JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"Brief Report: Trends in Hospital Readmissions Among Adults With and Without HIV in the United States, 2010-2020.","authors":"Xianming Zhu, Eshan U Patel, Stephen A Berry, Mary K Grabowski, Alison G Abraham, Keri N Althoff, Thomas C Quinn, Kelly A Gebo, Aaron A R Tobian","doi":"10.1097/QAI.0000000000003577","DOIUrl":"10.1097/QAI.0000000000003577","url":null,"abstract":"<p><strong>Background: </strong>Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the United States.</p><p><strong>Setting: </strong>Adult participants in the 2010-2020 Nationwide Readmissions Database, which weighted represents all US hospitalizations each year.</p><p><strong>Methods: </strong>We defined index admission and unplanned readmission using the US Centers for Medicare & Medicaid Services criteria. Overall and sex-specific readmission risks were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 Nationwide Readmissions Database. Random effect linear and Poisson regressions were used to estimate risk difference and annual percentage change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient's zip code median household income. All analyses were weighted to generate national estimates.</p><p><strong>Results: </strong>Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010 and 2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020 (RD= -1.60 [95% CI: -2.24,-0.95]). Nonpregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Nonpregnant female PWH <40 years had no reduction in readmission risk between 2016 and 2020 (RD= -0.45 [95% CI: -2.43, 1.53]).</p><p><strong>Conclusions: </strong>There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"98 4","pages":"334-339"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457987","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":"Increasing the Accessibility and Relevance of Implementation Science for Front-Line Implementers.","authors":"Sarit A Golub, Carly Wolfer, Cody A Chastain","doi":"10.1097/QAI.0000000000003580","DOIUrl":"10.1097/QAI.0000000000003580","url":null,"abstract":"<p><strong>Background: </strong>Implementation science has been heralded as a critical strategy for ending the HIV epidemic, and the United States has made a tremendous financial investment in implementation research. However, several dynamics in its development and organization may alienate front-line implementers and recapitulate some of the same missteps that have stymied past translational work.</p><p><strong>Setting: </strong>Increasing the accessibility and relevance of HIV implementation science for front-line implementers (eg, health department and health systems directors, clinic administrators, program managers, clinicians, and other providers) is critical.</p><p><strong>Methods: </strong>We review current challenges to the meaningful inclusion of front-line implementers in implementation science research, and consider specific changes to language, frameworks, and methods that would maximize the accessibility and relevance of the field.</p><p><strong>Results: </strong>Our analysis suggests the need for greater attention to implementation strategies most relevant to front-line implementers, that is, those focused on intervention recipients. We propose a novel, multilayer framework for conceptualizing the strategies necessary to achieve HIV implementation outcomes by organizations, providers, and recipients. There is a compelling rationale to adopt incentive structures that prioritize research questions most important for practice.</p><p><strong>Conclusions: </strong>Maximizing the impact of implementation science on ending the HIV epidemic goals requires (1) expanding the focus of implementation science to include more recipient-focused implementation strategies, (2) developing and applying frameworks that better reflect the experience and needs of front-line implementers, (3) using language most relevant and applicable to practice, and (4) prioritizing actionable research questions that directly address the needs and concerns of those doing implementation work.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"372-376"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785544","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":"The Impact of a Couple-Based Intervention on One-Year Viral Suppression Among Pregnant Women Living With HIV and Their Male Partners in Malawi: A Randomized Controlled Trial.","authors":"Nora E Rosenberg, Lauren A Graybill, Tiwonge Mtande, Nuala McGrath, Suzanne Maman, Tiyamike Nthani, Robert Krysiak, Isaac Thengolose, Irving F Hoffman, William C Miller, Mina Hosseinipour","doi":"10.1097/QAI.0000000000003583","DOIUrl":"10.1097/QAI.0000000000003583","url":null,"abstract":"<p><strong>Introduction: </strong>Couple-based behavioral interventions (CBIs) have been associated with improved HIV virological outcomes for pregnant women and their male partners living with HIV in observational settings, but have never been tested in a randomized controlled trial (RCT).</p><p><strong>Setting: </strong>Bwaila District Hospital Antenatal Clinic (Lilongwe, Malawi).</p><p><strong>Methods: </strong>An RCT was conducted among 500 pregnant women living with HIV (index clients) randomized 1:1 to the standard of care (SOC) or CBI and followed for 1 year. The CBI offered an initial session for index clients, HIV-assisted partner notification, 2 enhanced couple counseling and testing sessions, illustrated materials, and antiretroviral therapy pickup for either couple member at the antenatal clinic. At 12 months, viral load among index clients and male partners with HIV was measured. Risk differences (RD) and 95% confidence intervals (CIs) compared viral suppression (<1000 copies/mL) between arms.</p><p><strong>Results: </strong>The mean index client age was 26.6 years; most were married or cohabiting (93.3%). Index client viral suppression was 6.5% higher in the CBI arm (88.0%) than in the SOC arm (81.6%). Male partner viral suppression was 16.2% higher in the CBI arm (73.6%) than the SOC arm (57.4%). Overall, couple viral suppression was 7.8% higher (CI: 0.5% to 15.1%, P = 0.04) in the CBI arm (84%) than in the SOC arm (76.0%). Social harms were rare (3.6%) and comparable between arms ( P = 0.8).</p><p><strong>Conclusions: </strong>This CBI had a positive impact on couple viral suppression. Scaling this CBI to antenatal clients with HIV and their male partners could improve HIV outcomes among expecting families.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"386-394"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876499","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":"Brief Report: Associations Between Gender and Solicited Adverse Events After Passive Infusion of VRC01 or Placebo in HVTN 704/HPTN 085.","authors":"Deborah A Theodore, Moni Neradilek, Kevin Gillespie, Srilatha Edupuganti, Juan Carlos Hinojosa, Javier R Lama, Robert De La Grecca, Yi H Wu, Annet Davis, Daniel Mangini, Philip Andrew, Mary A Marovich, Sheryl Zwerski, Gail Broder, Michele P Andrasik, Delivette Castor, Alison C Roxby, Myron Cohen, Yunda Huang, Shelly T Karuna, Magdalena E Sobieszczyk","doi":"10.1097/QAI.0000000000003582","DOIUrl":"10.1097/QAI.0000000000003582","url":null,"abstract":"<p><strong>Background: </strong>Realizing the potential of HIV prevention options requires understanding product tolerability across diverse groups vulnerable to HIV acquisition. Gender minority (GM) individuals are understudied in clinical trials.</p><p><strong>Setting: </strong>HVTN 704/HIV Prevention Trials Network 085, a phase 2b randomized HIV prevention trial, enrolled MSM and transgender participants from Brazil, Peru, Switzerland, and the United States to receive an infusion every 8 weeks (10 total) of VRC01 30 mg/kg, VRC01 10 mg/kg, or placebo. Solicited adverse events (AEs) were recorded for 3 days after each infusion.</p><p><strong>Methods: </strong>Gender was defined by self-report and sex assigned-at-birth. Multivariate mixed logistic models were used to estimate the association between gender (cisgender men [CM] vs. GM participants [transgender women, transgender men, or another gender]) and solicited AE frequency and severity.</p><p><strong>Results: </strong>GM participants reported more solicited AEs than CM among all participants (adjusted OR 1.59, 95% CI: 1.20 to 2.10, P = 0.001) and among placebo recipients (1.72, 1.05 to 2.81, P = 0.031). The severity of solicited AEs (occurrence of grade 2 and higher event) did not significantly differ overall (1.83, 0.79 to 4.20, P = 0.174) or among placebo recipients (3.05, 0.76 to 12.32, P = 0.112). Grade 2 events were reported after 1% and 2% of total infusions among CM and GM participants, respectively. Grade 3-4 events were rare overall (<0.1%). Completion of 10 infusions was high (78.6%) and slightly higher in CM (79.2%) than GM participants (73%).</p><p><strong>Conclusions: </strong>This is the first report of associations between gender and solicited AEs after monoclonal antibody infusion. GM participants reported more events; severity was low. HIV prevention trials must engage and support GM individuals to best evaluate tolerability of novel agents.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"98 4","pages":"340-345"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457819","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":"Brief Report: Pancreatic Cancer in People With HIV: A Case-Control Study.","authors":"Sylvain Chawki, Gwenn Hamet, Alexandre Brun, Nelson Lourenco, Olivier Bouchaud, Julie Bottero, Pierre Sellier, Jean-Michel Molina","doi":"10.1097/QAI.0000000000003585","DOIUrl":"10.1097/QAI.0000000000003585","url":null,"abstract":"<p><strong>Background: </strong>We aimed to estimate the incidence and to assess the risk factors associated with pancreatic cancer (PC) in people with HIV (PWH).</p><p><strong>Setting: </strong>We used electronic medical record data from 2009 to 2020 available in the COREVIH Ile-de-France-Est database of PWH treated in Paris public hospitals.</p><p><strong>Methods: </strong>We analyzed data on patient demographics, treatment history, and immunovirologic status. A case-control study was designed; each case (PWH and PC) was matched on age, gender, and duration of HIV infection to 4 controls (PWH without PC).</p><p><strong>Results: </strong>Twenty-four cases were identified from the database, with an incidence of PC estimated at 28 cases (95% confidence interval: 19 to 43) per 100,000 person-years. The median age was 57 years [interquartile range (IQR) 51-68] at cancer diagnosis. Twenty-one cases (88%) were male. The median CD4 + T-cell count at PC diagnosis was 587/mm 3 (IQR 317-748), and the nadir CD4 + T-cell count was 194 (IQR 98-380). Twenty cases (91%) had a suppressed HIV replication at PC diagnosis. Twelve patients (50%) had metastasis on diagnosis. The median time to death after cancer diagnosis was 11 months (IQR 1-19). Twenty-two cases were matched with 88 controls. There were no statistically significant risk factors of PC identified in our analysis.</p><p><strong>Conclusion: </strong>PC remains rare in PWH and is associated with a severe prognosis at a relatively young age. Further studies are needed to identify risk factors associated with PC development in PWH.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"321-325"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864183","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":"Longitudinal Changes in Tenofovir and Tenofovir Diphosphate Concentrations Among Pregnant Women Using Oral PrEP for HIV Prevention: Findings From Durban, South Africa.","authors":"Ivana Beesham, Manjeetha Jaggernath, Yolandie Kriel, Jiaying Hao, Patricia M Smith, Jessica E Haberer, Craig W Hendrix, Christina Psaros, David R Bangsberg, Jennifer A Smit, Lynn T Matthews","doi":"10.1097/QAI.0000000000003586","DOIUrl":"10.1097/QAI.0000000000003586","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women are vulnerable to HIV acquisition. Oral HIV pre-exposure prophylaxis (PrEP) is safe and effective for use during pregnancy. We describe PrEP adherence among pregnant women using multiple measures.</p><p><strong>Methods: </strong>We conducted a secondary data analysis among women enrolled in a study evaluating an adherence intervention for PrEP among those planning for and with pregnancy in South Africa. Our analysis included women who used PrEP and became pregnant. Longitudinal PrEP use was assessed using concentrations of tenofovir (TFV) in plasma, tenofovir diphosphate (TFV-DP) in dried blood spots, and electronic pillcap data from quarterly visits. Plasma TFV ≤10 ng/mL and TFV-DP ≤16.6 fmol/punch were below quantifiable limits. Data were analyzed during prepregnancy (quarter before pregnancy) and pregnancy trimesters.</p><p><strong>Results: </strong>Among 35 women, 69% were 18-24 years old, 40% were nulliparous, and 94% did not know their partner's HIV serostatus. Median pillcap adherence was 55%-80% and was highest during prepregnancy (72%, interquartile range: 54%-86%) and third trimester (80%, interquartile range: 30%-94%). The proportion of women with quantifiable TFV was 47% (n = 8/17) prepregnancy and 33% (n = 9/27), 19% (n = 4/21), and 14% (n = 2/14) for trimesters 1-3, respectively. TFV-DP was detected in 75% of samples (n = 12/16) prepregnancy, and 50% (n = 13/26), 29% (n = 6/21), and 27% (n = 4/15) for trimesters 1-3, respectively. No women acquired HIV during pregnancy.</p><p><strong>Conclusions: </strong>PrEP use declined during pregnancy by all measures. Discrepancies between pillcap measurements and drug concentrations could be due to physiologic changes during pregnancy or under- or overuse of the pillcaps. Determining what drug metabolite concentrations are needed to confer protection during pregnancy is important for optimizing counseling and prevention support.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"357-362"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869300","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":"Weight and Metabolic Changes With Long-Acting Cabotegravir and Rilpivirine or Bictegravir/Emtricitabine/Tenofovir Alafenamide.","authors":"Darrell H S Tan, Andrea Antinori, Beng Eu, María José Galindo Puerto, Clifford Kinder, Donna Sweet, Cornelius N Van Dam, Kenneth Sutton, Denise Sutherland-Phillips, Alessandro Berni, Feifan Zhang, Rimgaile Urbaityte, Bryan Baugh, William Spreen, Jean van Wyk, Harmony P Garges, Parul Patel, Rachel Batterham, Ronald D'Amico","doi":"10.1097/QAI.0000000000003584","DOIUrl":"10.1097/QAI.0000000000003584","url":null,"abstract":"<p><strong>Background: </strong>Modest weight and lipid changes have been observed in cabotegravir plus rilpivirine long-acting (CAB + RPV LA) phase 3/3b studies. The SOLAR study included standardized evaluations of weight and metabolic changes in people living with HIV switching to CAB + RPV LA dosed every 2 months (Q2M) vs. continuing bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF).</p><p><strong>Setting: </strong>Phase 3b, randomized, open-label study conducted in 118 centers across 14 countries.</p><p><strong>Methods: </strong>Participants (n = 687) were randomized 2:1; 454 switched to CAB + RPV LA Q2M and 227 continued BIC/FTC/TAF. Participants who started lipid-modifying agents or underwent cosmetic procedures were excluded. We analyzed changes in body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), muscle mass, body fat, and proportion with insulin resistance or metabolic syndrome at 1 year.</p><p><strong>Results: </strong>Median (interquartile range) change in body weight from baseline was -0.40 kg (-2.95 to +2.10) and +0.05 kg (-2.30 to +1.95) in the LA and BIC/FTC/TAF arm, respectively. Median (interquartile range) changes in WC and HC were +0.06 cm (-4.50 to 4.00) and +0.00 cm (-4.00 to 3.97) in the LA arm, and +1.14 cm (-3.00 to 5.09) and +0.13 cm (-3.10 to 4.00) in the BIC/FTC/TAF arm. There were no clinically relevant changes in WHtR, WHR, or the proportion with metabolic syndrome or insulin resistance in either arm.</p><p><strong>Conclusions: </strong>Standardized changes in weight, BMI, and body composition were minor and similar between participant switching to CAB + RPV LA Q2M or continuing BIC/FTC/TAF, with no clinically relevant changes in metabolic syndrome or insulin resistance.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"401-409"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828560","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":"Brief Report: The Implications of Removing Race From Interpretation of Pulmonary Function Among Persons With or Without HIV.","authors":"Richard J Wang, Ken M Kunisaki, Alison Morris, M Bradley Drummond, Mehdi Nouraie, Laurence Huang, Phyllis C Tien, Aaron D Baugh, Igor Barjaktarevic, Neha Bhandari, Surya P Bhatt, Gypsamber D'Souza, Margaret A Fischl, Robert F Foronjy, Robert L Jensen, Deepa G Lazarous, Ighovwerha Ofotokun, Divya Reddy, Valentina Stosor, Meredith C McCormack, Sarath Raju","doi":"10.1097/QAI.0000000000003579","DOIUrl":"10.1097/QAI.0000000000003579","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest that the use of race-specific pulmonary function reference equations may obscure racial inequities in respiratory health. Whether removing race from the interpretation of pulmonary function would influence analyses of HIV and pulmonary function is unknown.</p><p><strong>Setting: </strong>Pulmonary function measurements from 1067 men (591 with HIV) in the Multicenter AIDS Cohort Study and 1661 women (1175 with HIV) in the Women's Interagency HIV Study were analyzed.</p><p><strong>Methods: </strong>Percent-of-predicted values for spirometry and single-breath diffusing capacity of carbon monoxide (DLCO) measurements were generated with race-specific reference equations derived from the National Health and Nutrition Examination Survey and with the race-neutral application of reference equations derived from the Global Lung Function Initiative database. Regression models were used to evaluate the association between HIV and percent-of-predicted measures of pulmonary function. Alpaydin's F test was used to compare how well these values predicted self-reported respiratory health-related quality of life.</p><p><strong>Results: </strong>Persons with HIV were observed to have significantly lower percent-of-predicted diffusing capacity for carbon monoxide (DLCO) than those without HIV but no significant differences in spirometric measures of pulmonary function, regardless of whether a race-specific or race-neutral approach was used. Among men, but not women, the race-neutral application of reference equations to generate percent-of-predicted DLCO values performed better for predicting respiratory-related quality of life.</p><p><strong>Conclusions: </strong>The race-neutral application of pulmonary function reference equations continues to identify lung function impairment in persons with or at risk for HIV and, for DLCO, may be superior to the use of race-specific reference equations in identifying clinically relevant impairments.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"98 4","pages":"395-400"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457823","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":"Alignment of PrEP Use With Potential HIV Exposure in Young Women and Men in Uganda.","authors":"Linxuan Wu, Timothy Ssebuliba, Timothy R Muwonge, Felix Bambia, Gabrielle Stein, Olivia Nampewo, Oliver Sapiri, B Jay Goetz, Kerri J Penrose, Urvi M Parikh, Andrew Mujugira, Renee Heffron","doi":"10.1097/QAI.0000000000003573","DOIUrl":"10.1097/QAI.0000000000003573","url":null,"abstract":"<p><strong>Background: </strong>Despite high oral pre-exposure prophylaxis (PrEP) uptake among young heterosexual cisgender women, early discontinuation is frequent. It is unclear whether this aligns with potential HIV exposure.</p><p><strong>Methods: </strong>Young women aged 16-25 years and ≥1 of their male partners were enrolled in separate but linked longitudinal HIV PrEP studies in Kampala, Uganda, from 2018 to 2021. Data on sexual behavior, PrEP use, sexually transmitted disease positivity, and Y chromosome DNA (Yc DNA; a marker for condomless sex) were collected at enrollment and quarterly visits. Potential HIV exposure was defined as one of the following in the past 3 months: any sexually transmitted disease, detection of Yc DNA, condomless vaginal sex, or multiple sex partners. Alignment between potential HIV exposure and PrEP use by participants was examined using generalized estimating equation (GEE) regression.</p><p><strong>Results: </strong>Eighty-eight young women (median age = 20.6 years, interquartile range 19.5-22.0) and 124 male partners (median age = 23.5 years, interquartile range 21.0-26.0) were included. Women and men were dispensed PrEP in 66.9% and 60.5% of their first linked visits, respectively. PrEP dispensation was more common when women or men self-reported condomless vaginal sex and multiple sex partners or when women had Yc DNA detected in vaginal swabs. Men's self-report of multiple partners (adjusted prevalence ratio = 1.56, P = 0.012) and the detection of Yc DNA (adjusted prevalence ratio = 1.52, P = 0.040) were significantly associated with women's PrEP dispensation.</p><p><strong>Conclusions: </strong>Women and their male partners may align their PrEP use with their HIV risk behaviors, providing some reassurance that PrEP discontinuation in young people often aligns with sexual behavior. Greater attention to measurement of and mismatches in PrEP discontinuation and potential HIV exposure is needed.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"326-333"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768892","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":"PrEP Beyond the Clinic: Evaluation of a Home-Based PrEP Follow-Up System Among a Cohort of Predominantly Black and Latino Men who Have Sex with Men in South Florida.","authors":"Stefani A Butts, Ariana L Johnson, Susanne Doblecki-Lewis","doi":"10.1097/QAI.0000000000003664","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003664","url":null,"abstract":"<p><strong>Background: </strong>PrEP is highly effective for HIV prevention, but structural and logistical barriers, such as stigma, transportation, and time required for appointment can limit PrEP continuation. Home-based (HB) PrEP systems may alleviate these barriers, promoting greater adherence and persistence in PrEP care.</p><p><strong>Methods: </strong>PrEP clients were recruited from a sexual health clinic program in South Florida. Participants received self-collection kits for urine, rectal, pharyngeal, and blood specimens by mail combined with remote assessments replacing three quarterly in-person visits. Data on demographic characteristics, PrEP follow-up preferences, and completion rates were collected. Bivariate and logistic regression analyses identified factors influencing HB PrEP adoption and completion.</p><p><strong>Results: </strong>Of 225 clients approached 160 (71.1%) were screened with 60 (37.5%) opting for HB PrEP. In logistical regression analysis, Black Non-Hispanic/Latino race/ethnicity and any comfort level other than \"very comfortable\" for specimen collection were independent negative predictors of HB PrEP election (OR 0.11; 95%CI 0.02-0.67; p=0.02 and OR 0.12-0.25; 95% CI 0.02-0.89; p=0.01-0.04 respectively). HB PrEP completion rates were 48.3%, 16.7%, and 15% for the first, second, and third follow-up. Despite initial preference for HB PrEP, most participants returned to in-clinic care citing discomfort with self-collection, logistical challenges, convenience, and reliability concerns.</p><p><strong>Conclusion: </strong>HB PrEP shows potential for improving PrEP maintenance but faces challenges in equitable uptake and persistence. Addressing logistical issues, enhancing specimen collection ease, and providing robust support systems are crucial for broader adoption and sustained PrEP care. Integrating flexible follow-up options may better accommodate the diverse needs of priority populations.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735861","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}