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Can HIV Post-Exposure Prophylaxis Services Change the Sexual Behavior Characteristics of Men Who Have Sex with Men? A Cohort Study in Guangzhou, China.
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-27 DOI: 10.1007/s10461-024-04604-8
Yuzhou Gu, Jinhan Fu, Yefei Luo, Lishan Zhan, Fanghua Liu, Wenting Zeng, Huifang Xu, Yongheng Lu, Yanshan Cai, Zhigang Han

This study examines the impact of HIV post-exposure prophylaxis (PEP) on sexual behavior changes in men who have sex with men (MSM), aiming to assess a comprehensive HIV prevention strategy integrating biomedical and behavioral interventions to maximize PEP service effectiveness. From a Guangzhou MSM cohort, participants without prior PEP experience were included. The exposed group received PEP services during follow-up (June 2019-April 2022), while controls did not. Cox proportional hazard regression models assessed PEP's effects on sexual behavior changes. Of 411 participants (mean age: 30.72), 14.1% received PEP during follow-up. The exposed group showed a higher likelihood of reducing Internet partner-seeking (aHR: 3.58, 95%CI: 1.80-7.10, P < 0.001), decreasing anal intercourse partners (aHR: 3.81, 95%CI: 2.14-6.82, P < 0.001) in the past 6 months, lowering last week's anal intercourse occurrences (aHR: 3.95, 95%CI: 2.33-6.68, P < 0.001), and improving condom use during past 6 months' anal intercourse (aHR: 3.94, 95%CI: 1.75-8.90, P = 0.001) and the most recent anal intercourse (aHR: 4.96, 95%CI: 1.77-13.88, P = 0.002) compared to controls. To sum up, PEP services contribute significantly to positive sexual behavior changes in MSM. Strengthening behavioral interventions at PEP's baseline and follow-up stages is crucial for maximizing comprehensive preventive impact on both biomedical and behavioral aspects in MSM.

{"title":"Can HIV Post-Exposure Prophylaxis Services Change the Sexual Behavior Characteristics of Men Who Have Sex with Men? A Cohort Study in Guangzhou, China.","authors":"Yuzhou Gu, Jinhan Fu, Yefei Luo, Lishan Zhan, Fanghua Liu, Wenting Zeng, Huifang Xu, Yongheng Lu, Yanshan Cai, Zhigang Han","doi":"10.1007/s10461-024-04604-8","DOIUrl":"https://doi.org/10.1007/s10461-024-04604-8","url":null,"abstract":"<p><p>This study examines the impact of HIV post-exposure prophylaxis (PEP) on sexual behavior changes in men who have sex with men (MSM), aiming to assess a comprehensive HIV prevention strategy integrating biomedical and behavioral interventions to maximize PEP service effectiveness. From a Guangzhou MSM cohort, participants without prior PEP experience were included. The exposed group received PEP services during follow-up (June 2019-April 2022), while controls did not. Cox proportional hazard regression models assessed PEP's effects on sexual behavior changes. Of 411 participants (mean age: 30.72), 14.1% received PEP during follow-up. The exposed group showed a higher likelihood of reducing Internet partner-seeking (aHR: 3.58, 95%CI: 1.80-7.10, P < 0.001), decreasing anal intercourse partners (aHR: 3.81, 95%CI: 2.14-6.82, P < 0.001) in the past 6 months, lowering last week's anal intercourse occurrences (aHR: 3.95, 95%CI: 2.33-6.68, P < 0.001), and improving condom use during past 6 months' anal intercourse (aHR: 3.94, 95%CI: 1.75-8.90, P = 0.001) and the most recent anal intercourse (aHR: 4.96, 95%CI: 1.77-13.88, P = 0.002) compared to controls. To sum up, PEP services contribute significantly to positive sexual behavior changes in MSM. Strengthening behavioral interventions at PEP's baseline and follow-up stages is crucial for maximizing comprehensive preventive impact on both biomedical and behavioral aspects in MSM.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045397","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}
引用次数: 0
High Prevalence of Posttraumatic Stress Disorder Symptoms Found in Well-Treated People with HIV after the Introduction of Patient-Reported Outcome Measures.
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-27 DOI: 10.1007/s10461-025-04617-x
Kevin Moody, Colette Smit, Pythia T Nieuwkerk, Maarten Bedert, Elise Nelis, Jeannine Nellen, Kim Sigaloff, Annouschka Weijsenfeld, Laura Laan, Claire Bruins, Suzanne E Geerlings, Marc van der Valk

People with HIV (PWH) are at greater risk of experiencing mental health problems, such as depression and post-traumatic stress disorder (PTSD). The purpose of our study was to determine the prevalence of posttraumatic stress disorder PTSD in PWH. PWH in care Amsterdam University Medical center (Amsterdam UMC) with access to the electronic patient portal were offered patient-reported outcome measures (PROMs) between May 2022 and May 2023, including the PC-PTSD-5 screen for PTSD as part of routine clinical care. Risk factors for a clinically relevant PC-PTSD-5 score were determined using univariate and multiple logistic regression analyses. Of 2476 PWH included, 1384 (55.9%) had access to the electronic patient portal of whom 474 (34.2%) completed the PC-PTSD-5. PWH without access to the patient portal were more often female, born in low- and middle-income countries, acquired HIV more often via heterosexual contact, and had worse HIV-related outcomes compared to those with access. Of 474 PWH who completed the PC-PTSD-5 screening question, 62 (13.1%) reached the threshold for clinically relevant PTSD. Age less than 50 years (OR 2.29, 95% CI: 1.21-4.35), and having originated from low- or middle-income countries (OR 2.02, 95% CI: 1.09-3.76) were associated with PTSD. Our findings show that 13% of PWH with a well-controlled HIV infection with access to the electronic patient portal at Amsterdam UMC experienced clinically relevant PTSD complaints.

{"title":"High Prevalence of Posttraumatic Stress Disorder Symptoms Found in Well-Treated People with HIV after the Introduction of Patient-Reported Outcome Measures.","authors":"Kevin Moody, Colette Smit, Pythia T Nieuwkerk, Maarten Bedert, Elise Nelis, Jeannine Nellen, Kim Sigaloff, Annouschka Weijsenfeld, Laura Laan, Claire Bruins, Suzanne E Geerlings, Marc van der Valk","doi":"10.1007/s10461-025-04617-x","DOIUrl":"https://doi.org/10.1007/s10461-025-04617-x","url":null,"abstract":"<p><p>People with HIV (PWH) are at greater risk of experiencing mental health problems, such as depression and post-traumatic stress disorder (PTSD). The purpose of our study was to determine the prevalence of posttraumatic stress disorder PTSD in PWH. PWH in care Amsterdam University Medical center (Amsterdam UMC) with access to the electronic patient portal were offered patient-reported outcome measures (PROMs) between May 2022 and May 2023, including the PC-PTSD-5 screen for PTSD as part of routine clinical care. Risk factors for a clinically relevant PC-PTSD-5 score were determined using univariate and multiple logistic regression analyses. Of 2476 PWH included, 1384 (55.9%) had access to the electronic patient portal of whom 474 (34.2%) completed the PC-PTSD-5. PWH without access to the patient portal were more often female, born in low- and middle-income countries, acquired HIV more often via heterosexual contact, and had worse HIV-related outcomes compared to those with access. Of 474 PWH who completed the PC-PTSD-5 screening question, 62 (13.1%) reached the threshold for clinically relevant PTSD. Age less than 50 years (OR 2.29, 95% CI: 1.21-4.35), and having originated from low- or middle-income countries (OR 2.02, 95% CI: 1.09-3.76) were associated with PTSD. Our findings show that 13% of PWH with a well-controlled HIV infection with access to the electronic patient portal at Amsterdam UMC experienced clinically relevant PTSD complaints.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045467","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}
引用次数: 0
Acceptability and Feasibility of Self-Collected Dried Blood Spot Specimens for Viral Load Monitoring among Rural Older People Living with HIV. 农村老年艾滋病病毒感染者自采干血斑标本进行病毒载量监测的可接受性和可行性。
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-27 DOI: 10.1007/s10461-024-04599-2
Jennifer L Walsh, Sabina Hirshfield, Steven A John, Katherine G Quinn, Olivia H Algiers, Timothy L McAuliffe, Andrew E Petroll

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 (Mage = 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.

{"title":"Acceptability and Feasibility of Self-Collected Dried Blood Spot Specimens for Viral Load Monitoring among Rural Older People Living with HIV.","authors":"Jennifer L Walsh, Sabina Hirshfield, Steven A John, Katherine G Quinn, Olivia H Algiers, Timothy L McAuliffe, Andrew E Petroll","doi":"10.1007/s10461-024-04599-2","DOIUrl":"https://doi.org/10.1007/s10461-024-04599-2","url":null,"abstract":"<p><p>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<sub>age</sub> = 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.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045350","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}
引用次数: 0
Patterns of Social Support and LGBTQ + Community Involvement Among Gay, Bisexual, and Other Men Who Have Sex with Men in Australia and Their Effect on HIV-Related Outcomes: A Latent Class Analysis.
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-27 DOI: 10.1007/s10461-025-04632-y
Curtis Chan, Benjamin R Bavinton, Horas T H Wong, John Rule, Loc Nguyen, Steven Spencer, Martin Holt

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.

{"title":"Patterns of Social Support and LGBTQ + Community Involvement Among Gay, Bisexual, and Other Men Who Have Sex with Men in Australia and Their Effect on HIV-Related Outcomes: A Latent Class Analysis.","authors":"Curtis Chan, Benjamin R Bavinton, Horas T H Wong, John Rule, Loc Nguyen, Steven Spencer, Martin Holt","doi":"10.1007/s10461-025-04632-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04632-y","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045470","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}
引用次数: 0
Aging Concerns Related to Sexuality and Gender: HIV Prevention and Healthy Aging.
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-24 DOI: 10.1007/s10461-025-04627-9
Ryan J Watson, Peter S McCauley, Amanda Taylor, Ethan Morgan, Brendan Jacka, Lisa A Eaton

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, Mage = 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.

{"title":"Aging Concerns Related to Sexuality and Gender: HIV Prevention and Healthy Aging.","authors":"Ryan J Watson, Peter S McCauley, Amanda Taylor, Ethan Morgan, Brendan Jacka, Lisa A Eaton","doi":"10.1007/s10461-025-04627-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04627-9","url":null,"abstract":"<p><p>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<sub>age</sub> = 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.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031768","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}
引用次数: 0
Analysis of Clinical Outcomes Following Implementation of a Rapid Antiretroviral Therapy Initiation Protocol at a Local HIV Clinic. 在当地一家HIV诊所实施快速抗逆转录病毒治疗启动方案后的临床结果分析。
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-20 DOI: 10.1007/s10461-024-04607-5
Harit Agroia, Leyla Mousli, Rajat Bansil, Kristin Walsh

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.

快速抗逆转录病毒治疗(ART)是指在诊断后7天内开始艾滋病毒治疗。实施快速抗逆转录病毒治疗方案的多学科团队可以有效地解决艾滋病毒患者的整体需求。本研究的目的是通过对2017年1月至2022年12月期间转介到当地HIV诊所的627名患者的回顾性研究前后设计,评估一个多学科团队对快速ART方案的实施情况。我们观察到从诊断到首次就诊的中位数天数有46%的差异(p
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引用次数: 0
Estimating the Cost-Saving Threshold of a Rural Syringe Services Program Before and During the COVID-19 Pandemic. 估算农村注射器服务项目在COVID-19大流行之前和期间的成本节约阈值
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-20 DOI: 10.1007/s10461-025-04615-z
Sean T Allen, Brian W Weir, Molly Reid, Kristin E Schneider, Allison O'Rourke, Tim Hazelett, Michael E Kilkenny, Carl Latkin

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.

本研究旨在研究在确定COVID-19大流行后的12个月内,农村注射器服务计划(SSP)的成本节约阈值发生的变化。我们使用西弗吉尼亚州卡贝尔-亨廷顿卫生部(Cabell-Huntington Health Department)运营的卡贝尔-亨廷顿减少危害计划(CHHRP)的行政数据,比较了SSP在确定COVID-19大流行之前和之后的12个月内的运营成本。数据包括每月客户接触计数、无菌注射器分发和艾滋病毒检测。进行了成本节约阈值分析,以估计在确定COVID-19大流行之前和之后的12个月内,为使CHHRP节省成本而必须避免的艾滋病毒感染数量。在确定2019冠状病毒病大流行后的12个月内,CHHRP提供的客户接触次数减少了13.6%,艾滋病毒检测次数减少了69.3%。从卫生保健的角度来看,在大流行前后的12个月里,CHHRP分别花费了190 151美元和116 727美元。在这两个时期和与艾滋病毒有关的终生医疗费用的所有估计数中,为使CHHRP节省费用所需避免的艾滋病毒感染人数少于1人。在确认COVID-19大流行后,人道主义人权项目的运营成本发生了变化;然而,提供减少伤害服务的费用远远低于单个人的终生艾滋病毒治疗费用。增加对减少危害的投资对于消除艾滋病毒传播至关重要。
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引用次数: 0
Trajectories of HIV Visit Engagement During the Perinatal Period among Women in Lilongwe, Malawi. 马拉维利隆圭妇女围产期艾滋病毒访问参与轨迹
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-17 DOI: 10.1007/s10461-024-04605-7
Danielle Giovenco, Yu Li, Wiza Kumwenda, Madelyn Frey, Shaphil Wallie, Mina C Hosseinipour, Angela M Bengtson

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.

艾滋病毒感染妇女在围产期参与护理的纵向模式尚不清楚。我们采用基于群体的轨迹模型(1)描述HIV访问参与的轨迹;(2)确定次优护理轨迹成员的预测因子。数据来自2020年2月至2022年8月期间在马拉维利隆圭五个城市诊所进行的一项前瞻性队列研究。参与者被跟踪从进入产前护理(ANC)到产后9个月。根据(1)是否参加过≥1次HIV护理访问,为375名参与者定义了轨迹;或(2)在随访期间,每3个月间隔错过1次HIV护理访问。在最多15个月的随访中,我们为每个艾滋病毒访问参与结果确定了两个不同的轨迹组:“较低”(7%)vs。“持续高”(93%)参加参观小组的可能性,“更高”(86%)vs。“一直很低”(14%)错过访问组的可能性。年龄1小时到诊所的旅行时间(OR = 3.54, 95% CI 1.44, 8.69)与参加就诊轨迹组的“较低”概率相关。在COVID-19大流行开始后入组(OR = 0.23, 95% CI 0.07, 0.74)和入组时胎龄较高(OR = 0.28, 95% CI 0.09, 0.86)分别对参加访问的“较低”概率组和错过访问轨迹的“较高”概率组的成员具有保护作用。在错过探视很常见的环境中,出勤率可能是护理参与的重要指标。
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引用次数: 0
Intentions to Use PrEP Among a National Sample of Transgender and Gender-Expansive Youth and Emerging Adults: Examining Gender Minority Stress, Substance Use, and Gender Affirmation. 在全国跨性别和性别膨胀青年和新兴成年人样本中使用PrEP的意图:检查性别少数群体压力,物质使用和性别肯定。
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-17 DOI: 10.1007/s10461-025-04613-1
Sabrina R Cluesman, Marya Gwadz, Charles M Cleland

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.

年龄在13-24岁之间的跨性别和性别扩张的年轻人面临着不成比例的艾滋病毒风险,但他们是美国PrEP使用率最低的人群(
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引用次数: 0
"You're in an Image of a Man but Not a Man": A Qualitative Analysis of Intersectional Stigma Among Men with HIV Experiencing Subfertility in Rural Southwestern Uganda. “你在一个男人的形象中,但不是一个男人”:对乌干达西南部农村艾滋病毒感染者生育能力低下的交叉耻辱的定性分析。
IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-17 DOI: 10.1007/s10461-025-04611-3
Madeline C Pratt, Moran M Owembabazi, Alex T Menninger, Eunice Kanini, B Rosemary Kansiime, Patricia M Smith, Janet M Turan, Lynn T Matthews, Esther C Atukunda

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.

许多携带艾滋病毒的男性(MWH)想要生孩子,可能会遇到与艾滋病毒和不孕症相关的耻辱经历。很少将男性生殖健康和艾滋病毒护理结合起来。在可获得的情况下,更安全的受孕护理侧重于艾滋病毒预防,但缺乏生育支持。我们在乌干达对30名MWH进行了定性深入访谈,这些MWH想要更多的孩子,并在12个月或更长时间的受孕尝试后自我报告没有伴侣怀孕。我们分别采访了10位女性合伙人。访谈探讨了污名化经历和影响艾滋病毒和生殖保健参与的因素。我们使用小插曲来引出对经历艾滋病毒和生育能力低下挑战的夫妇的故事的反应。研究小组讨论、编码和分析来自个体参与者访谈记录的数据,归纳地确定紧急主题。(1)在这种情况下,受社会上多层次的低生育能力耻辱感的影响,受艾滋病毒影响的夫妇往往优先考虑生殖目标,而不是预防艾滋病毒。(2) MWH可能会采取增加HIV传播风险的行为来实现其生殖目标。(3)男性和女性都渴望在医疗保健提供者的指导下维持其初级伙伴关系,预防艾滋病毒传播并实现其生殖目标。需要进一步研究东非受艾滋病毒影响的夫妇生育能力低下和不孕症的原因,以更好地支持他们的受孕目标。此外,在高生育率、高艾滋病毒流行地区,对艾滋病毒和不孕症污名的交叉研究对于设计满足夫妻社会、情感和医疗需求的干预措施至关重要。
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