JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"Acceptability of Multilevel Sexual Health Interventions and Sexually Transmitted Infection Screening and Testing Among Persons With HIV Across Three Clinical Sites in Florida.","authors":"Preeti Manavalan, L Beth Gadkowski, Archie Sachdeva, Subharup Guha, Stacy Porvasnik, John A Nelson, Jennifer W Janelle","doi":"10.1097/QAI.0000000000003569","DOIUrl":"10.1097/QAI.0000000000003569","url":null,"abstract":"<p><strong>Introduction: </strong>The US state of Florida has the third highest rate of HIV and high rates of sexually transmitted infections (STIs) indicating critical HIV and STI prevention needs remain unmet. To address gaps in the STI care continuum in people with HIV (PWH), evidence-based interventions were implemented across 3 Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Florida between August 2020 and August 2021. Interventions included comprehensive sexual health history (SHH) taking using audio computer-assisted self-interview (ACASI) software, self-collected extragenital gonorrhea and chlamydia testing, and the introduction of a lesbian, gay, bisexual, transgender, and queer (LGBTQ+) welcoming environment.</p><p><strong>Methods: </strong>We (1) assessed the acceptability of these interventions and examined if acceptability differed among youth and sexual, racial, and ethnic minorities; (2) determined the proportion of appropriate STI testing completed based on the SHH assessment; (3) examined whether STI at-risk individuals underwent STI screening 3-6 months after initial evaluation; and (4) determined the proportion of positive STI test results among priority intervention groups in Florida.</p><p><strong>Results: </strong>Acceptability of all interventions was high. Youth, lesbian, gay, and bisexual, and Hispanic individuals were significantly more likely to notice and like LGTBQ+ welcoming measures. The proportion of recommended tests completed was high, although only a subset of at-risk individuals completed rescreening. About 11.9% of rectal samples were positive for chlamydia, and 6.5% of pharyngeal samples were positive for gonorrhea.</p><p><strong>Conclusions: </strong>Our study highlights the importance of incorporating comprehensive sexual health care protocols, including extragenital STI testing, into the overall care of PWH.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"282-290"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Whether Providing Regular, Free HIV Self-Testing Kits Reduces the Time to HIV Diagnosis: An Internet-Based, Randomized Controlled Trial in Men Who Have Sex With Men.","authors":"David T Dunn, Leanne McCabe, Denise Ward, Andrew N Phillips, Fiona C Lampe, Fiona Burns, Valerie Delpech, Peter Weatherburn, T Charles Witzel, Roger Pebody, Peter Kirwan, Jameel Khawam, Sara Croxford, Michael Brady, Kevin A Fenton, Roy Trevelion, Yolanda Collaco-Moraes, Sheena McCormack, Alison J Rodger","doi":"10.1097/QAI.0000000000003564","DOIUrl":"10.1097/QAI.0000000000003564","url":null,"abstract":"<p><strong>Background: </strong>The risk of onward HIV transmission is strongly influenced by the interval between HIV infection and its diagnosis. The SELPHI trial examined whether this interval could be reduced by offering free HIV self-testing kits to men who have sex with men (MSM).</p><p><strong>Setting: </strong>Internet-based RCT of MSM aged ≥16 years, resident in England/Wales, recruited through sexual and social networking sites.</p><p><strong>Methods: </strong>The second-stage randomization of SELPHI was open to participants who used an initial free HIV self-test kit, were HIV seronegative, and reported recent condomless anal sex. They were randomized to receive a free HIV self-test kit every 3 months (repeat testing [RT] group) versus no such offer (nRT group). The primary outcome was time from randomization to a confirmed HIV diagnosis, determined from linkage to national HIV surveillance databases. The key secondary outcome was the frequency of HIV testing regardless of test modality.</p><p><strong>Results: </strong>In total, 2308 eligible participants (1161 RT, 1147 nRT) were randomized between April 2017 and June 2018, and followed for 15-27 months. The proportion of participants reporting an HIV test in the previous 3 months was much higher in the RT group (86%) than in the nRT group (39%). Overall, 16 (9 RT, 7 nRT) confirmed HIV diagnoses were observed (0.35/100 person-years), with no difference between the groups (hazard ratio = 1.27 [95% CI: 0.47 to 3.41], P = 0.63).</p><p><strong>Conclusions: </strong>Providing regular free self-testing kits to sexually active MSM was highly acceptable and markedly increased HIV testing. However, in this low incidence cohort, it did not result in a demonstrably more rapid diagnosis of incident infections.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"274-281"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma: A Pilot Cluster Randomized Control Trial.","authors":"M Kumi Smith, Danyang Luo, Siyan Meng, Yunqing Fei, Wei Zhang, Joseph Tucker, Chongyi Wei, Weiming Tang, Ligang Yang, Benny L Joyner, Shujie Huang, Cheng Wang, Bin Yang, Sean Y Sylvia","doi":"10.1097/QAI.0000000000003565","DOIUrl":"10.1097/QAI.0000000000003565","url":null,"abstract":"<p><strong>Background: </strong>Consistent evidence shows stigma impedes healthcare access in people living with HIV (PLWH) and men who have sex with men (MSM). We evaluated the impact of stigma reduction training for providers whose design was informed by direct observation of their clinical behaviors obtained through visits by incognito standardized patients (SPs).</p><p><strong>Setting: </strong>We conducted this study in sexually transmitted disease clinics in Guangzhou, China.</p><p><strong>Methods: </strong>This pilot cluster randomized control trial assessed the feasibility, acceptability, and preliminary efficacy of an intervention whose design was informed by a baseline round of incognito visits in which SPs presented standardized cases to consenting doctors. By randomly varying the HIV status and sexual orientation of each case, we could quantify stigma as differences in care quality across scenarios. We then conducted a follow-up round of SP visits and assessed the impact using linear fixed effects regression.</p><p><strong>Results: </strong>Feasibility and acceptability among the 55 provider participants were high, with no adverse visit events. The provider training improved the offering of testing to HIV-negative MSM (0.05 percentage points, 95% confidence interval, -0.24 to 0.33) and diagnostic effort for HIV-positive MSM (0.23 SD improvement, 95% CI: -0.92 to 1.37). Patient-centered care only improved for HIV-positive straight cases (SD, 0.57; 95% CI: -0.39 to 1.53). All estimates lacked statistical precision, an expected outcome of a pilot randomized control trial.</p><p><strong>Conclusions: </strong>Our training reduced stigma in several domains of care, but least of all for PLWH, suggesting that future trainings should include more clinical content to strengthen clinical skills in PLWH management.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"98 3","pages":"224-233"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of Dolutegravir vs Efavirenz on Viral Suppression and Retention at 6-months: A Regression Discontinuity Design.","authors":"Amy Zheng, Matthew P Fox, Ross Greener, Emma M Kileel, Jacob Bor, Willem Df Venter, Pedro T Pisa, Alana T Brennan, Mhairi Maskew","doi":"10.1097/QAI.0000000000003642","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003642","url":null,"abstract":"<p><strong>Background: </strong>In 2019, South Africa's Antiretroviral Therapy (ART) Treatment Guidelines replaced efavirenz with dolutegravir in first-line ART.</p><p><strong>Setting: </strong>We assessed the impact of this national guideline change on retention and viral suppression in the Themba Lethu Clinical Cohort, Johannesburg, South Africa. We applied a regression discontinuity design in a prospective cohort study of 1654 adults living with HIV initiating first-line ART within 12 months (±12 months) of the guideline change.</p><p><strong>Methods: </strong>We compared outcomes in individuals presenting just before and after the guideline change and estimated intention-to-treat effects on initiating a dolutegravir- vs efavirenz-based regimen. Primary outcomes were retention and viral suppression. Participants were defined as retained in care if a visit took place within +3-months of the 6-month endpoint. Viral suppression was defined as having a viral load < 1000 copies/mL 3-months prior to and up to 6-months after the 6-month endpoint.</p><p><strong>Results: </strong>The 2019 guideline change led to an increase in uptake of dolutegravir. We noted a 26.6 percentage point increase in the proportion initiating dolutegravir (95% Confidence Interval (CI): 14.1, 38.6). We saw a small increase in viral suppression (Risk Difference (RD): 7.4 percentage points; 95% CI: -1.6, 16.5) and no change in retention (RD: -1.7 percentage points; 95% CI: -13.9, 10.5) at 6 months, though our findings were imprecise.</p><p><strong>Conclusion: </strong>Our estimates suggest early uptake of the revised treatment guidelines after implementation. Despite this, there was no meaningful change in viral suppression and retention rates at 6-months.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in HIV Diagnosis Rates by Social Determinants of Health at the Census Tract Level Among Adults in the United States and Puerto Rico, 2021.","authors":"Krishna Kiran Kota, Samuel Eppink, Zanetta Gant Sumner, Harrell Chesson, Donna Hubbard McCree","doi":"10.1097/QAI.0000000000003541","DOIUrl":"10.1097/QAI.0000000000003541","url":null,"abstract":"<p><strong>Background: </strong>We compared racial and ethnic disparities in HIV diagnosis rates among adults in census tracts with the most disadvantaged vs. the most advantaged levels of social determinants of health.</p><p><strong>Methods: </strong>In this ecologic analysis, we used the National HIV Surveillance System data from 2021 and social determinants of health data from 2017-2021 American Community Survey. We measured racial and ethnic disparities stratified by sex in the most disadvantaged quartiles and advantaged quartiles for (1) poverty, (2) education level, (3) median household income, and (4) insurance coverage. We calculated 8 relative disparity measures [Black-to-White rate ratio, Hispanic/Latino-to-White rate ratio, index of disparity (ID), population-weighted ID, mean log deviation, Theil index, population attributable proportion, Gini coefficient] and 4 absolute disparity measures (Black-to-White rate difference, Hispanic/Latino-to-White rate difference, absolute ID, and population-weighted absolute ID).</p><p><strong>Results: </strong>Comparing the most disadvantaged quartiles with the most advantaged quartiles, all 4 absolute disparity measures decreased, but 7 of the 8 relative disparity measures increased: the median percentage decreases in the absolute measures for men and women, respectively, were 38.1% and 47.6% for poverty, 12.4% and 42.6% for education level, 43.6% and 44.0% for median household income, and 44.2% and 45.4% for insurance coverage. The median percentage increases in the relative measures for men and women, respectively, were 44.3% and 61.3% for poverty, 54.9% and 95.3% for education level, 19.6% and 90.0% for median household income, and 32.8% and 46.4% for insurance coverage.</p><p><strong>Conclusions: </strong>Racial and ethnic disparities in the most disadvantaged and the most advantaged quartiles highlight the need for strategies addressing the root causes of disparities.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"114-122"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Methamphetamine Use Is Essential to Stopping HIV Transmission.","authors":"Finn Black, Vanessa McMahan, Xochitl Luna Marti, Emily Pope, John Walker, Albert Liu, Phillip Oliver Coffin","doi":"10.1097/QAI.0000000000003542","DOIUrl":"10.1097/QAI.0000000000003542","url":null,"abstract":"","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"e9-e10"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Schizophrenia, Off-Label Antipsychotics, and Dementia Risk in People With HIV.","authors":"Joseph Magagnoli, Tammy H Cummings, Michael D Wyatt, Michael Shtutman, S Scott Sutton","doi":"10.1097/QAI.0000000000003545","DOIUrl":"10.1097/QAI.0000000000003545","url":null,"abstract":"<p><strong>Background: </strong>Comorbidities such as schizophrenia and medication such as antipsychotics may influence the risk of dementia among people living with HIV (PLWH). The objective of this article is to assess the associations among HIV patients with schizophrenia, off-label antipsychotics, and dementia risk.</p><p><strong>Setting: </strong>US Department of Veterans Affairs health care facilities from 2000 to September 2023.</p><p><strong>Methods: </strong>Retrospective cohort study of PLWH treated by the US Department of Veterans Affairs with history of schizophrenia, off-label antipsychotic use, and neither schizophrenia nor antipsychotic use. Propensity score-matched non-HIV controls were included for the respective HIV groups. The hazard of dementia is estimated using Cox proportional hazards models.</p><p><strong>Results: </strong>PLWH and schizophrenia, were found to have a 2.49 higher hazard of dementia than HIV patients with no history of schizophrenia or antipsychotic medication use (hazard ratio [HR] = 2.49, 95% confidence interval [CI]: 1.85 to 3.35). PLWH and off-label antipsychotic use were found to have a 1.77-fold higher hazard of dementia than HIV patients with no history of schizophrenia or antipsychotic medication use (HR = 1.77, 95% CI: 1.37 to 2.28). Propensity score-matched analysis reveals that, among patients with schizophrenia, those with HIV had a 1.65-fold higher hazard of dementia (HR = 1.65, 95% CI: 1.12 to 2.44). Among patients with no schizophrenia or antipsychotic medication, those with HIV had a 1.47-fold higher hazard of dementia (HR = 1.47, 95% CI: 1.33 to 1.63).</p><p><strong>Conclusions: </strong>This study demonstrates that among PLWH, history of schizophrenia or off-label antipsychotic medication use are associated with substantial increases in dementia incidence. Furthermore, propensity score-matched control analysis reveals that HIV infection itself is independently and significantly associated with elevated dementia risk.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"133-142"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Pre-Exposure Prophylaxis (PrEP) awareness and use among Rakai Community Cohort Study youth aged 15-24.","authors":"Emily Murphy, Susie Hoffman, Victor Ssempijja, Fred Nalugoda, Larry W Chang, Robert Ssekubugu, Tom Lutalo, Godfrey Kigozi, Joseph Kagaayi, Nelson K Sewankambo, Steven J Reynolds, John Santelli, Philip Kreniske","doi":"10.1097/QAI.0000000000003640","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003640","url":null,"abstract":"<p><strong>Background: </strong>Preventing HIV infections among adolescents and young adults (AYA) is crucial for curtailing the epidemic. Oral pre-exposure prophylaxis (PrEP) is a highly effective prevention method increasingly available to this age group in sub-Saharan Africa but population-based data on awareness and use of PrEP among AYA remains limited.</p><p><strong>Methods: </strong>Analyzing survey data from two rounds of the Rakai Community Cohort Study, an open, population-based cohort, we estimated prevalence ratios associating various sociodemographic characteristics with PrEP awareness and ever-use among 15- to 24-year-olds in south-central Uganda between 2018 and 2023.</p><p><strong>Results: </strong>Most (62.4%, N=3,308/5,301) participants were aware of PrEP as an HIV prevention method but only 1.7% (N=133/7,999) of AYA had ever used it. Among the 35.5% (N=2,838/7,999) of participants meeting PrEP eligibility criteria, ever-use was similarly rare (2.6%, N=75/2,838). Compared to 20 to 24-year-olds, 15 to 19-year-olds were less likely to report awareness (fullyadjPR=0.82, 95%CI 0.78, 0.86) or ever-use (fullyadjPR=0.35, 95%CI 0.21, 0.58). Participants from fishing communities were more likely to be PrEP-aware (fullyadjPR=1.22, 95%CI 1.16, 1.29) or have ever used the prevention method (fullyadjPR=6.07, 95%CI 4.10, 8.98) than those from non-fishing communities.</p><p><strong>Conclusion: </strong>In this cross-sectional study of AYA in Uganda, awareness of PrEP was common but ever-use was rare, even among the third of respondents who were likely PrEP-eligible. This suggests that prevention policies and barriers besides unawareness of the method impede PrEP initiation. Efforts that target those barriers, particularly for adolescents, are critical for reducing HIV incidence among this priority population.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV risk perception and PrEP uptake among pregnant women offered PrEP during antenatal care in Kenya.","authors":"Mary M Marwa, Anna Larsen, Felix Abuna, Julia Dettinger, Ben Odhiambo, Salphine Watoyi, Pascal Omondi, Nancy Ngumbau, Laurén Gómez, Grace John-Stewart, John Kinuthia, Jillian Pintye","doi":"10.1097/QAI.0000000000003641","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003641","url":null,"abstract":"<p><strong>Background: </strong>Self-perceived HIV risk influences PrEP use, though few data on risk perception are available among pregnant women. We evaluated HIV risk perception and PrEP uptake among pregnant women in Kenya.</p><p><strong>Methods: </strong>We utilized data from a randomized trial evaluating universal versus risk-based PrEP delivery models at 20 antenatal clinics in Kenya (NCT03070600). Pregnant women enrolled were offered PrEP at any gestational age. A validated risk score for predicting HIV acquisition among perinatal women defined high HIV risk. HIV risk perception was assessed by asking \"What is your gut feeling about how likely you are to get infected with HIV?\" without a specified timeframe and dichotomized as low (\"extremely/very unlikely\") versus high (\"extremely/ Somewhat likely/very likely\"). All women in the universal PrEP offer arm were included in the analysis.</p><p><strong>Results: </strong>Among 2250 pregnant women the median age was 24 years (IQR 21-28), 81% were married, and 22% did not know their partner's HIV status. Overall, 27% of women had high HIV risk scores of whom 61% self-perceived high risk. Among women with high HIV risk scores (n=617), 69% declined PrEP; those who self-perceived low risk were more likely to decline than those with high risk perception (82% vs. 60%, aPR=1.35, 95% CI 1.17-1.55, p<0.001). Declining PrEP was associated with later gestational age at PrEP offer and with monogamous marriage among women with high HIV risk scores (p<0.05).</p><p><strong>Conclusion: </strong>Declining PrEP was common among pregnant women with high HIV risk, especially those who self-perceived low HIV risk. Refining risk perception may encourage PrEP uptake.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive STEPS: Enhancing Medication Adherence and Achieving Viral Load Suppression in Youth Living with HIV in the United States - Results from a Stepped-Care Randomized Controlled Efficacy Trial.","authors":"Matthew J Mimiaga, Lisa M Kuhns, Katie B Biello, Jiahao Tian, Margie R Skeer, Christina Psaros, Ethan Moitra, Diane Chen, Elizabeth Yonko, Kenneth H Mayer, Steven A Safren, Robert Garofalo","doi":"10.1097/QAI.0000000000003639","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003639","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the U.S. and worldwide, there is a significant number of young people acquiring and living with HIV. Antiretroviral therapy (ART) has led to significant reductions in HIV-related illnesses and deaths, allowing young people living with HIV to manage their condition as a chronic disease. Ensuring high levels of ART adherence is vital for treatment success. Despite this, to the best of our knowledge, there are no efficacious behavioral interventions for improving ART adherence and viral suppression among youth in the U.S.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a multicity, randomized controlled trial-in Boston, MA Providence, RI and Chicago, IL- to examine the efficacy of an stepped-care, behavioral and technology-based intervention, \"Positive STEPS,\" compared to a standard of care (SOC) control, for improving ART adherence and viral suppression among youth living with HIV ages 16 to 29 years. Positive STEPS included: Step-1: TXTXT, an evidence-based, daily two-way personalized text message reminder to take ART medications; and Step-2: only participants with &lt;90% adherence anytime between weeks 5 and 12 post-randomization to the Positive STEPS arm, would then receive five 50-minute sessions of manualized individual adherence counseling. If their adherence remained at 90% or higher, then they did not progress to Step-2. Adherence was measured via Wisepill, an electronic medication monitoring device, and self-report. Participants were followed for 12-months and completed biospecimen collection (HIV plasma RNA viral load testing) and a quantitative assessment battery at baseline, and at their 4-, 8-, and 12-month follow-up visits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between March 2018 to March 2023, 123 participants were randomized (Positive STEPS = 63; SOC control = 60). Intention-to-treat analyses showed a significant positive main effect for the Positive STEPS arm, which increased the mean log ART adherence by 18.7% relative to the SOC control at the 4-month visit (coefficient=0.187, p=0.021). For the time effect, a significant overall increase in ART adherence across the subsequent follow-up visits was observed, with increased mean log ART adherence by 27.8% (p&lt;0.01) at 8 months and 30.1% at 12 months (p&lt;0.01), relative to the SOC control. With respect to our viral suppression outcome, the analysis revealed a significant negative main effect for the Positive STEPS arm at the 4-month visits (odds ratio [OR]=0.264, p=0.023), indicating that the odds of having an unsuppressed virus were 74% lower in the Positive STEPS arm compared to the SOC control; the interaction term revealed that this effect was maintained through the12-month visit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These findings on the efficacy of Positive STEPS to enhance ART adherence and viral suppression among youth living with HIV represents the first behavioral intervention for youth to show significant and sustained effects on both behavioral (Wisepi","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}