This systematic review and meta-analysis evaluated the Friendship Bench (FB) intervention's efficacy in relieving anxiety and depression among people living with HIV (PLHIV) and high-risk populations, explored interventi...This systematic review and meta-analysis evaluated the Friendship Bench (FB) intervention's efficacy in relieving anxiety and depression among people living with HIV (PLHIV) and high-risk populations, explored intervention effect heterogeneity, and provided evidence for mental health-HIV care integration in resource-limited areas. Multiple databases were searched from inception to July 19, 2025; 6 RCTs (2203 participants) were included for meta-analysis via Stata 16.0. The pooled SMD was - 0.57 (95% CI: -1.41 to 0.28, I²=98.7%); PLHIV-only analyses (n = 5) showed no significant effect (SMD = 0.12, 95% CI: -0.03 to 0.27, I²=0.0%). Measurement tools and population type were key sources of heterogeneity, with the DASS-21 subgroup yielding consistently non-significant results. Current evidence is insufficient to confirm FB's effectiveness, emphasizing the need for rigorous large-scale RCTs with standardized outcome measures.Clinical trial registration: This systematic review and metaanalysis has been prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD420251063331; Registration date June 3, 2025).
Mirrazavi SS, Magagula P, Swann SA
… +8 more, Lee T, Tognazzini S, Mudhikwa CV, Kaida A, King EM, Côté HCF, Murray MCM, British Columbia CARMA-CHIWOS Collaboration (BCC3; CIHR Canadian HIV Trials Network study 335)
Mental health conditions, such as post-traumatic stress disorder (PTSD), anxiety and depressive symptoms, are more prevalent among in women living with HIV and immigrant women as compared with men living with HIV and the...Mental health conditions, such as post-traumatic stress disorder (PTSD), anxiety and depressive symptoms, are more prevalent among in women living with HIV and immigrant women as compared with men living with HIV and the general population. However, less is known about the intersection of these identities and their impact on the mental health of immigrant women living with HIV. This cross-sectional analysis of survey data from the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study estimates the prevalence of mental health conditions among immigrant women living with and without HIV and explores potential risk (i.e., experiences of racism, sexism, childhood violence and adulthood violence) and protective (e.g., resilience, social support) factors contributing to mental health. Among n = 62 women living with HIV and n = 79 women without HIV, the prevalence of PTSD (50.0% vs. 37.0%, respectively (X(1) = 1.994, p = 0.16), anxiety (X(1) = 1.929, 29.0% vs. 17.7% (p = 0.76)), and depressive symptoms (X(1) = 0.912, 50.0% vs. 40.5% (p = 0.34)) did not differ significantly. Among all immigrant women (both living with or without HIV), lower resilience scores (aOR (adjusted odds ratio), 0.94 [95% CI, 0.89-0.97], p = 0.004), lower social support (0.73 [0.63-0.83], p < 0.001), higher experiences of sexism (1.08 [1.03-1.14], p < 0.001), racism (1.06 [1.02-1.11], p = 0.002) and childhood abuse (0.94 [0.90-0.98], p = 0.003) were associated with higher odds of having one or more mental health conditions. Policies and interventions aimed at strengthening social networks, promoting resiliency and addressing systemic barriers such as racism and sexism are essential to improving mental health outcomes among immigrant women.
Mpox has particularly adverse effects among people with HIV (PWH). We examined mpox vaccine utilization and hesitancy among men who have sex with men (MSM), and transgender women (TW) in HIV care in a multisite U.S. coho...Mpox has particularly adverse effects among people with HIV (PWH). We examined mpox vaccine utilization and hesitancy among men who have sex with men (MSM), and transgender women (TW) in HIV care in a multisite U.S. cohort. We queried MSM/TW reporting past 3-month sexual activity at 7 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites regarding mpox vaccination status, and willingness and hesitancy to vaccinate via questionnaires self-administered at routine HIV care visits between 1/2023 and 4/2024. We measured bivariate cross-sectional associations between vaccination status and demographic characteristics; among those reporting no vaccination, we measured associations between hesitancy and demographic characteristics. Among MSM/TW (n = 1146, mean age 46; 97% cisgender MSM, 3% TW; 46% white, 39% Black, 11% Hispanic), 52% (n = 597) reported not being vaccinated against mpox. Of these, 33% (n = 195) indicated they were not likely to be vaccinated despite provider recommendation. A higher proportion of Black respondents indicated they would not get vaccinated compared with white or Hispanic (42% vs. 23% and 33%, respectively; p ≤ 0.001). Key reasons were health concerns (57%, highest among Black participants, p ≤ 0.001), particularly concerns that 'not enough is known' about the vaccine (47%), side effects (25%), and low perceived acquisition risk (33%). Among sexually active MSM/TW in HIV care, mpox vaccine hesitancy was highest among persons of Black race. Common reasons were concerns about negative health effects, the belief that not enough is known about the vaccine, and low perceived risk. Education efforts should highlight mpox vaccine safety as well as mpox transmission risk.
Nigeria's 2025 PEPFAR funding suspension served as an unplanned natural experiment, uniquely demonstrating that behavioral instability among patients and providers precedes, and is in many respects more disruptive than,...Nigeria's 2025 PEPFAR funding suspension served as an unplanned natural experiment, uniquely demonstrating that behavioral instability among patients and providers precedes, and is in many respects more disruptive than, actual commodity shortages. This distinction, rarely documented in prior literature, has direct implications for how HIV program resilience should be designed and measured. We conducted in-depth key informant interviews with 15 healthcare providers at a major antiretroviral therapy (ART) facility in northern Nigeria, analyzed using Braun and Clarke's reflexive thematic analysis framework. Despite stable antiretroviral drug stocks, acute uncertainty triggered panic-driven patient visits, rumor-driven information gaps, and precautionary dispensing restrictions. Laboratory services deteriorated rapidly, and implementing partner staff worked without pay for up to two months, temporarily masking systemic fragility. Persistent structural barriers, transport costs, stigma, and treatment fatigue impeded adherence, independent of funding status. Providers distinguished technical capacity, which they judged sufficient, from political will, which they found lacking; transition structures existed but remained unimplemented. Sustaining ART delivery requires proactive crisis communication, protected multi-month dispensing, resilient laboratory financing, and governance reforms to reduce donor dependence. Political commitment is the central determinant of sustainable domestic HIV program ownership in Nigeria.
SOMOS Alianza is a strategic alliance of HIV service implementers, HIV researchers, and community members from three jurisdictions: Miami, Florida, Orlando, Florida, and San Juan, Puerto Rico. Because of high HIV inciden...SOMOS Alianza is a strategic alliance of HIV service implementers, HIV researchers, and community members from three jurisdictions: Miami, Florida, Orlando, Florida, and San Juan, Puerto Rico. Because of high HIV incidence among Latino men who have sex with men (LMSM), improved implementation of evidence-based HIV services is needed. We sought to identify determinants influencing the reach of HIV services to LMSM in these jurisdictions. Using the Consolidated Framework for Implementation Research 2.0 and rapid qualitative analysis, we identified facilitators and barriers across jurisdictions. Common implementation facilitators were client-centered resources and culturally grounded engagement strategies. Unique barriers included state policy affecting members from Florida, and the impact of Puerto Rico's colonial status on limiting the autonomy and distribution of health-related funds. These findings underscore the need for shared and tailored implementation strategies to address the multilevel drivers of HIV-related disparities among LMSM in these regions. SOMOS Alianza es una alianza estratégica que reúne a implementadores de servicios de VIH, investigadores de VIH y miembros de la comunidad de tres jurisdicciones: Miami (Florida), Orlando (Florida) y San Juan (Puerto Rico). Debido a la alta incidencia del VIH entre los hombres latinos que tienen sexo con hombres (HLSH), se require fortalecer la implementación de servicios de VIH basados en evidencia. Nuestro objetivo fue identificar los determinantes que influyen en el alcance de los servicios de VIH para los HLSH en estas jurisdicciones. Utilizando el Consolidated Framework for Implementation Research 2.0 y análisis cualitativo rápido, identificamos facilitadores y barreras en todas las jurisdicciones. Los facilitadores comunes incluyeron recursos centrados en el cliente y estrategias de participación culturalmente relevantes. Las barreras únicas incluyeron políticas estatales que afectan a los miembros de Florida y el impacto del estatus colonial de Puerto Rico en la autonomía y distribución de fondos relacionados con la salud. Estos resultados resaltan la necesidad de estrategias de implementación compartidas y adaptadas para abordar los factores multinivel que contribuyen a las disparidades relacionadas con el VIH entre los HLSH en estas regiones.
Adherence to daily oral HIV PrEP wanes over pregnancy and postpartum and new long-acting injectable HIV PrEP (LAI-PrEP) methods may address barriers to effective use. Understanding changing LAI-PrEP preferences during th...Adherence to daily oral HIV PrEP wanes over pregnancy and postpartum and new long-acting injectable HIV PrEP (LAI-PrEP) methods may address barriers to effective use. Understanding changing LAI-PrEP preferences during the perinatal period could inform the integration into maternal healthcare. We used data from a randomized trial of pregnant women initiating daily oral HIV PrEP at five public maternal child health facilities in western Kenya, followed through 9 months postpartum (NCT04472884). Participants completed surveys on LAI-PrEP interest from the third trimester through postpartum. Latent Transition Analysis (LTA) examined underlying patterns of LAI-PrEP interest. Predictors of transitions between statuses were assessed using univariate logistic regression. Overall, 598 pregnant women were enrolled (median age: 25 years). We identified three preferences statuses: "No interest in LAI-PrEP", "Willing to pay (WTP) for LAI-PrEP", and "Prefers free LAI-PrEP". About 10% comprised the "No interest in LAI-PrEP" at each time point. In pregnancy, 36.8% belonged to the "Prefers free LAI-PrEP" status, with participants increasingly transitioning to "WTP for LAI-PrEP" through the postpartum period. The "WTP for LAI-PrEP" status grew from 53.2% in third trimester to 76.6% at nine months postpartum, however women who were primigravida had 5-fold higher odds of transitioning out of "WTP for LAI-PrEP" to "Prefers free LAI-PrEP" (95% CI: 5.29-5.39, p < 0.001). Most women remained interested in LAI-PrEP across pregnancy and postpartum, with willingness to pay for LAI-PrEP growing over time. Expanding cost-free LAI-PrEP within MCH systems, especially for postpartum and primigravida women, could improve PrEP use during this critical period.ClinicalTrials.gov registration number: NCT04472884.
We compare indicators of HIV prevention and care in two rounds of National HIV Behavioral Surveillance for transgender women (NHBS-Trans) in San Francisco. NHBS-Trans recruited 201 trans women in 2019/20 and 339 in 2023/...We compare indicators of HIV prevention and care in two rounds of National HIV Behavioral Surveillance for transgender women (NHBS-Trans) in San Francisco. NHBS-Trans recruited 201 trans women in 2019/20 and 339 in 2023/2024 through peer referral methods. The proportion of trans women on ART significantly improved from 90% to 98% ([Formula: see text]=6.33, p = 0.018) over this time period. Additionally, methamphetamine use decreased overall from 32% to 22% (χ = 7.08, p = 0.008). Among trans women living with HIV, the proportion reporting injection drug use also decreased from 22% to 11% (χ = 3.98, p=0.046). HIV prevalence did not significantly change (42% in 2019/20 and 36% in 2023/24), nor did the proportion of participants reporting HIV testing (91% vs. 84%), condom use (45% vs. 48%), or PrEP use (43% vs. 40%). Notably, the proportions aware of their HIV status and virally suppressed remain below 90% in 2023/24, falling short of the > 95% targets set to end the HIV epidemic. Transgender women have consistently faced profound marginalization in the U.S. Stalled progress in addressing the HIV epidemic occurs in an era of increased politicization of transgender identity, cuts to HIV programs and research, and threats to the rights of transgender people in the United States. These efforts at erasure threaten progress in ending the HIV epidemic and risk creating structural, irreversible harm that no clinical innovation alone can overcome.
Goddard-Eckrich D, Sardana SM, Henry BF
… +13 more, Downey DL, Gilbert L, Stringer KL, Chang M, Wu E, Thomas BV, Bolden LA, Mckenna N, Abbas BT, Prichard C, Baholli B, El-Bassel N, Hunt T
People under community supervision who use drugs face elevated HIV risk. This randomized controlled trial used a mixed-methods approach to examine PrEP acceptance among community-supervised men who use drugs and their fe...People under community supervision who use drugs face elevated HIV risk. This randomized controlled trial used a mixed-methods approach to examine PrEP acceptance among community-supervised men who use drugs and their female partners. The study evaluated PrEP willingness among participants (N = 394) randomized to either PACT (5-session couples' HIV intervention) or control (1-session HIV counseling). Qualitative interviews with 20 couples (n = 40) explored PrEP attitudes. The PACT group showed significantly higher intentions to use condoms with PrEP compared to controls (64% vs. 53%, p = 0.03). Female partners in the PACT intervention demonstrated stronger PrEP use intentions than females in the control (aOR = 2.85, p = 0.02). Qualitative findings revealed five key factors affecting PrEP acceptance: (1) partner infidelity concerns, (2) substance use and decision-making, (3) HIV acquisition fears, (4) low-risk perception despite objective risk factors, and (5) medical mistrust. Gender influences PrEP acceptance among criminal legal-involved couples. Effective interventions should address gender differences, risk perception disparities, and medical mistrust. TRIAL REGISTRATION: ClinicalTrials.gov NCT01690494 registered September 19, 2012.
Understanding HIV care experiences of women veterans is essential for identifying gaps in an understudied population with unique care needs. Much of what is known relies on inferences from civilian women or combines wome...Understanding HIV care experiences of women veterans is essential for identifying gaps in an understudied population with unique care needs. Much of what is known relies on inferences from civilian women or combines women and men veterans, obscuring important sex-related differences. Mental health conditions are highly prevalent among women veterans and present a critical barrier to HIV care, as nearly half of Veterans Health Administration (VHA)-enrolled women veterans have at least one mental health diagnosis. This retrospective study analyzed a national cohort of 1255 women veterans with HIV from fiscal years 2022-2023. Logistic regression models examined associations between demographic and mental health characteristics and subsequent HIV care continuum outcomes (receipt of care, retention in care, and viral suppression), and one-sample binomial tests compared cohort outcomes to 2022 VHA-wide estimates. Among our cohort, 70.4% of women received care, 45.0% were retained, and 57.5% achieved viral suppression, each significantly lower than VHA-wide estimates (all ps < 0.05). Viral suppression among those with a viral load test on record was 95.4%, significantly higher than the VHA-wide estimate. In adjusted models, White (compared to Black) and separated (relative to divorced) women had lower odds of care engagement (p < 0.05). Serious mental illness was associated with lower odds of receiving care, while depression and anxiety were associated with greater odds of receiving care (all ps < 0.05). These findings highlight demographic and mental health factors associated with HIV care outcomes and underscore the value of sex-disaggregated analyses for identifying disparities in this understudied population.
Digital health tools are becoming increasingly essential for accessing health information, resources, and delivery of clinical care and supportive services. Recognizing the potential for digital tools to broaden access t...Digital health tools are becoming increasingly essential for accessing health information, resources, and delivery of clinical care and supportive services. Recognizing the potential for digital tools to broaden access to care and monitoring and managing health conditions, a growing body of research has shown that the expansion of internet mediated health resources and services also has the potential to exacerbate rather than mitigate health inequities. The goal of this study is to examine barriers to access and effective use of digital health tools among a diverse community cohort sample of adults living with HIV in New York City. We found that one and five participants lacked access to minimal technology for digital health utilization (smartphone/computer and internet access). Digital literacy is an issue, potentially limiting use of digital tools for being in touch with providers, using patient portals, and participating in telehealth visits. Almost half of cohort members face potential digital content barriers associated with digital interfaces not designed to accommodate persons with visual, auditory, mobility, limited English language proficiency, or educational disadvantage. Concerns with providing personally identifying information online is a barrier to telehealth utilization across a range of client characteristics and life circumstances. Addressing both trust and skill-based barriers are essential to promote digital equity among people with HIV. Without intentional efforts to ensure equity, disparities will only increase among those already vulnerable.
This study examined potential sociodemographic predictors, mental health and quality of life (QOL) outcomes of mental health care satisfaction in a national sample of rural, older (50+) people living with HIV (PLHIV). We...This study examined potential sociodemographic predictors, mental health and quality of life (QOL) outcomes of mental health care satisfaction in a national sample of rural, older (50+) people living with HIV (PLHIV). We used a sub-sample (N = 102) from a survey of individuals that received mental health services within the past two years. Linear regressions examined associations between sociodemographic characteristics and mental health care satisfaction. Associations between mental health care satisfaction and mental health-related QOL, depressive symptoms, and perceived stress was also examined. STROBE guidelines were used. Multiple regression analyses found individuals with lower education levels (B = -0.21, SE = 0.08, p = .01), who identified as a sexual minority (B = 0.39, SE = 0.15, p = .01), lived in the Midwest (B = 0.52, SE = 0.22, p = .02) or West, (B = 0.59, SE = 0.22, p = .01), and reported fewer barriers to care (B = -0.38, SE = 0.10, p < .001) were more satisfied with care. Further, individuals who were older (B = 0.05, SE = 0.02, p = .04), African American (B = 0.59, SE = 0.26, p = .03), and more satisfied with their care (B = 0.39, SE = 0.14, p = .01) reported higher mental health related QOL. Individuals less satisfied with care reported more depressive symptoms (B = -2.53, SE = 0.97, p = .01) and more perceived stress (B = -0.21, SE = 0.09, p = .02). These findings highlight important targets for improving mental health care satisfaction.
Food insecurity has re-emerged as a critical issue in Brazil, significantly worsened by the COVID-19 pandemic. We recruited Brazilian sexual and gender diverse (SGD) persons aged 18 + years on apps and social media acros...Food insecurity has re-emerged as a critical issue in Brazil, significantly worsened by the COVID-19 pandemic. We recruited Brazilian sexual and gender diverse (SGD) persons aged 18 + years on apps and social media across three periods: early (2020), late (2021), and post-COVID-19 (2024) pandemic. We explored two outcomes: food insecurity (all participants) and antiretroviral (ART) nonadherence (only persons living with HIV). Food insecurity was assessed using the 8-item version of the Brazilian Household Food Insecurity Measurement Scale. ART nonadherence was defined as reporting < 100% medication adherence in the past 30 days. Logistic regression models assessed factors associated with each outcome. In total, 22,327 participants were included (74.6% HIV-negative; 17.9% living with HIV, 7.5% HIV-unknown), mean age 37 years, 96.3% cisgender men. Compared to the early pandemic period, lower odds of experiencing food insecurity were observed for late (adjusted odds ratio [aOR]:0.65, 95% confidence interval [CI]:0.59-0.71) and post-pandemic (aOR:0.66, 95%CI:0.60-0.73) periods. Participants who reported to be living with HIV had higher odds of experiencing food insecurity (aOR:1.21, 95%CI:1.11-1.31). Food insecurity increased the odds of ART nonadherence (aOR:2.36, 95%CI:1.57-3.63). Compared to early pandemic period, late (aOR:2.69, 95%CI:1.81-4.09) and post (aOR:3.61. 95%CI:2.49-5.39) pandemic periods were associated with higher odds of ART nonadherence. Our study shows food insecurity as a critical barrier to optimal ART adherence among Brazilian SGD living with HIV. Although the experience of food insecurity decreased in the two most recent periods, its enduring association with HIV infection and ART adherence underscores the urgent necessity for comprehensive and integrated public policies.
Internalized HIV-related stigma undermines mental health, quality of life, and engagement in care among people living with HIV (PLHIV), yet data from Vietnam remain limited. We analyzed data from the 2020 PLHIV Stigma In...Internalized HIV-related stigma undermines mental health, quality of life, and engagement in care among people living with HIV (PLHIV), yet data from Vietnam remain limited. We analyzed data from the 2020 PLHIV Stigma Index, a cross-sectional study conducted in seven provinces. Participants were recruited primarily from public outpatient HIV treatment clinics and through limited chain referral. Internalized stigma was assessed using the 6-item Internalized AIDS-Related Stigma Scale (IARSS); scores of 5-6 were classified as high internalized stigma. Among 1,623 participants (mean age 34.6 years, 74.6% male), the IARSS showed acceptable internal consistency (Cronbach's alpha = 0.74), and 29.4% had high internalized stigma. In the multivariable logistic regression, secondary/high school education (adjusted odds ratio [aOR]: 0.47, 95% confidence interval [CI]: 0.35-0.65), university/tertiary education (aOR: 0.34, 95% CI: 0.22-0.52), and more than 5 years since HIV diagnosis (aOR: 0.66, 95% CI: 0.49-0.89) were associated with lower odds of high internalized stigma. Higher odds were observed among participants with depression/anxiety symptoms (aOR: 2.02, 95% CI 1.56-2.62), those unaware of their partner's HIV status (aOR: 1.79, 95% CI 1.21-2.65), and those reporting community stigma or discrimination in the prior 12 months (aOR: 1.49, 95% CI 1.06-2.09); internalized stigma also varied by province. Internalized stigma remains common among PLHIV in Vietnam and appears shaped by psychological, relational, community, and geographic factors. Integrated mental health, stigma-reduction, and context-responsive interventions may help reduce internalized stigma.
Internalized HIV stigma, defined as negative self-perceptions among people living with HIV (PLWH) based on the societal stereotype, is a significant barrier to effective HIV prevention and care in Sub-Saharan Africa. Thi...Internalized HIV stigma, defined as negative self-perceptions among people living with HIV (PLWH) based on the societal stereotype, is a significant barrier to effective HIV prevention and care in Sub-Saharan Africa. This study examined longitudinal correlates of internalized HIV stigma among PLWH in Uganda. The sample included 105 participants (mean age = 39.3 years (SD = 10.5); 69.5% women). Surveys were conducted at baseline, and 6, 12, and 18 month-follow-up. Lagged repeated measures regression models revealed that younger average participant age, younger average age of network members, and lower average trust in network members were associated with increased internalized stigma over time; age of participant and trust remained as predictors in a multivariate model. Interventions aiming to reduce stigma should prioritize building supportive and trustworthy social environments. Understanding multi-level predictors of stigma is essential for developing strategies to improve health outcomes for PLWH in high-burden settings.
While post-exposure prophylaxis (PEP) is considered a gate way to pre-exposure prophylaxis (PrEP), prospective evidence remains limited. This study aimed to investigate the association between PEP experience and subseque...While post-exposure prophylaxis (PEP) is considered a gate way to pre-exposure prophylaxis (PrEP), prospective evidence remains limited. This study aimed to investigate the association between PEP experience and subsequent PrEP initiation. A nested case-control study was conducted within a prospective cohort of men who have sex with men (MSM) in Qingdao, China. Cases were participants newly initiating PrEP, matched to four controls selected from participants who were at risk of initiating PrEP at the exact time the case occurred. The primary exposure was self-reported baseline PEP use, classified as never, ever, or recent use. Supplementary analyses examined PEP use at the visit immediately preceding PrEP initiation. A dichotomous exposure categorization grouping strategy was also applied across the above analysis (combining ever and recent users). Conditional Logistic regression estimated associations between PEP and PrEP initiation. Subgroup analyses were performed to assess the potential effect modification. A total of 59 cases and 234 matched controls were included. Baseline PEP experience was not significantly associated with subsequent PrEP initiation (ever use: aOR = 1.79, 95%CI: 0.86-3.69, P = 0.117; recent use: aOR = 1.52, 95%CI: 0.46-4.99, P = 0.488). This lack of a significant association persisted when ever and recent PEP users were combined into a single "prior use" category (aOR = 1.72, 95%CI: 0.88-3.35, P = 0.110). However, subgroup analyses showed that among participants who report recent recreational drug use, those with a history of PEP use were more likely to initiate PrEP (aOR = 2.25, 95%CI: 1.09-4.64, P = 0.029). These findings suggest that to effectively leverage PEP encounters as a gateway to sustained prevention, health systems should prioritize and intensify linkage interventions for high-risk groups identified during the PEP consultation, particularly individuals who use substances. Transforming PEP encounters into opportunities for tailored intervention can strengthen the HIV prevention cascade for those most in need.
Hepatitis C virus self-testing (HCVST) has emerged as a potential strategy to expand testing among key populations. We assessed the feasibility of HCVST in cisgender men-who-have-sex-with-men (cis-MSM) and transgender wo...Hepatitis C virus self-testing (HCVST) has emerged as a potential strategy to expand testing among key populations. We assessed the feasibility of HCVST in cisgender men-who-have-sex-with-men (cis-MSM) and transgender women (TGW) on pre-exposure prophylaxis (PrEP). This cross-sectional study included cis-MSM or TGW attending a PrEP consultation in Rio de Janeiro (Brazil). Participants performed HCVST using blood-based and oral-fluid kits on the same day under observation. Difficulties, errors and assistance during HCVST were recorded. Re-reading and re-testing concordance [Kappa(k)] and values/preferences were assessed. A total of 250 participants (88% cis-MSM, age = 34 [IQR,28-41] years, 42% with high education level) were included. The main steps where participants requested assistance (95%CI) for blood-based HCVST were to add buffer [35.6%(29.9-41.8)] and to collect blood sample with the dropper [34.0%(28.4-40.1)]. The main error during oral fluid HCVST was incorrect collection of oral fluid [29.6% (95%CI,24.2-35.6)]. A total of 62.4% (95%CI,56.2-68.2) and 28.8% (95%CI,23.5-34.8) participants needed assistance in at least one step of blood-based and oral fluid HCVST, respectively. Lower education level was associated with higher odds of needing assistance for blood-based HCVST [aOR = 2.07 (95%CI,1.99-3.59),p = 0.009]. Re-reading and re-testing k-indexes were 0.92 and 0.89 for blood-based, and 1.00 and 0.75 for oral fluid HCVST, respectively. More than 95% of people felt safe; would repeat or would recommend HCVST. A total of 46.4% (95%CI,40.3-52.6) preferred oral fluid versus 36.4% (95%CI,30.6-42.6) who preferred blood-based. A relatively high proportion of participants needed assistance, especially for blood-based HCVST. Despite these challenges, high re-reading and re-testing agreements were observed and HCVST was well-accepted.
Sexual and gender minority youth (SGMY) experience a heightened risk of HIV acquisition due to barriers to HIV prevention, specifically connected to a lack of comfort in discussing sexual identity and practices with heal...Sexual and gender minority youth (SGMY) experience a heightened risk of HIV acquisition due to barriers to HIV prevention, specifically connected to a lack of comfort in discussing sexual identity and practices with healthcare providers (HCPs). Decision-aid tools that support communication and shared decision-making may improve both access to and uptake of numerous HIV prevention modalities among SGMY. The study aimed to inform the decision-making process of HIV prevention modalities for HCPs and SGMY, providing key information about HIV prevention modalities with PrEPChoices, a web-based decision aid tool. Our study recruited two participant groups, HCPs (N = 15) and SGMY (N = 18). Eligible HCPs held a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), or Physician Assistant/Associate (PA) degree, were licensed to prescribe medications in at least one United States state, had provided care to patients aged 15 to 24 within the past month, and were 18 years of age or older. Eligible SGMY were assigned male sex at birth, reported sexual attraction to and/or sexual behavior with cisgender men or transgender women in the past six months, and were 15 to 24 years of age. Participants completed a semi-structured Webex interview focused on the clarity and relevance, presentation and usability, and application of PrEPChoices, a web-based decision aid tool to support HIV prevention modalities selection among HCPs and SGMY. Interview transcripts were coded using an iteratively developed codebook. Findings were thematically analyzed within a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework. Thirty-three participants enrolled (N = 33), including 15 HCPs and 18 SGMY. Strengths included: (1) support for HIV prevention-based decision making; (2) utilization of the filtering tool to select preferred HIV prevention modalities; and (3) intuitive website design. Weaknesses included: (1) gaps in needs and literacy levels between HCPs and SGMY; (2) limited visual design appeal and inclusive representation; and (3) limited in-tool features for comparing HIV prevention modalities. Opportunities included: (1) potential for multimodal dissemination; and (2) expanding external resources provided. Threats included: (1) challenge of integrating PrEPChoices into clinical practices; and (2) ability to stand out compared to other online HIV prevention education resources. HCPs and SGMY highlight the value of PrEPChoices as a web-based decision aid tool to enhance HIV prevention modality selection among SGMY. Our results emphasize the critical role PrEPChoices can play in reducing barriers to sexual health education among SGMY, improving the patient-provider relationship with the PrEP landscape, and strengthening HIV prevention among SGMY.
Electronic assessments of cognition in low-resource settings have the potential to widen access to cognitive appraisal in at-risk populations. We evaluated the performance of the shorter, tablet-based NIH cognition batte...Electronic assessments of cognition in low-resource settings have the potential to widen access to cognitive appraisal in at-risk populations. We evaluated the performance of the shorter, tablet-based NIH cognition battery (NIH-CB) against the validated paper-based Kaufman Assessment Battery for Children 2nd Edition (KABC-II) in assessment of neurocognitive function in adolescents living with HIV (ALWH). Adolescents aged 11-19 years living with HIV and an HIV-negative comparison group completed the NIH-CB and KABC-II. Convergent validity between NIH-CB and KABC-II subtest and global scores was measured using Pearson's R and Bland-Altman plots. The ability of the NIH-CB to differentiate between HIV-negative and ALWH participant cognition was evaluated using linear regression. The acceptability of the NIH-CB and KABC-II were evaluated through questionnaires, focus groups and interviews. Forty-two HIV-negative adolescents were enrolled in a pilot acceptability study. Subsequently, 507 (253 HIV-negative, 254 HIV-positive) adolescents (median age 15(IQR:13-17) years) were enrolled into the validation study. Subtest scores on the NIH-CB and KABC-II measuring memory demonstrated low-moderate correlation (R 0.140-0.491). A Bland-Altman plot showed HIV-negative participants had low mean difference between NIH fluid cognition Z-score and KABC-II MPI Z-score (0.02 + 0.21 average); 95.2% of measurements were within limits of agreement. NIH-CB fluid cognition Z-scores were higher in HIV-negative participants than ALWH (mean difference 0.27 [95%CI 0.10, 0.41] p < 0.001). The NIH-CB was highly acceptable to participants and test administrators. The NIH-CB may serve as both a valid and practical cognition assessment tool in adolescents in low-resource settings, including in HIV research.