Journal of the International Association of Providers of AIDS Care最新文献

{"title":"'You Are Always Worried and Have No Peace, You Cannot Be a Normal Adolescent': A Qualitative Study of the Effects of Mental Health Problems on the Social Functioning of Adolescents Living with HIV in Uganda.","authors":"Esther Kalule Nanfuka, Agatha Kafuko, Rita Nakanjako, James Thomas Ssenfuuma, David Kaawa-Mafigiri","doi":"10.1177/23259582241298166","DOIUrl":"10.1177/23259582241298166","url":null,"abstract":"<p><p>Adolescents living with HIV (ALHIV) are at heightened risk of experiencing mental health problems. However, research on the impact of mental health problems on ALHIV's everyday life is scanty. This article explores the effects of anxiety, depression and suicidal behaviour on the social functioning of ALHIV in a low-resource setting. The three mental health conditions were screened using the Patient Health Questionnaire modified for adolescents (PHQ-A) and Screen for Child Anxiety Related Disorder (SCARED), while social functioning was defined by normative role expectations of adolescents in the study setting. We conducted in-depth interviews with 31 ALHIV receiving care at two hospitals in Central Uganda. Data were analysed using thematic analysis techniques. We found that mental health problems impair the social functioning of ALHIV by obstructing them from realising normative expectations of adolescents within their socio-cultural milieu, including academic excellence, maintaining amicable relationships and good physical health. In a context of scarcity, impaired social functioning has grave implications for ALHIV's physical, psychological and social and economic wellbeing and concomitantly HIV treatment outcomes in the immediate and long term. Integration of mental health into HIV care is imperative, if the global goal to end AIDS is to be achieved.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241298166"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention.","authors":"Whitney C Irie, Merriah A Croston, Anais Mahone","doi":"10.1177/23259582231225278","DOIUrl":"10.1177/23259582231225278","url":null,"abstract":"<p><p>This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582231225278"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10768609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial.","authors":"Khamisi Musanje, Moses R Kamya, Rosco Kasujja, Wouter Vanderplasschen, Deborah L Sinclair, Martin M Baluku, Raymond F Odokonyero, Charles P Namisi, John Mukisa, Ross G White, Carol S Camlin","doi":"10.1177/23259582241236260","DOIUrl":"10.1177/23259582241236260","url":null,"abstract":"<p><p>Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, <i>P</i> = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, <i>P</i> = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241236260"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10919136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Preexposure Prophylaxis Practice among Urban Female Sex Workers in Northwest Ethiopia: Using Generalized Structural Equation Modeling.","authors":"Lakew Asmare, Atalay Goshu, Tihtna Alemu, Ejigu Gebeye","doi":"10.1177/23259582241302900","DOIUrl":"10.1177/23259582241302900","url":null,"abstract":"<p><strong>Background: </strong>Acquired immunodeficiency syndrome, caused by the human immunodeficiency virus, has remained a public health threat for the last decades with significantly high burden. Despite the introduction of various human immunodeficiency virus (HIV) prevention strategies targeting high-risk populations, including preexposure prophylaxis, there remains a notable gap in the literature regarding Pre-Exposure Prophylaxis (PrEP) practice among female sex workers (FSWs) in Ethiopia, particularly using advanced analytical methods like structural equation modeling. This study aimed to assess practice and associated factors of preexposure prophylaxis among urban female sex workers in Northwest Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was carried out at organizations of Organizations for Social Service, Health Development, Mehabere Hiwot for Social Development, and African Network for the Prevention and Protection Against Child Abuse and Neglect that serve FSWs. Systematic random sampling technique was employed among 549 FSWs. An interviewer-administered questionnaire was used to collect the data. Generalized structural equation modeling was employed to identify factors associated with PrEP practice. As the mediation of effects was present, the direct, indirect, and total effects were determined. A final model was selected based on the statistical significance of the path coefficient.</p><p><strong>Results: </strong>In this study, the practice of preexposure prophylaxis was 28.00% with 95% CI = 25.34% to 32.72%. Thus, female sex workers with an education level of college and above had both direct and indirect positive effects on PrEP practice when mediated by knowledge, knowledge had both direct and indirect effects on PrEP practice when mediated by attitude. Whereas, FSWs who had duration of sex work for 3 to 5 years had only a positive direct effect on PrEP practice compared to those who were living in sex work for less than three years duration.</p><p><strong>Conclusion: </strong>However, HIV remains a public health problem, and the practice of preexposure prophylaxis in this study was found to be low. FSWs having higher education levels, attitudes, and knowledge demonstrate a significantly positive effect on their likelihood to practice PrEP. They suggested enhancing their health outcomes and reducing the risk of HIV transmission. The result of this study was also significant for communities that are serving in a given organization targeting integrated HIV testing and counseling services among key populations.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241302900"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and Current Practices in Patient-Centered Care: A Qualitative Study of Ryan White HIV Providers in South Florida.","authors":"Jennifer M Knight, Melissa K Ward, Sofia Fernandez, Becky L Genberg, Mary Catherine Beach, Robert A Ladner, Mary Jo Trepka","doi":"10.1177/23259582241244684","DOIUrl":"10.1177/23259582241244684","url":null,"abstract":"<p><p><b>Background:</b> Patient-centered care (PCC) improves HIV adherence and retention, though lack of consensus on its conceptualization and understanding how it is interpreted has hindered implementation. <b>Methods:</b> We recruited 20 HIV providers at Ryan White Programs in FL for in-depth interviews. Thematic analysis identified core consistencies pertaining to: 1) provider perceptions, 2) current practices promoting PCC. <b>Results:</b> Provider perceptions of PCC emerged under four domains: 1) holistic, 2) individualized care, 3) respect for comfort and security, and 4) patient engagement and partnership. PCC practices occurred at multiple levels: 1) individual psychosocial and logistical support, 2) interpersonal support within patient-provider relationships through respectful communication and active engagement, and 3) institutional practices including feedback mechanisms, service integration, patient convenience, and diverse staffing. <b>Conclusions:</b> Our findings highlight the central tenets of PCC as respectful, holistic, individualized, and engaging care. We offer an HIV-adapted framework of PCC as a multilevel construct to guide future intervention.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241244684"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'You Can Get That Person on ART but You Can't Give Them Back Their Social System': A Qualitative Analysis of Voluntary Assisted Partner Notification for HIV for Marginalised and Vulnerable Populations.","authors":"Kate Bärnighausen, Astrid Berner-Rodoreda, Maureen McGowan, Mark Donald Reñosa, Caroline Mtaita, Florian Neuhann","doi":"10.1177/23259582241272059","DOIUrl":"10.1177/23259582241272059","url":null,"abstract":"<p><p>Little is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation, and whether its use is suitable for referral to HIV care pathways. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (<i>N</i> = 15) regarding their perspectives and experiences with VAPN policy and its implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted the flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241272059"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Moderating Role of HIV Stigma on the Relationship between Perceived Social Support and Antiretroviral Therapy Adherence Self-Efficacy among Adult PLHIV in South Africa.","authors":"Muziwandile Qiniso Luthuli, Johannes John-Langba","doi":"10.1177/23259582241228743","DOIUrl":"10.1177/23259582241228743","url":null,"abstract":"<p><strong>Background: </strong>People living with human immune deficiency virus (PLHIV) grapple with distinct challenges, including HIV stigma which affects their antiretroviral therapy (ART) adherence self-efficacy. This study investigates the interaction of HIV stigma and perceived social support on ART adherence self-efficacy among adult PLHIV in South Africa.</p><p><strong>Methods: </strong>This study utilized a cross-sectional design that involved 201 participants selected using time location sampling at a tertiary health facility in Durban.</p><p><strong>Results: </strong>HIV stigma was significantly and negatively associated with self-efficacy (β = -7.860, <i>t</i> = -4.654, <i>p </i>= .001), with variations across different stigma levels (β = -5.844, <i>t</i> = -4.003, <i>p</i> = .001). Social support was significantly and positively associated with self-efficacy at lower HIV stigma levels (β = 7.440, <i>t</i> = 3.887, <i>p</i> = .001), in contrast to higher levels (β = -2.825, <i>t</i> = 1.400, <i>p</i> = .163).</p><p><strong>Conclusion: </strong>Social support significantly influences ART adherence self-efficacy, particularly at lower levels of HIV stigma, but the effect of support weakens as stigma intensifies.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241228743"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of Social Determinants of Health on HIV Care Engagement in the Southern United States: A Cross-Sectional Study.","authors":"Maira Sohail, John D Cleveland, C Greer McCollum, Kaylee W Burgan, Larry R Hearld, Alyssa Carodine, Kendra Johnson, Melvin Fort, Jennifer Thompson, Michael J Mugavero","doi":"10.1177/23259582241251728","DOIUrl":"10.1177/23259582241251728","url":null,"abstract":"<p><p>Recent studies have shown social determinants of health (SDOH) to impact HIV care engagement. This cross-sectional study (Oct 20-Apr 21) assessed the impact of a range of SDOH on HIV care engagement using data from HIV Care Connect, a consortium of three HIV care facility-led programs (Alabama, Florida, Mississippi). The exposures were captured using the PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) scale. The outcome was captured using the Index of Engagement in HIV Care scale. Participants (n  =  132) were predominantly non-White (87%) and male (52%) with a median age of 41 years. Multivariable logistic regression adjusted for various sociodemographics showed lower HIV care engagement to be associated with being uninsured/publicly insured, having 1-3 unmet needs, socially integrating ≤five times/week, and having stable housing. Factors such as unmet needs, un-/underinsurance, and social integration may be addressed by healthcare and community organizations.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241251728"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes Over Time in the Proportion of Advanced HIV Disease in Two High HIV Prevalence Settings in Ndhiwa (Kenya) and Eshowe (South Africa).","authors":"Menard Chihana, Nolwenn Conan, Liesbet Ohler, Helena Huerga, Stephen Wanjala, Charles Masiku, Elisabeth Szumilin, Tom Ellman, Jean-Francois Etard, David Maman, Mary-Ann Davies","doi":"10.1177/23259582241260219","DOIUrl":"10.1177/23259582241260219","url":null,"abstract":"<p><strong>Background: </strong>The burden of advanced HIV disease remains a significant concern in sub-Saharan Africa. In 2015, the World Health Organization released recommendations to treat all people living with HIV (PLHIV) regardless of CD4 (\"treat all\") and in 2017 guidelines for managing advanced HIV disease. We assessed changes over time in the proportion of PLHIV with advanced HIV and their care cascade in two community settings in sub-Saharan Africa.</p><p><strong>Methods: </strong>Cross-sectional population-based surveys were conducted in Ndhiwa (Kenya) in 2012 and 2018 and in Eshowe (South Africa) in 2013 and 2018. We recruited individuals aged 15-59 years. Consenting participants were interviewed and tested for HIV at home. All participants with HIV had CD4 count measured. Advanced HIV was defined as CD4 < 200 cells/µL.</p><p><strong>Results: </strong>Overall, 6076 and 6001 individuals were included in 2012 and 2018 (Ndhiwa) and 5646 and 3270 individuals in 2013 and 2018 (Eshowe), respectively. In Ndhiwa, the proportion of PLHIV with advanced HIV decreased from 2012 (159/1376 (11.8%; 95% CI: 9.8-14.2)) to 2018 (53/1000 (5.0%; 3.8-6.6)). The proportion of individuals with advanced HIV on antiretroviral therapy (ART) was 9.1% (6.9-11.8) in 2012 and 4.2% (3.0-5.8) in 2018. In Eshowe, the proportion with advanced HIV was 130/1400 (9.8%; 8.0-11.9) in 2013 and 38/834 (4.5%; 3.3-6.1) in 2018. The proportion with advanced HIV among those on ART was 6.9% (5.5-8.8) in 2013 and 2.8% (1.8-4.3) in 2018. There was a significant increase in coverage for all steps of the care cascade among people with advanced HIV between the two Ndhiwa surveys, with all the changes occurring among men and not women. No significant changes were observed in Eshowe between the surveys overall and by sex.</p><p><strong>Conclusion: </strong>The proportion with advanced HIV disease decreased between the first and second surveys where all guidelines have been implemented between the two HIV surveys.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241260219"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11185002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast-Track Cities 2023 Oral Abstracts.","authors":"","doi":"10.1177/23259582241254920","DOIUrl":"10.1177/23259582241254920","url":null,"abstract":"","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241254920"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11177726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}