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Challenges and Opportunities in HIV

Challenges and Opportunities in HIV

Urada, L. A., McClung, M., Brocklin, R., & Blumenthal, J. (2022c)


Background: Peer navigation is an evidence-based model for engaging and retaining women living with HIV in medical care. Participants of an adapted Lotus peer navigation group intervention were hypothesized to have more self-perceived HIV self-care and advocacy behaviors following their participation than non-Lotus participants at an agency serving cisgender women and their families affected by HIV in San Diego, California.

Methods: The peer navigation intervention, Lotus, was adapted to include new modules on substance use, human trafficking, and intimate partner violence and piloted to compare its overall effects with a comparison group (2018-2019). Ninety-five cisgender women living with HIV (WLWH) completed posttest surveys measuring their perceived changes in peer advocacy and self-advocacy following their participation in a pilot of an adapted Lotus. Participants of the four-session Lotus group intervention (n=34) were compared to non-Lotus participants who engaged in other types of group activities at the agency (n=61). The Lotus group participants included a cohort of cisgender women > 50 years old, English and Spanish speaking women, and a mixed age and race/ethnicity group. All clients of Christie’s Place, an organization for women living with HIV in San Diego, were eligible if they were not actively using illicit substances substances in the past year. Cross-sectional bivariate analyses were run to determine differences between intervention and comparison groups. The groups were not randomized.

Results: Among 95 participants, 17% were White, 14% Black/African American, 44% Hispanic/Latino, and 25% Other/Mixed race/ethnicity with median age 51 years (IQR: 45-60). Eleven Latina, 9 White, 6 Black/African American, and 8 Other/Mixed individuals participated in Lotus. In bivariate analyses, Lotus WLWH living with HIV at posttest took their HIV medications correctly (p=0.040) and attended their healthcare/other service appointments as advised/scheduled 3 times more often than non-Lotus WLWH (p=0.014). They advocated for themselves within medical and social service settings 6 times more often (p<0.001) and talked openly with their doctor 4 times more often (p=0.028). They were also twice as likely to talk more often with their partner about safer sex (p=0.022) and PrEP (p=0.037) and a peer about safer sex (p=0.001). They were 3 times more likely to help a peer understand how HIV medications can improve their health (p=0.001). Medical records showed all Lotus intervention participants as virally suppressed one year after their participation.

Conclusions: Participants of an HIV peer navigation intervention experienced significant changes in self-reported self-advocacy outcomes. Peer navigation training interventions remain critical for medication adherence and self-advocacy among cisgender WLWH.

Katbi, M., Fom, T., Adedoyin, A., Klindera, K., Asaolu, O., Magaji, D., Agweye, A., & Faturiyele, I. (2023b)


Background: Pre-exposure prophylaxis (PrEP) is recommended for people at substantial risk of acquiring HIV to prevent new infections. The Nigeria PEPFAR program through USAID funded the implementation of PrEP for Key Population (KP) groups including Men Who Have Sex with Men (MSM), People who inject drugs (PWIDS), and Female sex Workers (FSW) in July 2020. We assessed the number of new infections averted and the financial resources saved because of this intervention.

Methodology: HIV-negative clients from the key population community in North- East Nigeria eligible for PrEP were enrolled over a 7-month period (July 2020 – February 2021). Eligibility criteria used include being at substantial risk for HIV infection based on a screening test administered. The person-month was calculated by using the duration the participants were retained on PrEP. The incidence 15.4/100 person-years of HIV among MSM at high risk of HIV infection in the TRUST study conducted in Nigeria was used to calculate the expected positive cases if PrEP was not provided for those enrolled using the formula (15.4/100 * X) where X is number of person-years. We compared the expected positive to the actual positive seen among KPs while on PrEP within the study period. The cost-effectiveness of being on PrEP was calculated by multiplying the standard cost per HIV infection averted ($13, 267 per HIV infection averted) by the No of HIV averted.

Results: We enrolled a total of 1,197 eligible HIV-negative KPs within the study period (189 were retained for seven months, 407 for four months, 585 for 3 months, and 18 for 1 month). A total of 4722 person-months (394 person-years) were accumulated over the period of the study. Using the incidence of 15.4/100 person-years, the expected positive cases if PrEP was not provided was 61 (15.4/100 *394). With the use PrEP, no client seroconverted to be HIV positive. This means that within the 7-month period, 61 HIV infections were averted. At the cost of $13,267 per HIV infection averted for PrEP, the project saved $809,287 for averting 61 HIV infections in seven months of using PrEP among HIV-negative KPs involved in high-risk behaviors.

Conclusion: This study shows that PrEP is effective in averting new infections among key population groups. Placing high-risk groups such as KPs on PrEP is cost-effective due to the money saved from new infections averted. Increased funding for proven and innovative strategies on PrEP enrolment, retention, and adherence of eligible clients should be expanded for KPs.

Okoro, N., Shanasha, O., Nambangi, N., Ballay, K., Rotich, C., Boumi, E., & Gobina, N. (2023)


Background: Incidence rates of HIV are higher among African-born immigrants than in the general US population. In Minnesota, African-born immigrant women accounted for 40% of all adult females (as assigned by birth) living with HIV and 39% of new diagnosis in 2021, while constituting only 2% of the female population. Findings from a preliminary study point to gender-specific, sociocultural factors as drivers of HIV in this population. Key among these is the lack of sexual and reproductive health knowledge, consequent to cultural norms that regard sex-related discussions as taboo, making African women particularly vulnerable to HIV infection. Conventional HIV prevention programming has not been effective as these approaches lack cultural congruence. In the absence of culturally responsive strategies, AB women are likely to remain at significant risk of HIV.

Program Description: This report is a description of the process and key elements employed in developing a curriculum for culturally-responsive, community-based sexual and reproductive health education for HIV prevention among African-born women. The Curriculum Design Team (CDT) of five (5) AB immigrant women adapted and augmented the Becoming A Responsible Teenager (BART) curriculum and developed a culturally congruent theoretical framework to guide programming. Feedback on the curriculum and programming was sought from community members through focus groups with African-born men and women, respectively.

Recommendations: Feedback from community-engaged efforts included alignment with cultural norms and values regarding the roles and influence of women; ensuring cultural appropriateness of content and delivery; racial-concordance of facilitators and participants; and use of informal social group setting as critical elements to facilitate engagement of African-born women in the proposed approach to HIV prevention in this population.

Amos, M, & Naomi, W. (2024)


Objective: The objective of the study was to investigate the Sexual and Reproductive Health (SRH) issues among Adolescents Living with HIV (ALHIV) in Gweru rural district in Zimbabwe.

Design: A cross sectional mixed method research design was used with qualitative and quantitative methods.

Setting: The study was conducted in Gweru rural district community.

Subjects: A total of 112 questionnaires were administered to ALHIV, four focus group discussions (FGDs) were conducted with ALHIV in Gweru rural district, and six key informant interviews with key informants were held at district and national levels.

Results: All respondents were not in relationships, while 94 percent lacked general understanding of relationships. All respondents reported that they were not sexually active, although 62 percent intend to have sex in future. Seventy-eight percent lacked comprehensive knowledge of HIV transmission. Respondents were aware of few modern contraception methods namely female condoms (39 percent), male condoms (37 percent) and the pill (25 percent). Adolescents Living with HIV (ALHIV) mainly access HIV related services in Gweru rural district. There is limited access to SRH services besides HIV treatment as 41 percent of ALHIV reported talking to a health service provider about SRH issues such as sexuality, family planning, condoms, sexually transmitted infections, pregnancy and childbearing.

Conclusion: The key SRH issues facing ALHIV include lack of comprehensive knowledge on SRH issues, such as sexuality, relationships, prevention of HIV re-infection, pregnancy and childbearing and family planning. There is also limited access to SRH services. Adolescents living with HIV in Gweru rural district face barriers to accessing SRH services at policy, programmatic, community, family and individual levels.

Figueiredo, I., Martins, M., Midões, C., & Ferrão, J. (2022b)


Opportunistic infections affect patients with immunocompromised status and are caused by common microorganisms with more severe presentations, or atypical organisms that do not cause disease in the immunocompetent. The type of infection varies with the type of immune dysfunction.

Patients with cell-mediated immune dysfunction tend to be infected with a range of viral infections, intracellular bacteria, and fungi. This contrasts to patients with defects in humoral immunity, where infections with encapsulated bacteria, and enteric organisms such Giardia lamblia and enteroviruses predominate. Patients with phagocytic defects are especially prone to infections with Gram-negative bacteria and fungi, whilst those with complement disorders are prone to recurrent infections with encapsulated bacteria. In contrast to patients with primary immunodeficiencies, which usually present with only one defect of the above, acquired immunodeficiencies present with a variety of those, and clinical presentations are diversified.

The epidemic of HIV and AIDS shed some light into infections that were before extremely rare, by making them frequent, but with the advent of anti-retroviral therapy their clinical presentation has shifted. Also, the emergence of novel immunotherapies for cancer and autoimmune diseases, allied with an increase in organ transplant has increased the pool of immunosuppressed patients without HIV, which present differently regarding opportunist infections.

Rapid and specific microbiologic diagnosis is essential. Newer microbiologic assays have improved the diagnosis and management of opportunistic infections.

Our aim was to revise and summarize the most frequent opportunist infections, and how their presentation and course compares in different immunosuppressed diseases (HIV and non-HIV).

Asaolu, O., Alawode, G., Ajike, S., Ogunsanmi, O., Bello, M., Ibitoye, J., Oyeyemi, A., Adeniran, A. A., Emeka, C. I., Obembe, O., Ojelade, O., Asaolu, O., Ugwu, A., Obanubi, C., Abubakar, A., Asaolu, A., Asaolu, O., Nalda, N., Amao, A., . . . Agbede, C. (2023)


Medication adherence and antiretroviral therapy retention are required for successful durable, virologic suppression and treatment outcomes among youths. The use of peer-led health education in increasing medication adherence and antiretroviral therapy retention has been advocated. Therefore, this study investigated the effect of peer education on medication adherence and antiretroviral-therapy retention practices among Youth Living with HIV in Niger state, Nigeria. The study was a quasi-experimental design in two selected hospitals. One hospital was assigned to a one-hour peer-led health education session for six weeks, and the 2nd served as the control group. Data were collected at baseline, immediate post-intervention, and at the sixth-week follow-up. Data were analyzed using descriptive and inferential statistics at a 0.05 level of significance.

Majority of respondents practice Islam and are within the ages of 20-24 years (control: 100%, 89%; intervention: 83%, 73%), from the Hausa Ethnic group (control: 62%; intervention: 56%). Majority of respondents in the control group have Islamic education (50%) and Secondary education (50%), while the majority of those in the intervention group have primary education (35%), secondary (29%), tertiary (19%) and Islamic (17%) respectively. Medication adherence and ART retention was higher in the intervention group (27%, 16%) compared with the control (17%, 9%). A significant association between knowledge and perception due to peer education on medication adherence was found (24%, 80%) in the intervention group and (11%, 36%) in the control group. Subsequently, the 6th week follow-up sustained findings from the intervention period on medication adherence and ART retention (27%, 16%) in the intervention group compared with control group (17%, 9%). Similarly, knowledge and perception follow-up post intervention was sustained (24%, 80%) in the intervention group and (11%, 36%) in the control group.

Interventions leveraging peer-led health education enhanced HIV medication adherence and antiretroviral therapy retention practices among youths. Thus, we recommend scale-up of the structured peer-led curriculum and integration into the health systems to improve health outcomes among HIV positive youths, achieve epidemic control and accelerate progress for the UNAIDS 95:95:95 goals.

Sabato, T. M. (2022)


Asian American Pacific Islanders (AAPI) are the fastest growing ethnic group in the United States.  Despite such growth, AAPI face considerable challenges to HIV prevention, treatment, testing and care. The development of multilevel and multi-strategy approaches to education, prevention, and treatment requires an understanding of personal and cultural barriers, as well as implementation of culturally sensitive and specific measures.  The purpose of this article is to highlight barriers to HIV-related prevention, treatment, and care for AAPI and provide practical, application-based suggestions which may facilitate greater inclusion of AAPI in the continuum of HIV care.

De Oliveira, D. C., Cecilio, H., Apostolidis, T., Da Costa, T. R., Hipólito, R., De Oliveira, D., Domingues, J. O., Stefaisk, R., Machado, Y., Gomes, A. M. T., & Marques, S. C. (2022b)


Background: Time perspective can be an important variable for the understanding the quality of life of people living with HIV/AIDS.

Aims: The objective was to examine the relation between quality of life and time perspective among persons living with HIV receiving care from public health services in Brazil.

Methods: Data were collected at four public health services in Brazil. Hierarchical regression analyses were then performed for each of six quality of life domains.

Results: The subscales associated with high quality of life in physical and level of independence domains were low past-negative and high future orientation; psychological and environmental domains were low past-negative, high past-positive and high future orientations; social relations domain were high past-positive and high future orientations; and spirituality, religion and personal beliefs domain was low past-negative orientation.

Conclusion: The hypothesis that time constructs have implications for the experience of the disease and for evaluation of quality of life was proven determined by positive orientations like future and past-positive and past-negative orientation.

Abbas, U. L., Dickson, A., Gilmore, D., Bamberger, D. M., & Scott, H. (2022)


Preexposure prophylaxis is a powerful biomedical intervention for prevention of human immunodeficiency virus. However, its implementation has been slow and uneven in the United States. Research into innovative agents, formulations and implementation, for preexposure prophylaxis, is ongoing, and a number of new and improved methods of delivery have been developed. However, the delivery of preexposure prophylaxis primarily by nurses, has not received much attention. We overview the global evidence and programs for nurse-led preexposure prophylaxis, and propose this as a feasible and promising implementation strategy for the United States.

Philippou, K., Kyriakou, M., Middleton, N., Charalambous, A., Raftopoulos, V., Constantinou, M., & Lambrinou, E. (2023)


A comorbidity like diabetes mellitus (DM) complicates heart failure (HF) self-care management and adherence to the therapy and results poorer clinical outcomes. This study aims to examine the various factors influencing adherence to the therapy of patients with HF and DM. A systematic literature search was established in the electronic data basis PubMed, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using inclusion and exclusion criteria. The search yielded eight articles. The introduction of empowerment models in the management of patients with HF and DM made patients more involved in their self-care management and their self-monitoring behavior and adherence were increased. Patients with HF and DM during their hospitalization, were less likely to receive smoking cessation counseling and blood pressure control and experienced longer length of stay. Patients with HF preserved ejection fraction (HFpEF) and DM were less likely to receive an angiotensin convertive enzyme (ACE) inhibitor or angiotensin receptor or beta-blockers and had worse blood pressure (BP) control compared with patients with reduced ejection fraction (HFrEF) and DM. Effective self-care management of patients with HF and DM seems to depend on the type and the severity of comorbid conditions and the availability of effective therapies. Adequate support to patients with HF and DM from health professionals (HPs) is important, in order to establish self-management and adherence to the therapy.

Sánchez, J., & Hibbert, J. M. (2023)


Background: Latino and Latina migrant workers constitute a vast amount of the agricultural workforce within the United States. A few studies indicate that a significant segment of the Latino migrant worker population in the United States is at high risk for alcohol abuse and related high-risk behaviors. Information about the prevalence of alcohol use and abuse and its association with high-risk sexual behaviors is needed to design effective prevention strategies in this underserved population.

Aims: To assess the association between alcohol use and high-risk sexual behaviors in this population.

Methods: Cross-sectional data was obtained from March 2018 through December 2019 as part of a study entitled “Project Salud: HIV Prevention among Latino Migrant Workers in Florida.” Study participants were recruited from neighborhoods and migrant camps in the Immokalee area in Central Florida by means of a stratified network-based (snowball) sampling design. Of the 782 screened participants, 671 (86%) met eligibility criteria and consented to participate in the study. Participants were grouped based on ‘‘no alcohol use” “alcohol use” and ‘‘binge drinking.”

Results: More than one-third (36.2%) of the sample reported no alcohol use during the last 30 days prior to the interview. The rest of study participants reported alcohol use (28.5%) and binge drinking (35.3%). Binge drinking was more common among male participants compared to their female counterparts (41.6% vs 29.6%). Among Latino migrant workers, rates of high-risk sexual behaviors in the last 30 days were generally high and did not vary as a function of alcohol use. Among Latina migrant workers, rates of vaginal sex were high for all study participants, but this behavior did not vary as a function of alcohol use.  However, binge drinking was found to be significantly associated with increase rates of anal sex and multiple sex partners.

Conclusion: High-risk sexual behaviors are prevalent in the Latino migrant worker community.  Among Latina migrant workers, these behaviors significantly increase among those who engage in binge drinking.  Further research on the intersection of alcohol use and high-risk behaviors in the Latino migrant worker community, especially among Latina migrant workers, is necessary to develop and implement appropriate interventions.

Chen, P., & Han, S. (2022c)


Hepatitis B (HBV) in special populations within this article is considered as acute on chronic liver failure due to HBV, coinfection with Hepatitis C (HCV), Hepatitis D (HDV), or Human Immunodeficiency Virus (HIV), and HBV infection in patients who are in immunosuppressive states due to specific therapies and liver transplant recipients. Patients within these special populations are at higher risk of liver-related complications such as fibrosis, accelerated cirrhosis, acute on chronic liver failure, and/or development of hepatocellular carcinoma (HCC). Given their respective complex pathophysiology, specific treatment approaches are required for each population. With the introduction of effective antiviral HBV therapies over the past decade and the respective treatment options for the special population diseases, patient outcomes have seen improvement. With the advent of HCV direct antivirals, treatment of HBV-HCV coinfection has been more successful and consistently shown high rates of sustained virologic response. Treatment of HBV-HDV coinfection remains primarily as interferon-based, though new promising therapies have shown greater improvement in viral suppression. HBV-HIV coinfection has also shown promising results given overlapping mechanisms for treatment and specific regimens should be chosen to decrease risk of resistance. HBV reactivation in patients undergoing immunosuppressive therapies have been reported and guidelines recommend close monitoring and in certain cases, HBV antiviral therapy prophylaxis. With the effective HBV therapies, the perception of HBV as a contraindication for liver transplant has been diminishing and prolonged graft survival with effective antiviral therapies have shown promising outcomes.

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