgroup analyses. These findings suggest that small, short-term financial incentives used to improve HIV treatment outcomes do not significantly alter IPV risks, however with the width of the CIs it is not possible to rule out small and moderate-sized effects. Further research among larger samples is needed as financial incentive programs are brought to scale for people living with HIV.

Optimal infant nutrition is crucial for good health and survival. HIV-exposed infants have a greater incidence of low birthweight than HIV-unexposed infants, predisposing them to malnutrition and a greater risk of HIV infection. A 12-month longitudinal study was conducted on 166 HIV-exposed infants, assessing nutritional status at 6 weeks, 6 months, and 12 months. Fisher's test and logistic regression analysed the data using WHO growth standards. Ethical approval was obtained (KEMRI/SERU/CPHR/002/3525). Results: Wasting: Younger maternal age (18-24 years) presented higher odds of infant wasting across all timepoints: 6 weeks aOR 4.31 (CI: 1.11, 1.83), 6 months aOR 4.49 (CI: 1.09, 27.34), and 12 months aOR 5.49 (CI: 1.41, 32.97). Stunting: At 6 months, infants of underweight mothers and those on second-line antiretroviral therapy (ART) regimens had higher odds of stunting aOR 4.76 (CI: 1.36, 16.65) and aOR 5.49 (CI: 1.64, 18.38), respectively. At 12 months, poor maternal ART adherence aOR 4.11 (CI: 1.14, 14.82) and mothers on second-line ART regimens aOR 3.68 (CI: 1.09, 12.49) had increased odds of infant stunting. Underweight: At 6 weeks, high maternal viral load aOR 6.33 (CI: 2.31, 17.36) was associated with higher odds underweight infants, whereas employed mothers had lower odds of underweight infants at 6 and 12 months aOR 0.10 (CI: 0.03, 0.32) and aOR 0.22 (CI: 0.09, 0.59) respectively. The results highlight maternal nutrition and ART adherence's influence on infant nutritional status and HIV vertical transmission risk. The study recommended integrating comprehensive nutritional care into HIV policies and enhancing ART counselling to reduce vertical transmission risk and poor infant growth.

The government of Kenya's Triple Threat strategy recognises the need for urgent intervention to address the high incidence of HIV, gender-based violence (GBV) and pregnancy among adolescent girls and young women (AGYW). We used nationally representative data among AGYW aged 13-24 (n = 1344) from the 2018-19 Kenya Violence Against Children & Youth Survey (VACS) in multivariable logistic regression analyses to examine associations between three potential protective factors - gender-equitable attitudes, food security and parental monitoring - and outcomes related to the triple threat: Intimate partner violence (IPV); sexual violence; high HIV exposure risk; adolescent pregnancy; child marriage; and not being in school or paid work. Results showed that AGYW with gender-equitable attitudes were less likely to report IPV (adjusted odds-ratio (aOR):0.47, p < 0.01) and adolescent pregnancy (aOR:0.58, p < 0.05). AGYW who were food secure were less likely to report adolescent pregnancy (aOR:0.57, p < 0.05) and child marriage (aOR:0.51, p < 0.05). Those with high parental monitoring were less likely to report IPV (aOR:0.44, p < 0.01), sexual violence (aOR:0.49, p < 0.05), adolescent pregnancy (aOR:0.61, p < 0.05), and child marriage (aOR:0.41, p < 0.01). AGYW who had gender-equitable attitudes, food security and high parental monitoring (i.e., all three factors compared to none) had lower predicted probabilities of reporting IPV (22.3% vs. 5.0%), sexual violence (20.4% vs. 6.0%), adolescent pregnancy (23.7% vs. 7.7%), and child marriage (10.0% vs. 1.6%). The findings indicate that improving gender-equitable attitudes, food security and parental monitoring may positively impact multiple outcomes related to the triple threat; and that addressing all three may have the greatest impact.

Pregnant women have a high HIV incidence in South Africa (SA), increasing the risk of mother-to-child transmission (MTCT) of HIV. Strengthening coverage of HIV prevention strategies such as pre-exposure prophylaxis (PrEP) is essential to ending the epidemic in SA. We estimated awareness and coverage of PrEP among pregnant women attending antenatal clinics. Using the national cross-sectional antenatal HIV sentinel survey SA, that was conducted from February to April 2022, we performed descriptive and survey logistic regression analyses. Women were deemed as aware about PrEP if they reported ever having heard of PrEP. Women were eligible for PrEP if they were HIV-negative and had either: (1) an HIV-positive/status-unknown partner; (2) multiple sexual partners in the past twelve months; (3) a sexually transmitted infection in the preceding six months; or (4) sex under the influence of alcohol/drugs in the past six months. 31.18% (n = 7 271) of HIV-negative women were eligible for PrEP. Among eligible women, 33.65% (n = 2 403) were aware about PrEP, 3.58% (n = 271) took PrEP before pregnancy, and 6.50% (n = 507) were currently on PrEP. Compared to follow-up visit attendees, first ANC visit attendees were less likely to be: (1) aware about PrEP (adjusted odds ratio (aOR) = 0.65; 95% confidence interval (CI): 0.59-0.72), and (2) to currently be on PrEP (aOR = 0.69; 95% CI: 0.57-0.84). Women who had never tested for HIV before pregnancy were less likely to: (1) be aware about PrEP (aOR = 0.51; 95% CI: 0.45-0.59), and (2) currently be on PrEP (aOR = 0.56; 95% CI: 0.43-0.74) compared to those who had tested for HIV before pregnancy. Women who reported having an HIV-positive partner compared to those with an HIV-negative partner had higher: (1) PrEP awareness (aOR = 2.21; 95% CI: 1.80-2.71), and (2) PrEP coverage during pregnancy (aOR = 8.51; 95% CI: 6.43-11.25). Overall PrEP awareness and coverage were low. PrEP is being integrated into safe conception programs as an HIV prevention strategy. Entry into ANC presents an important opportunity to prevent new HIV infections among new mothers, accelerating the elimination of MTCT of HIV in the country.

Test-to-PrEP, a bundled HIV self-test (HIVST) and PrEP educational kit was distributed to the social networks (SN) of PrEP clients using social network strategies (SNS). PrEP clients (n = 100) distributed kits to their SN members (n = 415). Multilevel analysis assessed the relationship between demographic/network characteristics and likelihood of PrEP discussions. Higher network density (e.g., the level of linkage among network members) and daily contact were associated with having previously talked about PrEP. Networks that were denser (more ties/connections), more frequently in contact, and had a relationship type that assumes greater closeness (proximal relations) resulted in greater likelihood of having had PrEP conversations. This work demonstrates the feasibility of using SNS to increase routine HIV testing and PrEP knowledge. The Test-To-PrEP SNS strategy is a promising tool to increase HIV prevention and care access to all who may benefit.

As the U.S. population of people with HIV (PWH) ages, PWH exhibit high rates of adverse health outcomes including everyday functioning decline. We aimed to (1) identify trajectories of self-reported everyday functioning and (2) examine baseline predictors (demographics, cognitive domains, psychiatric and medical comorbidities, HIV-disease characteristics) of trajectories among PWH. 742 PWH completed up to five semi-annual visits over two years. Latent growth mixture modeling identified a linear 3-class solution with good statistical fit and interpretability. Most PWH (88%) had good baseline functioning with stability. Two classes had elevated baseline functional declines with worsening (7%) or improvement (5%). Greater depressive symptoms and motor skills impairment predicted higher odds of impaired functioning. Having chronic pulmonary disease increased odds of improvement, which may reflect connection to care, while older age increased odds of worsening. Most aging PWH demonstrate stable everyday functioning; however, interventions for depression and motor skills may improve functioning.

The Information-Motivation-Behavioral Skills (IMB) model of antiretroviral therapy (ART) adherence describes self-reported ART adherence determinants among people living with HIV (PLWH) who struggle to achieve optimal adherence, but less is known about young Black gay, bisexual, and other men who have sex with men (MSM), a group reported to have less than optimal ART adherence levels, partially affected by depression. Using the IMB model, we analyzed baseline data from 315 Black MSM living with HIV aged 18-34 years struggling with ART adherence enrolled in a multi-state mobile health (mHealth) randomized controlled trial. Generalized structural equation modeling was used to estimate the direct and indirect effects of (1) ART-related information, (2) motivation and (3) behavioral skills, or treatment self-efficacy, on non-optimal self-reported ART adherence (< 80%, Wilson's adherence measure). Prevalence of non-optimal ART adherence was 28.3%. Low behavioral skills were directly associated with non-optimal ART adherence (β = 0.69, SE = 0.10, p <.001). Low behavioral skills significantly mediated the relationship between low motivation and non-optimal ART adherence (Sobel z = 4.12, p <.001). Low information was not associated with treatment self-efficacy. Low motivation had a greater overall effect on non-optimal ART adherence among those with none/mild depressive symptomatology (β = 0.30, SE = 0.13, p <.001), and the direct effect of low motivation on non-optimal adherence was null among those with moderate/severe depressive symptomatology. Development of combination HIV prevention interventions designed to improve ART adherence should combine culturally appropriate mental health care into HIV treatment that go beyond social support among those who may be experiencing depressive symptomatology.

Unhealthy alcohol use is prevalent among people with HIV, particularly among men who have sex with men (MSM). Pain frequently co-occurs with unhealthy alcohol use and is associated with suboptimal HIV care outcomes. The present study examined the effects of pain severity and experiences with pain management care (i.e., satisfied, dissatisfied, managing pain on own) on alcohol use. Participants were MSM with HIV reporting heavy alcohol use and pain in the past 30 days who were enrolled in a clinical trial targeting alcohol use (N = 125, 78.4% White, M_age=41.2). Participants completed measures of unhealthy alcohol use [alcohol-related problems, heavy drinking days, drinks per week, drinking to manage pain (yes/no)], pain severity, and pain management care experiences. An analysis of variance examined differences in pain severity by pain management experience. Regression analyses examined the associations of pain severity and pain management experience with unhealthy alcohol use. Pain severity was significantly associated with drinking to manage pain and heavy drinking days, but not drinks per week or alcohol-related problems. MSM with HIV who were dissatisfied with pain care reported significantly greater pain severity compared to those who were satisfied or managing pain on their own. Compared to satisfaction, dissatisfaction with pain care was also associated with significantly higher odds of drinking to manage pain, although the inclusion of pain severity attenuated this association. Results highlight pain severity as a key factor related to pain management experience and unhealthy alcohol use among MSM with HIV. Future studies should prioritize pain-alcohol integrated intervention development.

We investigated how COVID-19-related disruptions influenced antiretroviral therapy (ART) adherence among young adults living with HIV (YALHIV) in Southern Uganda, a region with limited resources and high rates of HIV. Data were analyzed from 499 YALHIV aged 19 to 25, participating in the Suubi+Adherence-R2 COVID-19 Supplement study. The study measured COVID-19 disruptions using an 8-item Coronavirus Impact Scale and evaluated ART adherence through self-reported measures. Our analytical framework was informed by the Health Belief Model and generalized estimating equations were estimated. We find no statistically significant association between COVID-19 disruptions, as quantified by the COVID-19 Impact Score, and sub-optimal ART adherence (OR = 0.99, 95% CI [0.87-1.14]). However, findings revealed that being employed (OR = 1.99, 95% CI [1.07-3.71]) and older age (OR = 1.18, 95% CI [1.02-1.37]) was associated with higher likelihood of poor adherence highlighting the complex interplay between economic activity, working schedules, and health management. Other notable predictors included marital status, with cohabiting individuals showing decreased odds of poor adherence (OR = 0.25, 95% CI [0.08-0.74]) compared to single and separated YALHIV. These insights emphasize the need for multifaceted intervention strategies that consider both individual and systemic factors affecting ART adherence. Tailored interventions must address the socioeconomic challenges intensified by the pandemic and leverage the inherent resilience within this population to enhance ART adherence outcomes for YALHIV in challenging environments. Trial Registration ClinicalTrials.gov, ID: NCT01790373.