Pub Date : 2024-09-13DOI: 10.1007/s10461-024-04493-x
Christopher W. Kahler, Anthony Surace, Tao Liu, David W. Pantalone, Nadine R. Mastroleo, Yufei Yan, Tyler B. Wray, Kenneth H. Mayer, Peter M. Monti
This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements.
Clinical Trials Number: NCT02709759
这项临床试验研究了三种不同方法对减少艾滋病病毒感染者中男性性少数群体(SMM)滥用酒精的个体和综合效果。具体来说,我们采用了 2 × 2 × 2 随机因子设计,比较了:(a) 基于动机访谈(MI)的行为干预与简短干预(BI);(b) 针对酒精使用的互动短信(ITM)与无 ITM;(c) 九个月的延长干预(EI)与一个月的干预持续时间。参与者(N = 188)是在佛罗里达州迈阿密和马萨诸塞州波士顿招募的感染艾滋病毒并滥用酒精的 SMM。参与者被随机分配到八个干预组合中的一个,并在 6 个月和 12 个月的随访中接受评估。在所有情况下,随访观察到每周饮酒量和大量饮酒天数均大幅减少 50%以上。与未接受 ITM 的人相比,接受 ITM 的人在 6 个月和 12 个月时每周饮酒量明显减少(发生率比分别为 0.73 [95% CI = 0.57, 0.90] 和 0.72 [95% CI = 0.56, 0.87]),在 12 个月时停止酒精滥用的几率增加,几率比为 1.46, 95% CI = 1.03, 2.08。研究结果表明,与对比条件相比,MI 或 EI 的酒精使用结果均无明显改善,而且没有任何特定的干预成分组合显示出明显的益处。这项研究表明,为期两节的 BI 可以大幅减少感染 HIV 的 SMM 的饮酒量,而增加一个月的 ITM 可以进一步改善饮酒情况。临床试验编号:NCT02709759NCT02709759
{"title":"Efficacy of Behavioral Intervention, Text Messaging, and Extended Intervention to Address Alcohol Misuse in Sexual Minority Men with HIV: A Factorial Randomized Clinical Trial","authors":"Christopher W. Kahler, Anthony Surace, Tao Liu, David W. Pantalone, Nadine R. Mastroleo, Yufei Yan, Tyler B. Wray, Kenneth H. Mayer, Peter M. Monti","doi":"10.1007/s10461-024-04493-x","DOIUrl":"https://doi.org/10.1007/s10461-024-04493-x","url":null,"abstract":"<p>This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (<i>N</i> = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements.</p><p> Clinical Trials Number: NCT02709759</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1007/s10461-024-04474-0
Minh X. Nguyen, Sarah E. Rutstein, Irving Hoffman, Ha V. Tran, Le M. Giang, Vivian F. Go
Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06–2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06–1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47–0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06–1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03–1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35–0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.
{"title":"Low HIV Testing and PrEP Uptake of Adolescent and Young Men who have Sex with Men in Vietnam","authors":"Minh X. Nguyen, Sarah E. Rutstein, Irving Hoffman, Ha V. Tran, Le M. Giang, Vivian F. Go","doi":"10.1007/s10461-024-04474-0","DOIUrl":"https://doi.org/10.1007/s10461-024-04474-0","url":null,"abstract":"<p>Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06–2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06–1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47–0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06–1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03–1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35–0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HIV/AIDS-Targeted Quality of Life (HAT-QOL) is an instrument for evaluating health-related quality of life (HRQOL) in people living with HIV (PLWHIV). This has been adapted into Brazilian Portuguese, but its dimensional structure has not been analyzed. This study evaluated the psychometric properties of the Brazilian Portuguese version of the HAT-QOL, using a sample of 319 PLWHIV in Salvador, Brazil. The study performed Exploratory Factor Analysis (EFA) to assess the HAT-QOL dimensional structure. The analysis used a polychoric correlation matrix, Robust Diagonally Weighted Least Squares (RDWLS) as an extraction method, Parallel Analysis for factor retention, robust promin as oblique rotation, and Generalized H-index (G-H) for construct replicability of each factor. Model adequacy was assessed using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). Concurrent validity was evaluated with the 36-item Short Form Health Survey, version 2 (SF-36v2). EFA identified a HAT-QOL six-factor solution: Financial Worries, Sexual Function, Medication Concerns, Life Satisfaction, Health Worries, and Overall Function. This solution showed high G-H indexes, concurrent validity, and satisfactory adequacy indexes (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). HIV Mastery, Disclosure Worries, and Provider Trust domains were not retained in EFA and did not have evidence of concurrent validity. This study proposed a HAT-QOL six-factor model for measuring HRQOL in the Brazilian PLWHIV. Future research could help identify another latent construct from not-included domains.
{"title":"Validation of the HIV/AIDS-Targeted Quality of Life (HAT-QOL) for Evaluation of Health-related Quality of Life in People Living with HIV/AIDS in Brazil","authors":"Juliet Rocío Valdelamar-Jiménez, Monica Bibiana Narváez Betancur, Carlos Brites, Liliane Lins-Kusterer","doi":"10.1007/s10461-024-04496-8","DOIUrl":"https://doi.org/10.1007/s10461-024-04496-8","url":null,"abstract":"<p>HIV/AIDS-Targeted Quality of Life (HAT-QOL) is an instrument for evaluating health-related quality of life (HRQOL) in people living with HIV (PLWHIV). This has been adapted into Brazilian Portuguese, but its dimensional structure has not been analyzed. This study evaluated the psychometric properties of the Brazilian Portuguese version of the HAT-QOL, using a sample of 319 PLWHIV in Salvador, Brazil. The study performed Exploratory Factor Analysis (EFA) to assess the HAT-QOL dimensional structure. The analysis used a polychoric correlation matrix, Robust Diagonally Weighted Least Squares (RDWLS) as an extraction method, Parallel Analysis for factor retention, robust promin as oblique rotation, and Generalized H-index (G-H) for construct replicability of each factor. Model adequacy was assessed using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). Concurrent validity was evaluated with the 36-item Short Form Health Survey, version 2 (SF-36v2). EFA identified a HAT-QOL six-factor solution: Financial Worries, Sexual Function, Medication Concerns, Life Satisfaction, Health Worries, and Overall Function. This solution showed high G-H indexes, concurrent validity, and satisfactory adequacy indexes (X<sup>2</sup> = 231.345, df = 291, <i>p</i> < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). HIV Mastery, Disclosure Worries, and Provider Trust domains were not retained in EFA and did not have evidence of concurrent validity. This study proposed a HAT-QOL six-factor model for measuring HRQOL in the Brazilian PLWHIV. Future research could help identify another latent construct from not-included domains.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1007/s10461-024-04494-w
Emily A. Miller, Kathleen A. McGinnis, E. Jennifer Edelman, Termeh Feinberg, Kirsha S. Gordon, Robert D. Kerns, Brandon D. L. Marshall, Julie A. Patterson, MaryPeace McRae
Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008–2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: “Few Co-occurring Diagnoses” (42.3%); “Multiple Pain Conditions” (21.3%); “Pain + SUD” (18.4%) and “Pain + SUD + Mental Health” (18.0%). Patients in the “Pain + SUD” class and “Pain + SUD + Mental Health” class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the “Few Co-occurring Diagnoses” class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.
{"title":"Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV","authors":"Emily A. Miller, Kathleen A. McGinnis, E. Jennifer Edelman, Termeh Feinberg, Kirsha S. Gordon, Robert D. Kerns, Brandon D. L. Marshall, Julie A. Patterson, MaryPeace McRae","doi":"10.1007/s10461-024-04494-w","DOIUrl":"https://doi.org/10.1007/s10461-024-04494-w","url":null,"abstract":"<p>Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008–2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: “Few Co-occurring Diagnoses” (42.3%); “Multiple Pain Conditions” (21.3%); “Pain + SUD” (18.4%) and “Pain + SUD + Mental Health” (18.0%). Patients in the “Pain + SUD” class and “Pain + SUD + Mental Health” class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the “Few Co-occurring Diagnoses” class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1007/s10461-024-04486-w
Eliyahu Poliker, Emilia Anis, Ehud Kaliner, George Avni, Zohar Mor
Mpox affected mainly men who have sex with men (MSM). This study aimed to assess MSM’s response to the threat, and compare MSM living in central Israel vs. its periphery. Data were collected by anonymous electronic surveys between September and October 2022 through a geospatial application (“Grindr”). Of the 665 MSM participants, 221 (33.2%) were vaccinated against mpox. In the multivariate analysis, living in central Israel, being in steady relationships, HIV infection, PrEP use, noticing suspicious skin lesions, and changing sexual behavior predicted vaccination. Of all participants, 317 (47.6%) changed their sexual behavior. In the multivariate analysis, living in central Israel, engaging in risky sexual behavior and being vaccinated against mpox predicted sexual behavior change. Of the 444 participants who were not vaccinated, 245 (55.1%) lived in peripheral regions of Israel. Those who lived in the periphery were less likely to get vaccinated or change their sexual behavior compared with MSM who lived in central Israel. Although the study was limited in size and the study population was relatively homogeneous, MSM perceived mpox as a potential threat on health, and almost 50% changed their sexual behavior and nearly one-third were vaccinated against mpox. The trend was mainly observed in MSM who were at high risk to acquire mpox and those who lived in central Israel.
{"title":"One Country, Different Reactions- How did the Gay Community in Israel Respond to the New Mpox Threat?","authors":"Eliyahu Poliker, Emilia Anis, Ehud Kaliner, George Avni, Zohar Mor","doi":"10.1007/s10461-024-04486-w","DOIUrl":"https://doi.org/10.1007/s10461-024-04486-w","url":null,"abstract":"<p>Mpox affected mainly men who have sex with men (MSM). This study aimed to assess MSM’s response to the threat, and compare MSM living in central Israel vs. its periphery. Data were collected by anonymous electronic surveys between September and October 2022 through a geospatial application (“Grindr”). Of the 665 MSM participants, 221 (33.2%) were vaccinated against mpox. In the multivariate analysis, living in central Israel, being in steady relationships, HIV infection, PrEP use, noticing suspicious skin lesions, and changing sexual behavior predicted vaccination. Of all participants, 317 (47.6%) changed their sexual behavior. In the multivariate analysis, living in central Israel, engaging in risky sexual behavior and being vaccinated against mpox predicted sexual behavior change. Of the 444 participants who were not vaccinated, 245 (55.1%) lived in peripheral regions of Israel. Those who lived in the periphery were less likely to get vaccinated or change their sexual behavior compared with MSM who lived in central Israel. Although the study was limited in size and the study population was relatively homogeneous, MSM perceived mpox as a potential threat on health, and almost 50% changed their sexual behavior and nearly one-third were vaccinated against mpox. The trend was mainly observed in MSM who were at high risk to acquire mpox and those who lived in central Israel.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1007/s10461-024-04458-0
Mary Jane Rotheram-Borus, Mark Tomlinson, Jackie Stewart, Zwelibanzi Skiti, Stephan Rabie, Jason Wang, Ellen Almirol, Lodewyk Vogel, Joan Christodoulou, Robert E. Weiss
HIV and substance abuse are common among young men, associated with a cluster of risk behaviors. Yet, most services addressing these challenges are delivered in setting underutilized by men and are often inconsistent with male identity. This cluster randomized controlled trial aimed to reduce multiple risk behaviors found among young men township areas on the outskirts of Cape Town, South Africa. Young men aged 18–29 years (N = 1193) across 27 neighborhoods were randomized by area to receive HIV-related skills training during either: (1) a 12-month soccer league (SL) intervention; (2) 6-month SL followed by 6 months of vocational training (VT) intervention (SL/VT, n = 9); or 3) a control condition (CC). Bayesian longitudinal mixture models were used to evaluate behaviors over time. Because we targeted multiple outcomes as our primary outcome, we analyzed if the number of significantly different outcomes between conditions exceeded chance for 13 measures over 18 months (with 83%, 76%, and 61% follow-up). Only if there were three significant benefits favoring the SL/VT over the SL would benefits be significant. Outcome measures included substance use, HIV-testing, protective sexual behaviors, violence, community engagement and mental health. Consistent participation in the SL was typically around 45% over time across conditions, however, only 17% of men completed SL/VT. There were no significant differences between conditions over time based on the number of study outcomes. These structural interventions were ineffective in addressing young men’s substance abuse and risk for HIV.
Clinical Trial Registration: This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov (NCT02358226).
{"title":"Soccer and Vocational Training are Ineffective Delivery Strategies to Prevent HIV and Substance Abuse by Young, South African Men: A Cluster Randomized Controlled Trial","authors":"Mary Jane Rotheram-Borus, Mark Tomlinson, Jackie Stewart, Zwelibanzi Skiti, Stephan Rabie, Jason Wang, Ellen Almirol, Lodewyk Vogel, Joan Christodoulou, Robert E. Weiss","doi":"10.1007/s10461-024-04458-0","DOIUrl":"https://doi.org/10.1007/s10461-024-04458-0","url":null,"abstract":"<p>HIV and substance abuse are common among young men, associated with a cluster of risk behaviors. Yet, most services addressing these challenges are delivered in setting underutilized by men and are often inconsistent with male identity. This cluster randomized controlled trial aimed to reduce multiple risk behaviors found among young men township areas on the outskirts of Cape Town, South Africa. Young men aged 18–29 years (N = 1193) across 27 neighborhoods were randomized by area to receive HIV-related skills training during either: (1) a 12-month soccer league (SL) intervention; (2) 6-month SL followed by 6 months of vocational training (VT) intervention (SL/VT, n = 9); or 3) a control condition (CC). Bayesian longitudinal mixture models were used to evaluate behaviors over time. Because we targeted multiple outcomes as our primary outcome, we analyzed if the number of significantly different outcomes between conditions exceeded chance for 13 measures over 18 months (with 83%, 76%, and 61% follow-up). Only if there were three significant benefits favoring the SL/VT over the SL would benefits be significant. Outcome measures included substance use, HIV-testing, protective sexual behaviors, violence, community engagement and mental health. Consistent participation in the SL was typically around 45% over time across conditions, however, only 17% of men completed SL/VT. There were no significant differences between conditions over time based on the number of study outcomes. These structural interventions were ineffective in addressing young men’s substance abuse and risk for HIV.</p><p>Clinical Trial Registration: This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov (NCT02358226).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1007/s10461-024-04465-1
Hae-Young Kim, Maxime Inghels, Thulile Mathenjwa, Maryam Shahmanesh, Janet Seeley, Phillippa Matthews, Sally Wyke, Nuala McGrath, Oluwafemi Adeagbo, Dickman Gareta, H. Manisha Yapa, Thembelihle Zuma, Adrian Dobra, Ann Blandford, Till Bärnighausen, Frank Tanser
Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86–1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.
{"title":"Effect of a Male-Targeted Digital Decision Support Application Aimed at Increasing Linkage to HIV Care Among Men: Findings from the HITS Cluster Randomized Clinical Trial in Rural South Africa","authors":"Hae-Young Kim, Maxime Inghels, Thulile Mathenjwa, Maryam Shahmanesh, Janet Seeley, Phillippa Matthews, Sally Wyke, Nuala McGrath, Oluwafemi Adeagbo, Dickman Gareta, H. Manisha Yapa, Thembelihle Zuma, Adrian Dobra, Ann Blandford, Till Bärnighausen, Frank Tanser","doi":"10.1007/s10461-024-04465-1","DOIUrl":"https://doi.org/10.1007/s10461-024-04465-1","url":null,"abstract":"<p>Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86–1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1007/s10461-024-04498-6
Se Hee Min, Emma Sophia Kay, Susan Olender, Scott Batey, Olivia R. Wood, Rebecca Schnall
Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.
{"title":"Bridge Nodes Linking Depression and Medication Taking Self-Efficacy Dimensions Among Persons With HIV: A Secondary Data Analysis","authors":"Se Hee Min, Emma Sophia Kay, Susan Olender, Scott Batey, Olivia R. Wood, Rebecca Schnall","doi":"10.1007/s10461-024-04498-6","DOIUrl":"https://doi.org/10.1007/s10461-024-04498-6","url":null,"abstract":"<p>Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1007/s10461-024-04487-9
Johanna Nice, Tonya R Thurman, Brian Luckett, Babalwa Zani
Social networks expand rapidly in adolescence, increasing HIV status disclosure considerations and concerns for young people living with HIV, especially in settings where HIV-related stigma is prevalent. This study examines HIV disclosure and enacted stigma among adolescents and young adults living with HIV in South Africa. This study uses survey data from a sample of 1186 youth living with HIV, aged 14-24, and enrolled in peer support groups led by community-based organizations in KwaZulu Natal and Gauteng provinces, South Africa. Study participants completed a questionnaire on sociodemographic details, physical health, school attendance, who knew the individual's HIV status, and experiences of HIV-related mistreatment. Mixed effects logistic regression examined the association between experiences of HIV-related mistreatment and factors that may inadvertently disclose one's status, such as poor physical health and missed school, and knowledge of an individual's HIV-positive status by their caregiver, household, friends, educators, and most recent sexual partner. Almost a quarter of the sample reported an experience of HIV-related mistreatment in the past six months. After controlling sociodemographic characteristics, missed school due to illness (AOR = 1.75, 95% CI = 1.27-2.43), and knowledge of HIV status by non-family members (AOR = 2.19, 95% CI = 1.60-3.00) were significantly associated with HIV-related mistreatment. Findings suggest that experiences of enacted stigma are common among youth and linked to poor physical health and knowledge of HIV status outside the family. Effective community-level stigma reduction interventions are urgently needed. In the meantime, adolescents need individualized disclosure counseling and support managing their physical health to prevent further inadvertent disclosure and discrimination.
社交网络在青少年时期迅速扩展,增加了感染 HIV 的年轻人对 HIV 感染状况披露的考虑和担忧,尤其是在与 HIV 相关的污名盛行的环境中。本研究探讨了南非青少年艾滋病病毒感染者中的艾滋病病毒公开情况和已形成的污名化问题。本研究使用的调查数据来自南非夸祖鲁-纳塔尔省和豪滕省的社区组织领导的同伴支持小组,调查对象为 1186 名感染 HIV 的青少年,年龄在 14-24 岁之间。研究参与者填写了一份调查问卷,内容包括社会人口详情、身体健康状况、学校出勤率、谁知道个人的艾滋病感染状况以及与艾滋病相关的虐待经历。混合效应逻辑回归研究了艾滋病相关虐待经历与可能无意中泄露个人身份的因素(如身体健康状况不佳和旷课)之间的关联,以及个人的照顾者、家人、朋友、教育者和最近的性伴侣对个人艾滋病病毒呈阳性状况的了解。近四分之一的样本报告在过去 6 个月中遭受过与 HIV 相关的虐待。在控制了社会人口学特征后,因病缺课(AOR = 1.75,95% CI = 1.27-2.43)和非家庭成员对 HIV 感染状况的了解(AOR = 2.19,95% CI = 1.60-3.00)与 HIV 相关虐待有显著关联。研究结果表明,在青少年中,被污名化的经历很常见,并且与身体健康状况不佳和家庭以外的人对 HIV 感染状况的了解有关。目前急需在社区层面采取有效的减少污名化干预措施。与此同时,青少年需要个性化的信息披露咨询和对其身体健康管理的支持,以防止进一步的无意披露和歧视。
{"title":"Disclosure and Experiences of HIV-Related Stigma among Adolescents and Young Adults Living with HIV in South Africa.","authors":"Johanna Nice, Tonya R Thurman, Brian Luckett, Babalwa Zani","doi":"10.1007/s10461-024-04487-9","DOIUrl":"https://doi.org/10.1007/s10461-024-04487-9","url":null,"abstract":"<p><p>Social networks expand rapidly in adolescence, increasing HIV status disclosure considerations and concerns for young people living with HIV, especially in settings where HIV-related stigma is prevalent. This study examines HIV disclosure and enacted stigma among adolescents and young adults living with HIV in South Africa. This study uses survey data from a sample of 1186 youth living with HIV, aged 14-24, and enrolled in peer support groups led by community-based organizations in KwaZulu Natal and Gauteng provinces, South Africa. Study participants completed a questionnaire on sociodemographic details, physical health, school attendance, who knew the individual's HIV status, and experiences of HIV-related mistreatment. Mixed effects logistic regression examined the association between experiences of HIV-related mistreatment and factors that may inadvertently disclose one's status, such as poor physical health and missed school, and knowledge of an individual's HIV-positive status by their caregiver, household, friends, educators, and most recent sexual partner. Almost a quarter of the sample reported an experience of HIV-related mistreatment in the past six months. After controlling sociodemographic characteristics, missed school due to illness (AOR = 1.75, 95% CI = 1.27-2.43), and knowledge of HIV status by non-family members (AOR = 2.19, 95% CI = 1.60-3.00) were significantly associated with HIV-related mistreatment. Findings suggest that experiences of enacted stigma are common among youth and linked to poor physical health and knowledge of HIV status outside the family. Effective community-level stigma reduction interventions are urgently needed. In the meantime, adolescents need individualized disclosure counseling and support managing their physical health to prevent further inadvertent disclosure and discrimination.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1007/s10461-024-04467-z
Tulani Francis L Matenga, Harsh Agarwal, Oluwamuyiwa P Adeniran, Melissa Lam-McCarthy, Enioluwaduroti Abigail Johnson, Josephine Nyambe, Rhoda Chabaputa, Sithembile Chanda, Douglas M Habinda, Laetitia Mulenga, Shimeo Sakanya, Margaret P Kasaro, Suzanne Maman, Benjamin H Chi, Stephanie L Martin
Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2-3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding-despite high ART adherence-and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence.
{"title":"Engaging Family Members to Support Exclusive Breastfeeding, Responsive care, and Antiretroviral Therapy Adherence Among Families with Children who are HIV-Exposed and Uninfected.","authors":"Tulani Francis L Matenga, Harsh Agarwal, Oluwamuyiwa P Adeniran, Melissa Lam-McCarthy, Enioluwaduroti Abigail Johnson, Josephine Nyambe, Rhoda Chabaputa, Sithembile Chanda, Douglas M Habinda, Laetitia Mulenga, Shimeo Sakanya, Margaret P Kasaro, Suzanne Maman, Benjamin H Chi, Stephanie L Martin","doi":"10.1007/s10461-024-04467-z","DOIUrl":"10.1007/s10461-024-04467-z","url":null,"abstract":"<p><p>Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2-3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding-despite high ART adherence-and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}