AIDS and Behavior最新文献

Despite Rwanda's progress in HIV prevention for key populations, female employees in alcohol-serving establishments (ASEs) remain underserved, with interventions often lacking attention to the contextual factors shaping their HIV risk and service uptake. Guided by the Exploration phase of the Exploration, Preparation, Intervention, and Sustainment (EPIS) framework, a qualitative study was conducted to identify contextual factors affecting HIV prevention uptake among young single mothers working in informal ASEs. In-depth interviews were conducted with 101 participants recruited through maximum variation purposive and snowball sampling. Data were analyzed thematically, with findings organized according to inner and outer EPIS contextual domains. Outer context findings revealed structural and socio-cultural barriers, including unaffordability of post-exposure prophylaxis and HIV self-testing kits, inconsistent condom availability, and gender norms limiting women's autonomy in sexual health decision-making. Inner context findings highlighted workplace-related challenges, such as limited support from establishment owners, absence of HIV prevention resources within venues, and the influence of male partners and clients on women's ability to negotiate safer sexual practices. Facilitators across both contexts included HIV risk awareness, fear of unintended pregnancy, and aspirations for improved economic and social futures for themselves and their children. By systematically examining contextual influences during the EPIS Exploration phase, this study addresses a critical gap in HIV prevention research among an underserved population. These findings can inform the development of context-responsive behavioral and structural interventions aimed at improving HIV prevention uptake and addressing workplace, social, and structural drivers of HIV vulnerability in ASEs.

Modern antiretroviral therapy (ART) regimens have increased life expectancy and improved quality of life in people with HIV (PWH). However, the necessity for lifelong ART use presents adherence and persistence challenges. Recent population-level data regarding such challenges with contemporary daily oral ART regimens are limited, particularly in the United States. This observational, retrospective, noncomparative cohort study used data from HealthVerity MarketPlace closed medical and pharmacy claims from PWH ≥ 18 years of age (treatment naive or treatment experienced) who were insured in the United States. Eligible PWH had ≥ 2 pharmacy refills for a Department of Health and Human Services (DHHS) guideline-recommended complete daily oral ART regimen between January 1, 2016, and November 30, 2023, with ≥ 365 days of continuous baseline enrollment and ≥ 180 days of follow-up. The index date was the date of the first recorded pharmacy claim for a complete ART regimen, regardless of prior treatment experience. Rolling adherence was measured using the Continuous, Multiple Interval Measure of Medication Acquisition method that compared the timing of prescription fills versus the number of days the prescription was intended to last, within blocks of 90 days. Suboptimal adherence was defined as proportion of days covered < 85%. Treatment interruption was defined as a gap in ART medication supply of > 90 days, followed by resumption of ART at any point, with combined treatment interruption/discontinuation defined as a > 90-day gap in ART medication supply, regardless of whether ART was restarted. Switching between DHHS guideline-recommended ART regimens and from DHHS guideline-recommended to nonguideline-recommended ART regimens was also evaluated. A total of 73,533 PWH were included in the study (60,062 [81.7%] treatment naive and 13,471 [18.3%] treatment experienced). The proportion of PWH on treatment for ≥ 1 year who remained adherent during all 90-day blocks decreased from 40.2% (95% confidence interval [CI], 39.6%-40.8%) by the end of Year 1, to 24.2% (95% CI, 23.7%-24.6%) at the end of Year 2, and to 17.7% (95% CI, 17.3%-18.1%) at the end of Year 3 when standardized by age group-sex-region. The standardized annual prevalence of suboptimal adherence remained relatively constant between 2017 and 2022 (46.7%-53.2%). The standardized proportion of PWH who persisted on daily oral ART without treatment interruption was 81.2% (95% CI, 80.8%-81.6%) after 1 year, 74.1% (95% CI, 73.7%-74.6%) after 2 years, and 70.6% (95% CI, 70.1%-71.1%) after 3 years. Switching between DHHS guideline-recommended daily oral ART regimens remained below 10% between 1 and 3 years of follow-up and was similar for switches from guideline-recommended to nonguideline-recommended daily oral ART regimens. The findings of this study suggest that suboptimal adherence to daily oral ART remains a challenge, even with the availability of modern regimens.

Repeating an intervention strategy consistent with the chronic disease care model has been demonstrated to be efficacious in improving cessation outcomes among smokers. However, evidence is lacking for repeat treatment outcomes among people with HIV (PWH) who smoke in low-resource settings. We evaluated outcomes among participants (n = 384) who were provided a second round of treatment after initial treatment failure in a randomized controlled trial of behavioral counseling (BC) with or without combination nicotine replacement therapy (nicotine patches and gum, cNRT). The primary outcome was self-reported smoking abstinence at 6 months after repeat treatment, biochemically verified using exhaled breath carbon monoxide (CO) and urine cotinine test. Secondary outcomes include smoking abstinence at 2 months after repeat treatment and smoking reduction, measured by changes in exhaled breath CO at 2 months and 6 months after repeat treatment. Overall, 35 (9%) participants were abstinent at 6 months post-repeat treatment, including 15 (8%) participants in the repeat BC group compared to 20 (11%) participants in the repeat BC + cNRT group. There was no significant difference in abstinence rates between repeat treatment groups (Chi Squared (χ²) = 0.23; p = 0.63), including after adjusting for potential confounders [adjusted risk ratio (aRR) = 1.16, 95% CI 0.39, 3.47; p = 0.79]. Although augmenting repeat treatment of BC with cNRT may not provide additional benefits for PWH with prior treatment failure in this population, PWH in this setting may benefit from a repeat treatment strategy of BC with or without cNRT.

Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexually active TWTFP aged 15+. Recruitment occurred between 6/2022 and 10/2023 via social media advertisements for a cross-sectional online sexual health survey. Analyses included past-year PrEP naïve TWTFP with no prior HIV diagnosis (N = 1648). Participants reported LAI-PrEP willingness and ranked PrEP modality preferences; recent healthcare-related experiences were explored as correlates, using adjusted multivariable Poisson regression with robust variance estimation. Among respondents, 26.3% were willing to use LAI-PrEP (n = 433/1648). Among participants willing to use LAI-PrEP and another modality (n = 390/433; 90.1%), 45.6% (n = 178/390) preferred LAI-PrEP. Discussing sexual health with a healthcare provider (HCP) was associated with increased LAI-PrEP willingness (adjusted prevalence ratio [aPR] = 1.34; 95% confidence interval [CI] = 1.12-1.60; p = 0.001); use of oral prescription medication (non-hormonal) was associated with decreased LAI-PrEP willingness (aPR = 0.60; 95% CI = 0.38-0.93; p = 0.022). No significant associations were found between healthcare-related experiences and LAI-PrEP preference. Given that most TWTFP who were willing to use LAI-PrEP were also willing to use oral-PrEP, but nearly half preferred LAI-PrEP, offering multiple PrEP modalities is essential to meet their needs. Associations between sexual health discussions and increased LAI-PrEP willingness highlight the importance of HCP engagement; initiatives which encourage HCPs to initiate LAI-PrEP conversations in supportive ways are crucial. Associations between oral prescription use and decreased LAI-PrEP willingness, coupled with null findings related to injection use, highlight the need for further investigation.

We examined the association between educational attainment and HIV positivity among pregnant women in a high HIV-prevalence setting and assessed how this relationship varies by age to inform targeted prevention strategies. This cross-sectional study included 2003 pregnant women aged 21-44 years attending their first antenatal visit (<27 weeks' gestation) at four public health facilities in East London, South Africa, between March 2021 and May 2024. Educational attainment was categorized as pre-high school (< grade 10), high school (grades 10-12), diploma (post-high school), or degree (associate's or bachelor's). Age was categorized into four groups (21-24, 25-29, 30-34, and 35-44 years). HIV status was determined through routine antenatal testing. We used logistic regression to assess associations between educational attainment and HIV positivity, adjusting for age, partner's HIV status, and participant sexually transmitted infection (STI) status. Overall HIV prevalence was 31.0% (95% CI, 28.9%-33.0%). Compared with women with less than a high school education, the odds of HIV infection were lower among women who attained high school education (adjusted odds ratio [AOR], 0.59; 95% CI, 0.40-0.87), a diploma (AOR, 0.40; 95% CI, 0.24-0.67), or a degree (AOR, 0.21; 95% CI, 0.09-0.43). However, this inverse association was not observed among women aged 35-44 years. In conclusion, higher educational attainment was associated with lower HIV prevalence among pregnant women, but this protective association diminished with increasing age. HIV prevention strategies should account for both socioeconomic factors and age-related interpersonal dynamics influencing HIV vulnerability.

Young adults experiencing homelessness (YAEH) are significantly more likely to engage in HIV risk-related sexual behavior relative to their stably housed peers, and their social support networks can influence their engagement in these behaviors. However, few studies have investigated HIV risk behaviors among YAEH who are "couch-surfing," a highly prevalent network-based survival strategy that involves cycling through temporary, informal housing arrangements. The current study utilizes survey data collected from 461 YAEH accessing drop-in center services in Los Angeles, California, between September 2016 and October 2018. Egocentric network analysis was used to examine associations among couch-surfing, sources of social support, and HIV risk and prevention behaviors. The potential moderating effect of social support on the relationship between couch-surfing and specific sexual risk behaviors was also tested. Compared to street- and shelter-based youth, couch-surfing YAEH reported the highest rates of recent transactional sex (18.0%) and concurrent or serial sexual partners (38.2%). Relative to residing in emergency shelter or transitional housing programs, couch-surfing was associated with over twice the odds of engaging in recent transactional sex (OR = 2.52, p = .023, 95% CI 1.13-5.62)-as was living unsheltered (OR = 2.06, p = .029, 95% CI 1.08-3.95). While social support was individually associated with several HIV risk-related sexual behaviors, its effect was ultimately eclipsed by homeless situation in the final model. Findings underscore the need for individual- and structural-level interventions that attend to the unique socioenvironmental contexts of couch-surfing YAEH.

The effects of food insecurity (FI) on mental health and HIV treatment outcomes among people with HIV (PWH) in Zimbabwe are not well understood, despite its high prevalence and links to poor health. We examined associations between FI and self-reported health quality, viral load, CD4 count, antiretroviral therapy (ART) adherence, depression diagnosis and symptoms, and gender-based violence (GBV) among PWH in Zimbabwe. Participants were 484 PWH receiving HIV care in Mashonaland East Province who were assessed for enrollment in a randomized controlled trial for depression. Associations were estimated using linear or logistic regression, controlling for gender and income type. We also tested an interaction between FI and depression on ART adherence. In the past 12 months, 51% reported having skipped a meal (moderate FI) and 29% reported having skipped an entire day of eating (severe FI). Moderate FI was associated with poorer overall perceived health quality (b = -8.48, 95%CI[-12.86 to -4.10], p < .001), increased likelihood of depression diagnosis (OR = 2.13, 95%CI[1.47-3.11], p < .001), greater depression severity (b = 0.89, 95%CI[0.27-1.51], p = .005), and being a woman who experienced GBV (OR = 2.35, 95%CI[1.43-3.93], p = .001). Severe FI was associated with poorer overall perceived health (b = -8.02, 95%CI[-12.89 to -3.16], p = .001), increased likelihood of depression diagnosis (OR = 2.91, 95%CI[1.92-4.43], p < .001), greater depression symptom severity (b = 1.36, 95%CI[0.68-2.04], p < .001), and poorer medication adherence (b = -3.90, 95%CI[-7.58 to -0.22], p = .038). There was an interaction between moderate FI and depression diagnosis on ART adherence (b = -8.88, 95%CI[-15.71 to -2.05], p = .011). Screening and targeted interventions are needed to address FI among PWH in Zimbabwe.

Chemsex, defined as the intentional use of psychoactive substances to enhance sexual activity, has been associated with a higher frequency of sexually transmitted infections (STIs) diagnosis among HIV pre-exposure prophylaxis (PrEP) users. Evidence from Latin America remains limited. This research aims to characterize the practice of chemsex and STIs prevalence in PrEP users in Buenos Aires, Argentina. We conducted a descriptive, cross-sectional study using clinical records and a self-administered ad-hoc questionnaire among PrEP users attending four public hospitals. Between February to October 2024, 165 PrEP users were included. The prevalence of chemsex, during the previous year, was 32%. The drugs used, in order of frequency, were MDMA 21%; cocaine 14%; gamma-hydroxybutyrate 12%; ketamine 10%; methamphetamine 6%; mephedrone 2%; and gamma-butyrolactone 1%. Additionally, 48% reported concurrent use of two or more drugs during the practice. A multivariate logistic regression analysis showed that engaging in chemsex was significantly associated with higher odds of reporting an STI in the past year [aOR 3.67 (95% CI 1.67 - 8.42) p 0.001). Age, time on PrEP, number of sexual partners, and engagement in group sex were not independently associated with STI diagnosis. In conclusion, chemsex was common among PrEP users in Buenos Aires and independently associated with recent STI diagnosis, highlighting the importance of integrating behavioral assessments and harm reduction strategies into PrEP and sexual health policymaking.

Despite substantial global efforts, adolescent girls and young women (AGYW) in Southern Africa remain disproportionately affected by HIV. In Zambia, the HIV prevalence among AGYW is nearly three times that of their male peers. The Informed Motivated Aware and Responsible Adolescents and Adults (IMARA) program, an evidence-based HIV/STI prevention intervention initially developed in the United States and later adapted in South Africa, demonstrated promising reduction in HIV risk through culturally tailored, mother-daughter-focused strategies. This paper outlines the process of adapting IMARA for Zambian AGYW by utilizing the Framework for Reporting Adaptations and Modifications-Expanded (FRAME). The adaptation process consisted of four phases: (1) Assessment through stakeholder meetings and focus groups involving adolescents and caregivers; (2) Intervention Delivery Decisions guided by community feedback; (3) Curriculum Adaptation through iterative revisions and collaborative input from Zambian and U.S.-based researchers; and (4) Theater Testing with adolescent-caregiver dyads to refine the content. All modifications were documented using FRAME. Eight key modifications, covering content, context, and training, were implemented to create ZAIMARA (Zambian Informed Motivated Aware and Responsible Adolescents and Adults). These changes were proactively planned, occurred pre-implementation, and were deemed fidelity-consistent. Examples include translating materials into a local language and changing intervention terms and scenarios to reflect cultural norms. Applying FRAME to adapt IMARA in Zambia provided a transparent, systematic method to maintain cultural relevance with fidelity to an evidence-based intervention. Our study demonstrates the utilization of the FRAME for future adaptations of HIV prevention programs in diverse global contexts.