AIDS and Behavior最新文献

{"title":"The Impact of Antiretroviral Therapy (ART) on HPV Persistence and Cervical Cancer Progression Among Women with HPV/HIV Co-infection: A Systematic Review.","authors":"Terkimbi Dominic Swase, Mary Olaoluwa Agunloye, Josiah Eseoghene Ifie, Tijjani Salihu Shinkafi, Joan Chabet, IIemobayo Victor Fasogbon, Solomon Adomi Mbina, Reuben Samson Dangana, Sandra Etumah Ifie, A B Agbaje, Chinyere Anyanwu, Umi Omar Bunu, Angela Mumbua Musyoka, Regan Mujinya, Vivian Onyinye Ojiakor, Makena Wusa, Ondari Eric Nyakundi, Patrick Maduabuchi Aja","doi":"10.1007/s10461-025-04835-3","DOIUrl":"https://doi.org/10.1007/s10461-025-04835-3","url":null,"abstract":"<p><p>Cervical cancer remains the leading cause of cancer-related morbidity and mortality among women globally, particularly in low- and middle-income countries. Women living with HIV are at risk of persistent high-risk human papillomavirus (HR-HPV) infections due to HIV-associated immunosuppression. Although antiretroviral therapy (ART) enhances immune function and reduces HIV-related complications, its influence on the persistence of HPV and the progression of cervical cancer remains inconclusive. This systematic review aimed to assess the impact of ART on HPV persistence and cervical cancer progression among HIV-positive women. A comprehensive search of PubMed, Web of Science, and Scopus was conducted for studies published between January 2010 and September 2024. Studies were screened, selected, and reviewed according to PRISMA guidelines using Rayyan. Data on HPV genotypes, ART status, CD4 counts, diagnostic methods, and cervical lesion grades were extracted and analyzed. Eighty studies met the inclusion criteria. HPV16 and HPV18 were the most frequently reported genotypes. Despite ART use, high-grade lesions (CIN II/III and HSIL) remained prevalent, particularly among women with CD4 counts < 350 cells/µL. Diagnostic methods varied, with pap smear and colposcopy most commonly used. ART adherence and duration were associated with improved outcomes, but not complete lesion resolution. ART contributes to immune restoration and may reduce HPV persistence, but does not fully prevent cervical disease progression, mostly in the advanced stage. Integration of regular cervical cancer screening within HIV care is essential to reduce disease burden in this high-risk population.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231041","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":"PrEP-Related Medical, Structural and Institutional Mistrust among a Socioeconomically Diverse Sample of Black, Latine, Asian, and White Young Sexual Minority Men: Lived Experiences of Intersectional Inequity.","authors":"Jessica Jaiswal, Marybec Griffin, Steven Meanley, Jerel M Ezell, Yahya Alnashri, Kevin Hascher, Benjamin Grin, Perry N Halkitis","doi":"10.1007/s10461-025-04882-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04882-w","url":null,"abstract":"<p><p>Mistrust among marginalized populations has been shown to negatively impact health behaviors and outcomes. Young sexual minority men (YSMM) experience many health inequities, including those related to HIV. Understanding how YSMM think about and experience medical, structural, and institutional mistrust is critical to effectively promoting engagement in preventive services like pre-exposure prophylaxis (PrEP). The study recruited 43 YSMM (ages 25-27) from diverse racial, ethnic, and socioeconomic backgrounds in New York City. Semi-structured interviews were conducted from July- November 2018 and focused on sexual health, HIV-related beliefs, PrEP, and experiences with healthcare systems and providers. Three main themes were identified: (1) concerns regarding PrEP as a medication, including its perceived novelty, potential side effects, and the perceived lack of a compelling reason to take preventive medication; (2) ethical and philosophical apprehensions around perceived U.S. government-pharmaceutical collusion, and (3) PrEP and healthcare providers are not necessarily perceived as nefarious; mistrust can coexist with support for PrEP. Although most participants expressed some level of government-pharmaceutical mistrust, such mistrust did not necessarily dissuade them from supporting or even taking PrEP. While most participants did not consider healthcare providers as actors in government-pharmaceutical collusion, clinicians can play an essential role in addressing patients' concerns and building trust. Clinicians should endeavor to make space for open, non-judgmental conversations not only about sexual behavior, but also patients' experiences of discrimination and socioeconomic exclusion. Finally, structural interventions must seek to address societal and institutional inequities to undo harm and earn trust.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231505","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":"Antiretroviral Therapy Adherence Interventions in the Era of Universal Test and Treat: A Hybrid Systematic-Narrative Literature Review of Global Evidence.","authors":"Claire M Keene, Lauren Jennings, Carl-Oscar Källström-Ståhlgren, Ingrid T Katz, Lora L Sabin, Chantel Schreuder, Yashna Singh, Catherine Orrell, Rivet Amico","doi":"10.1007/s10461-025-04867-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04867-9","url":null,"abstract":"&lt;p&gt;&lt;p&gt;An undetectable viral load (VL) in people living with HIV (PWH) is key to both individual and public health success. But for the millions of PWH on oral antiretroviral therapy (ART) worldwide, this requires consistent, sustained adherence. Review of interventions to support adherence published in recent literature can provide insights into promising and effective strategies. We conducted a hybrid systematic-narrative literature review to explore optimal adherence strategies in the era of universal test-and-treat. We searched PubMed, Scopus, and Web of Science according to PRISMA guidelines for peer-reviewed studies, available in English, including people ≥ 12 years old taking ART, published between 01 January 2015 and 18 January 2024. We extracted data on the included studies and the adherence interventions (strategies used -allocated to one of 14 a priori categories or 'other', measures of adherence, and intervention outcomes). Descriptive statistics were used for study information and those interventions with a positive effect were described narratively. We extracted data from 230 studies evaluating a total of 262 interventions among 97,037 PWH. Most studies enrolled participants in Africa (106, 46%) or North America (80, 35%). The majority randomized participants (215, 94%), including 30 cluster-randomized trials. Most included general HIV clinic populations, with 51 (22%) focused on youth and 23 (10%) on pregnant and post-partum women. Many (146, 64%) used VL as an outcome. Self-reported adherence was also a commonly used outcome (129, 56%), but a minority used self-reported measures alone (36, 16%). The most common intervention strategies included across the 262 interventions were eHealth/ mHealth technologies (90, 34%) and adherence-focused counseling (81, 31%). The majority of interventions had 'other' intervention features (133, 51%), typically combined with one or more of the a priori-defined strategies (107, 80%). Most studies evaluated an approach with multiple strategies packaged into a single intervention (k = 182/262, 70%).The majority of interventions had some evidence of effect on an adherence outcome (k = 159, 61%). In studies reporting VL outcomes, 52% (k = 87/166) found some evidence of effect, while 28% (k = 47/166) found significant effects. Intervention strategies demonstrating significant impact on VL included task-shifting and changing dispensing schedules (3/5, 60% in both), while nearly half the evaluations of economic strategies demonstrated significant impact on VL (10/21). A number of different adherence intervention strategies have the potential to impact viral suppression in different populations. Variability in intervention strategies and the resulting outcomes, supports calls to target interventions to PWH who are most likely to benefit, while at the same time addressing social determinants of health and reducing barriers to accessing care to make services more person-centered. Greater attention to evaluatin","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231373","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":"Identification of Clinical Phenotypes Among People with HIV Using Electronic Health Record Data.","authors":"Anoop Mayampurath, Sheriff Isakka, Joseph A Mason, Samuel Nycklemoe, Eleanor E Friedman, Jessica P Ridgway","doi":"10.1007/s10461-025-04893-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04893-7","url":null,"abstract":"<p><p>Loss to follow-up (LTFU) from HIV care affects nearly half of people with HIV (PWH). This study aimed to identify clinical phenotypes of PWH using electronic health record (EHR) data and assess their association with LTFU. We analyzed 4,316 visits from 849 adults receiving care at an urban Ryan White Clinic (2017-2020), extracting demographic, social history, laboratory, diagnosis, and clinical note features. Latent Class Analysis identified six distinct patient subgroups, and logistic regression assessed their association with LTFU and high viral load within one year of a clinic visit. Analysis of clinical phenotypes revealed the following characteristics: Class 1: higher rates of substance use and cardiovascular disease and mentions of \"heterosexual\" in notes; Class 2: younger men, new patients, highest rate of LTFU (OR 1.57, 95% CI 1.20-2.05) and elevated viral load (OR 1.74, 95% CI 1.42-2.13); Class 3: primarily women, with frequent mentions of \"pregnancy\" in notes; Class 4: more likely to be white or Hispanic, fewer mentions of \"substance use disorder\" in notes, increased LTFU risk (OR 1.39, 95% CI 1.02-1.89) and decreased risk of unsuppressed HIV viral load (OR 0.65, 95% CI 0.50-0.84); Class 5: more sexually active, with mentions of \"good adherence\" in notes; Class 6: older men, with fewer mentions of \"mental illness\" or \"STI\" in notes. In conclusion, we identified six clinically relevant phenotypes in an urban HIV clinic, two of which were associated with LTFU. Our findings could inform strategies to tailor interventions to improve retention in HIV care for PWH.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231492","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":"Awareness, Acceptance, and Uptake of HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men (MSM) in Northwestern China: A Cross-Sectional Study.","authors":"Rui Zhao, Yuxuan Li, Shiyi He, Wendi Zhang, Jiajun Sun, Zeping Fang, Leilei Zhang, Shu Su, Jason J Ong, Lei Zhang","doi":"10.1007/s10461-025-04884-8","DOIUrl":"https://doi.org/10.1007/s10461-025-04884-8","url":null,"abstract":"<p><p>We assessed the awareness, acceptance (willingness to use), and uptake of pre-exposure prophylaxis (PrEP), along with the gap between PrEP eligibility and self-perceived HIV risk among men who have sex with men (MSM) in Shaanxi Province, China in 2022. Participants completed surveys on PrEP, and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. PrEP eligibility was determined using Chinese PrEP guidelines, and participants' self-perceived HIV risk was documented. Multivariable logistic regression Analysed factors influencing PrEP-related outcomes And the discrepancy between perceived and actual risk. Among 1,085 participants (median age: 32 years), 54.4% resided in urban areas, 71.1% identified as homosexual, And 60.8% held a college degree or higher. Although 87.0% were PrEP-eligible, only 28.5% were identified as high risk. PrEP awareness was 82.0%, yet only 8.8% had used it, And 3.3% currently used it. Despite 72.9% expressing willingness, uptake was hindered by high costs. Rural residence and lower education correlated with reduced awareness and acceptance, while greater income, more male partners, and recent STI testing predicted higher acceptance. Prior PEP use was strongly associated with PrEP use. Targeted efforts to improve affordability, accessibility, and education are crucial for better prevention results.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184433","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":"Differences in Methamphetamine Use, Self-Reported Impact, and HIV-Related Outcomes by Gender and Sexual Orientation in a Multisite U.S. Cohort of People with HIV in Care.","authors":"R J Fredericksen, R M Nance, L N Drumright, L S Mixson, S A Ruderman, B M Whitney, C Fahey, K H Mayer, J P Jain, M Saag, J Eron, S Napravnik, L Bamford, E Cachay, G A Yendewa, J Keruly, R D Moore, A Rodriguez, S Safren, J A C Delaney, H M Crane, A W Hahn","doi":"10.1007/s10461-025-04877-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04877-7","url":null,"abstract":"<p><p>We aimed to identify methamphetamine use patterns and impact by gender/sexual orientation among people with HIV (PWH) in care. We queried 3-month drug use/impact. Women were grouped by gender (cis/trans); cisgender men by sexual orientation. Differences in drug use/impact were assessed using chi-squared and t-tests. We used linear and logistic regression models for each drug use measure, adjusting for age and race/ethnicity. Among 13938 PWH (MA 48), 30% reported ever using methamphetamine; 10% reported current use; 79% were cisgender men (74% men who have sex with men (MSM), 20% men who have sex with women (MSW), 6% men who have sex with men/women (MSMW). Among women (21%), 8% were transgender (TW). TW and MSM reported higher current methamphetamine use (each 14%) than other groups [MSMW (13%), MSW (6%), CW (3%)(p < 0.001)]. Severity of use was highest among TW, compared to MSM (17.8 vs. 14.1, p = 0.04). All groups using methamphetamine were more likely than MSM to currently use cocaine/crack (p = 0.002-0.04); all but TW were more likely than MSM to report illicit opioid use (p < 0.001-0.03). MSM had highest injection use (34% vs. 17-25%, p = 0.05). Related health/legal/financial/social problems were most frequent among TW and MSMW (71%, 55%)]. Persons currently using methamphetamine had lower antiretroviral adherence than those not using (81-85% vs. 91-94%), and higher detectable viral load (28-41% vs. 13-20%). In the adjusted analysis, TW were more likely than MSM to report daily/almost daily use (p = 0.04). Methamphetamine use and impact differ by gender and by cisgender men's sexual orientation, warranting inquiry into moderating factors.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184476","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":"Strategies to Improve PrEP Adherence in People Who Use Drugs: A Systematic Review.","authors":"Janae Briggs, John Chiosi, Sirisha Papineni, Megan Murray","doi":"10.1007/s10461-025-04876-8","DOIUrl":"https://doi.org/10.1007/s10461-025-04876-8","url":null,"abstract":"<p><p>People who use drugs (PWUD) face a disproportionately high risk of HIV, accounting for a considerable share of cases in the United States. Pre-exposure prophylaxis (PrEP) has been shown to be effective in preventing HIV transmission through both sexual contact and injection drug use. However, adherence is essential for real-world success. Following PRISMA guidelines, we conducted the first systematic review to examine PrEP interventions among PWUD and identify strategies to enhance adherence. Using EMBASE, PubMed, and ClinicalTrials.gov databases, we screened 1,389 abstracts, of which nine met the inclusion criteria. The nine studies analyzed demonstrated extensive heterogeneity in intervention components, program duration, adherence measures, and outcomes. Most interventions aimed to reduce out-of-pocket costs and improve medication accessibility, while nearly half incorporated digital or electronic tools. Successful interventions addressed financial and logistical barriers and were implemented in regions where PrEP had been integrated into national healthcare systems at no additional cost. Additionally, combining PrEP with opioid substitution therapy or medication for opioid use disorder was associated with higher adherence rates, ranging from 80 to 95% of participants. Behavioral interventions were underutilized, despite their potential to address psychosocial challenges. Finally, unique barriers faced by women who use drugs highlight the need for tailored, trauma-informed, and mental health support services to address gender-specific challenges. Ultimately, these studies serve as an important starting point, underscoring both the necessity of broader research and the potential effectiveness of targeted programs to achieve and maintain high PrEP adherence for this key population.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184451","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":"HIV Treatment Disruption and Viral Suppression Among Venezuelan Immigrants Living with HIV in Miami: A Comparative Analysis.","authors":"Yue Pan, Viviana E Horigian, Jorge Saavedra, Elizabeth Alonso, Xinyi Liao, Valeria Botero, Allan E Rodriguez, Daniel J Feaster","doi":"10.1007/s10461-025-04880-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04880-y","url":null,"abstract":"<p><p>Venezuelan immigrants living with HIV (VILH) in Miami represent a growing and understudied population that may face substantial barriers to continuous HIV care due to prior treatment disruptions, migration-related stressors, and limited healthcare access. This study compares HIV treatment trajectories, medication histories, and viral suppression among VILH, U.S.-born people living with HIV (PLWH), and other foreign-born PLWH in Miami. We used medical record abstractions from four HIV clinics in Miami. Eligible participants (n = 528) were newly enrolled between 2015 and 2019 and classified into three groups: VILH, U.S.-born PLWH, and other foreign-born PLWH. Generalized estimating equations (GEE) were used to assess longitudinal changes in viral suppression and antiretroviral therapy (ART) regimen changes across groups. VILH were more likely to have prior ART exposure (64%) compared to U.S.-born (37%) and other PLWH (33%). Viral suppression improved across all groups, with 89% of VILH achieving suppression at The last visit, compared to 86% among U.S.-born and other PLWH. ART regimen changes and drug resistance testing varied by group, with VILH experiencing more frequent regimen modifications and higher resistance positivity early in care. Significant interactions between migration status and time were observed for both viral suppression and regimen changes (p < 0.001). VILH experienced treatment disruptions prior to migration, shown by higher prior ART use, more regimen changes, and increased resistance at care entry. Despite these challenges, VILH achieved comparable viral suppression with sustained care. Ensuring timely and consistent ART regimens for migrants is essential to support treatment continuity and reduce the risk of drug resistance.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124094","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":"The Factorial Structure, Reliability, and Validity of a Coping Measure Among Women with HIV and Sexual Trauma in Cape Town, South Africa.","authors":"Stephan Rabie, Anubhuti Poudyal, Amaleah Mirti, Patrick Wilson, John A Joska, Kathleen J Sikkema","doi":"10.1007/s10461-025-04886-6","DOIUrl":"https://doi.org/10.1007/s10461-025-04886-6","url":null,"abstract":"<p><p>The dual epidemics of HIV and sexual violence against women complicate HIV care engagement in South Africa. In settings with limited mental health treatment, robust measures to enhance screening and intervention for mental health specific to people with HIV are needed. The current study developed a 42-item assessment for coping with HIV and trauma in isiXhosa. In a randomized controlled trial, 350 participants completed measures of coping, anxiety, traumatic stress, and depression at their baseline assessments. Participants were women with HIV residing in Khayelitsha, South Africa, initiating or re-initiating antiretroviral therapy (ART) and histories of sexual abuse and trauma symptoms. We performed exploratory factor analysis with oblique rotation using parallel analysis and calculated Cronbach's alpha for each coping factor to assess internal consistency. Finally, we evaluated convergent and discriminant validity among the subsequently identified factors and assessments of depression, traumatic stress, and anxiety. The parallel analysis suggested the retention of three factors: active, avoidant, and social/spiritual coping. The final measure included 39 items with an overall Cronbach's Alpha of 0.825. The factor structure demonstrated robust goodness of fit. Convergent validity was demonstrated through significant positive correlations between active and social/spiritual coping, and between avoidant coping and the depression, anxiety, and traumatic stress. Significant negative correlations of active and social/spiritual coping with depression, anxiety, and traumatic stress scores also supported the discriminant validity between subscales.We conclude that the Coping with HIV measure provides a strong and validated measure of coping for use in populations in South Africa living with HIV.Clinical Trial Number: NCT04793217.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123935","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":"The Acceptability of a Real-Time Medication Monitoring-Based Digital Adherence Tool Among Young People Living with HIV in Malawi.","authors":"Takondwa Charles Msosa, Felix Phuka, Marion Sumari-de Boer, Owen Mhango, Hussein Hassan Twabi, Madalo Mukoka, Iraseni Swai, Rob Aarnoutse, Tobias F Rinke de Wit, Kennedy Ngowi, Edred Lunda, Wongani Mphande, Chisomo Msefula, Marriott Nliwasa","doi":"10.1007/s10461-025-04885-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04885-7","url":null,"abstract":"<p><p>Adherence to antiretroviral therapy (ART) is required for young people living with HIV (YPLHIV, 15-24 years) to achieve viral suppression, prevent transmission, and reduce HIV-related morbidity and mortality. Real time medication monitoring based digital adherence tools (RTMM-DATs) - a combination of RTMMs (smart pillboxes), customised adherence feedback, SMS reminders, and optional alarms - may be used to provide promising interventions to improve ART adherence and viral suppression in YPLHIV. In this study, we sought to investigate the concurrent acceptability of a RTMM-DAT intervention which included RTMMs, customised adherence feedback, SMS reminders, and optional alarms, in non-adherent YPLHIV on ART in Malawi enrolled in a randomised controlled trial (RCT) to investigate the effect of the intervention on ART adherence and viral suppression. As a secondary objective, we explored barriers to ART adherence in YPLHIV using the intervention. We conducted a phenomenological study in fourteen YPLHIV enrolled in the intervention arm of the RCT for at least six months using semi-structured interviews between June and July 2024. The interview guide was structured around the constructs of the Theoretical Framework of Acceptability (TFA). Inductive and deductive thematic analysis were performed to achieve the objectives. Overall, the participants expressed positive attitudes toward the intervention and appreciated the portable and discreet design of the RTMM. They appreciated the intervention's usefulness in addressing forgetfulness and promoting routine medication use. Neutral SMS reminders and tailored adherence feedback were appreciated for promoting adherence while safeguarding privacy. Challenges included device recharging in settings with limited electricity, reliance on mobile phones for SMS reminders, lack of remote user access to adherence reports, potential unintended disclosure from audible alarms, and users' underlying social insecurities due to stigma. Furthermore, participants continued to face multiple and complex challenges to ART adherence, such as food insecurity, drug side effects, forgetfulness, and social stigma before and after engaging with the intervention. In conclusion, the intervention was generally acceptable among YPLHIV in Malawi. Addressing barriers such as electricity access, stigma, and enhancing user customisability and access to adherence reports could improve the intervention's acceptability. Additionally, tailoring the intervention to the socio-cultural context of YPLHIV is essential to improve acceptability.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124151","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}