AIDS and Behavior最新文献

This brief report presents findings on informal, non-prescribed PrEP use among an online sample of gay, bisexual and other men who have sex with men (n = 196). Mean age was 33.4. Participants were Hispanic (13.3%), African American (15.8%), white (63.8%), and other race/ethnicity (6.6%). Informal PrEP users (11%) more frequently reported past year sexually transmitted infections (p < 0.001), group sex (p < 0.001), sex in public (p < 0.01), transactional sex (p < 0.001), ever receiving a formal PrEP prescription (p < 0.05), and ease of finding diverted HIV medications on gay dating/sex apps (p < 0.05). Formal PrEP uptake should be encouraged to mitigate potential negative consequences of informal use.

Identifying county-level factors that influence pre-exposure prophylaxis (PrEP) adherence is critical for ending the HIV epidemic in the United States (US). PrEP primary reversal is a term used to describe patients who do not obtain their prescribed medication from the pharmacy. This study sought to identify factors associated with PrEP reversal at the county level in 2018. Data were collected from Symphony Health Analytics, AIDS Vu, the US Census Bureau, and the Centers for Disease Control and Prevention National Prevention Information Network. Bivariate Choropleth maps were created to identify counties with high and low levels of PrEP reversal and HIV incidence. This was followed by bivariate analysis to determine the association between predictor variables and percent PrEP reversal. Finally multivariable logistic regressions were used to assess the association between percent PrEP reversal and variables that were significant from the bivariate analysis. A total of 308 counties were included in this analysis, where the mean number of PrEP prescriptions for counties was 44, with a median of 14 (Interquartile range 7-34). In the multivariable analysis, counties with higher level of unemployment (aOR: 1.10, 95% CI: 1.05-1.16) and rural counties (1.10: 1.04-1.17) had higher odds of PrEP reversal; while counties with higher household crowding (0.97: 0.95-0.99) had lower odds of PrEP reversal. Findings show the need for expanding and implementing programs as well as policies to improve PrEP services that are tailored to local socioeconomic circumstances.

Loss to follow-up (LTFU) in antiretroviral therapy (ART) poses significant challenges in the management of HIV/AIDS. This study aims to identify socio-demographic and clinical factors influencing LTFU among patients undergoing ART in Luzhou, China, and to develop a predictive model for LTFU using Cox risk regression analysis. In this retrospective cohort study, data from 8,770 patients diagnosed with HIV infection between January 1, 2018 and December 31, 2022 who were enrolled in the national free ART program were analyzed. The primary outcome was the first occurrence of LTFU. Cox proportional risk regression analyses were conducted to identify predictors of LTFU. The study population had a median age of 64.25 years, and 73.2% were male. The overall LTFU rate was 4.14 per 100 person-years. Factors associated with a decreased likelihood of LTFU included female gender, homosexual transmission, absence of HIV-related diseases, negative HBV surface antigen, higher final CD4 count, and an increase in CD4 count from baseline. In contrast, older age, longer time from diagnosis to ART initiation, higher baseline viral load, missed medication doses, and the development of medication side-effects were associated with an increased risk of LTFU. Our prediction model identifying the risk of loss to follow-up demonstrated good predictive performance with a C-index of 0.721. The study highlights the importance of considering a range of socio-demographic and clinical factors in managing LTFU among people living with HIV (PLHIV) on ART. Our prediction model can be a valuable tool for healthcare providers to identify patients at high risk of LTFU, facilitating targeted interventions to improve treatment adherence and outcomes.

The HIV incidence rate continues to increase among youth, especially among young men who have sex with men (YMSM) and young transgender women (YTW). To date, behavioral intention has often been viewed as the likelihood of engaging in prevention behaviors and emphasized as a key antecedent for condom use, disclosure of serostatus, and PrEP use among people living with HIV. In addition, individuals with different sociodemographic factors may have varying degrees of HIV prevention intention, which is a critical knowledge needed to identify facilitators and barriers to HIV prevention intention. This is a secondary data analysis of baseline data from a randomized controlled trial (RCT) (N = 488). This study aimed to identify distinct, latent classes of HIV prevention intention among youth vulnerable to HIV acquisition and to understand the sociodemographic and contextual factors associated with each latent class. Latent class analysis was conducted to identify meaningful latent classes of youths based on HIV prevention intention. Class 1: "High condomless sex, low serosorting, low PrEP intention," Class 2: "High condomless sex, high serosorting, low PrEP intention," Class 3: "Moderate condom use, serosorting, low PrEP intention," and Class 4: "Moderate condom use, high serosorting, moderate PrEP intention" were identified. Significant differences were found in age, sexual orientation, level of education, current employment status, annual household income, housing/living arrangement, and relationship status. Overall, YMSM and YTW without a recent history of HIV testing or PrEP use may have particularly low intentions for HIV prevention, and therefore may be at higher risk for HIV infection.

This study examined the feasibility, acceptability, and preliminary efficacy of a mobile intervention called the Text-Based Adherence Game (TAG). TAG aimed to improve HIV treatment adherence among young people with HIV (YPWH) in Ghana. Participants, YPWH aged 18 to 24, were recruited from an HIV clinic in Kumasi, Ghana where study procedures were conducted. A randomized controlled pilot trial was conducted to evaluate TAG (ClinicalTrials.gov Identifier NCT03928717). Participants were randomized to receive TAG or a standard-of-care (SOC) control. All completed quantitative assessments on outcomes preintervention and at two follow-up visits at 6- and 12-months. TAG participants received personalized, semi-automated, and game-based text messages over the six-month intervention period. Primary outcomes included viral load, antiretroviral medication adherence, and missed HIV clinic visits. Secondary outcomes were also explored. Two surveys measured intervention acceptability. 60 YPWH were enrolled. 51 completed all assessments. At the 12-month follow-up assessment, TAG had a significant and positive effect on a measure of antiretroviral adherence but not viral load or missed clinic visits. Positive intervention effects were also found at postintervention and 12 months for several secondary outcomes (e.g., adherence-related social support). Intervention acceptability was generally high. TAG is a novel and promising mobile health intervention approach. Results suggest the need to further develop TAG as it may have the potential to reach populations of YPWH and improve HIV continuum of care outcomes in settings where access to more advanced mobile technology (e.g., smartphones) and the internet is not universal.

Youth living with HIV have low rates of medication adherence. Youth ages 15-24 years with adherence ≤ 80% or with HIV RNA PCRs (VL) ≥ 200 recruited through social media and clinical sites were randomized to brief weekday cell phone support (CPS) calls or daily, two-way, personalized text message (SMS) reminders for 3 months. Those with VL ≥ 200 or adherence ≤ 80% were rerandomized to receive SMS or CPS with monthly incentives for those utilizing the intervention at least 75% of days for 3 months. Those with VL < 200 or adherence > 80% after the initial 3 months were rerandomized to usual care or 3 months of tapered, 2x/week CPS or SMS. Self-reported adherence and VLs were collected every 3 months for one year. Eighty-three youth were recruited with 81% identifying as cisgender males, 55% Black, 22% Latine/x, and 76% gay, and 56% recruited from the Southern US. Both cohorts initially randomized to CPS and SMS demonstrated significant improvements in adherence over the 12-months (P <.001). Participants randomized to CPS had significant improvements in 7-day self-reported adherence over 12 months compared to those on SMS (P <.027). Those receiving a tapered intervention for an additional 3 months had improved self-reported adherence compared to those randomized to the standard of care arm (P <.001). Both SMS and CPS appear to be effective interventions for youth with poor antiretroviral adherence. Tapering the intervention for an additional 3 months is useful in maintaining adherence after the initial intervention. Additional research is required to determine how to best sequence these interventions, including the use of incentives.

For adolescents infected with the Human Immunodeficiency Virus (HIV), transitioning from pediatric to adult healthcare requires thorough preparation to maintain care continuity and optimal health outcomes. In China, a dedicated scale for assessing their transition readiness is lacking. The HIV Adolescent Readiness for Transition Scale (HARTS) addresses this by evaluating transition readiness across vital domains, with its 15-item design predicting post-transition viral suppression-a key indicator of a successful transition. With no equivalent tool in China, the HARTS's cross-cultural adaptation holds significant potential for enhancing personalized transition strategies and health management. To validate the HIV Adolescent Readiness for Transition Scale (HARTS) among adolescents with HIV in China, the validation was conducted from October 2023 to February 2024, following a five-step process: translation and back-translation; content validity examination by 13 experts; pre-survey with 30 adolescents with HIV; test-retest reliability assessment with 40 adolescents with HIV over a 10-day interval; and structural validation using exploratory factor analysis, including principal component analysis and varimax orthogonal rotation, among 170 adolescents with HIV. The average content validity index of the scale was 0.99. The Cronbach's alpha value for the pre-survey was 0.767, and for test-retest reliability, the intra-class correlation coefficient (ICC) was 0.901. With a total of 15 items, the four factors that made up the scale-"Disclosure," "Health Navigation," "Self-Advocacy," and "Health Literacy"-explained 81.73% of the variation. With alpha values of 0.940, 0.917, 0.929, and 0.888 for each of the four domains, the scale's overall Cronbach's alpha value was 0.943. The Chinese version of HARTS demonstrates good reliability and validity, serving as a tool for assessing the medical transition readiness level of adolescents with HIV in China.

Previous research suggests that depression impacts HIV outcomes, including viral suppression. This meta-analysis quantifies the association between depression and HIV viral suppression. A systematic literature search was conducted in PubMed, Web of Science, EBSCO, and OVID to identify studies published through 2012 to 2022. The software Rayyan was used to evaluate eligibility of studies, and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for abstracting data. A random effects meta-analysis was performed using Review Manager 5.4.1. Of the 1911 articles screened, 16 studies were included covering 80,103 participants. The results showed individuals without depression were more likely to achieve HIV viral suppression or undetectable viral load compared to individuals with depression (OR 1.30; 95%CI 1.15, 1.48; I² = 76%). Subgroup analysis indicated this effect was significant among the general population of people living with HIV (n = 75,353; OR 1.32; 95%CI 1.12, 1.55; I² = 85%) and cisgender women living with HIV (n = 4553; OR 1.28; 95%CI 1.09, 1.50; I² = 16%), but not among cisgender men living with HIV (most identified as men who have sex with men) (n = 197; OR 2.13; 95%CI 0.43, 10.61; I² = 83%). This meta-analysis shows a significant positive association between the absence of depression and achieving HIV viral suppression overall and among the subgroup of cisgender women. Public health interventions for people living with HIV should include strategies to identify and address the depressive symptoms that impact adherence to treatment, increase the risk of psycho-behavioral co-morbidities, and exacerbate social or structural factors impeding viral suppression.

Young sexual and gender minority (SGM) people assigned male at birth who use substances are at elevated risk of HIV acquisition. This brief report leverages a large cohort of SGM people assigned male at birth to estimate substance use homophily (i.e., same-same substance use status) in sexual partnerships. We found substance use homophily in this sexual network for marijuana, poppers, methamphetamine, and hallucinogens but not heavy episodic drinking, cocaine, or ecstasy. These results suggest substance use is associated with sexual network structure and may increase HIV disparities between individuals who do and do not use substances.