AIDS and Behavior最新文献

{"title":"Combination HIV Prevention Strategies in the Lisbon Cohort of Men who Have Sex with Men: A Longitudinal Cluster Analysis of Data from 2014 to 2021.","authors":"Rita Dias, Miguel Rocha, Luís Veríssimo, Fernando Ferreira, Maria João Novais, Milton Severo, Sílvia Fraga, Paula Meireles","doi":"10.1007/s10461-025-04693-z","DOIUrl":"https://doi.org/10.1007/s10461-025-04693-z","url":null,"abstract":"<p><p>This study aims to examine how HIV prevention tools were used and how they clustered together among men who have sex with men (MSM) testing at a community-based sexual health center in Lisbon, Portugal, from 2014 to 2021. We used data from 16,780 visits from adult cisgender MSM and had an HIV-negative test result at baseline in the Lisbon Cohort of MSM-an open, prospective cohort study conducted at CheckpointLX, a community-based sexual health center tailored to MSM, from 2014 to 2021. A longitudinal clustering approach was used to identify clusters of HIV prevention (cluster package for R). Six clusters of HIV prevention were identified: condom use (9,109 visits); low or no condom use, low PrEP (preexposure prophylaxis) use (6,258 visits); anal sex abstinence (746 visits); PEP (postexposure prophylaxis) and condom use (305 visits); PEP use (186 visits); and PrEP and condom use (176 visits). Most participants were aged 24 to 34 years old, were born in Portugal, had high education, and self-identified as gay. PrEP and PEP uptake were more associated with being born in Brazil, while low prevention adherence was less associated with high education. Condom use was the most frequently reported prevention strategy, followed by the low or no condom use, low PrEP use cluster. However, participants with higher odds of reporting HIV risk behaviors were the ones allocated to clusters with reports of higher frequency of prevention tools utilization.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963837","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":"Evaluating the Effects of the COVID-19 Pandemic on HIV Testing, Enrollment, ART Use and Mortality in Suriname Using Interrupted Time Series Analysis.","authors":"Deborah Stijnberg, M McKee, E Commiesie, M Adhin, W Schrooten","doi":"10.1007/s10461-025-04683-1","DOIUrl":"https://doi.org/10.1007/s10461-025-04683-1","url":null,"abstract":"<p><p>Our study evaluates the changes in HIV testing, new enrollments in the HIV surveillance system, treatment, and mortality of people with HIV during and after the SARS-CoV-2 (COVID-19) pandemic in Suriname. A retrospective population-based study was conducted, using interrupted time series analyses with data from the HIV surveillance system from January 2013 until December 2023. The commencement of the COVID-19 pandemic lead to a decline in HIV testing, enrollment, treatment initiation, and the annual number of individuals receiving treatment, respectively, by 16%, 32%, 40%, and 2% in 2020 compared to 2019. The mortality rate among people with HIV went from 7.8 in 2019 to 26 per 100,000 in 2022. The regression model showed an immediate significant effect at the start of the COVID pandemic for the HIV enrollments and the yearly number of people on treatment. For HIV mortality there is significant sustained effect. An overall decline in HIV services resulted in an increased mortality in 2021 and 2022. Innovative strategies and additional human and financial investments are needed to regain and improve access to health services and reverse the current epidemical trend.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966175","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":"Perspectives on COVID-19 Vaccination Among Unvaccinated and Under-Vaccinated African American/Black and Latine Frontline Essential Workers: A Qualitative Exploration.","authors":"Marya Gwadz, Jennifer A Robinson, Fernanda Gonzalez Blanco Serrano, Stephanie Campos, Robin M Freeman, Rauly Chero, Charles M Cleland, Lalitha Parameswaran, Robert L Hawkins, Prema Filippone, Maria Lizardo, Greg Bangser, Paola G Ramirez, Andrea Negret, Mehreen Kagzi, Hanna Lissinna","doi":"10.1007/s10461-025-04708-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04708-9","url":null,"abstract":"<p><p>Racial/ethnic disparities in COVID-19 morbidity and mortality are serious in the United States, particularly among African American/Black and Latine (AABL) populations. Staying up-to-date on COVID-19 vaccination is essential for mitigating risk, but AABL vaccination rates are low. The present qualitative study explores perspectives on COVID-19 among AABL persons at high-risk for exposure to the SARS-CoV- 2 virus: frontline essential workers engaged in public-facing professions (e.g., retail). From a larger study of AABL frontline essential workers not up-to-date on COVID-19 vaccination, N = 50 participants were purposively sampled for maximum variability. Participants engaged in semi-structured qualitative interviews in English or Spanish that were audio-recorded, professionally transcribed, and translated into English as needed. Data were analyzed using a directed content analysis approach that was both inductive and theory-driven. Participants were 37 years old, on average, and most (65%) were men. Approximately half (56%) were Latine/Hispanic and 44% were African American/Black. Occupations included food preparation (40%), retail (28%), construction (12%), in-home health care (8%), and building maintenance and personal services (12%). Approximately a third (38%) had received ≥ 1 COVID-19 vaccine dose. We found COVID-19 vaccination perspectives were grounded in a larger context of medical and institutional distrust and past/ongoing systemic racism. In this context, results were organized into the following themes: general perspectives on COVID-19; barriers/facilitators related to race/ethnicity, social class, and community; specific aspects of the COVID-19 vaccine as barriers; mandates, incentives, and pressures to be vaccinated; and mixed effects of public health initiatives. Overall, participants were knowledgeable about COVID-19. Social norms reduced vaccine intentions but altruism and community/family concern could motivate it. Aspects of the public health response (e.g., advertisement campaigns targeting AABL populations) increased distrust and reduced vaccination willingness. However, at least some ambivalence about vaccination was common (participants would consider it). Yet there was a large gap between considering and receiving vaccination. Thus, barriers to COVID-19 vaccination for AABL frontline essential workers operate at multiple levels of influence, but are addressable. The present study yields recommendations to improve vaccination, including increasing the trustworthiness of systems and institutions, reducing systemic/structural barriers, harnessing social forces, and engaging AABL communities in program planning.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956965","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":"Disease Intervention Specialist Field Experience in Re-engaging Out-of-Care People with HIV in Project CoRECT: A Mixed Methods Study.","authors":"Eteri Macharaviani, Frederick L Altice, Roman Shrestha, Janet Truebig, Constance Carroll, Lisa Nichols, Bachar Ahmad, Michael Copenhaver, Merceditas Villanueva","doi":"10.1007/s10461-025-04707-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04707-w","url":null,"abstract":"<p><p>The HIV care continuum is a framework that describes gaps in care engagement for people with HIV (PWH) who know their HIV status, are on antiretroviral therapy, and are virally suppressed. Despite the United Nations' 95 - 95 - 95 targets, significant gaps remain in the United States, driven by PWH who are not engaged in care. To evaluate a Data-to-Care strategy to re-engage PWH who recently fell out of care, the Centers for Disease Control and Prevention funded a randomized, controlled trial called the Cooperative Re-Engagement Controlled Trial (CoRECT) was conducted in Connecticut, Massachusetts, and Pennsylvania between 2014 and 2018. Three Disease Intervention Specialists (DIS) were trained to provide a public health intervention that adapted the Anti-Retroviral Treatment and Access to Services (ARTAS) model for re-engaging PWH in care. In this secondary analysis, we examined the implementation processes and field experiences of DIS in Connecticut using an explanatory sequential mixed methods design. Data sources included DIS field notes, an internal database, and in-depth interviews with two DIS. We found that the fidelity to the adapted ARTAS (ARTAS+) varied considerably, barriers to care assessments were completed consistently (95%), and structured interactive sessions were completed less frequently (35%). Qualitative interviews with DIS highlighted the importance of flexibility and rapport-building in re-engagement efforts. Re-engagement efforts were negatively impacted by psychiatric and substance use disorders and homelessness, while patient-reported barriers included time mismanagement, inconvenient clinic operational hours, or not perceiving themselves as sick. The study provides a roadmap for future Data-to-Care implementation efforts and underscores the importance of patient-centered approaches for re-engaging PWH in care. TRIAL REGISTRATION: https://www.clinicaltrials.gov/ with an identifier NCT02693145.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960925","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 Association Between Use of Adherence Support Interventions and Adherence to HIV Preexposure Prophylaxis Among Young South African and Zimbabwean Women in HPTN 082.","authors":"Abubaker Ibrahim Elbur, D Donnell, S Hosek, B Dye, J Velloza, S Delany-Moretlwe, C Celum","doi":"10.1007/s10461-025-04709-8","DOIUrl":"https://doi.org/10.1007/s10461-025-04709-8","url":null,"abstract":"<p><p>We assessed the association between PrEP adherence support interventions and intracellular tenofovir-diphosphate (TFV-DP) levels, a biomarker for PrEP adherence, using data from 368 South African and Zimbabwean adolescent girls and young women enrolled in the HIV Prevention Trials Network 082 trial from 2016 to 2018. Group-based trajectory modeling identified trajectories of TFV-DP levels and adherence support interventions, including weekly two-way SMS and optional monthly adherence clubs. Two trajectories of TFV-DP levels were identified: a consistently low trajectory (N = 248, 67.4%, with consistent TFV-DP levels of 100 fmol/punch) and a high-decreasing trajectory (N = 120, 32.6%, with TFV-DP levels decreasing from approximately 900 to 500 fmol/punch). Two trajectories were also observed for adherence club attendance: consistently moderate (N = 249, 67.7%, attended approximately two out of three clubs in a three-month period) and low-increasing (N = 119, 32.3%). Similarly, SMS response patterns included a consistently high engagement group (N = 222, 66.1%), who responded to approximately 90% of messages, and a consistently low engagement group (N = 114, 33.9%). Women with consistently high SMS responses had higher odds of being in the high-decreasing TFV-DP levels trajectory group (Adjusted Odds Ratio [AOR]: 6.6; 95% CI 2.8-15.5; p < 0.001), while those with a consistently moderate adherence club attendance trajectory had an AOR of 1.3 (95% CI 0.5-3.3, p = 0.620) for being in the same group. Use of PrEP was aligned with the higher response trajectories of SMS responses but not with attendance to adherence support clubs.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966222","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":"Frequency and Factors Associated To School Delay among HIV-infected and Uninfected Children Followed in the ANRS 12,225-PEDIACAM III Cohort in Cameroon.","authors":"Vanessa Feukeng Mafouedjio, Jules Brice Tchatchueng, Igor-Mathieu Gondje-Dacka, Thierry Joel Noumsi, Francis Ateba Ndongo, Suzie Tetang Ndiang, Ida Calixte Penda, Georgette Guemkam, Albert Faye, Josiane Warszawski, Mathurin Cyrille Tejiokem","doi":"10.1007/s10461-025-04698-8","DOIUrl":"https://doi.org/10.1007/s10461-025-04698-8","url":null,"abstract":"<p><p>Many studies have shown that Human Immunodeficiency Virus (HIV) infection and/or exposure to antiretroviral drugs during pregnancy can influence a child's neurocognitive development. Moreover, the family and social challenges experienced by some HIV-infected children may have a negative impact on their academic performance. The objective of this study was to estimate the frequency of school delay among HIV-infected adolescents followed up in the ANRS 12225-Pediacam III cohort in Cameroon and identify associated factors. The cohort consists of three groups of children enrolled before the age of 7 months: HIV-infected (HI; n = 210), HIV-exposed uninfected (HEU; n = 205); and HIV-unexposed uninfected (HUU; n = 196)). Data were collected from these children from the project's inception in 2007 until 2022 and analysed retrospectively. School delay was defined as the occurrence of at least two instances of grade retention at either primary or secondary education levels. After performing a descriptive analysis, we used the Kaplan-Meier method and Cox regression to identify determinants of school delay. A total of 405 children were considered; of whom 51.4% were male. The overall frequency of first school delay was 29.1% (118/405; 95% CI:24.8; 33.8), which differed significantly between the children's groups. In multivariate analysis, the risk of school delay was significantly higher among children living with HIV compared to HUU (adjusted hazard ratio (aHR): 2.7; 95% CI:1.66-4.64), male children (aHR: 1.9; 95% CI:1.33-2.84), children born from low educated mothers (aHR: 3.0; 95% CI:1.58-5.95), and children whose parents were not living together (aHR: 1.5; 95% CI:1.02; 2.39).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961896","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":"Non-disclosure of Known HIV Status among People Living with HIV in the Mozambique Population-Based HIV Impact Assessment (INSIDA 2021).","authors":"K Carter McCabe, Angelo Augusto, Olivier Koole, Stephen D McCracken, Orrin Tiberi, Makini Boothe, Isabel Sathane, Nely Honwana, Jordan McOwen, Peter W Young","doi":"10.1007/s10461-025-04699-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04699-7","url":null,"abstract":"<p><p>Non-disclosure of known HIV-positive status is a barrier to ending HIV as a global health threat as it leads to biased measurements of HIV-treatment coverage indicators and inaccurate estimates of epidemic progress, resulting in wasted resources. Identifying and understanding factors driving non-disclosure among people living with HIV is necessary for encouraging engagement with HIV services and improving treatment coverage, resource allocation, and monitoring of HIV programs in high HIV-burden areas. This analysis assessed factors associated with non-disclosure among survey respondents who had antiretrovirals (ARVs) detected in blood specimens. HIV-positive blood specimens (n = 2,038) from the 2021 Mozambique Population-based HIV Impact Assessment were tested for the presence of ARVs. Weighted prevalence estimates of non-disclosure and select covariates are reported and factors associated with non-disclosure modeled via multivariate logistic regression. Among 1,358 respondents with ARVs detected, 14.1% did not self-report their HIV-positive status during the interview. Adjusting for socio-demographic and clinical factors, non-disclosure was more likely among younger participants aged 15-24 years (adjusted odds ratio [aOR]: 2.15, 95% Confidence Interval [CI] 1.16-4.01) and among those without knowledge of their recent sexual partner's HIV-status (aOR: 2.67, 95%CI: 1.38-5.15). Participants with an unsuppressed viral load were over six times (aOR: 6.27, 95%CI: 2.76-14.23) more likely to not disclose. Improving disclosure rates is vital to obtaining accurate HIV-treatment estimates and assessing epidemic progress. Initiatives prioritizing pre- and post-test counseling, stressing treatment literacy, emphasizing undetectable = untransmittable (U = U) campaigns, and encouraging programs that promote social support may encourage disclosure among individuals living with HIV.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966203","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 HIV Anxiety Scale (HAS): Developing and Validating a Measure of Human Immunodeficiency Virus (HIV) Anxiety.","authors":"Liam Cahill, Anthony J Gifford, Bethany A Jones, Daragh T McDermott","doi":"10.1007/s10461-025-04690-2","DOIUrl":"https://doi.org/10.1007/s10461-025-04690-2","url":null,"abstract":"<p><p>Most research assessing human immunodeficiency virus (HIV) anxiety relies on single-item measures or psychometric measures that are outdated in terms of concepts and language. There is a critical need for a robust, reliable, and contemporary measure to identify populations at risk of avoiding HIV testing, treatment, and prevention, thereby supporting global HIV eradication goals. Focus groups informed the initial development of the HIV Anxiety Scale (HAS), revised through expert feedback. The factor structure was assessed in two studies. In Study 1, an Exploratory Factor Analysis (EFA) was conducted with 251 participants. In Study 2, a Confirmatory Factor Analysis (CFA) with 200 participants was performed alongside validity, internal consistency, and measurement invariance assessments. Studies 1 and 2 elicited a 3-factor model, resulting in a 16-item measure with the following subscales: Psychosocial Implications of HIV, Lifestyle Implications of HIV, and HIV Testing Anxiety. The HAS demonstrated a good factor structure, acceptable validity and excellent internal consistency across diverse groups in Study 2. The HAS provides a contemporary, robust measure of HIV anxiety, addressing limitations of previous tools and contributing to efforts to identify and support populations at risk of HIV avoidance behaviours. We recommend that future research continue to validate and test this new measure, but it offers a standardised tool to inform targeted interventions for HIV testing, prevention, and treatment.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787424","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":"Alcohol Use and the Pre-exposure Prophylaxis Continuum of Care Among Men in Rural South Africa: Results from a Longitudinal Study.","authors":"Alison C Castle, Jacob Busang, Jaco Dreyer, Carina Herbst, Nonhlanhla Okesola, Natsayi Chimbindi, Thembelihle Zuma, Jana Jarolimova, Judith A Hahn, Christina Psaros, Sheela V Shenoi, Maryam Shahmanesh, Mark J Siedner","doi":"10.1007/s10461-025-04694-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04694-y","url":null,"abstract":"<p><p>Despite freely available oral HIV pre-exposure prophylaxis (PrEP), HIV incidence among young men in South Africa remains high. This study explores the impact of alcohol use on PrEP initiation and continuation among South African men. We performed a secondary data analysis from a trial involving men aged 16-29, randomly selected in KwaZulu-Natal. Participants were referred to sexual health services, and those who were HIV negative and sexually active were offered oral PrEP. Alcohol consumption was categorized using AUDIT-C criteria as no/low risk (0-3) and hazardous alcohol use (4-12). Primary outcomes were PrEP initiation and continuation, defined as refilling prescriptions for ≥ 4 months. Logistic regression models adjusted for clinical and demographic confounders estimated relationships between PrEP initiation/continuation and alcohol use. Among 325 men analyzed, average age was 22.9 years (SD 3.6), with 146 (45%) reporting hazardous alcohol consumption. PrEP initiation was greatest among the hazardous/very-high risk group (40%), with the lowest uptake among men who do not use alcohol (17%). In multivariate analyses, those with hazardous alcohol use remained more likely to initiate PrEP compared to those with no/low risk alcohol use (aOR 1.96, 95%CI 1.13-3.40; p-value = 0.017). Only 27% (24/88) remained on PrEP at 4 months, with continuation similar between alcohol use groups (aOR 1.56, 95%CI: 0.47-5.12, p = 0.47). Hazardous alcohol use is prevalent among men in rural South Africa and associated with increased PrEP initiation. However, overall PrEP continuation was low and consistent across alcohol use levels. Hazardous alcohol use should not deter PrEP implementation efforts to engage young men.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787683","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":"Increasing Sustained Viral Suppression Among Youth Living with HIV: A Randomized Controlled Trial of Stepped Care Intervention.","authors":"Elizabeth Mayfield Arnold, Mary Jane Rotheram-Borus, Joan Christodoulou, Matthew M Yalch, Debra A Murphy, Peter Norwood, W Scott Comulada, Dallas Swendeman","doi":"10.1007/s10461-025-04692-0","DOIUrl":"https://doi.org/10.1007/s10461-025-04692-0","url":null,"abstract":"<p><p>This study aimed to decrease viral load (VL) to increase viral suppression (VS) among youth living with HIV (YLH) ages 12-24. This study was a stepped care randomized controlled trial. Sixty-eight YLH with established infection, without VS, and with at least two follow-ups (N = 68) were randomized to a control condition (n = 25) or a stepped care intervention (n = 43), and repeatedly assessed for up to 24 months. Both conditions received referrals for health services and a daily automated text-messaging and monitoring intervention (AMMI). YLH in stepped care who were unsuppressed at 4-month assessments stepped up to peer support and later to coaching. Random effects regressions examined VL trajectories over time as well as trajectories of secondary outcomes. There was significant evidence suggesting a different longitudinal trajectory of VLs for the two conditions. The control condition had improved VLs at about 12 months and then started to return to higher VLs. The stepped-care condition improved over the same time period and remained relatively stable. We estimated that the average VL was lower in the stepped care condition at 24 months, but we cannot claim a statistically significant difference between conditions. Both intervention groups appeared to have positive intervention impacts suggesting some benefits of the AMMI intervention. The improvement in VL at 24 months for stepped care compared to the control condition are suggestive of a viable intervention strategy that warrants further study.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787499","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}