Journal of the International AIDS Society最新文献

{"title":"Implementation research for today's HIV response: from theory to applied insights","authors":"Bohdan Nosyk, Eleanor Magongo Namusoke, Anne Trolard, Elvin H. Geng","doi":"10.1002/jia2.26305","DOIUrl":"10.1002/jia2.26305","url":null,"abstract":"<p>Global progress over the past 20 years has turned the tide on the HIV epidemic. Many countries are close to, and some have even reached, the UNAIDS 90-90-90 (and now 95-95-95) goals. Looking into the future, however, progress now requires not only continued attention, but a shift in scientific and strategic directions. Programmes must advance <i>equitable reach</i> to ensure that HIV prevention and treatment services meet the needs of populations and contexts that are outside of mainstream health services. We must shift from the continued rapid growth of capacity to <i>sustainable systems</i> embedded within policy and economic commitments around the world. Finally, the HIV response must evolve from a sole focus on HIV towards integrated services for comorbid conditions, both in persons living with HIV as well as to contribute to a global push for universal health coverage for all persons.</p><p>Implementation research is well-positioned to address this new generation of challenges and is, therefore, needed more than ever in the scientific response to HIV today. The growing prominence of implementation research for HIV is reflected in the assembly of this collection of articles for this supplement in the Journal of International AIDS Society (JIAS) on <i>Implementation research and the HIV response: Taking stock and charting the way forward</i>, as well as the growing number of funding opportunities, publication venues and professional settings which focus on implementation research. Implementation research has been defined as methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice to improve the quality, reach and sustainability of health services [<span>1</span>]. The scientific questions we seek to answer today are fundamentally questions about implementation: how to achieve greater and more equitable reach; how to sustain services in a changing economic and policy environment; how to integrate HIV services into wider public health structures. At the same time, the research needs of the HIV community also provide a critical testing ground to assess and refine implementation science methods to optimally deliver actionable insights for real-world problems and help us achieve greater epidemic control. Is the HIV research community up to the task?</p><p>This supplement responds strongly in the affirmative. This solicitation received over 100 submissions, with studies conducted in Africa, Asia, Europe, and North and South America. The 12 ultimately included cover a wide range of interventions—partner services, HIV self-testing, long-acting injectable antiretroviral therapy (ART) and stepped care for ART retention, and pre-exposure prophylaxis (PrEP)—as well as responses at the population level and for key populations, such as infants and young women. The articles also make use of a range of frameworks, from the Consolidated Framework for Implementation Research (CFIR) to Normalizatio","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering citizen-engaged HIV implementation science","authors":"Benedict Xin Hao Tan,&nbsp;Shao Yuan Chong,&nbsp;Daniel Weng Siong Ho,&nbsp;Ye Xuan Wee,&nbsp;Muhammad Hafiz Jamal,&nbsp;Rayner Kay Jin Tan","doi":"10.1002/jia2.26278","DOIUrl":"10.1002/jia2.26278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Successful implementation of evidence-based practices depends on contextual factors like stakeholder engagement, the socio-political environment, resource availability, and stakeholders’ felt needs and preferences. Nevertheless, inequities in implementation exist and undermine efforts to address HIV in marginalized key populations. Implementation science shows promise in addressing such inequities in the HIV response, but can be limited without meaningful engagement from citizens or communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We define the concept of a citizen-engaged HIV implementation science as one that involves citizens and communities deeply in HIV implementation science activities. In this commentary, we discuss how citizen science approaches can be leveraged to spur equity in HIV implementation science. Drawing on three areas previously defined by Geng and colleagues that serve to drive impactful implementation science in the HIV response, we discuss how citizens can be engaged when considering “whose perspectives?”, “what questions are being asked?” and “how are questions asked?”. With respect to “whose perspectives?” a citizen-engaged HIV implementation science would leverage participatory methods and tools, such as co-creation, co-production and crowdsourcing approaches, to engage the public in identifying challenges, solve health problems and implement solutions. In terms of “what questions are being asked?”, we discuss how efforts are being made to synthesize citizen or community-led approaches with existing implementation science frameworks and approaches. This also means that we ensure communities have a say in interrogating and deconstructing such frameworks and adapting them to local contexts through participatory approaches. Finally, when considering “how are questions asked?”, we argue for the development and adoption of broad, guiding principles and frameworks that account for dynamic contexts to promote citizen-engaged research in HIV implementation science. This also means avoiding narrow definitions that limit the creativity, innovation and ground-up wisdom of local citizens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By involving communities and citizens in the development and growth of HIV implementation science, we can ensure that our implementation approaches remain equitable and committed to bridging divides and ending AIDS as a public health threat. Ultimately, efforts should be made to foster a citizen- and community-engaged HIV implementation science to spur equity in our global HIV response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using FRAME to characterize provider-identified adaptations to a stepped care intervention for adolescents and youth living with HIV in Kenya: a mixed methods approach","authors":"Nok Chhun,&nbsp;Dorothy Oketch,&nbsp;Kawango Agot,&nbsp;Dorothy I. Mangale,&nbsp;Jacinta Badia,&nbsp;James Kibugi,&nbsp;Wenwen Jiang,&nbsp;Mary Kirk,&nbsp;Barbra A. Richardson,&nbsp;Pamela K. Kohler,&nbsp;Grace John-Stewart,&nbsp;Kristin Beima-Sofie","doi":"10.1002/jia2.26261","DOIUrl":"10.1002/jia2.26261","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The Data-informed Stepped Care (DiSC) study is a cluster-randomized trial implemented in 24 HIV care clinics in Kenya, aimed at improving retention in care for adolescents and youth living with HIV (AYLHIV). DiSC is a multi-component intervention that assigns AYLHIV to different intensity (steps) of services according to risk. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to characterize provider-identified adaptations to the implementation of DiSC to optimize uptake and delivery, and determine the influence on implementation outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between May and December 2022, we conducted continuous quality improvement (CQI) meetings with providers to optimize DiSC implementation at 12 intervention sites. The meetings were guided by plan-do-study-act processes to identify challenges during early phase implementation and propose targeted adaptations. Meetings were audio-recorded and analysed using FRAME to categorize the level, context and content of planned adaptations and determine if adaptations were fidelity consistent. Providers completed surveys to quantify perceptions of DiSC acceptability, appropriateness and feasibility. Mixed effects linear regression models were used to evaluate these implementation outcomes over time.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Providers participated in eight CQI meetings per facility over a 6-month period. A total of 65 adaptations were included in the analysis. The majority focused on optimizing the integration of DiSC within the clinic (83%, &lt;i&gt;n&lt;/i&gt; = 54), and consisted of improving documentation, addressing scheduling challenges and improving clinic workflow. Primary reasons for adaptation were to align delivery with AYLHIV needs and preferences and to increase reach among AYLHIV: with reminder calls to AYLHIV, collaborating with schools to ensure AYLHIV attended clinic appointments and addressing transportation challenges. All adaptations to optimize DiSC implementation were fidelity-consistent. Provider perceptions of implementation were consistently high throughout the process, and on average, slightly improved each month for intervention acceptability (β = 0.011, 95% CI: 0.002, 0.020, &lt;i&gt;p&lt;/i&gt; = 0.016), appropriateness (β = 0.012, 95% CI: 0.007, 0.027, &lt;i&gt;p&lt;/i&gt;&lt;0.001) and feasibility (β = 0.013, 95% CI: 0.004, 0.022, &lt;i&gt;p&lt;/i&gt; = 0.005).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Provider-identified adaptations targeted improved integration into routine clinic practices an","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study","authors":"Hlengiwe P. Madlala,&nbsp;Landon Myer,&nbsp;Jennifer Jao,&nbsp;Hayli Geffen,&nbsp;Mushi Matjila,&nbsp;Azetta Fisher,&nbsp;Demi Meyer,&nbsp;Erika F. Werner,&nbsp;Gregory Petro,&nbsp;Susan Cu-Uvin,&nbsp;Stephen T. McGarvey,&nbsp;Angela M. Bengtson","doi":"10.1002/jia2.26313","DOIUrl":"10.1002/jia2.26313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24–28 (baseline) and 33–38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 292 participants (48% WHIV), median age was 29 years (IQR, 25–33), median pre-pregnancy body mass index (BMI) was 31 kg/m² (IQR, 26–36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12–0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, <i>p</i>&lt;0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, <i>p</i> = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of &gt;4000 g (RR = 2.18 95% CI 1.18, 4.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating grey areas in HIV and mental health implementation science","authors":"Audrey Harkness,&nbsp;Ali Giusto,&nbsp;Alison B. Hamilton,&nbsp;Raul U. Hernandez-Ramirez,&nbsp;Donna Spiegelman,&nbsp;Bryan J. Weiner,&nbsp;Rinad S. Beidas,&nbsp;Michaela E. Larson,&nbsp;Sheri A. Lippman,&nbsp;Milton L. Wainberg,&nbsp;Justin D. Smith","doi":"10.1002/jia2.26271","DOIUrl":"10.1002/jia2.26271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high-impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, “grey areas,” or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A group of IS experts affiliated with NIMH-funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH-related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (<i>N</i> = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence-based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high-impact HIV/MH implementation research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beating the odds: medicines alone will not stop HIV","authors":"Beatriz Grinsztejn,&nbsp;Cristina Mussini,&nbsp;Claudia Cortes,&nbsp;Darrell H. S. Tan,&nbsp;Nittaya Phanuphak","doi":"10.1002/jia2.26321","DOIUrl":"10.1002/jia2.26321","url":null,"abstract":"&lt;p&gt;In the past 20 years, the world has made significant medical progress in addressing HIV. Groundbreaking HIV treatment and prevention options, such as pre-exposure prophylaxis (PrEP), are increasingly used around the world. As of 2023, 29.8 million of the 39 million people living with HIV (PLWH) globally were receiving HIV treatment [&lt;span&gt;1&lt;/span&gt;]. Access to PrEP has increased over 1000% from 2019 to 2022. This increased use of treatment and prevention options has resulted in an almost 60% reduction in new HIV acquisitions in children in 2022 compared to 2010, the lowest since the 1980s, and in almost three-quarters of PLWH in 2022 having suppressed plasma viraemia; though eastern Europe, central Asia and the Middle East and North Africa have reported increases in new HIV acquisitions.&lt;/p&gt;&lt;p&gt;Indeed, while the global data are encouraging, progress for key populations (KPs)—gay and other men who have sex with men (MSM), sex workers, transgender people and people who inject drugs (PWID) and migrants—is particularly uneven despite their increased vulnerability to HIV. In 2023, outside of sub-Saharan Africa, the majority of new HIV acquisitions were among KPs [&lt;span&gt;1&lt;/span&gt;]. PrEP coverage among KPs in low- and middle-income countries is typically under 5% [&lt;span&gt;1&lt;/span&gt;]. Antiretroviral therapy coverage and retention in care are lower for sex workers, transgender people and PWID compared to the general population [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Medicines alone will not close this gap. KPs need enabling legal and policy environments to support their access to and uptake of HIV- and other health-related services. In discriminatory and punitive legal and policy environments, KPs avoid HIV-related services for fear of harassment, discrimination or reporting to law enforcement by healthcare workers. In Argentina, a study found that transgender people who experienced stigma in healthcare settings were three times more likely to avoid seeking healthcare than those who had not experienced stigma [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The consequences of a punitive and discriminatory legal and policy environment on KPs and their health are staggering. MSM in countries that criminalize same-sex relations are more than twice as likely to be living with HIV compared to those in countries without such criminal penalties [&lt;span&gt;3&lt;/span&gt;]. A study conducted in 10 countries in sub-Saharan Africa found that HIV prevalence among sex workers was 7.17 times higher in countries where sex work was criminalized compared to countries where it was not criminalized [&lt;span&gt;4&lt;/span&gt;]. A 2017 systematic review found that 80% of included studies reported that criminalization of drug possession had a negative impact on PWID's access to HIV prevention, treatment, care and support services [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Yet, no country in the world has repealed laws criminalizing all KP behaviours, including laws related to sex work, possession of small amounts of drugs for personal use, same-sex sexual be","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco smoking, smoking cessation and life expectancy among people with HIV on antiretroviral therapy in South Africa: a simulation modelling study","authors":"Acadia M. Thielking,&nbsp;Kieran P. Fitzmaurice,&nbsp;Ronel Sewpaul,&nbsp;Stavroula A. Chrysanthopoulou,&nbsp;Lotanna Dike,&nbsp;Douglas E. Levy,&nbsp;Nancy A. Rigotti,&nbsp;Mark J. Siedner,&nbsp;Robin Wood,&nbsp;A. David Paltiel,&nbsp;Kenneth A. Freedberg,&nbsp;Emily P. Hyle,&nbsp;Krishna P. Reddy","doi":"10.1002/jia2.26315","DOIUrl":"10.1002/jia2.26315","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;As access to effective antiretroviral therapy (ART) has improved globally, tobacco-related illnesses, including cardiovascular disease, cancer and chronic respiratory conditions, account for a growing proportion of deaths among people with HIV (PWH). We estimated the impact of tobacco smoking and smoking cessation on life expectancy among PWH in South Africa.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In a microsimulation model, we simulated 18 cohorts of PWH with virologic suppression, each homogenous by sex, initial age (35y/45y/55y) and smoking status (current/former/never). Input parameters were from data sources published between 2008 and 2022. We used South African data to estimate age-stratified mortality hazard ratios: 1.2−2.3 (females)/1.1−1.9 (males) for people with current versus never smoking status; and 1.0−1.3 (females)/1.0−1.5 (males) for people with former versus never smoking status, depending on age at cessation. We assumed smoking status remains unchanged during the simulation; people who formerly smoked quit at model start. Simulated PWH face a monthly probability of disengagement from care and virologic non-suppression. In sensitivity analysis, we varied smoking-associated and HIV-associated mortality risks. Additionally, we estimated the total life-years gained if a proportion of all virologically suppressed PWH stopped smoking.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Forty-five-year-old females/males with HIV with virologic suppression who smoke lose 5.3/3.7 life-years compared to PWH who never smoke. Smoking cessation at age 45y adds 3.4/2.4 life-years. Simulated PWH who continue smoking lose more life-years from smoking than from HIV (females, 5.3 vs. 3.0 life-years; males, 3.7 vs. 2.6 life-years). The impact of smoking and smoking cessation increase as smoking-associated mortality risks increase and HIV-associated mortality risks, including disengagement from care, decrease. Model results are most sensitive to the smoking-associated mortality hazard ratio; varying this parameter results in 1.0−5.1 life-years gained from cessation at age 45y. If 10−25% of virologically suppressed PWH aged 30−59y in South Africa stopped smoking now, 190,000−460,000 life-years would be gained.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among virologically suppressed PWH in South Africa, tobacco smoking decreases life expectancy more than HIV. Integrating tobacco cessation interventions into HIV care, as endorsed by the World Health Organization, could substantially improve life expecta","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention strategies to improve adherence to treatment for selected chronic conditions in sub-Saharan Africa: a systematic review","authors":"Siphamandla Bonga Gumede,&nbsp;John B. F. de Wit,&nbsp;Willem D. F. Venter,&nbsp;Annemarie M. J. Wensing,&nbsp;Samanta Tresha Lalla-Edward","doi":"10.1002/jia2.26266","DOIUrl":"10.1002/jia2.26266","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Evidence-based intervention strategies to improve adherence among individuals living with chronic conditions are critical in ensuring better outcomes. In this systematic review, we assessed the impact of interventions that aimed to promote adherence to treatment for chronic conditions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We systematically searched PubMed, Web of Science, Scopus, Google Scholar and CINAHL databases to identify relevant studies published between the years 2000 and 2023 and used the QUIPS assessment tool to assess the quality and risk of bias of each study. We extracted data from eligible studies for study characteristics and description of interventions for the study populations of interest.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of the 32,698 total studies/records screened, 2814 were eligible for abstract screening and of those, 497 were eligible for full-text screening. A total of 82 studies were subsequently included, describing a total of 58,043 patients. Of the total included studies, 58 (70.7%) were related to antiretroviral therapy for HIV, 6 (7.3%) were anti-hypertensive medication-related, 12 (14.6%) were anti-diabetic medication-related and 6 (7.3%) focused on medication for more than one condition. A total of 54/82 (65.9%) reported improved adherence based on the described study outcomes, 13/82 (15.9%) did not have clear results or defined outcomes, while 15/82 (18.3%) reported no significant difference between studied groups. The 82 publications described 98 unique interventions (some studies described more than one intervention). Among these intervention strategies, 13 (13.3%) were multifaceted (4/13 [30.8%] multi-component health services- and community-based programmes, 6/13 [46.2%] included individual plus group counselling and 3/13 [23.1%] included SMS or alarm reminders plus individual counselling).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The interventions described in this review ranged from adherence counselling to more complex interventions such as mobile health (mhealth) interventions. Combined interventions comprised of different components may be more effective than using a single component in isolation. However, the complexity involved in designing and implementing combined interventions often complicates the practicalities of such interventions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is substantial evidence that community- a","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INcentives and ReMINDers to Improve Long-Term Medication Adherence (INMIND): impact of a pilot randomized controlled trial in a large HIV clinic in Uganda","authors":"Sebastian Linnemayr,&nbsp;Mary Odiit,&nbsp;Barbara Mukasa,&nbsp;Ishita Ghai,&nbsp;Chad Stecher","doi":"10.1002/jia2.26306","DOIUrl":"10.1002/jia2.26306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Habits are a common strategy for successfully countering medication non-adherence, yet existing interventions do not support participants during the long habit formation period, resulting in high attrition. We test a novel intervention combining text messages and incentives with anchoring to support antiretroviral therapy (ART) pill-taking habits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a randomized, parallel controlled trial, a sample of 155 participants 18 years and older who initiated ART within 3 months were recruited at Mildmay Uganda between October 2021 and April 2022. All participants were educated on the anchoring strategy and chose an anchor, that is existing routines, to pair with pill-taking. Participants were randomized to either usual care (C = 49), daily text message reminders to follow their anchoring plan (<i>Messages</i> group; T1 = 49) or messages and incentives conditional on pill-taking in line with their anchor (<i>Incentives</i> group; T2 = 57). Assessments occurred at baseline, month 3 (end of intervention) and month 9 (end of observation period). The primary outcomes are electronically measured mean adherence and pill-taking consistent with participants’ anchor time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary outcome of pill-taking in line with the anchoring plan was higher in the <i>Incentives</i> group during the 3-month intervention (12.2 p.p. [95% CI: 2.2 22.2; <i>p</i> = .02]), and remained significantly higher after the incentives were withdrawn (months 4−6 (14.2 p.p. [95% CI 1.1 27.2; <i>p</i> = .03]); months 7−9 (14.1 p.p. [95% CI −0.2 28.5; <i>p</i> = .05])). Mean adherence was higher in both treatment groups relative to the control group during the intervention (T1 vs. C, <i>p</i> = .06; T2 vs. C, <i>p</i> = .06) but not post-intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The promising approach of using incentives to support habit formation among ART treatment initiators needs to be evaluated in a fully powered study to further our understanding of the habit formation process and to evaluate its cost-effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017−2022","authors":"Christian Grov,&nbsp;Yan Guo,&nbsp;Drew A. Westmoreland,&nbsp;Alexa B. D'Angelo,&nbsp;Chloe Mirzayi,&nbsp;Michelle Dearolf,&nbsp;Pedro Carneiro,&nbsp;Meredith Ray,&nbsp;David Pantalone,&nbsp;Adam W. Carrico,&nbsp;Viraj V. Patel,&nbsp;Sarit A. Golub,&nbsp;Sabina Hirshfield,&nbsp;Donald R. Hoover,&nbsp;Denis Nash","doi":"10.1002/jia2.26312","DOIUrl":"https://doi.org/10.1002/jia2.26312","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We report data from a 4-year study (2017−2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59−1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79−3.28), Hispanic/Latinx (1.53, 1.19−1.96), housing instability (1.58, 1.22−2.05) and past year methamphetamine use (3.82, 2.74−5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51−0.87; 36 months, 0.60, 0.45−0.80; 48 months, 0.48, 0.35−0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17−0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74−6.46) or lack thereof (4.30, 1.85−9.88). However, those who initiated PrEP in the past year (0.14, 0.04−0.39) or persistently used PrEP in the past 2 years (0.33, 0.14−0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months &lt;i&gt;prior&lt;/i&gt; 128 (42.2%) times (overall).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only a","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}