AIDS And Behavior[JOURNAL]
Sun
200 papers
Racial Disparities in HIV Prevalence, Testing, and Care Among Men Who Have Sex with Men in Baltimore from 2008 to 2023: Fifteen Years of HIV Behavioral Surveillance.
German D, Gribbin M, Spencer L … +3 more , Burrell J, Kennedy K, Flynn C
AIDS Behav · 2026 Feb · PMID 41712052 · Full text
The Baltimore HIV epidemic among men who have sex with men (MSM) has been characterized by high HIV prevalence and stark racial disparities. We examined trends in HIV infection and service utilization among Baltimore MSM...
The Baltimore HIV epidemic among men who have sex with men (MSM) has been characterized by high HIV prevalence and stark racial disparities. We examined trends in HIV infection and service utilization among Baltimore MSM using data from CDC's National HIV Behavioral Surveillance (NHBS) project from 2008 to 2023. A total of 2,180 venue-recruited MSM participated: 68% Black, 19% White, and 13% other/multiple racial identities. By 2023, HIV prevalence remained high (35.4% overall) and disproportionately concentrated among Black MSM (43.9%). From 2008 to 2023, predicted probability of HIV infection declined from 48% to 37% among Black MSM and remained stable at approximately 19% among White MSM. HIV service utilization exceeded 90% by 2023, particularly among Black MSM. These improvements reflect considerable community response and public health investment. Ending the HIV epidemic in Baltimore will require sustained prevention and treatment funding, continued efforts to reduce racial disparities, and focused attention on social determinants of health.
Retrospective Study of Epidemiological and Clinical Characteristics of Mpox-HIV Coinfection in Men Who Have Sex with Men in Hangzhou, China.
Jin X, Huo L, Zhu L … +7 more , Wang J, Jin Q, Tao M, Wang J, Huang R, Gong Y, Chen J
AIDS Behav · 2026 Feb · PMID 41712051 · Publisher ↗
Monkeypox (Mpox) resurgence raises global public health concerns, particularly among men who have sex with men (MSM) with human immunodeficiency virus (HIV). We recruited 104 confirmed Mpox cases in Hangzhou, categorized...
Monkeypox (Mpox) resurgence raises global public health concerns, particularly among men who have sex with men (MSM) with human immunodeficiency virus (HIV). We recruited 104 confirmed Mpox cases in Hangzhou, categorized into Mpox-HIV coinfection and Mpox monoinfection groups, and HIV monoinfections were 1:1 matched with Mpox-HIV co-infections. We compared the characteristics and identifying coinfection risk factors. Mpox-HIV co-infections had higher lesion pain (67.39% vs. 39.66%, P = 0.004) and all 27 hospitalized (including 1 ICU) were coinfected. Despite 97.83% receiving antiretroviral therapy, up to 28.26% had CD4 + T-cell counts ≤ 350 cells/µL. Mpox-HIV co-infections caused more severe clinical manifestations and higher hospitalization, particularly in people with low CD4 + T-cell counts. High-risk sexual behaviors, including multiple sexual partners and frequent sexual activity, associated with coinfections. These results highlight the critical need to integrate surveillance and prevention strategies for HIV and Mpox among high-risk groups.
HIV Pre-exposure Prophylaxis at a Local Public Health Department in the Southern United States: Reducing Barriers, Increasing Access, and Lessons Learned.
Saxena S, Carrico S, Eagle C … +12 more , Mazurak K, McKnight-Brown C, Davis A, Weaver P, Ryan E, Stancil C, Harris K, Allen-Pulley T, Blowe T, Zitta JP, Mortiboy M, Jenks JD
AIDS Behav · 2026 Feb · PMID 41708543 · Publisher ↗
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is a key component of a comprehensive approach to ending the HIV pandemic. Still, uptake is low for individuals most likely to derive the greatest benefi...
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is a key component of a comprehensive approach to ending the HIV pandemic. Still, uptake is low for individuals most likely to derive the greatest benefit, including underrepresented populations in the Southern United States (U.S). We initiated a rapid PrEP initiation program to increase PrEP uptake. We performed a retrospective study analyzing demographic, clinical characteristics, and rates of PrEP follow-up for individuals started on rapid PrEP at the Durham County Department of Public Health in Durham, North Carolina, U.S. We also evaluated what factors were associated with continuation of PrEP and subsequent PrEP follow-up. Overall, rates of PrEP continuation were low at 42% at 3 months. PrEP continuation was positively associated with follow-up at one of the academic medical centers in our area. Almost half of the individuals who failed to make their 3-month PrEP appointment were subsequently seen back in our Sexual Health Clinic, and these individuals were more likely to identify as female and lack health insurance. Overall, PrEP discontinuation rates were high at 3 months, likely in part due to high rates of individuals lacking health insurance in our setting. Half of the individuals who discontinued PrEP returned to our health department for sexual health services, suggesting that while offering PrEP at local health departments in the U.S. may be an important entry point for PrEP care, providing the full spectrum of PrEP care at local public health departments may improve retention on PrEP.
HIV and Pregnancy in Türkiye: Gaps and Gains in the Era of Modern ART: A Multicenter Cohort Study.
Damar Çakırca T, Kurtaran B, Aydın Ö … +28 more , Kayaaslan B, Kaya B, Karaoğlan İ, Mete AÖ, Tuna N, Ceran N, Yıldız İE, Akgül F, Ergen P, Çiçek Şentürk G, Akça V, Mermutluoğlu Ç, Öztürk Engin D, Yılmaz GR, Çelen MK, Kaya O, Akbulut A, Aşan MA, Günal Ö, Topal Ş, Öztürk Çerik H, Çabalak M, Balık R, Şenbayrak S, Vatan A, Gürkök Budak G, Candevir A, Taşova Y
AIDS Behav · 2026 Feb · PMID 41701456 · Publisher ↗
We aimed to review perinatal outcomes in HIV-positive pregnant women and their infants, as well as Turkish clinicians' approaches to the management of HIV in pregnancy. This multicenter cohort study included pregnant wom...
We aimed to review perinatal outcomes in HIV-positive pregnant women and their infants, as well as Turkish clinicians' approaches to the management of HIV in pregnancy. This multicenter cohort study included pregnant women living with HIV (WLWH) across Türkiye from 2010 to 2024. 209 pregnancies among 162 WLWH were identified. Nearly 90.9% were diagnosed before or during pregnancy, and 90% were on antiretroviral therapy (ART) at delivery. 150 women had viral loads of less than 1,000 copies/mL during labor. The most chosen ART combination during pregnancy was tenofovir/emtricitabine+raltegravir. Most common mode of delivery was cesarean section (78.9%). Among 174 deliveries, 22 (12.6%) were preterm. Regarding newborn prophylaxis, 137 (88.4%) received zidovudine and 34 received nevirapine. 14 infants were breastfed. No congenital malformation, neonatal or maternal mortality was observed. Overall, 13 infants were diagnosed HIV-positive, indicating an MTCT rate of 7.9% in this cohort. Breastfeeding (OR: 30.1, 95% CI: 4.70-193.50, p < .001) and absence of ART during pregnancy (OR: 30.9, 95% CI: 5.20-183.90, p < .001) were the most prominent variables affecting the infants' HIV positivity. Despite efficient preventative strategies announced over years, we report a high MTCT rate of 7.9%, aligning with previous literature from Türkiye. The findings highlight that the absence of ART and breastfeeding remain critical risk factors for perinatal HIV transmission. This large real-world cohort, reflecting Turkish clinicians' practices, helps define major gaps in MTCT prevention in the modern ART era and provides valuable evidence to inform clinicians, policy makers, and public health strategies.
The Role of Mobility in HIV Intervention Engagement and Community Mobilization among Female Sex Workers Living with HIV in the Dominican Republic.
De Jesus M, Schuler ER, Rivara J … +6 more , Galai N, Barrington C, Donastorg Y, Perez M, Gomez H, Kerrigan D
AIDS Behav · 2026 Feb · PMID 41701455 · Full text
Female sex workers (FSWs) are often a mobile population, but the role of mobility in influencing FSW social capital outcomes-defined here as engagement with HIV intervention activities and community mobilization-remains...
Female sex workers (FSWs) are often a mobile population, but the role of mobility in influencing FSW social capital outcomes-defined here as engagement with HIV intervention activities and community mobilization-remains unclear. To date, the evidence is mixed, with mobility both facilitating and hindering community engagement, depending on the context. This study is the first to employ a mixed-methods approach to examine how mobility impacts these outcomes. We combined baseline survey data from 211 FSWs living with HIV with semi-structured interview data from a sub-cohort of 20 FSWs in Santo Domingo, Dominican Republic. Contrary to the expectation that mobility would reduce engagement, our quantitative findings indicate that mobile FSWs were more likely to participate in various HIV interventions, such as support groups for people living with HIV, compared to their non-mobile counterparts. Additionally, mobile women were more than twice as likely to engage in community mobilization efforts, such as rallies to promote sex worker rights, even after controlling for sociodemographic variables. Many participants, despite their mobility, shared that they actively engaged in HIV-related and community mobilization activities in Santo Domingo and gained benefits from these activities. Study implications highlight the need for more sex worker-driven activities in and outside of Santo Domingo to offer mobile women greater opportunities to connect and build social cohesion, as well as the development of mobile-friendly service delivery models and apps to facilitate connections when traveling outside the capital.
Adapting and Scaling-up Peer Navigators to Targeted Populations of Street-Involved Youth in Kenya and Canada to Increase Engagement in HIV Prevention, Testing, and Treatment.
Abramovich A, Apedaile D, MacEntee K … +8 more , Oudshoorn A, Van Berkum A, Saewyc E, Ferrara A, Kiptui R, Nyambura M, Apondi E, Wachira J
AIDS Behav · 2026 Feb · PMID 41701454 · Publisher ↗
Street-involved youth (SIY), particularly those who identify as 2-spirit, lesbian, gay, bisexual, transgender, queer, or other sexual and gender diverse identities (2SLGBTQ+), are among key populations disproportionately...
Street-involved youth (SIY), particularly those who identify as 2-spirit, lesbian, gay, bisexual, transgender, queer, or other sexual and gender diverse identities (2SLGBTQ+), are among key populations disproportionately affected by HIV. We adapted and scaled-up a Peer Navigator intervention to targeted populations of SIY in six sites across Kenya (Eldoret, Huruma, Kitale) and Canada (London, Toronto, Vancouver), with the aim of increasing engagement in HIV prevention, testing, and treatment. This article presents the key quantitative findings, highlighting participant characteristics and their engagement in HIV testing and care before and after implementation of the Peer Navigator intervention. This implementation science study utilized a mixed-methods approach to investigate the adaptation, implementation, and evaluation of the Peer Navigator intervention. The PNs at each site completed study encounter forms with participants at enrollment and all follow ups between 2021 and 2024. Baseline sociodemographic characteristics were summarized separately using descriptive statistics for each study site. HIV testing and treatment outcomes are reported at baseline-reflecting participants' status prior to the intervention-and after their last encounter with Peer Navigators. A total of 686 SIY aged 16-29 years participated across all sites (Kenya, n = 631; Canada, n = 55). The Peer Navigator intervention improved access to and uptake of HIV prevention, testing, and treatment among SIY across Canada and Kenya. Participants' engagement in HIV testing increased from pre- to post-intervention across all sites, with the majority of participants reporting that they had been tested for HIV by the end of the study. This study highlights the need for access to ongoing and accessible HIV testing for all populations of SIY globally. The findings also underscore the critical need to create sustainable Peer Navigator roles to support SIY and expand the availability of widespread access to HIV testing.
Acceptability of an Integrated Model of Mental Health and PrEP Service Delivery for South African Adolescent Girls: Qualitative Results from a Pilot Hybrid Effectiveness-Implementation Randomized Trial.
Mills L, Delany-Moretlwe S, Ndimande-Khoza MN … +7 more , Chauke H, Govender N, Poovan N, Verhey R, Chibanda D, Celum C, Velloza J
AIDS Behav · 2026 Jun · PMID 41697566 · Full text
Adolescent girls and young women (AGYW) at elevated HIV risk often experience common mental disorders (CMD), which are linked to lower PrEP adherence. We piloted a CMD intervention, the Youth Friendship Bench SA (YFB), a...
Adolescent girls and young women (AGYW) at elevated HIV risk often experience common mental disorders (CMD), which are linked to lower PrEP adherence. We piloted a CMD intervention, the Youth Friendship Bench SA (YFB), and delivered alongside PrEP to improve CMD symptoms and PrEP adherence among South African AGYW. From April 2023-February 2024, 116 AGYW (18-25 years) with CMD symptoms were randomized to YFB plus standard of care (SOC) or SOC alone and followed for 12 weeks. In-depth interviews were conducted with 30 AGYW and 13 study staff and key informants. CMD screening alone was seen as beneficial, but referral uptake was low due to perceived severity thresholds, staff attitudes, and logistical barriers. YFB was highly acceptable to AGYW, who valued the intervention for being confidential, informal, and empowering. Integrated CMD and PrEP services were acceptable, and lay counsellor delivery shows promise for addressing the mental health care gap.
Repeat Behavioral Counseling, With and Without Combination Nicotine Replacement Therapy, for Smoking Cessation Among People With HIV in South Africa.
Keke C, Lebina L, Motlhaoleng K … +8 more , Niaura R, Abrams D, Variava E, Abraham P, Gupte N, Golub JE, Martinson N, Elf JL
AIDS Behav · 2026 Jan · PMID 41689618 · Full text
Repeating an intervention strategy consistent with the chronic disease care model has been demonstrated to be efficacious in improving cessation outcomes among smokers. However, evidence is lacking for repeat treatment o...
Repeating an intervention strategy consistent with the chronic disease care model has been demonstrated to be efficacious in improving cessation outcomes among smokers. However, evidence is lacking for repeat treatment outcomes among people with HIV (PWH) who smoke in low-resource settings. We evaluated outcomes among participants (n = 384) who were provided a second round of treatment after initial treatment failure in a randomized controlled trial of behavioral counseling (BC) with or without combination nicotine replacement therapy (nicotine patches and gum, cNRT). The primary outcome was self-reported smoking abstinence at 6 months after repeat treatment, biochemically verified using exhaled breath carbon monoxide (CO) and urine cotinine test. Secondary outcomes include smoking abstinence at 2 months after repeat treatment and smoking reduction, measured by changes in exhaled breath CO at 2 months and 6 months after repeat treatment. Overall, 35 (9%) participants were abstinent at 6 months post-repeat treatment, including 15 (8%) participants in the repeat BC group compared to 20 (11%) participants in the repeat BC + cNRT group. There was no significant difference in abstinence rates between repeat treatment groups (Chi Squared (χ) = 0.23; p = 0.63), including after adjusting for potential confounders [adjusted risk ratio (aRR) = 1.16, 95% CI 0.39, 3.47; p = 0.79]. Although augmenting repeat treatment of BC with cNRT may not provide additional benefits for PWH with prior treatment failure in this population, PWH in this setting may benefit from a repeat treatment strategy of BC with or without cNRT.
Migration Status and HIV Pre-exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men and Non-binary People in Australia: Results of a National Cross-Sectional Survey.
Yu S, MacGibbon J, Bavinton BR … +6 more , Calabrese SK, Murphy DA, Ellard J, de Wit J, Broady TR, Holt M
AIDS Behav · 2026 Feb · PMID 41678010 · Publisher ↗
Increasing HIV prevention coverage among migrant gay and bisexual men (GBM) and non-binary people in Australia has become a priority, as recently arrived migrants are at higher risk of HIV acquisition than longer-term Au...
Increasing HIV prevention coverage among migrant gay and bisexual men (GBM) and non-binary people in Australia has become a priority, as recently arrived migrants are at higher risk of HIV acquisition than longer-term Australian residents. We compared GBM and non-binary participants who were willing to use but had never used pre-exposure prophylaxis (PrEP) before with current PrEP users, and explored how migration status was associated with PrEP uptake. A national, online cross-sectional survey of GBM and non-binary people was conducted in June–July 2023. Migration status was measured by region of birth and length of residency in Australia. Logistic regression was used to examine migration status, along with sociodemographic, behavioural, and health characteristics, as predictors of PrEP status. Of 2046 respondents, 1907 (93.2%) were HIV-negative/untested with 947 (80.6%) currently using PrEP and another 228 (19.4%) willing to use (but never having used) PrEP. Among PrEP users and willing participants (n = 1175), 28.3% were overseas-born including 4.1% who had recently arrived in Australia (< 2 years). Among recently-arrived willing non-PrEP-users, 87.5% were not covered by Medicare (Australia’s national health insurance scheme). Compared to current PrEP users, willing non-PrEP-users were younger, and more likely to be recently-arrived migrants, identify as bisexual/queer/other, and lived in regional and remote areas. They were also less likely to be in paid employment, know other PrEP users, or report recent STI diagnosis. Free or low-cost access schemes, supported by translators, publicised through educational institutions and relevant social networks may help promote PrEP uptake among recently-arrived GBM and non-binary people.
Interest in Long-Acting PrEP by Methamphetamine Use Among Men Who Have Sex with Men in Four Western US Cities.
McMahan VM, Moreno C, Al-Tayyib A … +7 more , Ma Y, McFarland W, Sey EK, Wilson EC, Liu AY, Coffin PO, Glick SN
AIDS Behav · 2026 Feb · PMID 41678009 · Full text
Methamphetamine use is a driver of HIV among men who have sex with men (MSM) and is associated with suboptimal adherence to daily, oral PrEP. Long-acting PrEP may be a promising alternative. We analyzed data from the 202...
Methamphetamine use is a driver of HIV among men who have sex with men (MSM) and is associated with suboptimal adherence to daily, oral PrEP. Long-acting PrEP may be a promising alternative. We analyzed data from the 2023 National HIV Behavioral Surveillance survey in four western cities to assess interest in long-acting PrEP among HIV-negative MSM participants. Of 1,450 participants, 7% used methamphetamine in the past 12 months. Two-thirds were interested in long-acting PrEP (68%); with no difference in interest (χ = 1.4, p = 0.24) or prior PrEP use (χ = 0.56, p = 0.46) by methamphetamine use. A larger proportion of participants unaware of PrEP had used methamphetamine (20% vs. 7%, χ = 10.7, p < 0.01). Among those interested, a plurality preferred biannual injection (47%). We found high interest in long-acting PrEP and similar PrEP use rates, but lower awareness, among participants who used methamphetamine. However, our sample may not have been representative of those with higher-risk methamphetamine use.
Joint Associations of Undetectable=Untransmittable Awareness and Social Proximity with Sexual Decision-Making With People Living With HIV: A Cross-Sectional Study in Japan.
Miwa T, Strong C, Ku SW … +6 more , Li CW, Huang P, Wu HJ, Wakabayashi C, Yamaguchi M, Ikushima Y
AIDS Behav · 2026 Feb · PMID 41670935 · Publisher ↗
While the message "Undetectable = Untransmittable" (U=U) is increasingly recognised in Japan, its impact-together with social proximity to people living with HIV (PLWH)-on sexual decision-making remains unclear. This stu...
While the message "Undetectable = Untransmittable" (U=U) is increasingly recognised in Japan, its impact-together with social proximity to people living with HIV (PLWH)-on sexual decision-making remains unclear. This study examined whether the combination of U=U awareness and social proximity is associated with attitudes toward sex with PLWH. An online survey was conducted from November 2022 to January 2023 in Japan primarily through a gay dating app. Participants were grouped into four categories based on U=U awareness and having a friend living with HIV. Poisson regression with robust error variance examined associations with reporting that learning a potential sexual partner is living with HIV would have "no" or "little" influence on the decision to have sex. A total of 4715 HIV-negative/unknown cisgender men and gender diverse individuals who have sex with men were included (median age: 36, IQR: 29-46); over two-thirds were aware of U=U. Of all participants, 26.5% had neither U=U awareness nor friends living with HIV, 52.5% had U=U awareness only, 3.1% had friends only, and 17.9% had both. Overall, 8.3% reported no or little influence of a potential sexual partner's HIV-positive status on their sexual decision-making. Compared with those with neither factor, having both was strongly associated with accepting attitudes (adjusted prevalence ratio: 4.53, 95% CI 3.24-6.32). Having a friend living with HIV alone was also significant, whereas U=U awareness only was not. Beyond promoting U=U, fostering opportunities for meaningful interaction with PLWH may help reduce stigma in sexual contexts.
Interventions Supporting Disclosure Among Children and Adolescents Living with HIV: A Scoping Review and Realist Synthesis.
Laurenzi C, Carels C, Walker D … +3 more , Willis N, Barr-DiChiara M, Ameyan W
AIDS Behav · 2026 Feb · PMID 41665776 · Publisher ↗
HIV status disclosure remains a persistent challenge for children and adolescents aged 6-19 years. Disclosure is critical to improving treatment adherence, viral suppression, and psychosocial wellbeing, and promoting inf...
HIV status disclosure remains a persistent challenge for children and adolescents aged 6-19 years. Disclosure is critical to improving treatment adherence, viral suppression, and psychosocial wellbeing, and promoting informed decision-making. This scoping review aimed to identify evidence on interventions focused on disclosing children's and adolescents' HIV statuses to them, and those supporting them with onward disclosure. We conducted a global scoping review to identify and analyze interventions supporting HIV status disclosure to, and by, children and adolescents living with HIV, identifying 25 interventions. Interventions were categorized into (1) disclosure-specific (directly focused on disclosure) and (2) disclosure-inclusive interventions (involving disclosure within broader support). Realist methods were used to evaluate disclosure-specific interventions; narrative synthesis was used for disclosure-inclusive interventions due to their heterogeneity. Disclosure-specific interventions shared common building blocks, including recognition of autonomy and dignity, tools to enhance engagement, and integration with broader health and social support systems. These contributed to improved confidence, communication, and decision-making among children and adolescents. Disclosure-inclusive interventions frequently employed intergenerational and peer support models, alongside health system strengthening strategies. Findings revealed differences in available evidence for disclosure interventions, with limited adolescent-tailored disclosure-specific interventions and few rights-based paradigms. While interventions to promote disclosure and retention in care aimed to work within participants' support systems, fewer made efforts to bolster these systems or enhance linkages; these approaches require further evidence. Priority actions emerging from the review include enhancing training and education, adopting youth-driven and rights-based approaches, strengthening metrics, and adapting to the evolving HIV landscape.
Providers' Experiences in Implementation of Friendship Bench: A Problem-Solving Therapy-Based Mental Health Intervention Adapted for People on Methadone Maintenance Treatment Who Live with HIV in Vietnam.
Nong HTT, Nguyen HN, Tran HV … +8 more , Cao ATV, Tran TTT, Filipowicz TR, Landrum KR, Giang LM, Verhey R, Pence BW, Gaynes BN
AIDS Behav · 2026 Feb · PMID 41649734 · Publisher ↗
People who inject drugs (PWID) living with HIV in Vietnam experience a high prevalence of common mental disorders (CMDs), which negatively impact their health, treatment adherence and overall quality of life. To address...
People who inject drugs (PWID) living with HIV in Vietnam experience a high prevalence of common mental disorders (CMDs), which negatively impact their health, treatment adherence and overall quality of life. To address the mental health care needs of this vulnerable population, we adapted and piloted Friendship Bench, a problem-solving therapy-based mental health intervention, for people on methadone maintenance treatment (MMT) who live with HIV and have CMDs in 6 MMT clinics in Hanoi, Vietnam, in 2021-2023. This paper aims to explore the experience of implementing aFB and the possibility of aFB expansion from the perspectives of the intervention providers who were directly involved in the delivery of the aFB program. We conducted formal in-person interviews with aFB providers including doctors (n = 6), counselors (n = 10) and supervisors (n = 2)following aFB intervention completion. Collected data was coded using NVivo 12.0 and thematic analysis was applied. All respondents were satisfied with and praised the aFB. Most providers reported that the aFB was beneficial to both overall and mental health of the MMT patients with HIV. All counselors shared that problem-solving therapy in the aFB was new for them; nevertheless, their counseling skills improved significantly after delivering the aFB sessions. All respondents were optimistic about the expansion of the aFB in other clinics. Application of aFB as a mental health intervention for care and treatment for MMT and ART patients could be a promising approach for Vietnam to address mental health care needs for this vulnerable population. Clinical Trial Number: NCT04790201 registered 3/10/2021.
The Critical Role of Community-Based National HIV Behavioral Surveillance in the United States' Response to HIV.
Glick SN, Al-Tayyib A, Wilson EC … +9 more , McFarland W, Lipira L, Kuo I, German D, Leonard C, Mgbere O, Rivera AV, Sey EK, Wermuth PP
AIDS Behav · 2026 Feb · PMID 41632368 · Publisher ↗
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Barriers and Facilitators of Access and Adherence to Antiretroviral Therapy Among Young People Living with HIV in Shinyanga Region, Tanzania.
Ntanguligwa CA, Tilli M, Borchi B … +14 more , Kajuna O, Munishi A, Jahari C, Mgute C, Salehe IA, Strohmeyer M, Petrini V, Didonè C, Putoto G, Azzimonti G, Bartoloni A, Zammarchi L, Morigoni G, Ierardi F
AIDS Behav · 2026 Feb · PMID 41632367 · Publisher ↗
Despite advancements in antiretroviral therapy (ART) in Tanzania, adherence remains a challenge, especially among young people living with HIV (YPLHIV) aged 10-24 years. This study, conducted in the Shinyanga region of T...
Despite advancements in antiretroviral therapy (ART) in Tanzania, adherence remains a challenge, especially among young people living with HIV (YPLHIV) aged 10-24 years. This study, conducted in the Shinyanga region of Tanzania, explored the factors affecting access and adherence to ART among YPLHIV. Access to ART refers to the ability to reach, enroll, and receive HIV care and education; adherence refers to proper use of medications as prescribed. The research employed focus group discussions and in-depth interviews with YPLHIV and their caregivers. Data were transcribed and thematically analyzed using Atlas.ti software. The qualitative data analysis revealed clear categories of barriers and facilitators. Barriers to ART access and adherence included forgetfulness, lack of privacy, family instability, poverty, reflected in lack of food or water. Perceived stigma and discrimination from family, school or community members played a significant role, alongside low participation in adherence support activities. Factors facilitating ART access and adherence included disclosure of HIV status and access to social or emotional support from the family members, peers, teachers, health workers, and community members. These factors may increase knowledge about the risks of treatment failure and drug resistance, help reduce their perceived stigma and discrimination and support treatment continuity. Interventions by health workers, family members, peers, teachers-at individual and social levels-as well as by government and local health authorities-at the policy level-are needed to address the above barriers and facilitators to ART access and adherence among YPLHIV enrolled in HIV care. A pesar de los avances en la terapia antirretroviral (TAR) en Tanzania, la adherencia sigue siendo un desafío, especialmente entre los jóvenes que viven con VIH (JVVHIV) de entre 10 y 24 años. Este estudio, realizado en la región de Shinyanga en Tanzania, exploró los factores que afectan el acceso y la adherencia a la TAR entre los JVVHIV. El acceso a la TAR se refiere a la capacidad de llegar, inscribirse y recibir atención y educación sobre el VIH; la adherencia se refiere al uso adecuado de los medicamentos según lo prescrito. La investigación empleó discusiones en grupos focales y entrevistas en profundidad con los JVVHIV y sus cuidadores. Los datos fueron transcritos y analizados temáticamente utilizando el software Atlas.ti. El análisis cualitativo reveló categorías claras de barreras y facilitadores. Las barreras al acceso y la adherencia a la TAR incluyeron el olvido, la falta de privacidad, la inestabilidad familiar y la pobreza, reflejada en la falta de alimentos o agua. La percepción de estigma y discriminación por parte de familiares, compañeros de escuela o miembros de la comunidad desempeñó un papel significativo, junto con una baja participación en actividades de apoyo a la adherencia. Los factores que facilitan el acceso y la adherencia a la TAR incluyeron la divulgación del estado serológico y el acceso a apoyo social o emocional por parte de familiares, compañeros, maestros, trabajadores de la salud y miembros de la comunidad. Estos factores pueden aumentar el conocimiento sobre los riesgos de fracaso del tratamiento y resistencia a los medicamentos, ayudar a reducir la percepción de estigma y discriminación y apoyar la continuidad del tratamiento. Se necesitan intervenciones por parte de los trabajadores de la salud, familiares, compañeros, maestros-a nivel individual y social-así como por parte del gobierno y las autoridades sanitarias locales-a nivel de políticas-para abordar las barreras y facilitadores mencionados en el acceso y adherencia a la TAR entre los JVVHIV inscritos en cuidados por VIH.
Factors Affecting Access to and Utilisation of HIV/AIDS Preventive Services Among Young Single Mothers Working in Alcohol Serving Establishments in Rwanda: An Exploratory Qualitative Study.
Uhawenimana TC, Betancourt TS, Sezibera V … +1 more , Brownson RC
AIDS Behav · 2026 Feb · PMID 41629725 · Publisher ↗
Despite Rwanda's progress in HIV prevention for key populations, female employees in alcohol-serving establishments (ASEs) remain underserved, with interventions often lacking attention to the contextual factors shaping...
Despite Rwanda's progress in HIV prevention for key populations, female employees in alcohol-serving establishments (ASEs) remain underserved, with interventions often lacking attention to the contextual factors shaping their HIV risk and service uptake. Guided by the Exploration phase of the Exploration, Preparation, Intervention, and Sustainment (EPIS) framework, a qualitative study was conducted to identify contextual factors affecting HIV prevention uptake among young single mothers working in informal ASEs. In-depth interviews were conducted with 101 participants recruited through maximum variation purposive and snowball sampling. Data were analyzed thematically, with findings organized according to inner and outer EPIS contextual domains. Outer context findings revealed structural and socio-cultural barriers, including unaffordability of post-exposure prophylaxis and HIV self-testing kits, inconsistent condom availability, and gender norms limiting women's autonomy in sexual health decision-making. Inner context findings highlighted workplace-related challenges, such as limited support from establishment owners, absence of HIV prevention resources within venues, and the influence of male partners and clients on women's ability to negotiate safer sexual practices. Facilitators across both contexts included HIV risk awareness, fear of unintended pregnancy, and aspirations for improved economic and social futures for themselves and their children. By systematically examining contextual influences during the EPIS Exploration phase, this study addresses a critical gap in HIV prevention research among an underserved population. These findings can inform the development of context-responsive behavioral and structural interventions aimed at improving HIV prevention uptake and addressing workplace, social, and structural drivers of HIV vulnerability in ASEs.
Transition to Adulthood and Adult Care: Lived Experiences of Young Adults with Perinatal HIV in the Netherlands.
Sattoe JNT, Weijsenfeld A, van Balen N … +2 more , van der Knaap L, van Staa A
AIDS Behav · 2026 Feb · PMID 41627699 · Publisher ↗
The transition from adolescence to adulthood is a critical phase for young people living with perinatal HIV, who must navigate typical developmental milestones while managing a chronic illness and facing (fear of) societ...
The transition from adolescence to adulthood is a critical phase for young people living with perinatal HIV, who must navigate typical developmental milestones while managing a chronic illness and facing (fear of) societal stigma. This qualitative study explored the lived experiences of Dutch young adults (aged 20-30) with perinatal HIV, focusing on their transition to adulthood and from pediatric to adult care. Semi-structured interviews were conducted with 11 participants. While the findings are based on a small, self-selected sample and are not intended to be statistically representative, they offer in-depth insight into key challenges during transition. The findings highlight the profound impact of stigma and selective disclosure of HIV-status. Parental support was important but complex, especially when views on disclosure differed. Peer contact could provide a sense of connection, though many did not feel the need for ongoing involvement. Participants described challenges in social and professional contexts. Experiences with the transition to adult care varied, with more recent transfers being more positive. Valued key elements of transitional care included support from nurse specialists, meeting the adult provider beforehand, and a warm welcome in adult care. Despite stable medical management, the psychological burden of stigma and fear of disclosure remained significant. These findings underscore the need for tailored transition programs addressing medical, psychosocial and emotional needs, including psychological support, structured attention to family dynamics, pre-transfer meetings with adult providers, and peer support.
Prevalence of and Time to Suboptimal Treatment Patterns Among People with HIV on Antiretroviral Therapy in the United States.
Lim T, McDwyer P, Zachry W … +2 more , Christoph MJ, Weinberg AR
AIDS Behav · 2026 Feb · PMID 41627698 · Publisher ↗
Modern antiretroviral therapy (ART) regimens have increased life expectancy and improved quality of life in people with HIV (PWH). However, the necessity for lifelong ART use presents adherence and persistence challenges...
Modern antiretroviral therapy (ART) regimens have increased life expectancy and improved quality of life in people with HIV (PWH). However, the necessity for lifelong ART use presents adherence and persistence challenges. Recent population-level data regarding such challenges with contemporary daily oral ART regimens are limited, particularly in the United States. This observational, retrospective, noncomparative cohort study used data from HealthVerity MarketPlace closed medical and pharmacy claims from PWH ≥ 18 years of age (treatment naive or treatment experienced) who were insured in the United States. Eligible PWH had ≥ 2 pharmacy refills for a Department of Health and Human Services (DHHS) guideline-recommended complete daily oral ART regimen between January 1, 2016, and November 30, 2023, with ≥ 365 days of continuous baseline enrollment and ≥ 180 days of follow-up. The index date was the date of the first recorded pharmacy claim for a complete ART regimen, regardless of prior treatment experience. Rolling adherence was measured using the Continuous, Multiple Interval Measure of Medication Acquisition method that compared the timing of prescription fills versus the number of days the prescription was intended to last, within blocks of 90 days. Suboptimal adherence was defined as proportion of days covered < 85%. Treatment interruption was defined as a gap in ART medication supply of > 90 days, followed by resumption of ART at any point, with combined treatment interruption/discontinuation defined as a > 90-day gap in ART medication supply, regardless of whether ART was restarted. Switching between DHHS guideline-recommended ART regimens and from DHHS guideline-recommended to nonguideline-recommended ART regimens was also evaluated. A total of 73,533 PWH were included in the study (60,062 [81.7%] treatment naive and 13,471 [18.3%] treatment experienced). The proportion of PWH on treatment for ≥ 1 year who remained adherent during all 90-day blocks decreased from 40.2% (95% confidence interval [CI], 39.6%-40.8%) by the end of Year 1, to 24.2% (95% CI, 23.7%-24.6%) at the end of Year 2, and to 17.7% (95% CI, 17.3%-18.1%) at the end of Year 3 when standardized by age group-sex-region. The standardized annual prevalence of suboptimal adherence remained relatively constant between 2017 and 2022 (46.7%-53.2%). The standardized proportion of PWH who persisted on daily oral ART without treatment interruption was 81.2% (95% CI, 80.8%-81.6%) after 1 year, 74.1% (95% CI, 73.7%-74.6%) after 2 years, and 70.6% (95% CI, 70.1%-71.1%) after 3 years. Switching between DHHS guideline-recommended daily oral ART regimens remained below 10% between 1 and 3 years of follow-up and was similar for switches from guideline-recommended to nonguideline-recommended daily oral ART regimens. The findings of this study suggest that suboptimal adherence to daily oral ART remains a challenge, even with the availability of modern regimens.
PrEPSteps: A Pilot Randomized Controlled Trial to Assess the Feasibility and Acceptability of a Digital Pill-Based PrEP Adherence Intervention in Men Who Have Sex with Men with Substance Use Disorder.
Chai PR, Lee JS, Goodman GR … +12 more , Albrechta H, Hokayem J, Loo L, Mohamed Y, Glynn TR, Rosen RK, Mayer KH, Boyer EW, Alpert P, Buffkin E, Carnes C, O'Cleirigh C
AIDS Behav · 2026 Feb · PMID 41627697 · Full text
One of the key pillars of Ending the HIV Epidemic is ensuring adherence to oral HIV pre-exposure prophylaxis (PrEP). Men who have sex with men (MSM) who also have substance use disorders experience multiple challenges to...
One of the key pillars of Ending the HIV Epidemic is ensuring adherence to oral HIV pre-exposure prophylaxis (PrEP). Men who have sex with men (MSM) who also have substance use disorders experience multiple challenges to maintaining PrEP adherence. We developed a digital pill system (DPS) linked to a personalized adherence intervention, PrEPSteps, to address barriers to PrEP adherence, and tested the feasibility and acceptability of this system, as well as its potential for an effect on PrEP adherence. We enrolled MSM with moderate to severe substance use disorder who were on oral PrEP in a two-arm pilot randomized controlled trial. Both arms received the DPS co-encapsulated with oral PrEP. Participants in the intervention arm also received "PrEPSteps" - a personalized cognitive-behavioral adherence intervention. Primary outcomes were feasibility and acceptability of DPS + PrEPSteps. To explore potential intervention effects, adherence changes from baseline to 3-month follow-up were compared across arms. At 6-month follow-up, adherence was assessed via self-report. Thirty-six participants were enrolled, 32, completed the run-in period, 28 were randomized, and 27 completed the 3-month intervention period. Of those, 26 completed six-month follow-up. Operation of the DPS and PrEPSteps was feasible, with consistent data recording throughout the 3-month intervention period. Qualitative interviews in the intervention arm at 3 months demonstrated PrEPSteps was acceptable. Intervention arm participants had 14% higher PrEP adherence (b = 13.67, 95%CI [.77-26.57], p = .039) at 3 month follow up. This effect persisted at six months, suggesting that PrEPSteps has the potential to improve PrEP adherence and help individuals sustain adherence benefits over time.Trial registration: www.ClinicalTrials.gov identifier: NCT03512418.
Developing a Toolkit to Support Dissemination and Implementation of the Red Carpet Entry Program.
Holt SL, Ortiz A, Rivell A … +6 more , Vu KL, Mullen N, Jordan A, Galindo CA, Betts JE, Gelaude D
AIDS Behav · 2026 Feb · PMID 41627696 · Full text
The Red Carpet Entry (RCE) program is an evidence-informed structural intervention to improve linkage to HIV care within 72 h of diagnosis. In this paper, we review a rigorous, novel approach for evaluating an implementa...
The Red Carpet Entry (RCE) program is an evidence-informed structural intervention to improve linkage to HIV care within 72 h of diagnosis. In this paper, we review a rigorous, novel approach for evaluating an implementation toolkit to support adoption and effective implementation of RCE. We fielded and evaluated an RCE implementation toolkit at two clinic sites over an 8-month period. We evaluated the toolkit by assessing implementation processes, contexts, and outcomes at each clinic site, and by surveying and interviewing key implementation staff (n = 9) to solicit their feedback on the toolkit routinely throughout program implementation. This study offers preliminary evidence that the toolkit can support effective implementation of RCE and bolsters evidence regarding the impact of RCE on linkage to care. Both clinics used the toolkit to implement the RCE program with a high degree of fidelity-clients received 85-100% of intended RCE services at the clinic sites. Moreover, as a result of implementing RCE, one site saw an improvement in linkage to care from 68% at baseline to 77% during the implementation period. Staff reported that toolkit components were well-designed for communicating key information but needed to be more succinct and easier to navigate to increase their utility for busy clinic staff. We refined the toolkit to incorporate key lessons learned from our evaluation. Toolkits, especially those that have been tested with program implementers and are informed by evidence regarding implementation and client outcomes, are a critical tool for supporting the integration of evidence-based practices into routine healthcare.
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