Open Forum Infectious Diseases最新文献

{"title":"Non-Hispanic Black Persons With HIV Have a Lower Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease and Clinically Significant Fibrosis Compared to Non-Hispanic White and Hispanic Individuals.","authors":"Tinsay A Woreta, Samer Gawrieh, Laura A Wilson, Yuchen Xin, Eduardo Vilar-Gomez, Kathleen E Corey, Richard K Sterling, Jordan E Lake, Susanna Naggie, Sonya Heath, Holly Crandall, Jennifer C Price, Rohit Loomba, Naga Chalasani, Mark S Sulkowski","doi":"10.1093/ofid/ofag001","DOIUrl":"https://doi.org/10.1093/ofid/ofag001","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of liver-related morbidity and mortality among people with human immunodeficiency virus (PWH). We aimed to determine the prevalence of MASLD and clinically significant fibrosis among PWH and investigate if racial and ethnic differences exist after adjustment for clinical risk factors and <i>PNPLA3</i> genotype.</p><p><strong>Methods: </strong>This cross-sectional analysis included adult PWH prospectively enrolled in 2 US multicenter studies from 2018 to 2023. MASLD was defined as a controlled attenuation parameter (CAP) score ≥263 dB/m with at least 1 cardiometabolic risk factor and clinically significant fibrosis as a liver stiffness measurement ≥8 kPa upon vibration-controlled transient elastography. Multivariable logistic regression analysis was performed to examine the association of race/ethnicity with the presence of MASLD and clinically significant fibrosis, adjusting for clinical risk factors and <i>PNPLA3</i> genotype.</p><p><strong>Results: </strong>Of the 996 participants, the mean age was 53.9 years (standard deviation, 12 years) and 72% were male. The prevalence of MASLD and clinically significant fibrosis were 49% and 14%, respectively. Non-Hispanic Black (NHB) persons had the lowest prevalence of MASLD (43%) compared to non-Hispanic White (NHW) (53%) and Hispanic individuals (60%) (<i>P</i> < .001). Similarly, NHB persons had the lowest prevalence of clinically significant fibrosis (12%) compared to NHW (20%) and Hispanic individuals (13%) (<i>P</i> = .005). After adjusting for clinical risk factors and <i>PNPLA3</i> genotype, NHB had a lower odds of MASLD (odds ratio [OR], 0.39 [95% confidence interval {CI}, .23-.66]) and clinically significant fibrosis (OR, 0.38 [95% CI, .20-.71]) compared to NHW persons.</p><p><strong>Conclusions: </strong>NHB PWH have a lower risk of MASLD and clinically significant fibrosis compared to NHW and Hispanic individuals, even after controlling for clinical risk factors and <i>PNPLA3</i> genotype.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag001"},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One- and Two-Year Outcomes of Switching to a Dolutegravir-Based ART Regimen: An Observational Emulation of Sequential Target Trials.","authors":"Amy Zheng, Eleanor J Murray, Alana T Brennan, Ross Greener, Emma M Kileel, Jacob Bor, Willem D F Venter, Pedro T Pisa, Matthew P Fox, Mhairi Maskew","doi":"10.1093/ofid/ofag151","DOIUrl":"https://doi.org/10.1093/ofid/ofag151","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials evaluating the impact of switching to dolutegravir have excluded individuals with poorly controlled viremia. However, in practice, clinicians may switch individuals to dolutegravir who have such challenges. Utilizing the Target Trial Framework, we estimated the effect of switching to a dolutegravir-based regimen, vs not switching and remaining on an efavirenz-based regimen, on 12- and 24-month retention and viral suppression in Johannesburg, South Africa, from 2019 to 2022.</p><p><strong>Methods: </strong>Using data from the Themba Lethu HIV Clinical Cohort, individuals were eligible if they were currently on an efavirenz-based regimen, aged 16+, and not pregnant at the start of each trial. We conducted a pooled linear regression model with bootstrapping to estimate the causal risk difference and 95% CI adjusting for patient characteristics via inverse probability treatment weighting.</p><p><strong>Results: </strong>Of 1493 individuals, 967 (64.7%) switched to a dolutegravir-based regimen over 9 sequential trials, and 526 (35.2%) did not. At 12 months, switch to a dolutegravir-based regimen was associated with a 14 percentage point (95% CI, 0.10 to 0.19) increase in retention and a 2 percentage point (95% CI, -0.04 to 0.08) increase in viral suppression. By 24 months, we observed a 1 percentage point (95% CI, -0.05 to 0.07) increase in retention and an 8 percentage point (95% CI, 0.02 to 0.14) increase in viral suppression.</p><p><strong>Conclusions: </strong>Switching to dolutegravir was associated with a 14 percentage point increase in retention at 12 months and an 8 percentage point increase in viral suppression at 24 months. Our findings suggest that switching to dolutegravir does not harm and might improve retention and viral suppression over a 24-month period.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag151"},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Enteric Fever Seroincidence in Bangladesh Using Rapid Serosurveys.","authors":"Sira Jam Munira, Naito Kanon, Nahidul Islam, Md Shakiul Kabir, Anik Sarkar, Shamsul Alam Polash, Hafizur Rahman, Alice S Carter, Richelle C Charles, Jason R Andrews, Stephen P Luby, Kristen Aiemjoy, Denise O Garrett, Samir K Saha, Jessica C Seidman, Senjuti Saha","doi":"10.1093/ofid/ofag197","DOIUrl":"10.1093/ofid/ofag197","url":null,"abstract":"<p><strong>Background: </strong>Enteric fever, caused by <i>Salmonella</i> Typhi or Paratyphi, is a major public health issue in low- and middle-income countries. Accurate burden estimation is hampered by limited microbiological facilities and low sensitivity of blood-culture tests. Serosurveillance offers a scalable alternative to address these challenges. This study estimated the seroincidence of enteric fever in Bangladesh using cross-sectional rapid serosurveys.</p><p><strong>Methods: </strong>School-based surveys (January-June 2022) were conducted in Chattogram, Dinajpur, Sylhet, Satkhira, and Faridpur, and community-based surveys (July 2019-November 2021) were conducted in Dhaka and Mirzapur. Blood samples (dried blood spots or venous blood) were collected and tested for anti-hemolysin E IgG responses using a kinetic enzyme-linked immunosorbent assay. Seroincidence was estimated using a maximum likelihood approach based on peak antibody titers and decay rates, modeled from blood-culture confirmed enteric fever cases in Bangladesh.</p><p><strong>Findings: </strong>A total of 2969 participants aged 0-22 years were enrolled, with 75.5% aged 5-15 years. Seroincidence rates (per 100 person-years) were highest in Dhaka (33.1; 95% confidence interval [CI], 29.0-37.9), followed by Mirzapur (19.5; 95% CI, 17.4-21.7) and Chattogram (17.1; 95% CI, 15.0-19.4), and the lowest in Faridpur (11.1; 95% CI, 9.6-12.7). The under 5 age group exhibited higher rates in Dhaka (40.3; 95% CI, 32.1-50.7) and Mirzapur (26.1; 95% CI, 21.0-32.4) compared to older age groups. Seroincidence was higher in areas with higher population density.</p><p><strong>Conclusions: </strong>This study highlights a substantial burden of enteric fever infections across Bangladesh. These provide important evidence to guide post-introduction monitoring and optimization of the typhoid conjugate vaccine program in the national immunization schedule.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag197"},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Rapid Change in Beta-lactam Resistance Epidemiology on the Management of Patients With Bloodstream Infections.","authors":"Laura Bobbitt, Lili Tao, Benjamin Ereshefsky, Austin Ing, Romney Humphries","doi":"10.1093/ofid/ofag225","DOIUrl":"https://doi.org/10.1093/ofid/ofag225","url":null,"abstract":"<p><p>The impact of a shift in the epidemiology of ceftriaxone resistance among <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> recovered from blood cultures was evaluated. 163 patients were included for analysis, 139 (85.3%) with <i>bla</i> _CTX-M detected and 24 (14.7%) without <i>bla</i> _CTX-M detected by molecular testing. All but 1 case in the no-CTX-M cohort occurred in 2024. Patients in the <i>bla</i> _CTX-M detected cohort were started on optimal antimicrobial treatment significantly earlier than patients in the no <i>bla</i> _CTX-M detected group (18.6 vs 59.2 hours, <i>P</i> < .001). Between 2022 and 2024, the rate of CTX-M negative ceftriaxone-resistant <i>E. coli</i> (<i>n</i> = 14) and <i>K. pneumoniae</i> (<i>n</i> = 10) increased from 3.2% to 5.6% to 20.3%, while at the same time the rate of ceftriaxone susceptibility decreased for both species. Whole genome sequencing identified AmpC genes (<i>bla</i> _CMY-2, <i>bla</i> _DHA-1, and <i>bla</i> _FOX-5), TEM extended-spectrum beta-lactamases (ESBL) variants (<i>bla</i> _TEM-190) and SHV ESBL variants (<i>bla</i> _SHV-12 and <i>bla</i> _SHV-7) as the likely cause of ceftriaxone resistance in these isolates. Despite this change, the negative predictive value for the test was 94% in 2024. Our data suggest continued reliance on molecular testing for de-escalation is appropriate for most patients, although rapid follow-up of final susceptibility results is warranted. In addition, institutions should be aware that epidemiology changes may occur and routinely monitor the incidence of ceftriaxone resistant but <i>bla</i> _CTX-M-negative isolates.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag225"},"PeriodicalIF":3.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocols for Randomized Controlled Trials: Advancing Transparency in Infectious Diseases.","authors":"Jean-Jacques Parienti, Roger Bedimo, Cynthia L Sears, Paul E Sax","doi":"10.1093/ofid/ofag163","DOIUrl":"https://doi.org/10.1093/ofid/ofag163","url":null,"abstract":"","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 4","pages":"ofag163"},"PeriodicalIF":3.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RE: Enterovirus D68 Respiratory Infections in Vietnamese Children.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1093/ofid/ofag242","DOIUrl":"https://doi.org/10.1093/ofid/ofag242","url":null,"abstract":"","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag242"},"PeriodicalIF":3.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunct Diagnostic Accuracy of Antigen-specific Interleukin-2 for Latent Tuberculosis Infection in Pregnancy.","authors":"Felix Bongomin, Phillip Ssekamatte, Ronald Olum, Diana Sitenda, Davis Kibirige, Joseph Baruch Baluku, Stephen Cose, Irene Andia-Biraro","doi":"10.1093/ofid/ofag237","DOIUrl":"https://doi.org/10.1093/ofid/ofag237","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy modulates immune responses against <i>Mycobacterium tuberculosis</i> (<i>Mtb</i>) infection. Cytokines, including interleukin-2 (IL-2), play a crucial role in <i>Mtb</i> containment, mainly by inducing the proliferation of T cells. However, the role of IL-2 in latent tuberculosis (TB) infection (LTBI) screening has not been completely explored. We, therefore, evaluated the diagnostic accuracy and optimal cutoff value (OCV) of IL-2 as a potential adjunct biomarker for screening LTBI during pregnancy.</p><p><strong>Methods: </strong>We enrolled pregnant women without previous active TB at Kawempe National Referral Hospital, Uganda, in 2020. We tested for LTBI using the QuantiFERON-TB Gold-Plus assay. Blood in quantiFERON blood collection tubes was stimulated with <i>Mtb</i> peptides of ESAT-6 and CFP-10 and following incubation, IL-2 culture supernatant levels were measured in an 11-plex Luminex assay using the Luminex® 100/200™ System with xPONENT® 3.1 software. LTBI positivity was defined as an IFN-γ concentration ≥0.35 IU/mL (calculated as TB1/TB2-Nil). A receiver operator characteristic curve was plotted to assess the diagnostic performance of <i>Mtb</i>-specific IL-2 culture supernatants using STATA 18.0. The OCV was determined using the Youden index, considering sensitivity and specificity.</p><p><strong>Results: </strong>Of 159 participants, the median gestational age was 26.1 (IQR: 20.0-31.6) weeks, 8.2% (n = 13) had HIV, and 10.1% (n = 16) were recent TB contacts. Overall, 79 (49.7%) had LTBI. <i>Mtb</i>-specific IL-2 levels were significantly higher in LTBI than in the non-LTBI group (847.9 (418.2-1309.1) versus 147.73 (100.38-207.19) pg/mL, <i>P</i> < .001). IL-2 achieved an AUC of 0.88 (95% CI: 0.82-0.93), with 76% sensitivity and 96% specificity. IFN-γ showed an AUC of 0.83 (95% CI: 0.76-0.90), with 78% sensitivity and 90% specificity. The combined IL-2 + IFN-γ response yielded the highest accuracy, with an AUC of 0.89 (95% CI: 0.83-0.94), 77% sensitivity, and 95% specificity.</p><p><strong>Conclusions: </strong><i>Mtb</i>-specific IL-2 culture supernatant levels showed good discriminatory power for LTBI detection in pregnancy, comparable to IFN-γ, with the combined IL-2+ IFN-γ response yielding the highest accuracy. These findings support the potential utility of IL-2, alone or with IFN-γ, as an adjunct biomarker for LTBI screening in pregnant women, warranting further validation in larger, diverse cohorts.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag237"},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Increases the Risk and Frequency of Lower Respiratory Tract Infections in Older Adults: A Multicenter Prospective Cohort Study.","authors":"Qing Zhang, Xiaoying Gu, Kang Chang, Yawen Ni, Chun Wang, Jie Zi, Baocheng Zhao, Xiaohui Zou, Bin Cao","doi":"10.1093/ofid/ofag223","DOIUrl":"https://doi.org/10.1093/ofid/ofag223","url":null,"abstract":"<p><strong>Background: </strong>Lower respiratory tract infections (LRTIs) are a leading cause of morbidity in older adults, yet risk stratification based solely on chronological age remains insufficient. Frailty, reflecting cumulative declines in physiological reserve, may better capture susceptibility to respiratory infections. We aimed to investigate the association of frailty with the risk and frequency of LRTIs in older adults.</p><p><strong>Methods: </strong>We conducted a multicenter prospective cohort study among older adults in senior living communities in China, from November 2023 to September 2025. Baseline frailty was evaluated using the clinical frailty scale. Participants were monitored for LRTIs throughout the follow-up period. The association between frailty and LRTI risk was evaluated using cause-specific Cox proportional hazards models, with subgroup and sensitivity analyses performed to assess the consistency and robustness of the findings. For the LRTI frequency analysis, Poisson generalized estimating equation models were applied.</p><p><strong>Results: </strong>The cohort included 522 older adults with a median follow-up of 473.5 days. 104 LRTI episodes were documented, and 13.4% participants experienced at least one event. Frailty was a significant predictor of LRTI risk (adjusted HR, 1.29; 95% CI, 1.10-1.52), which remained robust across different LRTI types and sensitivity analyses. This association was particularly pronounced in participants with albumin levels < 45 g/L. Beyond initial infection risk, frailty was also associated with an increased frequency of LRTIs (adjusted incidence rate ratio, 1.30; 95% CI, 1.09-1.54).</p><p><strong>Conclusions: </strong>Frailty constitutes an independent and modifiable risk factor for LRTIs in older adults, emphasizing the importance of frailty management in LRTI preventive strategies.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag223"},"PeriodicalIF":3.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slow Thinking for Fast Results: Reclaiming Analytical Reasoning in Antimicrobial Susceptibility Test Interpretation.","authors":"Carlos R V Kiffer, Paulo J M Bispo","doi":"10.1093/ofid/ofag214","DOIUrl":"https://doi.org/10.1093/ofid/ofag214","url":null,"abstract":"<p><p>Antimicrobial susceptibility testing (AST) is the basis of directed antimicrobial therapy and stewardship. However, its interpretation frequently relies on rapid and intuitive judgment, rather than on deliberate analytical reasoning. Using Kahneman's dual-process theory of cognition, we argue that AST interpretation is particularly vulnerable to system 1 heuristic bias, especially in real clinical environments. Using illustrative examples from contemporary resistance scenarios, such as extended-spectrum β-lactamase-producing Enterobacterales and multidrug-resistant <i>Pseudomonas aeruginosa</i>, we discuss the evolving resistance patterns over years, and it has increased interpretive complexity beyond what categorical AST outputs alone convey. We propose that interpretative errors may often arise from predictable cognitive responses, rather than from insufficient knowledge, which may be reinforced by current laboratory reporting formats and clinical workflows. Finally, we discuss educational, structural, and reporting strategies to foster system 2 engagement and mechanism-aware interpretation, with implications for antimicrobial stewardship and the training of medical students and early-career clinicians.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 5","pages":"ofag214"},"PeriodicalIF":3.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of the My Personal Health Guide Mobile Phone App on ART Adherence Among Young African American Men Who Have Sex With Men Living With HIV in the United States.","authors":"Mark S Dworkin, Kara Herrera, Sierra Upton, Jeb Jones, Li Liu, Ruiqi Ren, Casey M Luc, Paul Burns, Antonio Jimenez, Meaghan Woody, Robert Garofalo, Sangyoon Lee","doi":"10.1093/ofid/ofag182","DOIUrl":"https://doi.org/10.1093/ofid/ofag182","url":null,"abstract":"<p><strong>Background: </strong>We created My Personal Health Guide, a relational agent-based mobile health app to improve antiretroviral therapy (ART) adherence among young African American men who have sex with men (AAMSM), a priority population for developing treatment-as-prevention interventions. We assessed the efficacy of My Personal Health Guide on improving ART adherence among young AAMSM with HIV over 6 months.</p><p><strong>Methods: </strong>We implemented a randomized controlled trial among young AAMSM (18-34 years) with nonoptimal ART adherence throughout the United States. Participants were randomized to My Personal Health Guide or a control arm. ART adherence was assessed with Wilson's 3-item self-reported adherence measurement and dichotomized at ≥80%. Generalized estimating equations were employed to evaluate the effect of My Personal Health Guide over time, with <i>P</i> < .05 considered statistically significant.</p><p><strong>Results: </strong>A significant group effect (<i>P</i> = .014) indicated that those randomized to My Personal Health Guide were 1.54 times (95% CI, 1.25-12.50) more likely to achieve ≥80% adherence throughout the study duration, after adjusting for HIV treatment adherence self-efficacy, Hispanic ethnicity, unemployment, residing in the South, and serious substance use.</p><p><strong>Conclusions: </strong>This randomized controlled trial demonstrated statistically significant efficacy of the My Personal Health Guide app in improving ART adherence among young AAMSM. As hypothesized, a >10% effect for improved ART adherence was observed at 6-month follow-up among those randomized to the My Personal Health Guide app. These findings provide evidence of efficacy out to 6 months of My Personal Health Guide use to improve ART adherence among young AAMSM.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 4","pages":"ofag182"},"PeriodicalIF":3.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}