AIDS and Behavior最新文献

{"title":"Electronic Dose Monitoring Feedback (EMF) with Youth Living with HIV: Qualitative Exploration of Reactions to Viewing Dosing Calendars.","authors":"Eamonn McGonigle, Megan Mueller Johnson, Heather Tucker, Michael Hudgens, Ronald Dallas, Keith J Horvath, Rachel Goolsby, Elizabeth Secord, Murli Purswani, Daniel Reirden, Mobeen Rathore, Lisa-Gaye Robinson, Aditya H Gaur, K Rivet Amico","doi":"10.1007/s10461-025-04820-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04820-w","url":null,"abstract":"<p><p>Electronic dose monitoring with feedback (EMF) offers an opportunity to visualize daily dosing behaviors that can otherwise be difficult to appreciate. Visual displays, including early, on-time, late, or missed doses over time, can foster insights around patterns of dosing. Reactions to seeing these patterns among youth with HIV (YWH) who struggle with adherence are important to consider with EMF. YWH (ages 14-25) participating in the ATN152 TERA intervention were presented withsmart-bottle-generated 1-month EMF calendars as part of their sessions with a remote 'coach'. To characterize how youth reacted to these visualizations, transcripts from this portion of the coaching sessions were thematically analyzed. A total of 64 youth-coach discussions were characterized across 37 unique participants (22 years old on average, 81% Black/African American, 46% acquired HIV vertically). Six main reactions to EMF calendars were identified: feelings of pride/satisfaction, empowerment/motivation, positive surprise, negative surprise, shame/guilt, and/or neutral reactions. Although most reactions were positive, those with negative reactions tended to be in response to calendars showing low adherence. Over a quarter (28%) of youth ranked the EMF as one of the most beneficial/helpful aspects of the intervention when asked about experiences with intervention tools within the coaching session. A calendar EMF appeared to offer unique opportunities to explore adherence in the context of a supportive counseling session.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673744","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":"Preferences for Long-Acting HIV Pre-Exposure Prophylaxis among Women of Reproductive Age in Low- and Middle-income Countries: A Systematic Review.","authors":"Sophia Ngugi, Elizabeth Echoka, Vincent Were, Jacob Kazungu, Kenneth Ngure","doi":"10.1007/s10461-025-04821-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04821-9","url":null,"abstract":"<p><p>HIV remains a major public health problem in low- and middle-income countries (LMICs). While oral pre-exposure prophylaxis (PrEP) is documented as safe and effective for HIV prevention, adherence remains a challenge. Long-acting PrEP could address adherence challenges associated with oral PrEP and significantly reduce HIV acquisition among high-risk populations. However, evidence of preferences for long-acting products remains limited, especially in LMICs. Understanding the preferences is crucial for informing the design of interventions to enhance not only adherence but also uptake. We conducted a systematic review to investigate preferences for long-acting PrEP among women of reproductive age (WRA), 15-49 years in LMICs. We searched PubMed, CINAHL and EMBASE databases for empirical literature relevant to our study, published between January 2010 and April 2024. Additional articles were manually searched for in the reference lists of included articles. We identified 20 studies reporting preferences for long-acting PrEP alone or in comparison with short-acting PrEP, such as oral daily pills, vaginal gels or suppositories. We found that WRA preferred long-acting PrEP products comprising injectables, implants and vaginal rings over short-acting options. The preferences were associated with product attributes, including longer duration of action, less frequent dosing, effectiveness and fewer side effects. The findings suggest that, in addition to oral PrEP, long-acting PrEP products can be employed as a strategy to reduce the burden of HIV among WRA in LMIC settings. Further research should be conducted to evaluate preferences in specific population groups, such as pregnant and lactating women, especially in high HIV prevalence settings.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673745","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":"A Treatment Mobile App for Sexual Minority Men Who Use Methamphetamine Demonstrates Reductions in Methamphetamine Use and HIV Sexual Risk Behaviors: Getting Off.","authors":"Cathy J Reback, Chunqing Lin, Michael J Li, Jesse B Fletcher, Raymond P Mata","doi":"10.1007/s10461-025-04816-6","DOIUrl":"10.1007/s10461-025-04816-6","url":null,"abstract":"<p><p>Sexual minority men (SMM) have elevated rates of methamphetamine use, which is deeply integrated into their sexual identities, sexual behaviors, and cultural spaces. Smartphone applications (apps) are often used to procure drugs and sexual partners. This study was a randomized clinical trial that evaluated the efficacy of the adaptation of an evidence-based intervention (Getting Off) into a mobile app format. From May 2021 to May 2023, 226 SMM who self-reported methamphetamine use in the past year were randomized to immediate delivery (ID) of the Getting Off app (n = 113) or a 30-day delayed delivery (DD) of the Getting Off app (n = 113). The average DSM-5 score for MUD was in the severe range (8.9 out of a possible 11). Mixed-effects models showed that at 1-month assessment, participants in the ID condition had significantly fewer days of injection methamphetamine use (estimate = - 0.57; SE = 0.15; p < 0.001), lower likelihood to have condomless anal intercourse (CAI; estimate = - 1.14; SE = 0.47; p = 0.017), and CAI while high on methamphetamine (estimate = - 1.15; SE = 0.49; p = 0.021) in the past 30 days, compared to the DD condition. When comparing pre- to post-app delivery, the combined ID and DD sample showed significant reductions in all methamphetamine use and sexual risk outcomes, including days using and injecting methamphetamine, CAI, and CAI while high on methamphetamine (p < 0.05 for all post-app assessments, with some fluctuations at certain time points). Overall, the reductions in methamphetamine use and sexual risk behaviors demonstrated the efficacy of the Getting Off app, which is extremely promising for the future of app-based treatment options.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Patterns and Predictors of Racial Disparities of HIV Retention in Care: A Statewide Cohort Analysis.","authors":"Fanghui Shi, Chen Zhang, Jiajia Zhang, Bankole Olatosi, Sharon Weissman, Xiaoming Li, Xueying Yang","doi":"10.1007/s10461-025-04813-9","DOIUrl":"https://doi.org/10.1007/s10461-025-04813-9","url":null,"abstract":"<p><p>Racial disparities have historically existed regarding HIV care outcomes, including retention in care (RIC). However, data regarding the longitudinal patterns and predictors of such disparities among different racial groups and various geolocations are limited. This study aims to explore the contribution of contextual features (e.g., socioeconomic and structural environmental factors) to the changes in RIC outcome disparity at the county level. All adult people with HIV who received a HIV diagnosis in South Carolina (SC) between 2013 and 2020 were included in this study, and their de-identified CD4 counts and viral load information were derived from the SC statewide HIV registry system. All contextual factors were extracted from multiple publicly available datasets, such as the American Community Survey. To provide a comprehensive view, we used four indices to measure racial disparities in the county-level percentage of RIC, i.e., Black to White ratio (BWR), Index of Disparity (ID), Weighted Index of Disparity (Weighted ID), and Gini coefficient. Linear mixed-effect models were used to estimate the relationship between various contextual factors and these disparity indexes, except BWR. The temporal trend of the four indices suggested no significant increase or decrease in racial disparities in RIC across 46 counties in SC from 2013 to 2020. Counties with more primary care providers and higher social capital in collective efficacy showed lower racial disparities in RIC when ID and Gini coefficient were used as outcomes. For ID only, higher racial disparities in RIC were observed in counties with lower isolation index (β=-1.92, 95%CI: -3.31~-0.53). For weighted ID only, no county-level contextual features explored were significantly associated with racial disparities in RIC. Racial disparities in RIC persist without major changes in SC despite the national implementation of the \"Ending the HIV Epidemic\" initiative. Efforts to address racial disparities should continue; specifically, efforts that focus on social and structural factors should be developed and implemented for populations that have poor HIV outcomes in the US.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641554","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":"Assessing the Effectiveness of Data-to-Care Strategies for Improving HIV Care Outcomes: A Systematic Review","authors":"Kristin Tansil Roberts,&nbsp;Mary Mullins,&nbsp;Darrel H. Higa,&nbsp;Linda J. Koenig,&nbsp;Megan Mallett,&nbsp;Megan Wichser,&nbsp;Christa L. Denard,&nbsp;Jayleen Gunn,&nbsp;Miriam A. M. Nji,&nbsp;Briana Nguyen,&nbsp;Janae Mitchell,&nbsp;Miya Pontes,&nbsp;Madison Underwood,&nbsp;Theresa Ann Sipe","doi":"10.1007/s10461-025-04768-x","DOIUrl":"10.1007/s10461-025-04768-x","url":null,"abstract":"<div><p>Data-to-Care (D2C) is a strategy that uses HIV surveillance data or other data sources to identify out-of-care (OOC) persons with HIV (PWH) and link or re-engage them in care to improve viral suppression (VS). While some evidence suggests D2C is effective, no comprehensive systematic review has been published. This review aims to determine the effectiveness of D2C. A systematic search in five databases (i.e., MEDLINE, EMBASE, PsycINFO, CINAHL, sociological abstracts) identified 3868 U.S. studies published between January 2009 and January 2021 that described D2C interventions and measured HIV care outcomes. Two reviewers screened titles/abstracts, reviewed full reports for eligibility, and abstracted data. Risk of bias was assessed using the Mixed Methods Appraisal Tool, and included studies were synthesized quantitatively and qualitatively (Protocol registered on PROSPERO ID = CRD42020173095). Thirty-four studies with 30 unique interventions were identified. Two different meta-analyses, each with six interventions, found that D2C approached significance in improving engagement in care (Relative Risk (RR) 95% CI 1.18 [0.99 to 1.41]) and VS (RR 95% CI 1.44 [0.99 to 2.09]). Studies that could not be incorporated into the meta-analyses, also showed improvements in engagement in care (median percent [IQI]: 63% [45% to 81%], 18 interventions) and VS (median percent [IQI]: 39% [25% to 57%], 14 interventions). Overall, this systematic review suggests that D2C may enhance HIV care outcomes, emphasizing the need for effective strategies to identify and engage OOC persons in care.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 10","pages":"3172 - 3221"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641553","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":"Stigma and Time: A Longitudinal Qualitative Analysis of Co-occurring HIV and Tuberculosis Stigma in South Africa","authors":"Alanna J. Bergman,&nbsp;Michael V. Relf,&nbsp;Nomusa Mthinkhulu,&nbsp;Nkateko Ndlouvu,&nbsp;Kelly Lowensen,&nbsp;Jason E. Farley","doi":"10.1007/s10461-025-04803-x","DOIUrl":"10.1007/s10461-025-04803-x","url":null,"abstract":"<div><p>For people with HIV and tuberculosis (TB), stigma may change over time. Identifying time points when individuals are most likely to experience HIV or TB related stigma, or when stigma begins to abate, may be useful in tailoring stigma-reduction interventions in resource-limited settings. This study used longitudinal qualitative data to explore if and how HIV and TB stigma change over the course of treatment. People living with HIV and rifampicin-resistant TB were purposively recruited at a district TB hospital in KwaZulu-Natal, South Africa. Participants consented to in-depth interviews throughout TB treatment. The team used reflexive thematic analysis to develop latent themes within the transcripts. This study was designed to identify longitudinal changes stigma over time from the perspective of someone living with HIV and TB. However, participants were more expansive in their conceptualization of evolving stigma. 30 individuals discussed changes in stigma from three distinct perspectives. First was a <i>perspective of lived experience</i>, where participants described changes in experienced, internalized, and anticipated stigma over time beginning with diagnosis. The second was from a <i>shifted perspective</i>, as participants described their diagnosis and movement from status neutral to status positive transitioning from a potential enactor of stigma to someone at risk for experiencing stigma. Finally, participants described changes in stigma from the <i>community perspective</i> whose attitudes towards HIV and TB disease were shaped by time. To strengthen care engagement, we must effectively intervene on disease-related stigma. Appropriate interventions must consider time and shifting social expectations that impact stigma.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3608 - 3616"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04803-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behaviourally-Informed Two-Way Text Messaging to Improve Return to HIV Care in South Africa: Evidence from a Randomised Controlled Trial","authors":"Christine Njuguna,&nbsp;Preethi Mistri,&nbsp;Lawrence Long,&nbsp;Candice Chetty-Makkan,&nbsp;Brendan Maughan-Brown,&nbsp;Alison Buttenheim,&nbsp;Laura Schmucker,&nbsp;Sophie Pascoe,&nbsp;Harsha Thirumurthy,&nbsp;Cara O’Connor,&nbsp;Barry Mutasa,&nbsp;Kate Rees","doi":"10.1007/s10461-025-04808-6","DOIUrl":"10.1007/s10461-025-04808-6","url":null,"abstract":"<div><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 &gt; 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.</p><p><i>Clinical Trial Number</i>: PACTR202202748760768 &amp; DOH-27-042022-6703. 28 February 2022.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3661 - 3672"},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04808-6.pdf","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":"OA","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,&nbsp;M. Prescott,&nbsp;J. Ma,&nbsp;S. Yeager,&nbsp;L. Ham,&nbsp;S. Serrano,&nbsp;J. Narez,&nbsp;J. Delgado,&nbsp;L. Burke,&nbsp;B. Gouaux,&nbsp;M. Beckwith,&nbsp;S. R. Morris,&nbsp;D. J. Moore,&nbsp;J. L. Montoya","doi":"10.1007/s10461-025-04810-y","DOIUrl":"10.1007/s10461-025-04810-y","url":null,"abstract":"<div><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></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3687 - 3702"},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04810-y.pdf","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":"OA","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":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335848/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}