Journal of acquired immune deficiency syndromes (1999)最新文献

{"title":"Trajectories of BMI Before, During and Following the COVID-19 Pandemic among Participants in the MACS/WIHS Combined Cohort Study.","authors":"Aruna Chandran, Sarah Olson, Andrew Edmonds, Caitlin A Moran, Jordan E Lake, Phyllis Tien, Ernesto Marques, Anjali Sharma, Maria Alcaide, Todd Brown, Deborah Gustafson, Frank Palella, Michael Plankey, Shivanjali Shankaran, Jenni Wise","doi":"10.1097/QAI.0000000000003779","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003779","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is increasing across the US, with people with HIV experiencing greater risk of obesity-related adverse health outcomes including metabolic diseases. Weight gain has been shown during the widespread shutdowns during the COVID-19 pandemic. We examined weight trajectories before, during and after the COVID-19 pandemic among people with and without HIV.</p><p><strong>Setting: </strong>Participants in the Multicenter AIDS Cohort Study-Women's Interagency HIV Study Combined Cohort Study (MWCCS).</p><p><strong>Methods: </strong>Study time periods were: 1) Pre-pandemic period, May 15, 2018 through March 15, 2020; 2) Pandemic period, March 15, 2020 through September 30, 2021; and 3) Post-pandemic period, October 1, 2021 through September 30, 2024. A piecewise linear mixed effects regression model adjusted for baseline age was fitted with a random intercept for individual. Interaction terms examined differences by sociodemographic characteristics.</p><p><strong>Result: </strong>Among 1,586 participants, 66.5% were living with HIV. From the pre- to during-pandemic period, there was a statistically significant 0.14 kg/m2/visit increase in BMI (95% CI:0.07. 0.22). There was a 0.3 kg/m2 reduction in mean BMI in the 36 months from pandemic [32 kg/m2 (SD: 8.6)] to post-pandemic [31.7 kg/m2 (SD: 8.5)] periods. Similar trajectories were noted among sociodemographically vulnerable subgroups.</p><p><strong>Discussion: </strong>Contrary to our hypothesis, we observed a downward BMI trajectory back to baseline with the exception of those with residential instability in the post-COVID-19 pandemic period following a statistically significant weight gain during the pandemic. Understanding factors associated with decreasing BMI trajectories in the post-pandemic period is important in continuing to address the obesity epidemic in the U.S.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential associations of violence and mental health outcomes by HIV status among adolescent girls and young women aged 15-24 years in 5 countries in Sub-Saharan Africa, 2018/2019.","authors":"Sushma Dahal, Joseph Logan, Udhayashankar Kanagasabai, Francis Annor, Peter A Minchella, Stella Wanjohi, Puleng Ramphalla, Norbert Forster, Meagan Cain, Meghan Duffy, Joseph Trika, Caroline Kambona, Masechache Sechache, Tebello Ralebitso, Jennifer Hegle","doi":"10.1097/QAI.0000000000003769","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003769","url":null,"abstract":"<p><strong>Background: </strong>It is unclear if having both prior violence experiences and HIV interact on mental health (MH) among adolescent girls and young women (AGYW).</p><p><strong>Methods: </strong>We used 2018/2019 Violence Against Children and Youth Survey data on 7,593 AGYW who ever had sex and had a known HIV status from five sub-Saharan African countries. We assessed the interactions between HIV status and violence-exposures- childhood physical violence (PV), childhood emotional violence, childhood sexual violence (SV), lifetime SV, lifetime PV/SV, and age at first SV experienced on four mental health outcomes, adjusting for the socio-demographic covariates. We applied the Benjamini-Hochberg procedure to address multiple comparisons and presented adjusted odds ratio (aOR) with 95% confidence intervals (CIs) stratified by HIV status.</p><p><strong>Results: </strong>Of the total AGYW sample, 2.08% were HIV-positive, 37.06% had moderate psychological distress (PD), 10.03% had severe PD, 10.64% had substance misuse, and 13.53% had suicidality history. Two models had significant interactions between HIV and violence. The likelihood of severe PD among AGYW with childhood SV experiences was significantly higher if they were diagnosed with HIV (aOR: 83.89, 95% CI: 18.26-385.36) versus those without HIV diagnoses (aOR: 2.86, 95% CI: 1.91-4.29). Similarly, the aOR for the association of lifetime SV and severe PD was 12.95 times higher among AGYW with HIV (aOR: 31.85, 95% CI: 7.62-133.11) versus those without HIV (aOR: 2.46, 95% CI: 1.54-3.92).</p><p><strong>Conclusion: </strong>Our results emphasize the need for trauma-informed HIV care with integrated violence and mental health services, particularly for AGYW who have HIV and prior SV experiences.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An HIV-1 risk assessment tool for men aged 15-59 years in 13 African countries: A pooled analysis of nationally representative surveys.","authors":"Nora E Rosenberg, Amber M Young, Yating Zou, Jessica Justman, Manhattan E Charurat, Sizulu Moyo, Khangelani Zuma, Linda-Gail Bekker, Lynda Stranix-Chibanda, Sam J Phiri, Nadia A Sam-Agudu, Marcel Yotebieng, Michael G Hudgens, Benjamin H Chi, Bonnie E Shook-Sa","doi":"10.1097/QAI.0000000000003773","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003773","url":null,"abstract":"<p><strong>Background: </strong>Globally, approximately half of new HIV acquisitions occur among African adults. This analysis examines which African men are at highest risk of acquiring HIV-1 and in greatest need of HIV pre-exposure prophylaxis (PrEP).</p><p><strong>Setting: </strong>National population-based surveys from Eswatini, Ivory Coast, Kenya, Lesotho, Malawi, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, Zimbabwe.</p><p><strong>Methods: </strong>The thirteen surveys were pooled and sampling weights were applied to represent all susceptible men aged 15-59 years-old. HIV-1 incidence was calculated based on a recent HIV-1 testing algorithm. A least absolute shrinkage and selection operator (Lasso) regression model was fit with 28 variables to predict recent HIV-1. Models were trained and internally cross-validated to estimate area under the receiver-operating characteristic (ROC) curve (AUC). Along the ROC curve, at sensitivity levels from 10%-90%, performance tradeoffs were evaluated.</p><p><strong>Results: </strong>Of 167,121 participants, 112 had recent HIV-1, representing 256,000 new annual infections among 122 million men. Only two variables were retained-reporting a male sexual partner and living in a subnational area where a high proportion of adults have detectable HIV-1 viremia. Overall AUC was 0.80 (95% Confidence Interval (CI): 0.71-0.89); cross-validated AUC was 0.76 (95% CI: 0.64-0.87). At 10% sensitivity, 25,000 cases could be averted if 357,000 men adhered to PrEP (Number Needed to Treat [NNT]=14). At 90% sensitivity, 229,000 cases could be averted if 50 million men adhered to PrEP (NNT=219).</p><p><strong>Conclusion: </strong>This predictive, parsimonious, generalizable risk assessment tool could help policymakers weigh tradeoffs between PrEP reach and efficiency.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Knowledge, Attitudes, and Practices among People with and Without HIV in Four Countries in Sub-Saharan Africa.","authors":"Brennan R Cebula, Seth Frndak, Tyler Hamby, Allahna Esber, Hannah Kibuuka, John Owuoth, Valentine Sing'oei, Jonah Maswai, Emmanuel Bahemana, Zahra Parker, Glenna Schluck, Paul Robert, Neha Shah, Julie A Ake, Trevor A Crowell","doi":"10.1097/QAI.0000000000003770","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003770","url":null,"abstract":"<p><strong>Background: </strong>Pandemic preparedness requires understanding knowledge, attitudes, and practices related to disease prevention. We characterized these factors in a vulnerable population during the COVID-19 pandemic across four sub-Saharan African countries to inform outbreak responses.</p><p><strong>Methods: </strong>The African Cohort Study (AFRICOS) enrolls people with and without HIV aged ≥15 years in Kenya, Nigeria, Tanzania, and Uganda. From May 2022 to October 2023, we collected self-reported past-month preventive practices, attitudes toward preventive measure effectiveness, perceptions of community preventive measure use, and concern for personal infection and community spread. Purposeful variable selection using Robust Poisson regression with prevalence ratios (PR) was used to test associations with each preventive practice.</p><p><strong>Results: </strong>Among 2,521 participants (57% female, median age 43.2 [interquartile range 32-51.5] years), 70% reported mask wearing, 53% social distancing, and 35% avoiding crowds. Negative attitudes toward social distancing effectiveness were associated with lower preventive measure use (mask wearing: PR=0.76, 95% CI [0.63-0.91]; social distancing: 0.42 [0.30-0.59]; avoiding crowds: 0.29 [0.18-0.35]) as was having little-no concern about personal infection and community spread (mask wearing: 0.77, [0.70-0.85]; social distancing: 0.54 [0.45-0.64]; avoiding crowds: 0.45 [0.35-0.57]). Perceptions of lower community social distancing were associated with higher preventive measure use (mask wearing: 1.12 [1.06-1.18]; social distancing: 1.41 [1.29-1.54]; avoiding crowds: 1.66 [1.41-1.97]) as were perceptions of lower community mask wearing (mask wearing: 1.21 [1.15-1.27]; social distancing: 1.21 [1.10-1.33]; avoiding crowds: 1.24 [1.04-1.47]).</p><p><strong>Conclusion: </strong>Based on these findings, future efforts to enhance uptake of preventive measures should prioritize improving perceptions of their effectiveness and understanding of infection risks.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing cognitive symptoms in people with HIV: Outcomes from a holistic screening and management pathway.","authors":"Kate Alford, Colin Fitzpatrick, Samuel Rhodes, Clara O'Brien, Eileen Nixon, Sube Banerjee, Jaime H Vera","doi":"10.1097/QAI.0000000000003775","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003775","url":null,"abstract":"<p><strong>Objective: </strong>To describe the implementation and outcomes of a cognitive screening and management pathway in people living with HIV within a large UK HIV service.</p><p><strong>Methods: </strong>Since 2021, cognitive symptoms have been screened during routine HIV appointments using the cognitive screening questions endorsed by the European AIDS Clinical Society. Symptomatic individuals underwent the Montreal Cognitive Assessment (MoCA); scores <26/30 prompted referral to a dedicated HIV-Memory clinic. Pathway data from 2021-2023 were retrospectively analysed. Baseline and follow-up neuropsychological test results were compared. Cognitive impairment was defined by global and domain-specific Z scores, and changes in cognitive performance were evaluated using global deficit and reliable change index scores compared to norms via t-tests. The interventions delivered were quantified.</p><p><strong>Results: </strong>Of the 2662 individuals attending the HIV service, 1518 (57%) received screening; 155 (10%) reported symptoms (mean age was 59.5 ± 11.6; 93.5% VL <40 copies/ml). 71 (46% then completed a MoCA), and 33 (46.5%) scored <26. Among 136 HIV-Memory clinic attendees, 38 were followed up to track cognitive progression and intervention impact. 196 interventions were delivered, including comorbidity/lifestyle management (n=33,31%), mental health support (n=22, 19%), HIV-therapy adjustment (n=16, 11%) and cognitive remediation (n=11, 6%). Improvements were seen in global cognitive and most domains, notably delayed memory and executive function (both p<0.03).</p><p><strong>Conclusions: </strong>Implementing a cognitive screening and management pathway in routine HIV care is feasible. In individuals receiving management, cognitive performance generally remained stable or improved, highlighting the potential benefit of personalised interventions addressing holistic factors associated with cognitive impairment in people with HIV.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Individuals with Advanced HIV Disease and Risk Factors for Mortality in a Contemporary Cohort in South Africa.","authors":"Joshua Fieggen, Graeme Meintjes, Andrew Boulle, Jonathan Euvrard","doi":"10.1097/QAI.0000000000003767","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003767","url":null,"abstract":"<p><strong>Background: </strong>Advanced HIV disease is a major contributor to the slowing decline in HIV-related deaths globally. However, limited data exist on which individuals with advanced HIV are at highest risk of death.</p><p><strong>Methods: </strong>A retrospective cohort study was nested within a larger cohort of 13 primary care HIV treatment facilities in Khayelitsha, South Africa. All adults who had a CD4 count less than 200cells/mm3 between 1 January 2017 and 31 March 2021 were enrolled. Descriptive statistics were calculated, and the cohort was then restricted to those who had linked vital status information. We evaluated risk factors for mortality using Kaplan-Meier curves, and univariable and multivariable Cox Proportional Hazards models.</p><p><strong>Results: </strong>Between 19% and 28% of the larger cohort (n=72,102) were estimated to have advanced HIV disease at any point during the study period. Of these individuals, 20% were on treatment, 40% were disengaged from care and 40% were treatment naïve at enumeration. Overall mortality was 12%, with mortality highest in the first year (6,8%) following enumeration. There were 608, 371, and 370 deaths among those disengaged, on ART, and ART naïve respectively representing 14%, 17%, and 8% of individuals in each group. Over a quarter of all participants were found to have current tuberculosis at enrolment into the cohort.</p><p><strong>Conclusion: </strong>ART-exposed individuals with advanced HIV disease contribute substantially to ongoing HIV-related mortality in South Africa. Improved adherence and retention strategies within HIV programmes could reduce this mortality.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Exposure Prophylaxis (PrEP) Guideline Awareness and Prescribing Behaviors Among Healthcare Providers in the United States: DocStyles Survey, 2022-2024.","authors":"Nivedita L Bhushan, Vanessa Boudewyns, Hannah Getachew-Smith, Jo Ellen Stryker, Jennifer D Uhrig","doi":"10.1097/QAI.0000000000003774","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003774","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-exposure prophylaxis (PrEP) prescription rates in the U.S. remain suboptimal despite its high efficacy in HIV prevention. Healthcare provider (HCP) awareness of PrEP guidelines is crucial, yet limited data exist on guideline-specific awareness versus general PrEP knowledge. This study examined PrEP guideline awareness, prescribing behaviors, and associated HCP characteristics using 2022-2024 DocStyles data to inform targeted interventions.</p><p><strong>Methods: </strong>Data were drawn from the 2022-2024 DocStyles surveys of U.S. HCPs (N = 4,507). Chi-square tests and generalized linear models assessed relationships between PrEP guideline awareness, prescribing behaviors, and HCP demographic and clinical characteristics.</p><p><strong>Results: </strong>PrEP guideline awareness increased from 44% (2022) to 57% (2023), then declined to 50% (2024; p <.001). HCPs over age 44 and OB/GYNs were more likely to be aware of PrEP guidelines than younger HCPs and family practitioners. Guideline awareness did not differ by region, sex, race/ethnicity, or clinical setting. PrEP prescribing to all sexually active individuals increased from 23% (2022), 29% (2023) to 33% (2024; p <.001). Non-White HCPs were more likely to prescribe PrEP than White HCPs. Compared to HCPs in the South, those in the Northeast and West were more likely to prescribe PrEP, while Midwestern HCPs were less likely. OB/GYNs, NPs, and PAs were less likely to prescribe PrEP than family practitioners.</p><p><strong>Conclusion: </strong>Significant variations in PrEP guideline awareness and prescribing behaviors exist among U.S. HCPs. Targeted communication campaigns and tailored interventions are essential to address these differences, enhance guideline adherence, and optimize PrEP uptake to reduce HIV incidence nationally.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undiagnosed HIV among transgender women in the United States: Implications for testing programs.","authors":"Meg Stevenson, Erin Cooney, Annick Borquez, Asa E Radix, Tonia C Poteat, Sabriya Linton, Andrew J Wawrzyniak, Ceza Pontes, Carter Brown, Marissa Miller, Arianna Lint, Sari L Reisner, Andrea L Wirtz","doi":"10.1097/QAI.0000000000003776","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003776","url":null,"abstract":"<p><strong>Introduction: </strong>Transgender women experience healthcare barriers which can impede HIV status awareness, increasing the risk of delayed diagnosis. We sought to characterize undiagnosed HIV among transgender women in the US.</p><p><strong>Methods: </strong>We used data from a hybrid cohort utilizing digital and in-person strategies for transgender women in the US who are not living with HIV. Assessments include a sociobehavioral questionnaire and HIV testing. Using baseline screening data, we identified undiagnosed HIV among transgender women who self-reported no HIV testing history or a negative result at last test. Bivariate and multivariable Firth-penalized logistic regression models were fit to assess correlates of undiagnosed HIV.</p><p><strong>Results: </strong>A total of 2549 participants completed HIV testing. Forty-three participants tested positive, 15 of whom disclosed during post-test counseling they had been previously diagnosed and were excluded from this sample. Of the 2534 with no previous HIV diagnosis, 28 (1.1%) were estimated to have undiagnosed HIV at baseline. Correlates of undiagnosed HIV included identifying as a person of color (aOR=4.8; 95%CI=2.1-11.1) and past 6-month stimulant use (aOR=2.8; 95%CI:1.2-6.4). Among transgender women of color, correlates of undiagnosed HIV were past 6-month stimulant use (OR=2.5; 95%CI=0.9-6.7), no lifetime HIV testing history (OR=3.1; 95%CI=1.2-8.0), and no insurance (OR=4.5; 95%CI=1.0-20.5) or public health insurance (OR=4.4; 95%CI=1.1-17.1) vs. private insurance.</p><p><strong>Conclusions: </strong>Undiagnosed HIV among transgender women is concerning and disproportionately affects transgender women of color. Addressing stimulant use is important for HIV prevention. Findings underscore the urgent need for free, accessible HIV testing with linkage to HIV prevention and care to achieve HIV strategy goals.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Traditional Health Practitioners Deliver HIV Counseling and Testing Services? A Pilot Study in Rural South Africa.","authors":"Carolyn M Audet, Tshegofatso Seabi, Wonderful Mabuza, Praises Mnisi, Taofik Oyekunle, Jennifer Hove, Taylor Carty, Kathleen Kahn, Ryan G Wagner","doi":"10.1097/QAI.0000000000003712","DOIUrl":"10.1097/QAI.0000000000003712","url":null,"abstract":"<p><strong>Introduction: </strong>In 2021, 7.2 million South Africans were living with HIV. Uptake of HIV testing is undermined by a combination of factors, including HIV stigma, distrust in the health system, skepticism toward allopathic medicine, preference for traditional medicine, and long distances to the nearest health facility.</p><p><strong>Methods: </strong>We conducted a single arm pilot trial to determine the acceptability and feasibility of training traditional healers to conduct rapid HIV counseling and testing in rural South Africa. Seventeen healers were enrolled in a nationally recognized training program with the goal of healers recruiting their clients for testing during regular clinical visits.</p><p><strong>Results: </strong>Sixteen healers completed training and began offering HIV counseling and testing services; 14 healers enrolled participants of which 4 healers accounted for 73% of enrolled (tested) participants. Healers offered testing to 575 clients; 64 (11.1%) self-reported that they were HIV+ so were not eligible to participate and 93 refused. Healers conducted 418 HIV tests (82% uptake) with 20 (4.8%) testing HIV positive. The median age of clients was 30 years (IQR: 23-40) and 51.1% were women. In total, 34.4% had never completed an HIV test, with significantly more men reported never having tested than women.</p><p><strong>Conclusions: </strong>Traditional healers in rural South Africa successfully completed a rapid, point-of-care HIV counseling and testing training. The clients of trained healers were largely willing to be tested; referral of those with a positive result to treatment proved more difficult to implement, with only 60% of those testing positive enrolling in HIV treatment services.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"115-122"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328422","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":"Impact of Depressive Symptom Severity on Stroke Risk in a US Cohort of People with HIV.","authors":"Jimmy Ma, Robin M Nance, Stephanie A Ruderman, Lydia N Drumright, L Sarah Mixson, Felicia C Chow, Joseph Zunt, Christina M Marra, Maile Karris, Emily L Ho, Kyra Becker, Rizwan Kalani, Andrew Huffer, Rob Fredericksen, Sonia Napravnik, Richard D Moore, Barbara Gripshover, Amanda Willig, Jacklyn D Foley, Greer Burkholder, Michael S Saag, Katerina Christopoulos, Mari M Kitahata, David Tirschwell, Joseph A C Delaney, Heidi M Crane","doi":"10.1097/QAI.0000000000003710","DOIUrl":"10.1097/QAI.0000000000003710","url":null,"abstract":"<p><strong>Background: </strong>Depression is a common psychiatric condition and an independent stroke risk factor among people with HIV (PWH). The impacts of depressive symptom severity on stroke are not clear in PWH.</p><p><strong>Methods: </strong>We studied adult PWH in clinical care at 5 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites with ≥1 assessment for depressive symptoms (Patient Health Questionnaire-9) from 2010 to 2022. We used Cox models to evaluate (1) associations between time-varying depressive symptom severity and adjudicated incident stroke, serially adjusted for clinical factors and (2) modification of this association by age and sex. Participants were followed from 6 months after first CNICS visit or date the CNICS site began stroke adjudication (baseline) (whichever later) until the first stroke, death, loss to follow-up, last clinic visit, or study end.</p><p><strong>Results: </strong>Among 13,817 PWH (mean age 45 years, 19% women, 58% non-White race/ethnicity), 23% screened positive for depression at baseline and 173 had an incident stroke during follow-up (mean follow-up 7.6 years). Time-varying depressive symptom severity (per 5 points Patient Health Questionnaire-9 score) was associated with higher stroke risk (adjusted Hazard Ratio 1.16, P = 0.01) with greater impact in PWH <50 years than ≥50 years (interaction P = 0.02) but no significant difference by sex. Adjusting for combinations of sociodemographic, cardiovascular, HIV, and substance use factors only slightly attenuated estimates.</p><p><strong>Conclusions: </strong>Depressive symptom severity was an independent risk factor for stroke with higher severity depressive symptoms predicting higher stroke risk and greater impact in PWH <50 years. Depression may be a modifiable risk factor for stroke and should be studied further to understand, develop, and target interventions to reduce stroke risk, especially in younger PWH.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"154-161"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334808","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}