AIDS and Behavior最新文献

{"title":"Behaviourally-Informed Two-Way Text Messaging to Improve Return to HIV Care in South Africa: Evidence from a Randomised Controlled Trial.","authors":"Christine Njuguna, Preethi Mistri, Lawrence Long, Candice Chetty-Makkan, Brendan Maughan-Brown, Alison Buttenheim, Laura Schmucker, Sophie Pascoe, Harsha Thirumurthy, Cara O'Connor, Barry Mutasa, Kate Rees","doi":"10.1007/s10461-025-04808-6","DOIUrl":"10.1007/s10461-025-04808-6","url":null,"abstract":"<p><p>One-way text messaging to re-engage people in HIV care has shown promise, but little is known about two-way messaging. We evaluated a behaviourally-informed two-way text messaging intervention to increase re-engagement in care following missed visits. We conducted an individual-level randomised controlled trial between February and March 2023 in Capricorn District, South Africa. Adults aged ≥ 18 years who had missed an ART visit by > 28 days were randomised to (1) a standard one-way text message, or (2) behaviourally-informed two-way text messages. The primary outcome was return to care within 45 days, analysed as (1) intention to treat, and (2) restricted to successful message delivery. 3,695 participants were randomised: 1,845 to the one-way message group and 1,850 to the two-way message group. 27.9% (515/1845) of participants sent a one-way message and 27.2% (503/1850) sent a two-way message returned for an ART visit within 45 days (proportion difference: -0.7%, p-value: 0.622). In an analysis restricted to participants whose text message was delivered, 28.3% (310/1094) in the one-way message group compared to 28.3% (304/1076) in the two-way message group returned to care (proportion difference: -0.09%, p-value: 0.966). 19.5% (210/1076) responded to the two-way message. The two most reported reasons for missed appointments were being out of town (41.0%) and still having medication (31.0%.). Behaviourally-informed two-way text messages did not improve return to care over one-way messages. However, they elicited reasons for disengagement. Additional research is needed on the mode, content and timing of two-way messages intended to increase return to care.Clinical Trial Number: PACTR202202748760768 & DOH-27-042022-6703. 28 February 2022.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607136","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":"Barriers and Facilitators to PrEP Adherence among Transgender and Non-binary Individuals: A Mixed-Methods Analysis of Psychosocial Factors and Health Belief Model Constructs.","authors":"D Paltin, M Prescott, J Ma, S Yeager, L Ham, S Serrano, J Narez, J Delgado, L Burke, B Gouaux, M Beckwith, S R Morris, D J Moore, J L Montoya","doi":"10.1007/s10461-025-04810-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04810-y","url":null,"abstract":"<p><p>Despite known benefits of Motivational Interviewing (MI) for medication adherence, its effectiveness in supporting pre-exposure prophylaxis (PrEP) adherence among transgender and nonbinary (TGNB) populations remains underexplored. This study applies mixed-methods analysis to understand PrEP adherence among TGNB individuals who received a daily individualized text-message intervention and phone-based MI for non-adherence to PrEP. Individuals who did not respond to three consecutive messages were identified as potential MI recipients. We had three objectives: (1) examine psychosocial differences between participants who needed MI (MI Indicated group; n = 81) versus those who did not (MI Not Indicated group; n = 48), (2) assess whether Health Belief Model (HBM) constructs were associated with PrEP adherence, and (3) identify adherence barriers and facilitators. This secondary analysis builds on primary intervention outcomes published in Morris et al. (J Acquire Immune Defic Syndr 91:453-459, 2022). We conducted multivariable linear regression on psychosocial measures and PrEP adherence, and inductive qualitative analysis on a subset of participants who completed at least one MI session (n = 60). Results were deductively mapped onto HBM constructs. Significant differences emerged between MI groups in HBM constructs, with the MI Indicated group reporting higher perceived HIV risk, stress, depressive symptoms, and poorer coping and self-efficacy. Findings highlight the need for personalized interventions to support PrEP adherence, mental health, and HIV risk perception among TGNB individuals. Future adherence interventions may benefit from assessing and addressing HBM constructs. To support the Ending the HIV Epidemic initiative, it is critical to enhance access to facilitators and mitigate barriers to PrEP adherence for this population.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607135","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":"Changes in the PrEP Care Cascade in People Who Inject Drugs in 2018 and 2022.","authors":"Hunter C Spencer, Matthew A Town, LaLaine Sevillano, Lauren Lipira, Tim W Menza","doi":"10.1007/s10461-025-04819-3","DOIUrl":"https://doi.org/10.1007/s10461-025-04819-3","url":null,"abstract":"<p><p>HIV pre-exposure prophylaxis (PrEP) prevents HIV transmission. However, PrEP remains underutilized among people who inject drugs (PWID), even when clinically indicated. Here, we assess changes in PrEP awareness, access, and use in 2018 and 2022 and factors associated with PrEP awareness in 2022. We analyzed a sample of PWID not living with HIV with an indication for PrEP based on National HIV Behavioral Surveillance (NHBS) in Portland, Oregon during the 2018 and 2022 survey cycles. We compared PrEP awareness, access, and use in 2018 and 2022 with χ². Using 2018 and 2022 data, we compared PrEP awareness between the two years with a Poisson regression. Using 2022 data, we assessed factors associated with PrEP awareness. Compared to 2018, PrEP awareness was higher in 2022 (33% vs 17%, p < 0.001, aPR = 1.24, 95% CI = 1.14-1.36). There were no significant differences in PrEP access or use between 2018 to 2022. In the 2022 sample, PrEP awareness was higher among those with Hispanic ethnicity compared to white, non-Hispanic PWID (aPR = 2.18, 95% CI = 1.21-3.90) and previous drug treatment (aPR = 1.79, 95% CI = 1.20-2.69). Although PrEP awareness was higher in 2022 than 2018, PrEP access and use were unchanged and remained rare. PrEP use among PWID remains insufficient to meet national Ending the HIV Epidemic goals.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599097","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":"Development and Validation of a Novel Risk Calculator to Predict Sub-optimal HIV Outcomes Among Pregnant and Postpartum Women with HIV in Kenya.","authors":"Kevin Owuor, Janet M Turan, Jeff M Szychowski, Maricianah Onono, Linet Ongeri, Laura K Beres, Anna Helova, Emmah Ouma, Mercelline Onyando, Rena C Patel, Patrick Oyaro, Lisa L Abuogi, Karen Hampanda","doi":"10.1007/s10461-025-04814-8","DOIUrl":"10.1007/s10461-025-04814-8","url":null,"abstract":"<p><p>No tool currently exists to predict the cumulative risk of suboptimal clinical outcomes among pregnant and postpartum women with HIV (PPWH). This study sought to develop and validate a parsimonious risk calculator capable of predicting disengagement from care and HIV treatment failure among PPWH. We created the risk calculator using data from 1,331 PPWH from Southwestern Kenya (Homabay, Migori, and Kisumu Counties) in the Mother Infant Visit Adherence and Treatment Engagement Trial. Least absolute shrinkage and selection operator logistic regression retained the most predictive variables from 16 candidate factors to estimate the probability of treatment failure or disengagement from care. Three risk quintiles were calculated. We assessed external validation with an independent dataset (Opt4Mamas; N = 820). Cross-validated area under the curve of receiver operating characteristic (AUROC) and calibration measures assessed model performance. Two unique risk calculators were created - one for PPWH with known HIV diagnosis prior to pregnancy and one for PPWH with new HIV diagnoses. The combined outcome of care disengagement or treatment failure occurred in 43% of PPWH with known diagnosis and 40% with new diagnosis in the development dataset; and 37% with known diagnosis and 13% with new diagnosis in the validation dataset. The calculators included demographic (age, parity, marital status), clinical (virological failure, missed visits, regimen line, gestation age), and psychosocial variables (intimate partner violence, stigma, depression, partner support, disclosure, food insecurity). The model for PPWH with known diagnosis demonstrated better calibration and discrimination (AUROC 0.843 [95% CI 0.805, 0.866]) than the model for PPWH with a new HIV diagnosis (AUROC 0.463 [95% CI 0.347, 0.597]). Mean predicted risk probabilities among PPWH with known HIV diagnosis were: low (6%), moderate (56%), and high (70%). Mean predicted risk probabilities among those with a new HIV diagnosis were: low (31%), moderate (48%), and high (65%). The novel risk calculator for PPWH with a known HIV diagnosis has the potential to identify those who are at risk of sub-optimal HIV treatment and care outcomes for targeted interventions to prevent treatment failure and loss to follow-up.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599098","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":"Efficacy of CHAMPS for Improving Viral Suppression: A Randomised Clinical Trial.","authors":"Rebecca Schnall, Haomiao Jia, Maeve Brin, Emma S Kay, Olivia R Wood, Joseph Abua, D Scott Batey","doi":"10.1007/s10461-025-04811-x","DOIUrl":"https://doi.org/10.1007/s10461-025-04811-x","url":null,"abstract":"<p><p>Given the fragmented condition of the United States healthcare system and the challenges inherent in the lives of poor, stigmatized, and minoritized groups, our study team conducted a multi-site randomized (1:1) controlled efficacy trial of Community Health Workers And MHealth to ImProve Viral Suppression (CHAMPS), a combination intervention comprised of both the WiseApp and community health worker delivered health information, among adults with HIV in New York City and Birmingham, Alabama. Data analysis used an intention-to-treat approach. Enrollment for this study was from May 2021-May 2023 with follow-up completed at 6- and 12-months following study enrollment. In the analytic sample of 300 study participants, the mean age was 48.1 years; 219 (73.2%) participants identified as Non-Hispanic Black, 28 (9.4%) as Non-Hispanic White, 39 (13.0%) as Hispanic, and 10 (3.3%) as Other Non-Hispanic. From baseline to six months, the proportion of participants who were virally suppressed increased for both study arms, with OR = 1.16 (SE = 0.26, p = 0.52, 95%CI 0.75-1.79) for standard of care and OR = 1.66 (SE = 0.33, p = 0.010, 95%CI 1.13-2.44) for CHAMPS. However, there was no statistically significant difference in changes between the two study arms (p = 0.28). The CHAMPS intervention did not have a significant effect on HIV viral suppression relative to non-suppression at 12-months compared with the standard of care arm. Nonetheless, these findings should be interpreted in the context of the COVID-19 and Monkeypox pandemic with persistent concerns related to exposure to the viruses and limited access to healthcare and other social services. Trial Registration: ClinicalTrials.gov Identifier: NCT04562649.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599099","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":"Randomized Controlled Trial Testing an HIV/STI Prevention Intervention Among People Leaving Incarceration Who Were Assigned Male at Birth, Have Sex with Men and A Substance Use Disorder.","authors":"Katrina M Schrode, Gabriel G Edwards, Brandon Moghanian, Robert E Weiss, Cathy J Reback, Charles McWells, Charles L Hilliard, Nina T Harawa","doi":"10.1007/s10461-025-04818-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04818-4","url":null,"abstract":"<p><p>HIV disproportionately impacts minoritized individuals, particularly those of intersectional minoritized identities. Incarceration disproportionately impacts minoritized individuals as well, and increases HIV risk, in part due to its disruption to people's lives, social networks, and access to care. We developed MEPS, a 6-month intervention designed to holistically support HIV prevention in men who have sex with men and transgender women leaving incarceration. We tested MEPS in a 1:1 randomized controlled trial with 208 individuals. All participants received a needs assessment and personalized wellness plan, followed by either standard of care or the MEPS intervention. MEPS integrated support from a Peer Mentor, incentives for engagement in social and health services, and a mobile app. Participants completed baseline assessments and follow-up assessments at 3, 6, and 9 months. We tested for changes in PrEP use using a group-based trajectory model, for changes in HIV and STI testing, frequent substance use and recidivism using logistic mixed models, and for changes in HCV testing and in having a regular place for care using Poisson models. MEPS participants were significantly more likely than control participants to be among those who used PrEP [AOR (95% CI) = 3.8 (1.8, 8.0)]. Recent HIV testing in the MEPS arm remained above 50% over time while decreasing in the control arm, with a significant difference between arms at 6 months [AOR (95% CI) = 3.5 (1.3, 9.5)]. There were no significant differences between arms in the other outcomes. The MEPS intervention was effective in increasing PrEP uptake and HIV testing in people leaving incarceration. Interventions that implement peer mentor support and incentives to encourage service engagement can improve engagement in HIV prevention services among populations that experience unique barriers to care. This study was registered with ClinicalTrials.gov on July 25, 2019 (NCT04036396).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599100","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":"Recent Alcohol Use Influences Associations between Cortisol Levels and Negative Affect: The New Orleans Alcohol Use in HIV Study.","authors":"Taylor Fitzpatrick-Schmidt, Evrim Oral, David A Welsh, Patricia E Molina, Tekeda F Ferguson, Scott Edwards","doi":"10.1007/s10461-025-04815-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04815-7","url":null,"abstract":"<p><p>Human immunodeficiency virus (HIV) infection contributes to both neurological and psychiatric disorders. People with HIV (PWH) are disproportionately affected by chronic pain and negative affective comorbidities, such as generalized anxiety disorder (GAD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). PWH are also more likely to consume alcohol, further exacerbating these conditions. Dysregulation of biological stress systems, including the hypothalamic-pituitary-adrenal (HPA) axis, is believed to contribute to these comorbidities. The current analysis sourced data from the New Orleans Alcohol Use in HIV (NOAH) study, a longitudinal investigation of alcohol use patterns in an underserved cohort of PWH. Prior findings from this cohort demonstrated that higher alcohol consumption is associated with worse mental health outcomes (e.g., greater depression and anxiety). Here we examined the relationships between negative affective comorbidities (anxiety, depression, and PTSD), pain, alcohol use, and plasma levels of cortisol, the major stress hormone, in PWH. Our analysis revealed significant associations between cortisol levels, PTSD symptoms, and pain intensity. Moreover, the relationship between PTSD and cortisol was stronger among recent alcohol drinkers (PEth-positive participants) and males. The association between pain intensity and cortisol was also stronger in recent alcohol drinkers. Although depression and cortisol levels showed no overall relationship, females with the highest depression scores exhibited significantly higher cortisol levels. Our findings emphasize the need for further investigation into how ongoing alcohol use may increase relationships between cortisol and the deterioration of mental health in male and female PWH.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574655","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":"Attrition from Care and Barriers to PrEP Use Among Key Populations in Kinshasa, DRC: A Multiple Methods Study.","authors":"Natalia Zotova, Alisho Shongo, Patricia Lelo, Nana Mbonze, Didine Kaba, Paul Ntangu, Qiuhu Shi, Adebola Adedimeji, Kathryn Anastos, Marcel Yotebieng, Viraj Patel, Jonathan Ross","doi":"10.1007/s10461-025-04809-5","DOIUrl":"10.1007/s10461-025-04809-5","url":null,"abstract":"<p><p>Female sex workers (FSW) and gay and other men who have sex with men (MSM) are disproportionately affected by HIV. Oral pre-exposure prophylaxis (PrEP) is increasingly available in African countries, including the Democratic Republic of Congo (DRC), but data on factors influencing PrEP use remain limited. This multiple methods study examined PrEP attrition patterns and barriers to engagement among FSW and MSM in Kinshasa, DRC, using programmatic data from five sites, clinical records, and qualitative interviews. Logistic regression identified factors associated with attrition; qualitative data were thematically analyzed. Among 8,822 FSW and MSM eligible for PrEP in 2019-2021, only 24% (n = 2,070) initiated it. Of 809 FSW initiators, 33% (n = 268) were lost to follow-up by 1 month and 78% (n = 421) by 3 months. Among 1,261 MSM, 26% (n = 332) and 87% (n = 808) were lost by 1 and 3 months, respectively. For FSW, prior PrEP use and recent STIs were associated with higher attrition at 1 month. Older age, more sexual partners, income beyond sex work, and no prior PrEP use were linked to lower attrition at 3 months. Among MSM, no prior PrEP use predicted higher attrition at 1 month but lower attrition at 3 months. Qualitative findings identified stigma, side effects, dislike of daily dosing, and limited services for key populations at risk of HIV as major barriers. Findings underscore the need for improved PrEP messaging, including information on side effects decreasing over time. Raising awareness among key and general populations may reduce stigma and improve PrEP engagement.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574719","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":"Medical Mistrust and Willingness to Use Long-Acting PrEP Among Black and Hispanic/Latino MSM.","authors":"Jerris L Raiford, Robin J MacGowan, Rob Stephenson, Ruth Dana, Lisa Hightow-Weidman, Kristin M Wall, Jeb Jones, Patrick S Sullivan","doi":"10.1007/s10461-025-04801-z","DOIUrl":"https://doi.org/10.1007/s10461-025-04801-z","url":null,"abstract":"<p><p>Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM's unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574720","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":"Shades of Contemplation: HIV Pre-Exposure Prophylaxis Decision-Making among Young Women in South Africa.","authors":"Kirsty M Sievwright, Melissa M Ertl, Theresa M Exner, Londeka Mbewe, Nonhlonipho Bhengu, Mariam Onafowokan, Abigail D Harrison, Jill Hanass-Hancock, Susie Hoffman","doi":"10.1007/s10461-025-04805-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04805-9","url":null,"abstract":"<p><p>Expanding women's awareness of and access to HIV pre-exposure prophylaxis (PrEP) is key to enhancing its uptake, yet young women face difficulties in deciding whether to initiate any form of PrEP. Understanding factors that shape decision-making to initiate PrEP can support uptake and continuation. The Masibambane (\"Let us work together\") pilot in eThekwini (Durban), South Africa, compared a gender-enhanced (GE) online group workshop (N = 50) to an \"individual access\" (IA) control condition (N = 50) for women (ages 18-25 years). Both conditions aimed to increase knowledge and motivation to initiate oral PrEP. This study used 3-month follow-up qualitative interviews from 40 women (20 per condition). The Transtheoretical Model of Health Behavior Change guided interviews and a framework analysis was used to understand stages of and influences on PrEP decision-making. Underscoring that PrEP uptake is not a straightforward or singular decision, most respondents, regardless of condition, conveyed shades of contemplation for initiating PrEP; only a few stated they currently were using or were uninterested in PrEP. Many viewed PrEP as an effective woman-controlled method and believed their partners placed them at risk of HIV. Other considerations included relationship status, pill modality, daily adherence, and side effects. For those who prepared to use PrEP, logistical barriers were frequent. Peers were perceived as sources of encouragement for adopting PrEP. Given these findings, HIV prevention efforts need to include interventions to support PrEP decision-making, recognizing that the process is continuous, multifaceted, and changes over time. This study elucidated relevant factors for supporting young women's PrEP decision-making in South Africa.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558811","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}