AIDS and Behavior最新文献

{"title":"An Adapted Friendship Bench Counseling Intervention (FB) to Improve Mental Health and HIV Care Engagement Outcomes Among People Living with HIV (PWH) Who Inject Drugs in Hanoi, Vietnam: Results from the VITAL Pilot Randomized Controlled Trial.","authors":"Bradley N Gaynes, Ha V Tran, Ha T T Nong, Teresa R Filipowicz, Kelsey R Landrum, Thuy T T Tran, Vu Q Nguyen, Ruth Verhey, Ha Nhat Nguyen, Le Minh Giang, Brian W Pence","doi":"10.1007/s10461-025-04645-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04645-7","url":null,"abstract":"<p><p>Common mental disorders (CMDs) are prevalent among people living with HIV (PWH) and cause morbidity, jeopardize HIV care engagement, and worsen HIV outcomes. In Vietnam, PWH who inject drugs are at high risk for poor HIV and CMD outcomes. However, few evidence-based interventions are available to address this population. We conducted a three-arm individually randomized pilot trial assigning 75 PWH with opiate use disorder and a CMD from methadone maintenance treatment clinics to either FB by a professional counselor, FB by a peer counselor, or enhanced usual care. Primary outcomes were feasibility, acceptability, and fidelity of FB; we also assessed preliminary indicators of CMD improvement and HIV care engagement. Feasibility was high, with 99% retention at 6 weeks and 96% retention at 6 months. 100% of patients receiving FB attended all 6 weekly sessions. Acceptability of FB was high for participants in both the professional and peer counselor groups. Providers were highly satisfied with the FB experience. Fidelity was adequate: 72% of professional counselors met or exceeded fidelity expectations, while 44% of peer counselors did. Preliminary indicators of effectiveness for CMDs were promising. Participants in the professional counselor arm had the greatest improvement as measured by CMD symptom improvement and CMD response rates at most follow-up visits. The adapted FB intervention should be scaled up and evaluated in a larger, fully powered randomized controlled trial to evaluate its efficacy in improving CMDs and HIV engagement for PWH and CMDs at greatest risk of poor HIV and CMD outcomes.Clinical Trial Number: NCT04790201 registered 3/10/2021.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078382","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":"Experiences and Preferences in Zambia and South Africa for Delivery of HIV Treatment During a Client's First Six Months: Results of the PREFER Study's Cross-Sectional Baseline Survey.","authors":"Nyasha Mutanda, Allison Morgan, Aniset Kamanga, Linda Sande, Vinolia Ntjikelane, Mhairi Maskew, Prudence Haimbe, Priscilla Lumano-Mulenga, Sydney Rosen, Nancy Scott","doi":"10.1007/s10461-025-04640-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04640-y","url":null,"abstract":"<p><p>Disengagement from antiretroviral therapy (ART) is highest in the early treatment period (≤ 6 months after initiation/re-initiation), but low intensity models designed to increase retention generally exclude these clients. We describe client preferences for HIV service delivery in the early treatment period. From 9/2022 to 6/2023, we surveyed adult clients who were initiating or on ART for ≤ 6 months at primary health facilities in South Africa and Zambia. We collected data on experiences with and preferences for HIV treatment. We enrolled 1,098 participants in South Africa (72% female, median age 33) and 771 in Zambia (67% female, median age 32), 38% and 34% of whom were initiating/re-initiating ART in each country, respectively. While clients expressed varied preferences, most participants (94% in South Africa, 87% in Zambia) were not offered choices regarding service delivery. 82% of participants in South Africa and 36% in Zambia reported receiving a 1-month supply of medication at their most recent visit; however, South African participants preferred 2- or 3-month dispensing (69%), while Zambian participants preferred 3-or 6-month dispensing (85%). Many South African participants (65%) would prefer to collect medication in community settings, while Zambian participants (70%) preferred clinic-based collection. Half of participants desired more one-on-one counselling and health information. Most participants reported positive experiences with providers, but long waiting queues were reported by South African participants.During the first six months on ART, many clients would prefer less frequent clinic visits, longer dispensing intervals, and frequent, high-quality counselling. Care models for the early treatment period should reflect these preferences.Registration: Clinicaltrials.gov NCT05454839, Clinicaltrials.gov NCT05454852.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073430","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 Testing and PrEP Use Among Trans and/or Non-binary Participants in the TASG Study, a Participatory Study in Germany.","authors":"Uwe Koppe, Jonas A Hamm, Chris Spurgat, Alexander Hahne, Robin K Saalfeld, Manuel Ricardo Garcia, Viviane Bremer, Kathleen Pöge","doi":"10.1007/s10461-025-04631-z","DOIUrl":"https://doi.org/10.1007/s10461-025-04631-z","url":null,"abstract":"<p><p>HIV testing and pre-exposure prophylaxis (PrEP) are recommended in Germany for individuals at increased HIV risk. However, data on HIV testing, PrEP use, and PrEP knowledge among trans and non-binary people are limited. We analysed data from the 'Sexuelle Gesundheit in trans und nicht-binären Communitys' (TASG) study, a participatory study on HIV/STI and sexual health among trans and non-binary people in Germany. The study was designed, promoted, and analysed with active involvement of community members. Participants were invited to complete an anonymous online survey between 1 March and 1 July 2022. The outcomes included HIV testing within the last 5 years, PrEP use, and PrEP-specific knowledge. Predictors for HIV testing were identified using a bootstrap stepwise selection procedure. Among 2468 HIV-negative participants with information on potential HIV risks, 21.5% had potential needs for HIV testing and PrEP. Of these, only 44.3% (208/470, missing: 60) reported testing for HIV within the last 5 years. Older participants, those living in larger cities, and those with higher education levels were more likely to have tested for HIV. Additionally, only 8.3% (38/459, missing: 71) reported ever using PrEP. Among 451 participants with potential PrEP needs (missing: 79), only 57.4% knew at least one of three key PrEP-related facts at the time of the survey. Our findings highlight substantial gaps in HIV testing and prevention among trans and non-binary individuals in Germany with potential needs for these services. Reducing barriers to testing and prevention is essential to enable broader access to these critical services.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073432","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 Disparities Among Transgender Feminine, Transgender Masculine, Nonbinary, and Gender Expansive Youth and Young Adults in the United States.","authors":"Anne E Fehrenbacher, Demetria Cain, Joshua A Rusow, Swetha Lakshmanan, Dianna Polanco, Demi Ward, Yara Tapia, Risa P Flynn, Patrick S Sullivan, W Scott Comulada, Keith J Horvath, Cathy J Reback, Dallas T Swendeman","doi":"10.1007/s10461-024-04590-x","DOIUrl":"10.1007/s10461-024-04590-x","url":null,"abstract":"<p><p>This study assessed disparities in pre-exposure prophylaxis (PrEP) use among transgender and gender expansive youth and young adults (N = 477) between 15 and 24 years old in the CARES (ATN 149) and TechStep (ATN 160) study protocols within the National Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Structural equation modeling was used to test mediation pathways between gender identity and PrEP uptake among the full sample and stratified by sex assigned at birth. Lifetime PrEP uptake was higher among those assigned male at birth (26%) versus assigned female at birth (9%), explained by greater structural and behavioral risks and perceived need for PrEP, especially among trans women. Among those assigned female at birth, PrEP uptake was higher among trans men (12%) than nonbinary participants (6%). Our findings characterize key structural and behavioral drivers of PrEP use and highlight the need to reduce barriers to healthcare for trans youth, particularly in the South.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063193","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":"Chronic Pain, Mental Health, and Sense of Purpose in Life Among Women Living with HIV Compared to HIV-Negative Women in the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study.","authors":"Dragos C Ragazan, Tetiana Povshedna, Shelly Tognazzini, Angela Kaida, Melanie C M Murray, Helene C F Cote","doi":"10.1007/s10461-025-04644-8","DOIUrl":"https://doi.org/10.1007/s10461-025-04644-8","url":null,"abstract":"<p><p>Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073429","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":"Brief Report: Preferences and Acceptability in Methods of Tenofovir Diphosphate in Dried Blood Spots Collection and Feedback in a Cohort of PLWH in Cape Town South Africa.","authors":"Paul A D'Avanzo, Christopher M Ferraris, Melissa Pence-Moore, Lauren Jennings, Reuben N Robbins, Catherine Orrell, Robert H Remien","doi":"10.1007/s10461-025-04626-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04626-w","url":null,"abstract":"<p><p>Antiretroviral therapy (ART) adherence is crucial for HIV viral suppression. Tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS) offer a potential tool for monitoring and supporting adherence. We assessed acceptability and preferences of fingerstick-based DBS collection and drug-level feedback among 224 people living with HIV (PLWH) in South Africa. DBS monitoring was highly acceptable (99%) and viewed as helpful (96%). Participants indicated willingness for clinic staff-administered collection (79.5%) and less willingness for community health workers (26.1%) or pharmacists (37.0%). Participants favored receiving results in clinic (52%). These findings demonstrate high acceptability and strong preferences among participants for DBS-based collection procedures.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063259","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":"Willingness to Use Long-Acting Injectable Pre-Exposure Prophylaxis among Adolescent Girls and Young Women in Kampala, Uganda.","authors":"Jane Frances Lunkuse, Charles Lwanga, Felix Wamono, Vincent Muturi-Kioi, Matt Price, Yunia Mayanja","doi":"10.1007/s10461-025-04616-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04616-y","url":null,"abstract":"<p><p>Pre-exposure prophylaxis (PrEP) has proven to be a powerful tool in preventing HIV infection. There is limited information about the factors associated with willingness to use different PrEP modalities among adolescent girls and young women (AGYW) in Africa. We assessed willingness to use long-acting injectable PrEP (LAI-PrEP) among 14-24-year-old AGYW at high risk of HIV in Uganda, and associated factors determined using multivariable complementary log-log regression. Of the 285 participants, 69.8% of participants showed willingness to use LAI-PrEP despite only 3.9% having knowledge about it before enrolment. Report of recent transactional sex was high (92.6%). Participants that were divorced/separated (aOR = 1.74, 95% CI 1.03-2.92) and those with multiple sexual partners (aOR = 2.11, 95% CI 1.46-3.06) compared to those with one partner were more likely to be willing to use LAI-PrEP while those that were screened as heavy episodic drinkers (consuming 6 or more drinks on an occasion as per the AUDIT tool) were less likely to be willing to use LAI-PrEP (aOR = 0.61, 95% CI 0.42-0.87). LAI PrEP has shown efficacy in clinical trials; the product is approved for use by the Government of Uganda (MoH) and should be expedited for use by AGYW engaged in paid sex and those with multiple sexual partnerships. As it becomes available, we recommend PrEP education and counseling to increase awareness of LAI PrEP as an alternative HIV prevention method.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063197","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":"Pre-exposure Prophylaxis (PrEP) Awareness and Engagement Among MSM at High Risk of HIV Infection in China: A Multi-City Cross-Sectional Survey.","authors":"Jun Du, Sainan Wang, Hongbo Zhang, Tao Liu, Shufang Sun, Cui Yang, Nickolas Zaller, Zhen Dai, Haipeng Zha, Yanqiu Zhao, Yue Zhao, Xuejiao Hu, Han Yan, Pan Gao, Jun Wang, Yehuan Sun, Zhihua Zhang, Operario Don","doi":"10.1007/s10461-025-04633-x","DOIUrl":"https://doi.org/10.1007/s10461-025-04633-x","url":null,"abstract":"<p><p>This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063192","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":"Experiences of Disclosure, Resilience and Viral Suppression among People Living with HIV in Ghana.","authors":"Mary Anne Elizabeth Roach, Talia Loeb, Amrita Rao, Carrie Lyons, Gnilane Turpin, Omar Syarif, Pim Looze, Katarzyna Lalak, Jean Anoubissi, Sophie Brion, Keren Dunaway, Laurel Sprague, Carlos Garcia de Leon Moreno, Daria Matyushina, Elsie Ayeh, Stefan Baral, Katherine Rucinski","doi":"10.1007/s10461-025-04641-x","DOIUrl":"10.1007/s10461-025-04641-x","url":null,"abstract":"<p><p>Support for people living with HIV (PLHIV) as they disclose their HIV status can impact continuity of HIV treatment and adherence to antiretrovirals. In the presence of multi-level adversities, resilience among PLHIV can promote health-seeking behaviors and better health outcomes. However, few studies have examined how disclosure experience and resilience work together to impact HIV treatment outcomes among PLHIV. In this study, we assessed the relationships between HIV disclosure experience, resilience and viral suppression among PLHIV in Ghana. The Stigma Index 2.0 questionnaire was completed by 1827 PLHIV in Ghana in 2021 to assess demographics, experiences of HIV related stigma, resilience-factors, and other self-reported outcomes including viral suppression. Participants were also asked to classify their disclosure experience with friends and family as positive or negative. Multivariable log-binomial models estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the association between disclosure experience and viral suppression. A dichotomized measure of resilience was evaluated as a potential effect measure modifier, and subgroup analyses explored associations by key population. Overall, those with a positive disclosure experience were more likely to have achieved viral suppression than participants with a negative disclosure experience (PR 1.09, 95%CI:1.00-1.19). This association increased among participants with lower resilience scores (PR 1.33, 95%CI:1.11-1.60). Findings suggest the importance of early positive social interactions for sustained engagement in ART, particularly for marginalized populations who face psychosocial and structural stigmas that challenge resilience. Ultimately, optimizing HIV treatment necessitates interventions that mitigate community stigma and promote resilience-building strategies for PLHIV in Ghana.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063262","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":"Implementation Determinants of PrEP and Behavioral Health Treatment Referral among HIV Test Counselors.","authors":"Audrey Harkness, Vanessa Morales, Kyle Grealis, Nequiel Reyes, Daniel J Feaster, Steven Safren, DeAnne Turner, Raymond R Balise","doi":"10.1007/s10461-025-04620-2","DOIUrl":"https://doi.org/10.1007/s10461-025-04620-2","url":null,"abstract":"<p><p>Pre-exposure prophylaxis (PrEP), an effective biomedical prevention intervention, is not sufficiently reaching populations experiencing high HIV incidence. Behavioral health (BH) treatment addressing mental health and substance use similarly requires increased reach to HIV-affected populations. HIV testing is an opportunity to refer individuals to PrEP and BH treatment. This study, conducted in Miami-Dade County, FL, a domestic HIV epicenter, aimed to assess (1) self-reported rates at which HIV test counselors refer clients to PrEP and BH treatment, (2) barriers and facilitators to PrEP and BH treatment referral, and (3) the relationship between barriers and facilitators and test counselors' referral rates. Among 127 HIV test counselors, the average PrEP referral rate was 63.8% (SD = 41.5) of those potentially meeting PrEP indications. Insufficient time was associated with lower PrEP referral (OR: 0.64, 95% CI: 0.42-0.99, p = 0.023) and training in PrEP screening was associated with higher rates of PrEP referral (OR: 1.27, 95% CI: 0.98-1.64, p = 0.034). The average BH treatment referral rate was 52.7% (SD = 44.4) of clients who the counselor felt would potentially benefit from treatment. Counselors lacking knowledge of screening (OR: 0.4, 95% CI: 0.2-0.78, p = 0.004), referral procedures (OR: 0.45, 95% CI: 0.23-0.87, p = 0.008), or locations to refer clients (OR: 0.47, 95% CI: 0.25-0.86, p = 0.008), as well as those with higher caseloads (OR: 0.998, 95% CI: 0.997-0.999, p < 0.001) were less likely to refer for BH. Training in substance use screening (OR: 1.26, 95% CI: 0.96-1.64, p = 0.046) and referral (OR: 1.28, 95% CI: 0.99-1.66, p = 0.029) were associated with increased BH referral. Implementation strategies are needed to address key barriers to PrEP and BH referrals in HIV testing contexts.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063264","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}