JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"\"You are the tutor, you are the counselor, you are the school nurse, you are everything\": Secondary school staff experience with youth living with HIV.","authors":"Irene Njuguna, Hellen Moraa, Anne Mbwayo, Florence Nyapara, Calvins Aballa, Cyrus Mugo, Grace John-Stewart, Irene Inwani, Dalton Wamalwa, Gabrielle O'Malley","doi":"10.1097/QAI.0000000000003659","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003659","url":null,"abstract":"<p><strong>Background: </strong>Optimized treatment regimens have improved the survival of children/youth living with HIV (YLH) allowing them to pursue career goals. More YLH are now spending time in schools, but evidence points to poor support and adherence challenges in schools. We explored school staff experiences with YLH in the school environment.</p><p><strong>Methods: </strong>Four focus group discussions included 32 school staff from 32 high/secondary schools in Kenya. Inclusion criteria included having health responsibilities. Interview data were analyzed using directed content analysis.</p><p><strong>Results: </strong>The median age of participants was 35 (IQR: 31, 45) years and over half were female (56%). The majority of participants (91%) had both teaching and health roles, and half were staff at boarding schools. School staff reported YLH expressing feelings of hopelessness that resulted in medication non-adherence and demotivation to excel in school. Sometimes, YLH HIV status was only disclosed when YLH were referred for disciplinary action due to behavioral problems. Parent/caregiver psychological challenges and difficult home environments made it difficult for schools to work with families to support YLH. School staff often stepped in to offer psychological support to YLH, but this created significant time demands. School staff felt they were not adequately trained to provide the services that YLH needed and advocated for schoolwide staff training on HIV and management of common psychological problems.</p><p><strong>Conclusion: </strong>To support YLH to achieve their full potential, there is a need to support school staff to gain the skills needed to support YLH health. Future work on addressing psychological and social health challenges in schools is warranted.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597114","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":"Predictors of Acute HCV Incidence in People with HIV: Insights from a Long-term Cohort Study.","authors":"Antoine Chaillon, Noah C Gaitan, Lynn E Taylor, Kunling Wu, Tanyaporn Wansom, Sara Gianella, Ronald J Bosch, Kenneth E Sherman","doi":"10.1097/QAI.0000000000003660","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003660","url":null,"abstract":"<p><strong>Background: </strong>Persons living with HIV (PWH) remain at risk for hepatitis C virus (HCV) acquisition despite antiretroviral therapy, particularly among those who inject drugs or engage in high-risk sexual behaviors. We evaluated acute HCV incidence and associated risk factors in PWH, incorporating sex-specific differences and the use of Nucleic Acid Testing (NAT) methods, which were not addressed in previous analyses.</p><p><strong>Methods: </strong>We assessed NAT-based HCV incidence from 1996-2011 in the ACTG ALLRT cohort, a long-term study of PWH after initiating antiretroviral therapy. Multivariable Poisson regression identified associations with self-reported injection drug use (IDU), and time-varying CD4+ count, HIV RNA level and increased ALT (grade ≥3). No sexual risk factors or non-IDU drug use data were available.</p><p><strong>Results: </strong>Among 4,015 PWH (18% women, n=703) with an initial negative HCV antibody result, there were 18,150 person-years (PY) of follow-up. Forty-two participants seroconverted, an incidence of 0.23 per 100 PY (95% CI: 0.17, 0.31). Incidence was lower in females (n=2) versus males (n=40; 0.06 vs 0.27 per 100 PY; p=0.04). Seroconversion was associated with time-updated HIV RNA ≥400 copies/mL (RR 2.7, 95% CI 1.4-5.1, p=0.003), time-updated grade ≥3 ALT (RR 4.7, 95% CI 1.6, 13.4, p=0.005), and IDU (RR 6.3, 95% CI 2.7, 14.4, p<0.001).</p><p><strong>Conclusions: </strong>Our analysis showed that IDU history and unsuppressed HIV RNA were associated with HCV acquisition among PWH. Elevated ALT levels are consistent with the biology of acute/recent hepatitis and should trigger HCV RNA testing. These findings emphasize the need for targeted interventions to reduce HCV transmission risk in PWH.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567141","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 Clusters Reported by State and Local Health Departments in the United States, 2020-2022.","authors":"David Ce Philpott, Kathryn G Curran, Olivia O Russell, Robert P McClung, Camden J Hallmark, Lauren Love Pieczykolan, Karen Schlanger, Nivedha Panneer, Alexandra M Oster, Anne Marie France","doi":"10.1097/QAI.0000000000003658","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003658","url":null,"abstract":"<p><strong>Background: </strong>Clusters of rapid HIV transmission indicate larger underlying networks that are not effectively reached by HIV prevention, testing, and care services. Starting in 2018, the Centers for Disease Control and Prevention (CDC) funded 59 U.S. health departments (HDs) to detect and respond to HIV clusters; HDs began reporting clusters to CDC in January 2020.</p><p><strong>Methods: </strong>For clusters reported to CDC, we described cluster characteristics at detection, including detection method; size; HIV transmission category, defined as that of >50% of cluster members; and HD investigation and response activities.</p><p><strong>Results: </strong>During 2020-2022, 45 HDs reported 322 HIV clusters, with most detected by molecular analysis of HIV sequences (75%). Most were detected in the South (46%) and three-quarters were predominant sexual transmission. Median cluster size at detection for molecular clusters was 10 persons (interquartile range 7-18). Among 205 clusters with follow-up data, investigation and response activities were conducted for 95%, including direct outreach to persons in clusters for partner services (64%), medical chart reviews (42%), and focused testing events (13%). Limited data on named partners tested showed that 11% received new HIV diagnoses.</p><p><strong>Conclusions: </strong>HD HIV cluster detection activities detected many clusters. Response activities were tailored for different clusters and intervened in networks with rapid transmission and high undiagnosed infection, as indicated by high positivity among partners. Cluster detection and response is an important tool to identify and address gaps in HIV prevention, testing, and care that facilitate rapid transmission.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567138","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":"A novel method for assessing poor quality of life among people with HIV.","authors":"Sharoda Dasgupta, Yunfeng Tie, Kate Buchacz, Linda J Koenig, Jen-Feng Lu, Linda Beer","doi":"10.1097/QAI.0000000000003644","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003644","url":null,"abstract":"<p><strong>Background: </strong>The U.S.'s National HIV/AIDS Strategy (NHAS) prioritizes improving QoL among people with HIV (PWH) but co-occurrence of different aspects of QoL is not well described. We developed and applied a novel, multi-item assessment of poor quality of life (QoL) among PWH, and examined associations with selected outcomes.</p><p><strong>Setting: </strong>2018-2021 CDC Medical Monitoring Project data on 15,855 U.S. PWH.</p><p><strong>Methods: </strong>The poor QoL index, measured by the number of indicators of poor QoL experienced included: poor/fair self-rated health, unmet needs for mental health services, and subsistence needs (hunger/food insecurity, unstable housing/homelessness, unemployment). Score distributions were analyzed alongside data on individual QoL indicators. Associations with selected adverse outcomes were assessed, including not being retained in care, missing ≥1 HIV medical appointments, missing ≥1 ART dose, not having sustained viral suppression, and having ≥1 emergency room visit or ≥1 hospitalization.</p><p><strong>Results: </strong>Overall, 55.1% of PWH had ≥1 indicator of poor QoL; 8.4% had ≥3 indicators. Over a quarter (26.5%) of people who inject drugs experienced ≥3 indicators of poor QoL. A large percentage of people aged 18-24 years and transgender women had subsistence needs; 36.4% of cisgender Black women had poor/fair self-rated health. After adjusting for age, race/ethnicity, and gender, higher poor QoL index scores-and each indicator of poor QoL-were associated with worse outcomes.</p><p><strong>Conclusions: </strong>We demonstrated the utility in using the poor QoL index to identify those at higher risk of experiencing health challenges. Expanding national recommendations to include this QoL assessment could help in meeting NHAS goals for improving PWH's well-being.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567135","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":"Resistance to Dolutegravir in Treatment-experienced Patients in South Africa: A Retrospective Cohort Study.","authors":"Ying Zhao, Melanie Holtman, Vanessa Mudaly, Gert van Zyl, Gary Maartens, Graeme Meintjes","doi":"10.1097/QAI.0000000000003657","DOIUrl":"10.1097/QAI.0000000000003657","url":null,"abstract":"<p><strong>Background: </strong>Dolutegravir resistance has been reported more frequently in patients with prior treatment experience compared to those on dolutegravir in first-line antiretroviral therapy (ART). The widespread use of dolutegravir in resource-limited programmatic settings might facilitate the emergence of resistance. Data on the prevalence of dolutegravir resistance from programmatic settings in Africa are scarce.</p><p><strong>Methods: </strong>This retrospective observational cohort study assessed dolutegravir resistance in routine care settings of the Western Cape provincial public healthcare sector program between February 2021 and June 2024. Treatment-experienced adults who developed virologic failure (two HIV-1 RNA ≥1000 copies/mL), who had received dolutegravir-based ART for >24 months, were eligible for genotypic antiretroviral resistance testing (GART). Drug resistance mutations (DRMs) and resistance levels were classified using the Stanford database.</p><p><strong>Results: </strong>Among 99 eligible patients, 76 had GART performed, and 68 had successful sequences. Among these 68, 43 (63%) had dolutegravir DRMs with: 1 potential low, 1 low, 15 intermediate, and 26 high resistance levels. The median time on dolutegravir-based ART was 24 months (IQR, 23-31). Of the 43 patients with dolutegravir DRMs, 21 (49%) were receiving zidovudine-lamivudine-dolutegravir and 19 (44%) were receiving tenofovir-lamivudine-dolutegravir; 42/43 had prior ART experience.</p><p><strong>Conclusions: </strong>Over 60% of patients with prior treatment experience who had been on dolutegravir-based ART for over two years and experienced virologic failure had intermediate or high level dolutegravir resistance. This suggests that criteria for GART used are too stringent, which has resource implications in programmatic settings where access to resistance testing for individual management is limited.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542028","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":"A Cross-Biomeasure Study to Optimize Antiretroviral Adherence Estimation.","authors":"Aaron S Devanathan, Amanda J Poliseno, Nicole R White, Amanda P Schauer, Craig Sykes, Ann Marie K Weideman, Kayla W Kilpatrick, Michael G Hudgens, Cynthia L Gay, Elias P Rosen, Julie B Dumond, Angela D M Kashuba, Mackenzie L Cottrell","doi":"10.1097/QAI.0000000000003570","DOIUrl":"10.1097/QAI.0000000000003570","url":null,"abstract":"<p><strong>Background: </strong>Incomplete adherence to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) reduces effectiveness. Adherence biomeasures (ie, drug concentrations in biological specimen) are more accurate than self-report. TDF/FTC's intracellular active metabolites (tenofovir-diphosphate; TFVdp and FTC-triphosphate; FTCtp) can be quantified in different types of blood samples to estimate adherence. To optimize adherence estimation, we investigated approaches to measure TFVdp and FTCtp in 4 blood matrices.</p><p><strong>Methods: </strong>Twelve HIV-negative, healthy volunteers were enrolled in a single-center, open-label, 3-phase, directly observed therapy study. LC-MS/MS methods quantified TFVdp/FTCtp in dried blood spots, volumetrically accurate microsampling, upper layer packed cells, and peripheral blood mononuclear cells (PBMCs). Noncompartmental analysis estimated half-lives and accumulation ratios. Correlations characterized relationships between clinical variables and exposure. Regression models were fit to determine concentrations associated with <4 and ≥4 doses/week; correct classification percentages were determined.</p><p><strong>Results: </strong>Terminal half-life estimates of 3-4 vs 15-22 days distinguished between moderate-term (FTCtp in all samples; TFVdp in PBMCs) versus long-term (TFVdp in red blood cell-containing matrices) measures. Model-derived thresholds accurately categorized <4 and ≥4 doses/week when including both metabolites for 14- and 28-day dosing periods (81%-91% and 82%-85%, respectively). Within each classification and regression trees analyses containing both moderate- and long-term measures, dried blood spots exhibited highest accuracy to predict stable (74%-94%) and changing (42%-47%) adherence patterns.</p><p><strong>Conclusions: </strong>We demonstrate higher accuracy of moderate-term biomeasures to classify adherence over a 14-day period compared with long-term biomeasures to classify adherence over a 28-day period. Combined moderate- and long-term biomeasures predicted stable and changing adherence patterns, with dried blood spots exhibiting highest accuracy.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"291-299"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005226","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":"Tenofovir Disoproxil Fumarate/Emtricitabine Prophylaxis Has No Effect on Bone Mineral Density and Bone Mineral Content in African Breastfeeding Women Receiving Pre-Exposure Prophylaxis for HIV.","authors":"Gaysheen Kistan, Motshedisi Sebitloane, Carl Lombard, Zukiswa Godlwana, Alicia C Desmond, Richard Clark, James F Rooney, Glenda Gray, Dhayendre Moodley","doi":"10.1097/QAI.0000000000003563","DOIUrl":"10.1097/QAI.0000000000003563","url":null,"abstract":"<p><strong>Background: </strong>Tenofovir disoproxil fumarate (TDF) when used as pre-exposure prophylaxis (PrEP) during pregnancy is considered safe overall, however, there is insufficient evidence of its effect on maternal bone. We compared bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine (LS) and hip of African breastfeeding women exposed and not exposed to TDF-containing PrEP in a randomized control trial (RCT).</p><p><strong>Methods: </strong>This is a secondary data analysis of an RCT where pregnant women were randomized to initiating PrEP during pregnancy or delayed initiation of PrEP until breastfeeding cessation. BMD and BMC at the LS and hip were measured using dual-energy x-ray absorptiometry (DXA) at 6, 26, 50, and 74 weeks postpartum. In an exploratory analysis, BMD at the hip and LS were evaluated against varying tenofovir levels during pregnancy.</p><p><strong>Results: </strong>Of 300 women in the RCT who had a DXA at 6 weeks postpartum, 102 (66%) women in the Immediate PrEP arm and 105 (72%) in the Delayed PrEP arm had a 74-week DXA scan. Adjusting for breastfeeding duration and body mass index, there were no significant differences in BMD or BMC at the hip and LS between treatment arms. There was no consistent dose-effect of tenofovir diphosphate detected during pregnancy on BMD at the hip ( P = 0.231) or the LS ( P = 0.277).</p><p><strong>Conclusions: </strong>After adjusting for breastfeeding and body mass index, tenofovir disoproxil fumarate when given as oral PrEP during pregnancy had no deleterious effect on BMD and BMC at the hip and LS of African breastfeeding women.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"98 3","pages":"265-273"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255581","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":"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":"Economic Evaluation of Delivering an Evidence-Based Online HIV Prevention Program to MSM via Direct-To-Consumer Marketing Versus Community-Based Organization Recruitment.","authors":"Sarah Munroe, Bruce R Schackman, Krystal Madkins, Rana Saber, Kathryn Macapagal, Jocelyn Vititow, Nicholas Sweeney, Noah M Feder, Nanette Benbow, Brian Mustanski, Benjamin P Linas","doi":"10.1097/QAI.0000000000003572","DOIUrl":"10.1097/QAI.0000000000003572","url":null,"abstract":"<p><strong>Purpose: </strong>This study, conducted as part of the Keep It Up! (KIU!) 3.0 trial, compares the implementation costs of 2 strategies-centralized direct-to-consumer (DTC) marketing and decentralized distribution through community-based organizations (CBO)-in delivering an evidence-based online HIV prevention program.</p><p><strong>Methods: </strong>We conducted interviews and collected data to identify and quantify all costs for both delivery strategies. Costs were then categorized into start-up and ongoing (time-dependent and variable) costs and assigned dollar values based on established microcosting protocols.</p><p><strong>Results: </strong>In the DTC arm (1468 enrollees), the program was implemented from October 2019 through August 2022. Total ongoing costs including overhead and excluding start-up costs were $735,953, averaging $501 per participant. Start-up costs were $398,384 ($376,393 for content design and development and $21,991 for other costs), time-dependent costs were $219,177 ($149 per participant), and variable costs were $491,658 ($335 per participant). In the CBO arm (656 enrollees across 22 sites), KIU! was implemented for a 2-year period between October 2019 and December 2022. Total ongoing costs including overhead and excluding start-up costs were $2,780,682 ($4239 per participant). Start-up costs were $511,528 ($401,141 for content design and development and $110,386 for other costs), time-dependent costs were $1,926,958 ($2937 per participant), and variable costs were $256,543 ($391 per participant).</p><p><strong>Conclusions: </strong>The DTC arm demonstrated a lower overall cost and a lower cost per participant than distribution by the CBO arm. Understanding these cost dynamics is pivotal for guiding decisions on program sustainability and determining funding requirements for future large-scale implementation.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"257-264"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768937","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":"HIV Pre-exposure Prophylaxis Prescription Initiation and Maintenance Among Homeless-Experienced People Who Use Drugs.","authors":"William H Eger, Leah C Shaw, Katie B Biello, Claudia Lopez, Jennifer K Brody, Angela R Bazzi","doi":"10.1097/QAI.0000000000003568","DOIUrl":"10.1097/QAI.0000000000003568","url":null,"abstract":"<p><strong>Background: </strong>HIV pre-exposure prophylaxis (PrEP) remains particularly underused among homeless-experienced people who use drugs (PWUD).</p><p><strong>Setting: </strong>Boston Health Care for the Homeless Program, a Federally Qualified Health Center serving homeless-experienced individuals in Boston, Massachusetts.</p><p><strong>Methods: </strong>To identify determinants of PrEP prescription initiation and continuation, we analyzed electronic medical records and pharmacy data between April 2018 and March 2022. Participants were HIV-negative and reported sexual, drug, or community-related HIV exposures. Adjusted multinomial logistic regression explored associations between sociodemographics, social vulnerabilities, behavioral factors (eg, injection drug use), and mental health and substance use disorder diagnoses with filling of 1 and more than 1 PrEP prescription.</p><p><strong>Results: </strong>Among 509 participants, mean age was 38 years, 28% were women, 19% were Black, and 24% were Hispanic/Latino. At program enrollment, most were experiencing homelessness (92%), injecting drugs (78%), and living with a mental health disorder (71%). In multivariable-adjusted models, injection drug use was positively associated with filling 1 and more than 1 PrEP prescription (adjusted odds ratio [AOR]: 2.88, 95% confidence interval [CI]: 1.33 to 6.26; and AOR: 3.60, 95% CI: 2.02 to 6.42, respectively). Participants with opioid use disorder and generalized anxiety disorder were more likely to fill 1 and more than 1 prescription, whereas those with bipolar disorder were less likely to fill 1 prescription. No sociodemographic characteristics, sexual behaviors, or other mental health or substance use disorders were associated with study outcomes.</p><p><strong>Conclusions: </strong>A low-threshold, harm reduction-oriented PrEP program supported prescription initiation and continuation for homeless-experienced PWUD. Implementation research is needed to facilitate scale-up of this approach.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"234-241"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11854316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005289","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}