AIDS patient care and STDs最新文献

{"title":"Measuring Pre-Exposure Prophylaxis (PrEP) Stigma Among Adolescent Girls and Young Women in Western Kenya: Scale Development, Validation, and Associations with PrEP Adherence.","authors":"Sarah T Roberts, Sophie Otticha, Erica N Browne, Carla Bann, Laura Nyblade, Miriam Hartmann, Marylyn Ochillo, Kawango Agot","doi":"10.1177/10872914251361105","DOIUrl":"https://doi.org/10.1177/10872914251361105","url":null,"abstract":"<p><p>Qualitative studies suggest stigma is a barrier to pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in sub-Saharan Africa, but there are few quantitative data or validated measures available. This study sought to develop and validate a scale to measure PrEP stigma among AGYW in western Kenya. An initial scale was developed, then pilot tested with 200 AGYW taking PrEP. The final scale was used in a longitudinal study with 250 AGYW to assess the prevalence and sources of PrEP stigma and to test whether PrEP stigma is associated with PrEP adherence, measured by hair tenofovir levels. The pilot testing resulted in the final 17-item Young Women's PrEP Stigma Scale (YW-PSS) with subscales for perceived, anticipated, experienced, and internalized PrEP stigma, high internal consistency (Cronbach's alpha = 0.81), and evidence of divergent and construct validity. In the longitudinal study, 72% of participants reported any perceived PrEP stigma, 64% any anticipated stigma, 35% any experienced stigma, and 15% any internalized stigma. The most commonly reported stigma perpetrators were friends, male partners, and men and women from the community. Participants with higher total, perceived, or experienced PrEP stigma scores were significantly less likely to have high PrEP adherence, while anticipated and internalized stigma were not associated with PrEP adherence. Findings from this study support the validity and reliability of the YW-PSS among AGYW in Kenya and suggest that PrEP stigma is highly prevalent and predicts poor PrEP adherence. Stigma reduction interventions are needed to support PrEP adherence and well-being in this population.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Major Adverse Cardiovascular Events in Antiretroviral Therapy-Treated People with HIV: A Long-Term Cohort Study in Turkey.","authors":"Ceren Atasoy Tahtasakal, Dilek Yıldız Sevgi, Sibel Yıldız Kaya, Zühal Yeşilbağ, İnci Yılmaz Nakir, Alper Gündüz, Okan Derin, Bilgül Mete, Ahsen Öncül, Hayat Kumbasar Karaosmanoğlu, Esra Zerdali, Fehmi Tabak","doi":"10.1177/10872914251359817","DOIUrl":"https://doi.org/10.1177/10872914251359817","url":null,"abstract":"<p><p>People living with HIV (PLWH) continue to experience longer life expectancy due to effective antiretroviral therapy (ART). However, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Despite improved HIV care, major adverse cardiovascular events (MACE) remain prevalent, with limited data from long-term cohorts. This study aimed to determine the incidence, risk factors, and predictors of MACE in long-term ACTHIV-IST cohort of PLWH in Istanbul. We conducted a retrospective analysis of 1059 patients followed for at least 10 years. Patients with prior MACE or noncardiac mortality were excluded. Traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities were analyzed using Cox proportional hazards regression. MACE incidence was 7.55% (80/1059) with a cumulative rate of 11.1%. The most frequent events were ischemic heart disease (30.4%), myocardial infarction (27.6%), and sudden cardiac death (18.6%). Among those without traditional CVD risk factors, a CD4⁺ count <200 cells/mm³ at diagnosis was associated with a 4.5-fold increased MACE risk. Hypertension (hazard ratio [HR]: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031/year) were the strongest independent predictors (<i>p</i> < 0.05). Patients who should have used statins but did not were at higher risk of developing MACE (34% vs. 17%) compared to those who did (<i>p</i> < 0.05). Twenty-one statin users of those who had MACE were before the event. A significantly higher MACE rate was observed in patients who used protease inhibitor (PI) compared to those who did not (<i>p</i> = 0.002). Low baseline CD4⁺ T-cell count, prolonged HIV duration, comorbidities (e.g., hypertension, CAD, and dyslipidemia), PI experienced, and older age at HIV diagnosis significantly increase MACE risk. Early diagnosis, continuous cardiovascular monitoring, start statins if indicated, and individualized ART strategies are essential to reduce MACE-related morbidity and mortality in PLWH.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider Perspectives on the Data-to-Suppression Initiative in Ryan White Part A Housing and Behavioral Health Programs.","authors":"Meghan Peterson, Connor Emmert, William You, Mary Irvine, Tigran Avoundjian, Denis Nash, Honoria Guarino","doi":"10.1177/10872914251361088","DOIUrl":"https://doi.org/10.1177/10872914251361088","url":null,"abstract":"<p><p>The New York City \"Data-to-Suppression\" (D2S) initiative was launched to improve HIV viral suppression among Ryan White HIV/AIDS Program Part A (RWPA) clients through a combination of surveillance-based, client-level reporting and capacity-building activities with RWPA housing and behavioral health service providers. This study qualitatively examines provider perspectives on its implementation. Drawing from 8 RWPA-funded agencies participating in D2S, we conducted semistructured interviews with 24 purposively sampled providers from 8 RWPA-funded agencies participating in D2S, including patient navigators engaged in D2S outreach, patient navigator supervisors, and administrators. Interviews were conducted between August and November 2022. The interviews explored four topics: (1) D2S workflow and benefits, (2) implementation facilitators, (3) implementation barriers, and (4) areas for improvement. Providers reported that D2S was easy to implement and identified clients in need of additional support. Suggestions for improvement included issuing more timely reports, adding more detailed data to reports, and focusing the intervention on agencies where behavioral health and housing program staff do not already have access to clients' HIV care and viral suppression status. Providers described barriers such as organizational capacity constraints (e.g., hiring and retaining staffing levels) and clients' difficulty with maintaining viral suppression due to competing needs. Qualitative feedback from the providers responsible for delivering an intervention is critical to identifying refinements that could strengthen engagement in intervention implementation and thus critical to achieving and sustaining the intended impact.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting an Intervention to Improve Adolescent Sexual Health Assessment and Pre-Exposure Prophylaxis Prescription by Family Medicine Physicians in Alabama.","authors":"Madeline C Pratt, Oluwaseyi O Isehunwa, Samantha V Hill, Tina Simpson, Robin Gaines Lanzi, Nicholas Van Wagoner, Brook A Hubner, Douglas Krakower, Tara E Wood, Latesha E Elopre, Lynn T Matthews","doi":"10.1089/apc.2025.0064","DOIUrl":"https://doi.org/10.1089/apc.2025.0064","url":null,"abstract":"<p><p>High HIV incidence in the US South disproportionately affects adolescents, young adults, and Black women. Using a community-engaged approach and intervention mapping, we developed PrEP-Pro, an intervention to support family medicine physician-trainees to elicit a sexual history from and provide pre-exposure prophylaxis (PrEP) to adolescents, with special emphasis on engaging with Black adolescent girls and young women (AGYW). Intervention content includes PrEP curricula, adaptations to the Centers for Disease Control and Prevention (CDC)'s sexual history tool, and a PrEP Champion training program. Two community advisory boards (CABs)-one consisting of PrEP Champions and physicians, the other of AGYW-and two focus group discussions with physicians (<i>N</i> = 7) informed intervention content. We pretested PrEP-Pro at two sites over 3 months and assessed acceptability, appropriateness, feasibility. The provider CAB advised multiple training strategies: (1) locally informed sexual history videos; (2) HIV epidemiology review; (3) quick-reference badge and pocket cards on PrEP and eliciting sexual histories; (4) didactic, case-based content; (5) web-based content. The AGYW CAB informed development of (6) a sexual history screener and (7) clinic posters emphasizing confidentiality for adolescent clients. Across two family medicine residency programs, eight physicians participated in the 3-month pretest of the intervention. Acceptability (mean = 4.16/5 [standard deviation (SD) = 1.36]), appropriateness (4.16/5 [1.36]), and feasibility (4.19/5 [1.37]) were high. Six physician interviews informed adaptations including fostering a community of practice, increased case-based learning, and quick-reference card content modifications. We combined theory-driven and evidence-informed components to adapt and pilot PrEP-Pro to support physicians in discussing PrEP with adolescents. The adapted intervention was piloted across clinics to inform a future trial.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Misunderstanding to Marginalization: The Role of Knowledge in HIV-Related Discrimination and Risk Behavior Among Adolescents in Germany.","authors":"Gunda Waldmann, Stefan Zippel, Markus Reinholz, Corbinian Fuchs","doi":"10.1089/apc.2025.0050","DOIUrl":"10.1089/apc.2025.0050","url":null,"abstract":"<p><p>Adolescents frequently demonstrate limited knowledge about HIV/AIDS, contributing to persistent stigma, misconceptions, and risky behaviors. These knowledge gaps and stigmatizing attitudes hinder effective HIV prevention and health outcomes. Understanding the sources of adolescents' HIV knowledge and identifying demographic disparities can inform targeted educational interventions. We conducted a cross-sectional, anonymous survey with 2110 adolescents aged 14-18 in Munich, Germany, prior to an extracurricular sexual health lecture between November 2023 and February 2024. The questionnaire assessed sociodemographics, HIV knowledge, sources of information, attitudes toward people living with HIV (PLHIV), and risk perceptions. Data were analyzed using descriptive and inferential statistics to identify knowledge gaps and demographic trends. Significant misconceptions about HIV transmission and prevention were observed, with 40.9% of students uncertain about transmission routes. Male students and those in nonacademic school tracks exhibited higher rates of uncertainty and misinformation. Social media, particularly TikTok, emerged as a major but inconsistent source of HIV information, alongside schools. Stigmatizing attitudes, such as discomfort with PLHIV, were linked to knowledge gaps and misinformation. Demographic factors, including gender and educational background, significantly influenced both knowledge and attitudes. These findings underscore the need for targeted, inclusive educational interventions to bridge HIV knowledge gaps and reduce stigma among adolescents. Leveraging both traditional school-based education and reliable digital platforms can address misconceptions and promote empathy toward PLHIV. Efforts to standardize comprehensive sexual health curricula and develop accurate online resources are critical to improving adolescent health literacy and fostering inclusive attitudes.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":"281-288"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEalth Record Optimization for Identifying Candidates for HIV PRe-Exposure Prophylaxis: A Community-Informed Approach to Model Development.","authors":"Meredith E Clement, Jennifer Thomas, Clare Kelsey, Tonya Jagneaux, Catherine O'Neal, Stephen Lim, Shannon Widman, Julia Marcus, Nwora Lance Okeke, Sarah Wilson","doi":"10.1089/apc.2025.0022","DOIUrl":"10.1089/apc.2025.0022","url":null,"abstract":"<p><p>Electronic health record (EHR)-based models to identify individuals who may benefit from pre-exposure prophylaxis (PrEP) outperform traditional risk scores and may alleviate challenges associated with PrEP initiation. Pre-implementation work is critical to ensure algorithms are optimized for the local context, particularly given regional differences in the US HIV epidemic. To inform the derivation and implementation of EHR-based models within health systems in New Orleans and Baton Rouge, Louisiana, we conducted focus group discussions (FGDs) with community advocates and in-depth interviews (IDIs) with emergency department, primary care, and HIV-trained clinicians. We asked about their perspectives on HIV epidemiology and PrEP uptake and sought suggestions for locally relevant variables to optimize model performance. FGDs and IDIs were audio-recorded and analyzed using thematic analysis. From January to March 2023, FGDs were conducted with 18 community advocates and IDIs with 12 clinicians. Community advocates did not believe that PrEP had reduced local HIV incidence, primarily due to a lack of inclusive marketing. Clinicians noted that improving PrEP uptake would require better access to education, PrEP providers, and affordable medication. Community advocates suggested adding sexual assault history and number of pregnancies to the model; clinicians suggested adding hepatitis B, more sexually transmitted infection treatment modalities, incarceration history, and opiate use. To optimize model implementation, community advocates emphasized the need to convey model output respectfully and compassionately, and clinicians suggested involving ancillary staff in PrEP discussions. Although evidence supports the use of EHR-based models to identify PrEP candidates, local stakeholders can provide unique insight into optimizing model performance and implementation.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":"266-272"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Barriers and Facilitators in a Pilot Long-Acting HIV Treatment Intervention for Trans Women Living with HIV in San Francisco.","authors":"Erin C Wilson, Janet Myers, Geovanny Muñoz Acosta, Sofia Sicro, Emily Schaeffer, Cat-Dancing Alleyne, Alfonso Diaz, Nicole Walker, Janie Vinson, Susan Buchbinder, Hyman Scott, Albert Liu","doi":"10.1089/apc.2024.0259","DOIUrl":"10.1089/apc.2024.0259","url":null,"abstract":"<p><p>Little is known about long-acting HIV treatment implementation with trans women. We piloted and evaluated the implementation of novel strategies to increase uptake and use of long-acting HIV treatment among trans women in San Francisco. In 2022, qualitative formative nominal groups (<i>n</i> = 8) and in-depth interviews with providers (<i>n</i> = 11) were conducted to elicit facilitators and barriers to long-acting HIV treatment delivery among trans women living with HIV and to inform a pilot delivery model. Between August 2023 and August 2024, participants were enrolled into the program. Sequential mixed methods were used to evaluate formative and implementation data to understand barriers to starting long-acting treatment. Barriers for trans women were concerns about side effects, fear of needles, and difficulty adhering to bi-monthly injections. They were also concerned about missed injections from lack of transportation and incarceration and medical mistrust. Providers were most concerned with participant adherence due to social determinants (e.g., housing) and behavioral health challenges (e.g., methamphetamine use, mental health disorders). Buttock fillers and implants, patient worries about interactions with hormones, clinical barriers (e.g., availability of genotyping data), insurance, and managing prescriptions were also potential barriers. A significant barrier to implementation was the burden on referring clinic providers for eligibility screening and many trans women who were referred declined participation or were not eligible due to contraindicated clinical histories. Our study identified barriers to implementing long-acting HIV treatment among trans women living with HIV and provides novel implementation insights for clinics and interventions serving this community.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":"257-265"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Preferences, Concerns, and Implementation of Different Long-Acting Antiretroviral Strategies for Youth with HIV Facing Adherence Challenges.","authors":"Ashle Barfield, Elise Tirza Ohene-Kyei, Raina Smith, Maria Trent, Jamie Perin, Kevon-Mark Jackman, Steven Huettner, Ethel Weld, Amanda Haines, Allison Agwu","doi":"10.1089/apc.2025.0039","DOIUrl":"10.1089/apc.2025.0039","url":null,"abstract":"<p><p>Youth living with human immunodeficiency virus (YHIV) aged 13-25 often struggle with adherence to daily oral antiretroviral treatment (ART) regimens. Recently approved intramuscular injectable long-acting ART (LA-ART) may promote adherence and improve longitudinal health outcomes. The study explores the willingness to use LA-ART strategies among YHIV. This cross-sectional pilot study included a telephone-based survey embedded into a randomized controlled trial of an intervention (NCT03600103) designed to enhance viral suppression among YHIV with baseline adherence challenges and detectable viremia. Participants completed 34-item telephone surveys between October 2021 and February 2022 to evaluate preferences and willingness to use four LA-ART delivery alternatives [intramuscular injection (IM), subcutaneous injection (SC), subdermal implant (SDI), and LA-ART pills] compared with daily oral ART. Long-acting pills were most preferred (84%, 16/19), while 79% of participants (15/19) expressed willingness to try IM, 79% (15/19) SC, and 74% (14/19) SDI. However, when asked to choose only one method, most (58%, 11/19) selected IM as the method that would work best. The arm was the preferred injection site (73% [8/11]) compared with the thigh (18% [2/11]). Willingness to use LA-ART was higher with less frequent injections, e.g., for IM LA-ART, 47% (9/19) were willing to try weekly vs. 79% (15/19) were willing to try every three-month injections. YHIV experiencing adherence challenges are willing to use novel LA-ART delivery methods. Addressing concerns around LA-ART methods and educating YHIV on their efficacy could help increase uptake, which could reduce rates of non-adherence in YHIV.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":"289-295"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Distrust and the Intention to Initiate Pre-Exposure Prophylaxis in Black Cisgender Women.","authors":"Tami Alade, Shawnika Hull, Hannah Sinks, Jennifer Zack, Patricia Moriarty, Rachel K Scott","doi":"10.1089/apc.2025.0043","DOIUrl":"10.1089/apc.2025.0043","url":null,"abstract":"<p><p>Black women bear a disproportionate burden of the US HIV epidemic, compared with women of other racial groups. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to communication and shared decision-making with health care providers. Using an institutional review board-approved questionnaire, we surveyed 186 adults (83% Black; 9% White; 3% American Indian/Alaskan Native; 4% Other) who were PrEP eligible, HIV seronegative, cisgender women in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction. Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months [index = -0.3093, standard error (SE) = 0.1886, 95% confidence interval (CI; -0.7455, -0.0122)] and 12 months [index = -0.3248, SE = 0.1987, 95% CI: (-0.7827, -0.0040)] through an anticipated discussion with a provider. When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity. This study was limited by the low number of non-Black participants (17%) as well as the requirement that subjects be English-speaking only.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":"273-280"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"We're Going to Be Here\": Providers' Perspectives on Implementing a Revised HIV Care Coordination Program.","authors":"Connor Emmert, Tigran Avoundjian, Mary Irvine, Thamara Tapia-Munoz, Rachel Schenkel, Miguel Hernandez, Sarah Kozlowski, Denis Nash, Honoria Guarino","doi":"10.1089/apc.2025.0047","DOIUrl":"https://doi.org/10.1089/apc.2025.0047","url":null,"abstract":"<p><p>As HIV outcomes continue to improve, disparities in viral suppression and care engagement persist, exacerbated by socioeconomic inequities, mental health stressors, systemic racism, HIV-related stigma, and other forms of discrimination. HIV care coordination programs address structural and psychosocial barriers to care and treatment, but these interventions must adapt to the evolving circumstances and perspectives of those expected to participate in them to achieve and sustain maximal impact. In 2009, the New York City Department of Health implemented a Ryan White-funded HIV Care Coordination Program (CCP). The CCP has demonstrated effectiveness, particularly among those newly diagnosed with HIV and those out of care or unsuppressed in the prior year. However, implementation challenges prompted a 2018 redesign to increase provider and client engagement. We conducted 30 semi-structured interviews with providers from six agencies delivering the revised CCP to examine barriers and facilitators to implementation. Providers highlighted the revised CCP's flexible, client-centered approach as a strength, allowing for personalized care plans and improved client engagement. Additionally, they emphasized the contributions of driven, committed staff. However, providers noted several barriers associated with the revised model or its implementation context, including increased paperwork burden, unrealistic service expectations, understaffing, and burnout from uncompensated emotional labor. Our findings suggest the value of retaining a client-centered model while streamlining administrative processes, enhancing training and support for providers, and increasing staff-client ratios. Adjustments based on providers' experience with a complex intervention can improve the fit of the intervention to its intended delivery settings and promote sustainability.</p>","PeriodicalId":7476,"journal":{"name":"AIDS patient care and STDs","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}