AIDS and Behavior最新文献

Methamphetamine use is a driver of HIV among men who have sex with men (MSM) and is associated with suboptimal adherence to daily, oral PrEP. Long-acting PrEP may be a promising alternative. We analyzed data from the 2023 National HIV Behavioral Surveillance survey in four western cities to assess interest in long-acting PrEP among HIV-negative MSM participants. Of 1,450 participants, 7% used methamphetamine in the past 12 months. Two-thirds were interested in long-acting PrEP (68%); with no difference in interest (χ² = 1.4, p = 0.24) or prior PrEP use (χ² = 0.56, p = 0.46) by methamphetamine use. A larger proportion of participants unaware of PrEP had used methamphetamine (20% vs. 7%, χ² = 10.7, p < 0.01). Among those interested, a plurality preferred biannual injection (47%). We found high interest in long-acting PrEP and similar PrEP use rates, but lower awareness, among participants who used methamphetamine. However, our sample may not have been representative of those with higher-risk methamphetamine use.

While the message "Undetectable = Untransmittable" (U=U) is increasingly recognised in Japan, its impact-together with social proximity to people living with HIV (PLWH)-on sexual decision-making remains unclear. This study examined whether the combination of U=U awareness and social proximity is associated with attitudes toward sex with PLWH. An online survey was conducted from November 2022 to January 2023 in Japan primarily through a gay dating app. Participants were grouped into four categories based on U=U awareness and having a friend living with HIV. Poisson regression with robust error variance examined associations with reporting that learning a potential sexual partner is living with HIV would have "no" or "little" influence on the decision to have sex. A total of 4715 HIV-negative/unknown cisgender men and gender diverse individuals who have sex with men were included (median age: 36, IQR: 29-46); over two-thirds were aware of U=U. Of all participants, 26.5% had neither U=U awareness nor friends living with HIV, 52.5% had U=U awareness only, 3.1% had friends only, and 17.9% had both. Overall, 8.3% reported no or little influence of a potential sexual partner's HIV-positive status on their sexual decision-making. Compared with those with neither factor, having both was strongly associated with accepting attitudes (adjusted prevalence ratio: 4.53, 95% CI 3.24-6.32). Having a friend living with HIV alone was also significant, whereas U=U awareness only was not. Beyond promoting U=U, fostering opportunities for meaningful interaction with PLWH may help reduce stigma in sexual contexts.

HIV status disclosure remains a persistent challenge for children and adolescents aged 6-19 years. Disclosure is critical to improving treatment adherence, viral suppression, and psychosocial wellbeing, and promoting informed decision-making. This scoping review aimed to identify evidence on interventions focused on disclosing children's and adolescents' HIV statuses to them, and those supporting them with onward disclosure. We conducted a global scoping review to identify and analyze interventions supporting HIV status disclosure to, and by, children and adolescents living with HIV, identifying 25 interventions. Interventions were categorized into (1) disclosure-specific (directly focused on disclosure) and (2) disclosure-inclusive interventions (involving disclosure within broader support). Realist methods were used to evaluate disclosure-specific interventions; narrative synthesis was used for disclosure-inclusive interventions due to their heterogeneity. Disclosure-specific interventions shared common building blocks, including recognition of autonomy and dignity, tools to enhance engagement, and integration with broader health and social support systems. These contributed to improved confidence, communication, and decision-making among children and adolescents. Disclosure-inclusive interventions frequently employed intergenerational and peer support models, alongside health system strengthening strategies. Findings revealed differences in available evidence for disclosure interventions, with limited adolescent-tailored disclosure-specific interventions and few rights-based paradigms. While interventions to promote disclosure and retention in care aimed to work within participants' support systems, fewer made efforts to bolster these systems or enhance linkages; these approaches require further evidence. Priority actions emerging from the review include enhancing training and education, adopting youth-driven and rights-based approaches, strengthening metrics, and adapting to the evolving HIV landscape.

People who inject drugs (PWID) living with HIV in Vietnam experience a high prevalence of common mental disorders (CMDs), which negatively impact their health, treatment adherence and overall quality of life. To address the mental health care needs of this vulnerable population, we adapted and piloted Friendship Bench, a problem-solving therapy-based mental health intervention, for people on methadone maintenance treatment (MMT) who live with HIV and have CMDs in 6 MMT clinics in Hanoi, Vietnam, in 2021-2023. This paper aims to explore the experience of implementing aFB and the possibility of aFB expansion from the perspectives of the intervention providers who were directly involved in the delivery of the aFB program. We conducted formal in-person interviews with aFB providers including doctors (n = 6), counselors (n = 10) and supervisors (n = 2)following aFB intervention completion. Collected data was coded using NVivo 12.0 and thematic analysis was applied. All respondents were satisfied with and praised the aFB. Most providers reported that the aFB was beneficial to both overall and mental health of the MMT patients with HIV. All counselors shared that problem-solving therapy in the aFB was new for them; nevertheless, their counseling skills improved significantly after delivering the aFB sessions. All respondents were optimistic about the expansion of the aFB in other clinics. Application of aFB as a mental health intervention for care and treatment for MMT and ART patients could be a promising approach for Vietnam to address mental health care needs for this vulnerable population. Clinical Trial Number: NCT04790201 registered 3/10/2021.

The transition from adolescence to adulthood is a critical phase for young people living with perinatal HIV, who must navigate typical developmental milestones while managing a chronic illness and facing (fear of) societal stigma. This qualitative study explored the lived experiences of Dutch young adults (aged 20-30) with perinatal HIV, focusing on their transition to adulthood and from pediatric to adult care. Semi-structured interviews were conducted with 11 participants. While the findings are based on a small, self-selected sample and are not intended to be statistically representative, they offer in-depth insight into key challenges during transition. The findings highlight the profound impact of stigma and selective disclosure of HIV-status. Parental support was important but complex, especially when views on disclosure differed. Peer contact could provide a sense of connection, though many did not feel the need for ongoing involvement. Participants described challenges in social and professional contexts. Experiences with the transition to adult care varied, with more recent transfers being more positive. Valued key elements of transitional care included support from nurse specialists, meeting the adult provider beforehand, and a warm welcome in adult care. Despite stable medical management, the psychological burden of stigma and fear of disclosure remained significant. These findings underscore the need for tailored transition programs addressing medical, psychosocial and emotional needs, including psychological support, structured attention to family dynamics, pre-transfer meetings with adult providers, and peer support.

The Red Carpet Entry (RCE) program is an evidence-informed structural intervention to improve linkage to HIV care within 72 h of diagnosis. In this paper, we review a rigorous, novel approach for evaluating an implementation toolkit to support adoption and effective implementation of RCE. We fielded and evaluated an RCE implementation toolkit at two clinic sites over an 8-month period. We evaluated the toolkit by assessing implementation processes, contexts, and outcomes at each clinic site, and by surveying and interviewing key implementation staff (n = 9) to solicit their feedback on the toolkit routinely throughout program implementation. This study offers preliminary evidence that the toolkit can support effective implementation of RCE and bolsters evidence regarding the impact of RCE on linkage to care. Both clinics used the toolkit to implement the RCE program with a high degree of fidelity-clients received 85-100% of intended RCE services at the clinic sites. Moreover, as a result of implementing RCE, one site saw an improvement in linkage to care from 68% at baseline to 77% during the implementation period. Staff reported that toolkit components were well-designed for communicating key information but needed to be more succinct and easier to navigate to increase their utility for busy clinic staff. We refined the toolkit to incorporate key lessons learned from our evaluation. Toolkits, especially those that have been tested with program implementers and are informed by evidence regarding implementation and client outcomes, are a critical tool for supporting the integration of evidence-based practices into routine healthcare.

One of the key pillars of Ending the HIV Epidemic is ensuring adherence to oral HIV pre-exposure prophylaxis (PrEP). Men who have sex with men (MSM) who also have substance use disorders experience multiple challenges to maintaining PrEP adherence. We developed a digital pill system (DPS) linked to a personalized adherence intervention, PrEPSteps, to address barriers to PrEP adherence, and tested the feasibility and acceptability of this system, as well as its potential for an effect on PrEP adherence. We enrolled MSM with moderate to severe substance use disorder who were on oral PrEP in a two-arm pilot randomized controlled trial. Both arms received the DPS co-encapsulated with oral PrEP. Participants in the intervention arm also received "PrEPSteps" - a personalized cognitive-behavioral adherence intervention. Primary outcomes were feasibility and acceptability of DPS + PrEPSteps. To explore potential intervention effects, adherence changes from baseline to 3-month follow-up were compared across arms. At 6-month follow-up, adherence was assessed via self-report. Thirty-six participants were enrolled, 32, completed the run-in period, 28 were randomized, and 27 completed the 3-month intervention period. Of those, 26 completed six-month follow-up. Operation of the DPS and PrEPSteps was feasible, with consistent data recording throughout the 3-month intervention period. Qualitative interviews in the intervention arm at 3 months demonstrated PrEPSteps was acceptable. Intervention arm participants had 14% higher PrEP adherence (b = 13.67, 95%CI [.77-26.57], p = .039) at 3 month follow up. This effect persisted at six months, suggesting that PrEPSteps has the potential to improve PrEP adherence and help individuals sustain adherence benefits over time.Trial registration: www.ClinicalTrials.gov identifier: NCT03512418.