RESUMEN
Introduction: female sex workers (FSWs) are vulnerable to acquiring HIV and other sexually transmitted infections due to unprotected sex. Understanding and addressing the gaps in safer sex among FSWs can help to reduce HIV acquisition and transmission. This study described sexual practices, their correlates and use of HIV services among FSWs in Mombasa County, Kenya. Methods: participants were recruited for a baseline survey by a time-location cluster randomized design at predetermined intervals from five bars and five clubs in Mombasa County until a sample size of 160 was reached. Descriptive statistics and inferential analysis using R were conducted, and p<0.05 was regarded as statistically significant. Results: nearly all (99%) of the participants were unmarried, and 11% had tertiary education. Ninety-eight percent (98%) reported vaginal intercourse, 51% reported using alcohol/drugs before sex, and 28% practiced unprotected intercourse. About 64% had tested for HIV within three months, 14% believed that it is safe to reuse condoms, and 10% that it is safe to engage in unprotected sex. In bi-variate analysis, FSWs were more likely to engage in unprotected intercourse if they reported more frequent sex, more frequent sex with regular clients, poor HIV knowledge, alcohol/drug use, and violence. In multivariate analysis, risky sexual practices were associated with frequency of sexual intercourse, alcohol/drug use, and poor HIV knowledge. Conclusion: female sex workers engage in unprotected sex while under the influence of substances, belief in re-using condoms and have high frequency of sexual intercourse. Inadequate knowledge of HIV and substance use significantly correlated with unprotected sex. Interventions to address these modifiable factors are needed to mitigate the risk of HIV among FSWs.
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Condones , Infecciones por VIH , Trabajadores Sexuales , Conducta Sexual , Sexo Inseguro , Humanos , Kenia , Trabajadores Sexuales/estadística & datos numéricos , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Adulto , Adulto Joven , Sexo Inseguro/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Condones/estadística & datos numéricos , Adolescente , Conocimientos, Actitudes y Práctica en Salud , Asunción de Riesgos , Trabajo Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Sexo Seguro/estadística & datos numéricos , Prueba de VIH/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
BACKGROUND: Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. OBJECTIVE: The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. METHODS: A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users' behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. RESULTS: At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). CONCLUSIONS: The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611.
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Infecciones por VIH , Heterosexualidad , Humanos , Masculino , Adulto , Infecciones por VIH/prevención & control , Heterosexualidad/estadística & datos numéricos , China , Femenino , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual , Parejas Sexuales , Adulto JovenRESUMEN
Despite the substantial national resources invested in the fight against HIV to achieve its elimination, its incidence has remained stable in recent years. In 2022, the FOPH estimated that 7% of people living with HIV in Switzerland remained undiagnosed, underlining the potential for improving screening. The aim of this article is to present the process of HIV screening and diagnosis in clinical practice, adapted to the Federal Office of Public Health (FOPH) national strategy, and including the different indications for screening, the interpretation of available tests, and the place of post-exposure prophylaxis (PEP).
Malgré les ressources nationales considérables investies dans la lutte contre le VIH pour atteindre son élimination, son incidence est restée stable ces dernières années. En 2022, l'Office fédéral de la santé publique (OFSP) a estimé que 7 % des personnes vivant avec le VIH en Suisse n'étaient pas diagnostiquées, soulignant ainsi un potentiel d'amélioration du dépistage. L'objectif de cet article est de présenter le processus de dépistage et de diagnostic du VIH en pratique clinique, conformément à la stratégie nationale de l'OFSP. Il couvre les différentes indications au dépistage, l'interprétation des tests disponibles, ainsi que la place de la prophylaxie postexposition (PEP).
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Infecciones por VIH , Tamizaje Masivo , Profilaxis Posexposición , Humanos , Infecciones por VIH/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Tamizaje Masivo/métodos , Profilaxis Posexposición/métodos , Suiza/epidemiología , Prueba de VIH/métodos , Prueba de VIH/estadística & datos numéricosRESUMEN
BACKGROUND: HIV/AIDS has emerged as a nationwide epidemic and has taken the forefront position as the primary infectious killer of adults in China. The control and prevention of the disease have been hampered by a weak link in the form of heterosexual transmission. However, conventional intervention measures have demonstrated suboptimal efficacy in reducing the incidence of new HIV infections. In light of the current epidemiological characteristics, we have developed and executed an innovative intervention model known as the Joint Prevention and Control Mechanism of the 'CDC-Public Security Bureau-NGO'. The purpose of this research is to assess the impact of this model on the AIDS awareness, HIV infection rates, sexual behavior, and associated factors among female sex workers and elderly clients. Through the provision of robust evidence of the efficacy of this innovative model, we seek to advocate for its implementation in future interventions. METHODS: The research design of this study incorporates both a serial cross-sectional study and time-series analysis from 2014 to 2021, including a 4-year traditional intervention (2014-2017) and the 4-year 'CDC-Public Security Bureau-NGO' innovative intervention (2018-2021), was conducted to evaluate the effects of the new intervention. The GM(1, 1) model was performed to predict the proportion of HIV infection without implementing the innovative intervention in 2018-2021; P and C values were used to evaluate the performance of the model. Mann-Kendall test and descriptive methods were used to analyzed the trend of traditional and innovative interventions models on HIV positive detection rate in FSWs and elderly clients. RESULTS: The condom usage rates during the last commercial sexual encounter for FSWs and elderly clients improved from 74.9% and 9.1%, respectively, to 96.9% and 28.1%. (P < 0.05), newly reported cases of HIV have decreased by 15.56% yearly and the HIV positive detection rate among middle-aged and elderly people has dropped by 14.47%. The innovative intervention model has significantly reduced the HIV infection rates. CONCLUSIONS: The 'CDC-Public Security Bureau-NGO' innovative intervention has achieved beneficial effects on HIV/AIDS prevention and control and provides a good reference for Guangxi, China.
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Infecciones por VIH , Humanos , China/epidemiología , Femenino , Adulto , Estudios Transversales , Estados Unidos/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Persona de Mediana Edad , Centers for Disease Control and Prevention, U.S. , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Anciano , Adulto Joven , Conducta Sexual/estadística & datos numéricos , Masculino , Conocimientos, Actitudes y Práctica en SaludRESUMEN
INTRODUCTION: The efficacy of pre-exposure prophylaxis (PrEP) is highly dependent on adherence, and adherence behavior is influenced by motivation. The aim of this study was to explore the longitudinal relationship between PrEP motivation and change in adherence among men who have sex with men (MSM) in Western China. METHODS: From November 2019 to June 2021, we conducted a PrEP prospective cohort study. Motivation to take medicine was measured by the PrEP Motivation Scale at baseline, and was grouped into different levels of latent categories by Latent Profile Analysis (LPA). A multinomial logistic regression model was used to explore the longitudinal relationship between change in adherence (improvement, decline, no change) and different levels of PrEP motivation. RESULTS: MSM were divided into two categories of PrEP motivation, a "high motivation group" (n = 506, 69.89%) and a "low motivation group" (n = 218, 30.11%). High PrEP motivation had no significant effect on the change in short-term adherence, however, it contributed to the improvement in long-term adherence [odds ratio (OR) = 3.028 (1.100-8.332), p = 0.031]. The predictive power of the adherence model was significantly enhanced with the addition of the PrEP motivation factor. CONCLUSIONS: There was a positive correlation between high PrEP motivation at baseline and an improvement in long-term adherence. Surveillance and intervention of PrEP motivation in MSM can increase their adherence, and then promote PrEP efficacy.
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Infecciones por VIH , Homosexualidad Masculina , Cumplimiento de la Medicación , Motivación , Profilaxis Pre-Exposición , Humanos , Masculino , China , Profilaxis Pre-Exposición/estadística & datos numéricos , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Estudios Prospectivos , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Estudios Longitudinales , Persona de Mediana Edad , Adulto JovenRESUMEN
Artisanal and small-scale mining (ASM) is a significant source of income for tens of millions of people worldwide. Consistent condom use is pivotal in the prevention of HIV/AIDS and other STIs. This study assessed sexual behaviors and factors associated with consistent condom use among young male artisanal miners in Kassanda District, Uganda. A cross-sectional survey was conducted with 304 miners aged 15-24 years. Data -analysis included frequency distributions, chi-squared tests, and binary logistic regression. 89% had sexual intercourse in the past year, 55% had multiple partners, 11% engaged in transactional sex, and only 42% used condoms consistently. Married/cohabiting young men (OR=0.41; CI=0.19-0.87), those with a neutral attitude towards condom use (OR=0.30; CI=0.11-0.85), and those with only their mothers as parents (OR=0.37; CI=0.19-0.73) were less likely to use condoms consistently. The study highlights the need for targeted interventions promoting condom use among married young men and those raised by single mothers to reduce the risk of STI transmission.
L'exploitation minière artisanale et à petite échelle (ASM) constitue une source de revenus importante pour des dizaines de millions de personnes dans le monde. L'utilisation systématique du préservatif est essentielle à la prévention du VIH/SIDA et d'autres IST. Cette étude a évalué les comportements sexuels et les facteurs associés à l'utilisation systématique du préservatif chez les jeunes mineurs artisanaux du district de Kassanda, en Ouganda. Une enquête transversale a été menée auprès de 304 mineurs âgés de 15 à 24 ans. L'analyse des données comprenait des distributions de fréquences, des tests du chi carré et une régression logistique binaire. 89 % ont eu des rapports sexuels au cours de l'année écoulée, 55 % ont eu plusieurs partenaires, 11 % se sont livrés à des relations sexuelles transactionnelles et seulement 42 % ont utilisé des préservatifs de manière constante. Jeunes hommes mariés/cohabitants (OR=0,41 ; IC=0,19-0,87), ceux ayant une attitude neutre à l'égard de l'utilisation du préservatif (OR=0,30 ; IC=0,11-0,85) et ceux dont la mère est seule comme parent (OR=0,37 ; IC=0,19-0,73) étaient moins susceptibles d'utiliser régulièrement des préservatifs. L'étude souligne la nécessité d'interventions ciblées promouvant l'utilisation du préservatif parmi les jeunes hommes mariés et ceux élevés par des mères célibataires afin de réduire le risque de transmission des IST.
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Condones , Conocimientos, Actitudes y Práctica en Salud , Conducta Sexual , Humanos , Masculino , Condones/estadística & datos numéricos , Uganda , Estudios Transversales , Adolescente , Adulto Joven , Conducta Sexual/estadística & datos numéricos , Mineros/estadística & datos numéricos , Minería , Enfermedades de Transmisión Sexual/prevención & control , Parejas Sexuales , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Sexo Seguro/estadística & datos numéricos , AdultoRESUMEN
Side effects are a common concern of current and potential HIV pre-exposure prophylaxis (PrEP) users, potentially leading to missed doses. We examined the relationship between reported side effects and adherence in the Ontario PrEP Cohort Study (ON-PrEP). In total, 600 predominantly gay (87.3%), White (65.8%), and male (95.0%) participants completed questionnaires assessing the presence and severity of five side effect categories (nausea, diarrhea, headache, abdominal pain, and "other") as well as their adherence to daily PrEP (any missed doses in the previous 4 days). In total, 175 participants (29%) ever reported experiencing side effects: most commonly diarrhea (7.5% of study visits), and most were of mild severity. Lower incomes (p = 0.01), identifying as bisexual (p = 0.04), and baseline concern about side effects (p < 0.001) were associated with ever reporting side effects. The odds of reporting any side effects decreased by a factor of 0.44 (95% confidence interval 0.25-0.80) with each additional year of PrEP use, however 1 in 10 participants still reported side effects after 1 year of use. The odds of reporting optimal adherence were 0.48 (0.28-0.83) times lower for participants reporting any side effects, 0.67 (0.51-0.89) times lower per additional side effect category reported, and 0.78 (0.65-0.97) times lower per incremental increase in side effect severity ratings. We found some evidence of interaction between side effect measures and duration of PrEP use, suggesting that these relationships were stronger for participants taking PrEP for longer. Clinicians should make efforts to ascertain patients' experience of side effects and consider risk counseling and alternative PrEP regimens to promote adherence.
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Fármacos Anti-VIH , Infecciones por VIH , Cumplimiento de la Medicación , Profilaxis Pre-Exposición , Humanos , Profilaxis Pre-Exposición/estadística & datos numéricos , Masculino , Infecciones por VIH/prevención & control , Ontario/epidemiología , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Femenino , Cumplimiento de la Medicación/estadística & datos numéricos , Estudios de Cohortes , Persona de Mediana Edad , Encuestas y Cuestionarios , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiologíaAsunto(s)
Infecciones por VIH , Reducción del Daño , Hepatitis C , Abuso de Sustancias por Vía Intravenosa , Humanos , Mianmar , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Hepatitis C/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Masculino , Femenino , AdultoRESUMEN
The prevalence of human immunodeficiency virus (HIV) among adolescents is on the rise due to a lack of comprehensive knowledge, leading to suboptimal attitudes and behaviors, which emphasizes the critical need for targeted interventions. The aim of this review study was to evaluate the effectiveness of educational interventions for HIV prevention among adolescents by assessing their impact on knowledge, attitude, and behavior. A systematic review of seven databases: PubMed, Science Direct, Cochrane, JSTOR, Embase, Scopus, and EBSCO were identified, and 14 eligible randomized controlled trials published until June 2023 were included. Two independent authors assessed quality appraisal using the Risk of Bias 2.0. Outcomes were measured using the standard mean difference (SMD) with random effects model and a 95% confidence interval. Subgroup analyses and meta-regression were performed to explore heterogeneity. The results showed significant improvements in participants' knowledge (SMD: 1.13, 95%CI: 0.78-1.49), behavior intentions (SMD: 1.22, 95%CI: 0.37-2.07), and attitude (SMD: 0.48, 95%CI: 0.02-0.95) after receiving HIV prevention education programs. Interventions grounded in theoretical principles and incorporating technology, group settings, and audio-visual aids were found to be effective in enhancing knowledge of HIV prevention and promoting behavioral intentions. Peer-led education positively impacted both knowledge and attitude. Moreover, excluding parents from these programs was identified as a crucial factor in improving adolescents' knowledge of HIV prevention. In conclusion, educational programs focused on HIV effectively enhance adolescents' knowledge, attitudes, and behavioral intentions among adolescents. Professionals planning interventions should consider these impactful components in designing comprehensive strategies.
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Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Humanos , Adolescente , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Educación en Salud/métodos , Conducta del Adolescente/psicología , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective pharmaceutical intervention that prevents HIV infection, but PrEP uptake across the US has been slow among men who have sex with men (MSM), especially among Black/African American (B/AA) and Hispanic /Latino (H/L) MSM. This study investigates the acceptability and essential components of a peer-driven intervention (PDI) for promoting PrEP uptake among MSM, with a specific focus on B/AA and H/L communities. METHODS: We conducted 28 semi-structured, qualitative interviews with MSM in southern New England to explore the components of a PDI, including attitudes, content, and effective communication methods. A purposive sampling strategy was used to recruit diverse participants who reflect the communities with the highest burden of HIV infection. RESULTS: Of 28 study participants, the median age was 28 years (interquartile range [IQR]: 25, 35). The sample comprised B/AA (39%, n = 11) and H/L (50%, n = 14) individuals. Notably, nearly half of the participants (46%) were current PrEP users. We found that many participants were in favor of using a PDI approach for promoting PrEP. Additionally, several participants showed interest in becoming peer educators themselves. They emphasized the need for strong communication skills to effectively teach others about PrEP. Moreover, participants noted that peer education should cover key topics like how PrEP works, how effective it is, and any possible side effects. CONCLUSIONS: Our study shows that effective PDIs, facilitated by well-trained peers knowledgeable about PrEP, could enhance PrEP uptake among MSM, addressing health disparities and potentially reducing HIV transmission in B/AA and H/L communities.
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Infecciones por VIH , Homosexualidad Masculina , Grupo Paritario , Profilaxis Pre-Exposición , Investigación Cualitativa , Humanos , Masculino , Profilaxis Pre-Exposición/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Infecciones por VIH/prevención & control , New England , Entrevistas como Asunto , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificaciónRESUMEN
BACKGROUND: The global community has set an ambitious goal to end HIV/AIDS as a public health threat by 2030. Significant progress has been achieved in pursuing these objectives; however, concerns remain regarding the lack of disaggregated routine data for key populations (KPs) for a targeted HIV response. KPs include female sex workers, transgender populations, gay men and other men who have sex with men, people who are incarcerated, and people who use drugs. From an epidemiological perspective, KPs play a fundamental role in shaping the dynamics of HIV transmission due to specific behaviors. In South Africa, routine health information management systems (RHIMS) do not include a unique identifier code (UIC) for KPs. The purpose of this protocol is to develop the framework for improved HIV monitoring and programming through piloting the inclusion of KPs UIC in the South African RHIMS. OBJECTIVE: This paper aims to describe the protocol for a multiphased study to pilot the inclusion of KPs UIC in RHIMS. METHODS: We will conduct a multiphased study to pilot the framework for the inclusion of KPs UIC in the RHIMS. The study has attained the University of Johannesburg Research Ethics Committee approval (REC-2518-2023). This study has four objectives, including a systematic review, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (objective 1). Second, policy document review and in-depth stakeholder interviews using semistructured questionnaires (objective 2). Third, exploratory data analysis of deidentified HIV data sets (objective 3), and finally, piloting the framework to assess the feasibility of incorporating KPs UIC in RHIMS using findings from objectives 1, 2, and 3 (objective 4). Qualitative and quantitative data will be analyzed using ATLAS.ti (version 6; ATLAS.ti Scientific Software Development GmbH) and Python (version 3.8; Python Software Foundation) programming language, respectively. RESULTS: The results will encompass a systematic review of literature, qualitative interviews, and document reviews, along with exploratory analysis of deidentified routine program data and findings from the pilot study. The systematic review has been registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42023440656). Data collection is planned to commence in September 2024 and expected results for all objectives will be published by December 2025. CONCLUSIONS: The study will produce a framework to be recommended for the inclusion of the KP UIC national rollout. The study results will contribute to the knowledge base around the inclusion of KPs UIC in RHIMS data. TRIAL REGISTRATION: PROSPERO CRD42023440656; https://tinyurl.com/msnppany. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55092.
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Infecciones por VIH , Gestión de la Información en Salud , Humanos , Sudáfrica/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Proyectos Piloto , Gestión de la Información en Salud/métodos , Masculino , FemeninoRESUMEN
BACKGROUND: Population ageing and access to antiretroviral therapy have resulted in an increase in the proportion of older people living with human immunodeficiency virus (HIV). However, scant knowledge is available to inform the design of educational programmes to target these persons in low- and middle-income countries. AIM: This study aimed to examine how persons aged ≥ 50 years view their risk of contracting HIV, and the extent to which they are supported in preventing infection and are impacted by the HIV or acquired immune deficiency syndrome (AIDS) epidemic. SETTING: Rural sites in the Western Cape Province of South Africa. METHODS: This study followed a qualitative design. Two focus group discussions with persons aged ≥ 50 years and interviews with two key informants were conducted at seniors' centres. Discussions were digitally audio recorded and the recordings were transcribed, and data were thematically analysed. RESULTS: Overall, awareness of the risk of older persons contracting HIV infection in this population was poor. Stigmatisation of the disease in the community and at health care facilities affected individuals' willingness to be tested for the virus and/or to disclose their status, if positive. Participants viewed HIV and AIDS education programmes as focussed on the youth and educational sessions for large groups were not helpful in stemming the epidemic. CONCLUSION: Dissemination of information on older persons' vulnerability to the disease, and education on HIV and AIDS tailored for and targeted at this age group have been relatively neglected.Contribution: Educational programmes on HIV, as well as productive channels and platforms to target older populations, particularly those with a low health literacy level are required.
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Síndrome de Inmunodeficiencia Adquirida , Grupos Focales , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Investigación Cualitativa , Humanos , Sudáfrica , Masculino , Femenino , Infecciones por VIH/prevención & control , Persona de Mediana Edad , Anciano , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Población Rural , Estigma SocialRESUMEN
BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. METHODS: We leveraged programmatic data collected by the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the 'pre-restriction' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the 'high-level restriction' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. CONCLUSION: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.
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COVID-19 , Infecciones por VIH , Análisis de Series de Tiempo Interrumpido , Humanos , Sudáfrica/epidemiología , COVID-19/prevención & control , COVID-19/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Masculino , Femenino , Adulto , Trabajadores Sexuales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Personas Transgénero/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricosRESUMEN
Young men of color who have sex with men are vulnerable to HIV and experience poor PrEP uptake and retention. We conducted a secondary data analysis and calculated adjusted Prevalence Odds Ratios (aPORs) for PrEP retention along with 95% CIs at 90, 180, and 360 days at an organization running safety net clinics in Texas for gay and bisexual men. We found statistically significant association with age, race, in-clinic versus telehealth appointments, and having healthcare insurance. White clients had an aPOR of 1.29 [1.00, 1.67] as compared to Black clients at 90 days. Age group of 18-24 had a lower aPOR than all other age groups except 55 or older at all three time periods. Clients who met providers in person had an aPOR of 2.6 [2.14, 3.19] at 90, 2.6 [2.2, 3.30] at 180 days and 2.84 [2.27, 3.54] at 360 days. Our findings highlight the need for population-specific targeted interventions.
Lower PrEP retention for black and young MSM in TexasOur study findings suggest that of all clients who start PrEP, Black clients and younger clients had a higher chance of not continuing PrEP as compared to White clients and older clients respectively. This analysis was done for a clinic that pre-dominantly offers services to gay and bisexual men. We also found that those who were attending clinic in person had higher chances of continuing. Further those who are insured also had higher chances of continuing.
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Fármacos Anti-VIH , Negro o Afroamericano , Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Proveedores de Redes de Seguridad , Humanos , Masculino , Infecciones por VIH/prevención & control , Adulto , Adulto Joven , Homosexualidad Masculina/estadística & datos numéricos , Persona de Mediana Edad , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Proveedores de Redes de Seguridad/estadística & datos numéricos , Texas , Profilaxis Pre-Exposición/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Bisexualidad/estadística & datos numéricos , Población Blanca/estadística & datos numéricosRESUMEN
Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 (n = 398) and 2018 (n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.
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Negro o Afroamericano , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos , Profilaxis Pre-Exposición , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificación , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Encuestas Epidemiológicas , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Infecciones por VIH/prevención & control , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Ciudad de Nueva York/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Salud Sexual/etnologíaRESUMEN
Little is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation, and whether its use is suitable for referral to HIV care pathways. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and its implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted the flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.
A qualitative analysis of voluntary assisted partner notificationLittle is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.
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Trazado de Contacto , Infecciones por VIH , Investigación Cualitativa , Poblaciones Vulnerables , Humanos , Masculino , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/prevención & control , Poblaciones Vulnerables/psicología , Trazado de Contacto/métodos , Adulto , África del Sur del Sahara , Persona de Mediana Edad , Parejas Sexuales/psicología , Personal de Salud/psicología , Apoyo Social , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Entrevistas como AsuntoRESUMEN
BACKGROUND: Medical students, as future health-care providers (HCPs) play a significant role in shaping attitudes towards people living with HIV/AIDS (PLWHA) and should possess adequate knowledge of this infection. The study aim was to assess knowledge about HIV among medical students of the University of Zagreb School of Medicine, and to determine the level of discriminatory attitudes towards PLWHA. METHODS: We assessed knowledge about epidemiology, treatment, and prevention of HIV by using closed-ended and multiple-choice questions. Likert-scale questions were employed to determine attitudes towards PLWHA. Bivariate and multivariate ordinal logistic regression was used to assess correlates of certain discriminatory attitudes. RESULTS: 561 medical students participated, with 46.7% attending preclinical courses. Overall, 42.1% of students think they received sufficient information on HIV/AIDS during elementary and high school education. Among clinical students, 42.6%, 20.8% and 11.8% estimated accurately transmission risk after a needle injury, unprotected vaginal, and anal intercourse, respectively. 66.8% of clinical students were aware that treatment can prevent AIDS, while 58.7% and 69.8% were familiar with the rationale of using pre-exposure (PrEP) and post-exposure prophylaxis (PEP). In the multivariate analysis, individuals lacking infectology course attendance (aOR = 1.45; CI: 1.00-2.09) and those unaware of transmission routes (aOR = 1.49; CI: 1.06-2.09) showed higher odds of advocating HIV status disclosure compared to those who did not yet attend an infectology course. Students supporting extra protection for handling PLWHA bodily fluids were more likely to support refusal to treat PLWHA (aOR = 1.80; CI: 1.22-2.69) compared to those who did not support that opinion. Males were more inclined to state that they would refuse to treat PLWHA (aOR = 1.66; CI: 1.11-2.50) and disclose their HIV status (aOR = 1.62; CI: 1.17-2.27) than females. Overestimating needle injury transmission risk raised treatment refusal likelihood (aOR = 2.22; CI = 1.29-3.92) compared to those accurately informed of this risk. CONCLUSION: Results indicate lack of knowledge of HIV transmission risks after specific exposures and about PrEP, PEP and treatment effectiveness. Gender and knowledge about HIV transmission risks influence students' attitudes towards PLWHA. Medical education should be focused on fostering correct attitudes and addressing stigma, which undermines prevention and treatment outcomes of PLWHA.
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Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Estudiantes de Medicina , Humanos , Croacia , Estudiantes de Medicina/psicología , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Masculino , Femenino , Adulto , Adulto Joven , Encuestas y Cuestionarios , Actitud del Personal de SaludRESUMEN
BACKGROUND: Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. FINDINGS: Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. CONCLUSIONS: In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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Infecciones por VIH , Reducción del Daño , Abuso de Sustancias por Vía Intravenosa , Humanos , India/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto Joven , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Adulto , Accesibilidad a los Servicios de Salud , Femenino , Adolescente , Prestación Integrada de Atención de Salud , MasculinoRESUMEN
Stabilized trimers preserving the native-like HIV envelope structure may be key components of a preventive HIV vaccine regimen to induce broadly neutralizing antibodies (bnAbs). We evaluated trimeric BG505 SOSIP.664 gp140 formulated with a novel TLR7/8 signaling adjuvant, 3M-052-AF/Alum, for safety, adjuvant dose-finding, and immunogenicity in a first-in-healthy adult (n = 17), randomized, and placebo-controlled trial (HVTN 137A). The vaccine regimen appeared safe. Robust, trimer-specific antibody, and B cell and CD4+ T cell responses emerged after vaccination. Five vaccinees developed serum autologous tier 2 nAbs (ID50 titer, 1:28-1:8647) after two to three doses targeting C3/V5 and/or V1/V2/V3 Env regions by electron microscopy and mutated pseudovirus-based neutralization analyses. Trimer-specific, B cell-derived monoclonal antibody activities confirmed these results and showed weak heterologous neutralization in the strongest responder. Our findings demonstrate the clinical utility of the 3M-052-AF/Alum adjuvant and support further improvements of trimer-based Env immunogens to focus responses on multiple broad nAb epitopes.