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

{"title":"Plasma Viral Load of 200 Copies/mL is a Suitable Threshold to Define Viral Suppression and HIV Drug Resistance Testing in Low- and Middle-Income Countries: Evidence From a Facility-Based Study in Cameroon.","authors":"Collins Ambe Chenwi, Rachel Audrey Nayang Mundo, Alex Durand Nka, Ezechiel Ngoufack Jagni Semengue, Grâce Angong Beloumou, Aude Christelle Ka'e, Willy Leroi Togna Pabo, Désiré Takou, Aissatou Abba, Sandrine Claire Djupsa, Evariste Molimbou, Naomi-Karell Etame, Aurelie Minelle Kengni Ngueko, David Kob Same, Jolle Nounouce Bouba Pamen, Aristide Stephane Abah Abah, Serge Clotaire Billong, Rogers Ajeh Awoh, Gregory Edie Halle-Ekane, Giulia Cappelli, Anne-Esther Njom-Nlend, Anne-Cecile Zk Bissek, Elvis Temfack, Maria Mercedes Santoro, Francesca Ceccherini-Silberstein, Vittorio Colizzi, Jean Kaseya, Nicaise Ndembi, Alexis Ndjolo, Carlo Federico Perno, Joseph Fokam","doi":"10.1177/23259582241306484","DOIUrl":"10.1177/23259582241306484","url":null,"abstract":"<p><strong>Introduction: </strong>In low-and-middle-income-countries (LMIC), viral suppression is defined as plasma viral load (PVL) below 1000 copies/mL (low-level viremia [LLV]) and threshold for HIV drug resistance (HIVDR) testing. However, there is evidence that drug resistance mutations (DRMs) may emerge at LLV, thus compromising antiretroviral treatment (ART) response<b>.</b> We evaluated sequencing success rates (SSR) at LLV, described HIVDR profiles and adequacy with potential efficacy of tenofovir-lamivudine-dolutegravir (TLD).</p><p><strong>Methods: </strong>A cross-sectional study was conducted among individuals with LLV at the Chantal BIYA International Reference Centre, Yaoundé, Cameroon from January 2020 through August 2021. HIV-1 sequencing was performed on protease/reverse-transcriptase, and sequences analysed using Stanford HIVdbv9.5. SSR and HIVDR rates were assessed according to viral-load ranges, with <i>P</i> < .05 considered statistically significant.</p><p><strong>Results: </strong>In total, 131 individuals were enrolled (median [IQR] age = 41 [30-49] years; 67.9% female; 54.7% at WHO clinical-stage I/II; median ART-duration 7 [4-11] years; median CD4-count 221 [103-402] cells/mm³ and median PVL 222 [96-436] copies/mL). Overall, SSR at LLV was 34.4% (45/131) and increased significantly with decreasing-age (<i>P = </i>.002) and increasing-PVL (<i>P </i>= .017). SSR were doubled at PVL≥150 copies/mL (21.8% at [40-150] vs. 43.3% at [150-1000]; OR = 2.8, <i>P = </i>.01). Of the 45 sequences obtained, 75.6% were recombinant strains (CRF02_AG, CRF09_cpx, CRF11_cpx) and 24.4% pure-subtypes (A1, D, F2, G). Overall, HIVDR prevalence at LLV was 82.2% (37/45), with 74.6% and 15.6% resistance to reverse-transcriptase inhibitors (RTIs) and ritonavir-boosted protease inhibitors (PI/r) respectively. Interestingly, HIVDR rates were similar at PVLs [50-200] versus [200-1000] copies/mL (<i>P = </i>.69). The most frequent DRMs were M184 V (73.3%) and K103N (40.0%) for RTIs and M46I (6.7%) for PIs/r. Overall 55.6% (25/45) of individuals were on suboptimal ART (needing ART-optimisation), with 48.9% (22/45) having suboptimal TLD predictive efficacy. Optimisation need was higher in first-line (81.8%, <i>P = </i>.03), but similar across viral clades and PVL-ranges (<i>P = </i>.6).</p><p><strong>Conclusion: </strong>In this LMIC context, sequencing for HIVDR is feasible at LLV even with broad HIV-1 diversity, with significantly higher SSR above 150 copies/mL and/or in paediatrics. About 80% of individuals with LLV harbour HIVDR strains, with half of them needing ART optimisations to limit HIVDR emergence and prevent treatment failure. Our findings underscore the clinical benefits of HIVDR during persisting LLV and the need to reconsider the threshold for viral suppression around 200copies/mL in LMICs.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241306484"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877415","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":"Metabolic Syndrome and Associated Factors Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy in Northern Tanzania.","authors":"Tumaini E Mirai, Kajiru G Kilonzo, Abid M Sadiq, Ibrahim Ali Ibrahim Muhina, Norman J Kyala, Annette A Marandu, Sarah K Gharib, Andrea R Costantine, Elifuraha W Mkwizu, William P Howlett, Elichilia R Shao, Gissela B Nyakunga, Huda F Akrabi, Vibhu R Kshettry, Venance P Maro, Nyasatu G Chamba, Furaha S Lyamuya","doi":"10.1177/23259582241306492","DOIUrl":"10.1177/23259582241306492","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic systemic inflammation from human immunodeficiency virus (HIV) may cause metabolic abnormalities in lipid metabolism. Additionally, the development of metabolic syndrome has been associated with specific anti-retroviral therapy, particularly dolutegravir. This study aimed to determine the prevalence and associated factors of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.</p><p><strong>Methods: </strong>This was an analytical cross-sectional study conducted between October 1, 2022, and March 31, 2023, among 312 people living with HIV. A structured questionnaire was used to collect socio-demographic and clinical characteristics including anthropometric indices and a blood pressure reading. A blood sample was collected to measure plasma glucose levels and serum lipid levels. The outcome being metabolic syndrome, odds ratios were evaluated using logistic regression analysis, and a <i>P</i>-value of <.05 was considered statistically significant.</p><p><strong>Results: </strong>The prevalence of metabolic syndrome was 42.3%. Waist circumference (73%) and reduced high-density lipoprotein cholesterol (59.9%) were the most prevalent components. Factors associated with metabolic syndrome were patients aged 18-44 years (aOR: 3.10; 95% CI: 1.24-7.79; <i>P</i> = .016), female gender (aOR: 5.40; 95% CI: 2.07-14.13; <i>P</i> = .001), no physical activity (aOR: 4.00; 95% CI: 1.05-15.10; <i>P</i> = .042), and patients who earned >300 000 Tanzanian shillings per month (aOR: 2.15; 95% CI: 1.07-4.32; <i>P</i> = .032).</p><p><strong>Conclusion: </strong>The prevalence of metabolic syndrome among patients on dolutegravir-based therapy is high. There is a need to adhere to routine screening of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241306492"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877510","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":"Monitoring Patient Adherence and Follow-up in Option B+ Program: Understanding Healthcare Workers' Practices, Challenges, and Facilitators in Lilongwe, Malawi.","authors":"Wiza Kumwenda, Angela M Bengtson, Shaphil Wallie, Agatha K Bula, Jimmy Ba Villiera, Edith Ngoma, Mina C Hosseinipour, Victor Mwapasa","doi":"10.1177/23259582241299006","DOIUrl":"10.1177/23259582241299006","url":null,"abstract":"<p><strong>Background: </strong>Option B+ aims to prevent mother-to-child transmission of HIV by providing lifelong antiretroviral therapy (ART) to pregnant and breastfeeding women living with HIV (PBWHIV). Identifying and reengaging PBWHIV who disengage or fail to initiate ART is essential for the success of Option B+. However, the process is often suboptimal, leading to challenges such as misclassification of patients as lost to follow-up. Healthcare workers (HCWs) are pivotal for monitoring engagement, but little is known about their monitoring practices. This study aimed to explore how HCWs monitor women's engagement in Option B+ services.</p><p><strong>Methods: </strong>A qualitative study was conducted in five high-volume health facilities in Lilongwe, Malawi. Thirty HCWs responsible for monitoring women in Option B+ were purposively selected as key informants. Semistructured interviews were conducted between March and June 2021. Thematic analysis employing deductive and inductive coding methods was utilized. The Consolidated Framework for Implementation Research was used to map gaps, strategies, barriers, and facilitators of monitoring.</p><p><strong>Results: </strong>Monitoring was described as tracking a PBWHIV from HIV diagnosis to initiation of ART to subsequent ART visits for up to 2 years postpartum. <i>The gaps</i> included timing variations in tracing. No procedures to follow up formal transfer-outs or management of silent transfers during emergency ART refills were identified. <i>Strategies</i> identified included interfacility collaboration, record review, tracing, escorting women during initial visits, and self-reports. Technological innovations, such as WhatsApp groups, were highlighted as game changers in interfacility collaboration when tracking women's movements. <i>Barriers</i> included resource constraints (human and operational), poor work attitudes, and challenges faced by women (partner support, stigma, and HCW rapport). <i>The facilitators</i> included implementing partner support, leadership, and strategies such as education and tracing.</p><p><strong>Conclusion: </strong>Addressing resource constraints, women's relationship dynamics for self-management, HCWs' attitudes, and standardizing tracing protocols are crucial for effective monitoring. Leveraging instant messaging for clinic coordination may enhance tracing. Further research and interventions should target identified gaps to promote effective monitoring in similar settings.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241299006"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668340","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":"Efficacy and Safety of Fluconazole Mucoadhesive Patches in Human Immunodeficiency Virus-Related Oral Candidiasis.","authors":"Srikanth Deenadayalan, Ashok Shenoy, Ashwin Kamath, Mahalaxmi Rathnanand, Sheetal Ullal, Nandita Shenoy","doi":"10.1177/23259582241299014","DOIUrl":"10.1177/23259582241299014","url":null,"abstract":"<p><strong>Background: </strong>Opportunistic fungal infections like oral candidiasis account for a significant amount of morbidity in HIV disease and an indicator of immune suppression. Fluconazole is a broad-spectrum antifungal agent that has been extensively used in the management of oral, candidiasis. Highly efficacious fluconazole is also known to have systemic toxicity due to high drug interaction and hence the present study focuses on the formulation of bioadhesive film as a controlled release carrier for fluconazole.</p><p><strong>Materials and methods: </strong>Patients were randomised, using a computer-generated list of random numbers, into one of the three groups: patients in group A received fluconazole mucoadhesive film 20 mg (sustained release) that was to be applied at bedtime and film 10 mg (intermediate release) to be applied during the day after lunch.</p><p><strong>Results: </strong>There was a significant decrease in oral discomfort, pain and clinical improvement in group A compared to group B (Fluconazole oral tablets 100 mg/day) (P = 0.005) and group C (Fluconazole Mouth rinse) (P = 0.002). The patients who received the mucoadhesive patches had a more tolerable safety profile as expected compared to the other groups.</p><p><strong>Conclusion: </strong>The bioadhesive films of fluconazole were used in HIV positive patients with oral candidiasis to overcome the problems of high dose requirement of the drug and reduce associated adverse reactions in an already immunocompromised patients and improve the quality of life.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241299014"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780329","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":"Sociodemographic and Clinical Predictors of Weight Gain During the First Year of Antiretroviral Therapy among Adults Living With HIV in Urban Tanzania.","authors":"Pilly Chillo, Alfa Muhihi, Goodarz Danaei, Muhammad Bakari, Gideon Kwesigabo, Marina Njelekela, Nzovu Ulenga, Wafaie W Fawzi, Ferdinand Mugusi, Christopher R Sudfeld","doi":"10.1177/23259582241281010","DOIUrl":"10.1177/23259582241281010","url":null,"abstract":"<p><p>Antiretroviral therapy (ART) has improved the survival of people living with HIV (PLHIV) but this success has been accompanied by an increase in noncommunicable diseases. We conducted a prospective cohort study of 4000 adult PLHIV who were initiating ART in Dar es Salaam, Tanzania, to assess weight gain during the first year of treatment and associated sociodemographic and clinical factors. Anthropometric data were collected at ART initiation and monthly follow-up visits. The mean weight gain during the first year of treatment was 2.6 ± 0.3 kg, and the prevalence of overweight or obesity increased from 26.3% at baseline to 40.7%. Female sex, greater household wealth, lower CD4-T-cell counts, higher WHO HIV disease stage, and pulmonary tuberculosis were associated with a greater increase in body mass index (<i>P</i> < .05). Weight gain following ART initiation was common but was greater among females and PLHIV with advanced HIV or comorbidities.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241281010"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365706","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":"Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at Ryan White-Funded Clinics in the Southeastern United States Responded to COVID-19 and Its Effects on Their Well-Being.","authors":"Caroline W Kokubun, Katherine M Anderson, Olivia C Manders, Ameeta S Kalokhe, Jessica M Sales","doi":"10.1177/23259582241235779","DOIUrl":"10.1177/23259582241235779","url":null,"abstract":"<p><p>As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241235779"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10998491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856563","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":"Accuracy of Provider Predictions of Viral Suppression Among Adolescents and Young Adults With HIV in an HIV Clinical Program.","authors":"Johannes Thrul, Hasiya Yusuf, Janardan Devkota, Jill Owczarzak, Elise Tirza Ohene-Kyei, Kelly Gebo, Allison Agwu","doi":"10.1177/23259582241252587","DOIUrl":"10.1177/23259582241252587","url":null,"abstract":"<p><strong>Background: </strong>Providers caring for adolescents and young adults with HIV (AYA-HIV) mostly base their adherence counseling during clinical encounters on clinical judgment and expectations of patients' medication adherence. There is currently no data on provider predictions of viral suppression for AYA-HIV. We aimed to assess the accuracy of provider predictions of patients' viral suppression status compared to viral load results.</p><p><strong>Methods: </strong>Providers caring for AYA-HIV were asked to predict the likelihood of viral suppression of patients before a clinical encounter and give reasons for their predictions. Provider predictions were compared to actual viral load measurements of patients. Patient data were abstracted from electronic health records. The final analysis included 9 providers, 28 patients, and 34 observations of paired provider predictions and viral load results.</p><p><strong>Results: </strong>Provider prediction accuracy of viral suppression was low (59%, Cohen's Kappa = 0.16). Provider predictions of lack of viral suppression were based on nonadherence to medications, new patient status, or structural vulnerabilities (e.g., unstable housing). Anticipated viral suppression was based on medication adherence, history of viral suppression, and the presence of family or other social forms of support.</p><p><strong>Conclusions: </strong>Providers have difficulty accurately predicting viral suppression among AYA-HIV and may base their counseling on incorrect assumptions. Rapid point-of-care viral load testing may provide opportunities to improve counseling provided during the clinical encounter.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241252587"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093742","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":"Incidence and Predicting Factors of Opportunistic Infections after Antiretroviral Therapy Initiation among Treatment-naïve Patients with HIV Infection: A Retrospective Cohort Study in A Tertiary Care Hospital.","authors":"Prapon Wongkittipong, Sasisopin Kiertiburanakul","doi":"10.1177/23259582241241167","DOIUrl":"10.1177/23259582241241167","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence of opportunistic infections (OIs) and the predictive factors for the development of OIs after antiretroviral therapy (ART) initiation among treatment-naïve patients with HIV infection.</p><p><strong>Results: </strong>Of 401 HIV-infected patients, 38 (9.5%) HIV-infected patients developed OIs after initiating ART, with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to OI occurrence was 26.5 (14-73) days. In multivariate Cox proportional hazard regression, body mass index ≤18.5 kg/m² (adjusted hazard ratio [aHR] 2.28, 95% confidence interval [CI] 1.18-4.42, <i>P</i> = .015), symptoms at presentation (aHR 13.59, 95% CI 3.24-56.9, <i>P</i> < .001), serum glutamate-pyruvate transaminase >55 U/L (aHR 2.09, 95% CI 1.06-4.15, <i>P</i> = .035), and initiation of a dolutegravir-based regimen (aHR 4.39, 95% CI 1.54-12.48, <i>P</i> = .006) were significantly associated with OIs after ART initiation.</p><p><strong>Conclusion: </strong>OIs after ART initiation are common. Malnutrition, symptomatic presentation, abnormal liver enzymes, and DTG-based regimens are predictors of OI occurrence after ART initiation. Physicians must monitor and appropriately treat OIs after ART initiation.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241241167"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11005498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855282","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":"Improving Adherence to the Target Window for Cabotegravir + Rilpivirine Long-Acting Injections Through the CHORUS™ App and Web Portal: A Cluster Randomized Trial.","authors":"Michael B Wohlfeiler, Laurence Brunet, Quateka Cochran, Jennifer S Fusco, Ricky K Hsu, Gregory P Fusco","doi":"10.1177/23259582241245223","DOIUrl":"10.1177/23259582241245223","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the impact of the CHORUS™ app on adherence to the cabotegravir and rilpivirine long-acting injectable (CAB + RPV LAI) monthly injections schedule.</p><p><strong>Methods: </strong>Healthcare centers (HCCs) were randomized to access CHORUS™ CAB + RPV LAI features (intervention) or not (control) from 01OCT2021-31JAN2022. Target window adherence (maintenance injections ≤7 days before/after target day) was assessed with multivariate logistic regression (generalized estimating equations).</p><p><strong>Results: </strong>CAB + RPV LAI was administered to 188 and 79 individuals at intervention and control HCCs, respectively. Intervention was not associated with improved target window adherence (adjusted odds ratio: 0.61 [95% CI: 0.30-1.25]). However, app use was associated with increased odds of adherence compared to no app use among all intervention HCCs (2.98 [1.26-7.06]) and at smaller HCCs (3.58 [1.31-9.80]).</p><p><strong>Conclusions: </strong>While access to CHORUS™ CAB + RPV LAI features did not improve target window adherence, app use did, especially at smaller HCCs which may not have established LAI management procedures.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/show/NCT04863261.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241245223"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11017239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867508","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":"Client Perspectives on the Development of a Rapid PrEP Initiative at a Sexual Health Center in New Orleans, Louisiana.","authors":"Aish Lovett, Rose Luder, Rebecca A Lillis, Isolde Butler, Julia Siren, Samuel Gomez, Kevin Kamis, Oluyomi Obafemi, Sarah E Rowan, Stefan Baral, Meredith E Clement","doi":"10.1177/23259582241258559","DOIUrl":"10.1177/23259582241258559","url":null,"abstract":"<p><p>Uptake of PrEP remains suboptimal, especially in the Southern United States. Same-day or \"Rapid PrEP Initiatives\" (RPIs) in sexual health centers (SHCs) could facilitate access and overcome barriers to PrEP. We studied the adaptation of an RPI from Denver, Colorado to an SHC in New Orleans, Louisiana. Through focus group discussions (FGDs) with local SHC staff and PrEP providers, we developed a preliminary RPI model. In 5 FGDs with SHC clients referred for or taking PrEP, we gathered adaptation recommendations and feedback on model acceptability, feasibility, and utility. Providers and clients voiced unanimous support for the RPI. Clients favored the ease of same-day PrEP initiation and emphasized a desire for navigational support, financial counseling, and integration of PrEP care with their other clinical needs. Clients recommended that SHC providers discuss PrEP and HIV with all patients, regardless of providers' perception of risk. Next steps include small-scale implementation and evaluation.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241258559"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262046","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}