HIV Care Continuum Research Articles

Cannabis use and HIV among Black sexually minoritized men: a systematic review and narrative analysis.

We conducted a systematic review evaluating the extant literature examining the impacts of cannabis use on HIV-related outcomes among Black sexual minoritized men (BSMM). Systematic review. We conducted a search in November 2024 of PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science using keywords related to BSMM, HIV, and cannabis. Study quality was assessed utilizing a tool developed for observational studies. 108 unique articles were screened with 55 undergoing full-text review, and 20 met inclusion criteria. Results were synthesized and presented utilizing a narrative review process. We identified 20 studies published between 1999-2024. Measures of cannabis use included any use (e.g., ever, past 30 days), daily/intermittent/heavy use, use before/during sex, and problematic use. Outcomes included: HIV positivity/seroconversion, HIV Continuum of Care (CoC), PrEP CoC, and sex behavior strengths, vulnerabilities, and assets. Study findings were generally mixed, however positive associations between cannabis use and HIV seroconversion, inconsistent condom use, being HIV-positive and unaware of one's serostatus, and suboptimal ART adherence were reported. This systematic review identified a growing literature on cannabis use and HIV among Black SMM. Conclusions that can be drawn from the evidence are limited. There is a critical need for studies that more rigorously measure cannabis use by considering contexts of cannabis use. In addition, there is a need for research that examines the pathways and mechanisms through which cannabis use may affect prevention and treatments outcomes related to HIV among Black SMM.

Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

ABSTRACT We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.

Characterizing disparities in the HIV care continuum among U.S. transgender and cisgender medicare beneficiaries, 2008–2017

ABSTRACT Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008–2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender (male, female) beneficiaries with HIV and explored within and between gender group differences in the predicted probability of engagement in the HIV Care Continuum. Transgender and gender-diverse individuals had a higher predicted probability of every HIV-related care outcome vs. cisgender individuals, with TFN individuals showing the highest probability of HIV care visit engagement, sexually transmitted infection screening, and antiretroviral treatment receipt and persistence. Notably, except for sexually transmitted infection screening, cisgender females and TMN people had a slightly lower probability of engaging in HIV-related care than TFN people and cisgender males. Although transgender and gender-diverse beneficiaries living with HIV had better engagement in the HIV Care Continuum than cisgender individuals, findings highlight disparities in engagement for TMN individuals and cisgender females, though engagement was still low for Medicare beneficiariesof all genders. Interventions are needed to reduce HIV care engagement barriers for all Medicare beneficiaries.

Chronic Pain, Mental Health, and Sense of Purpose in Life Among Women Living with HIV Compared to HIV-Negative Women in the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study.

Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.

P-472. Development of a Local HIV Care Continuum for the Kansas City Metropolitan Area (KCMA)

Abstract Background There were 36,136 new HIV diagnoses in the USA in 2021. Still, an estimated 13% of persons living with HIV (PLHIV) are unaware of their infection. The status of the HIV epidemic can be better understood by constructing an HIV care continuum.Figure 1.Diagnosis-Based KCMA HIV Care Continuums 2019-2022Local diagnosis-based care continuums for 2019-2022 compared with the most recent national HIV surveillance data. Methods HIV surveillance data reported to the Kansas Department of Health and Environment (KDHE) and Missouri Department of Health and Senior Services (DHSS) were utilized to create diagnosis-based HIV care continuums for 2019-2022. This included data from Johnson, Wyandotte, and Leavenworth counties in Kansas, and Jackson, Clay, and Platte counties in Missouri. Prevalence-based care continuums were constructed for Kansas City, Missouri for 2019-2021 utilizing the CD4-depletion model employed by CDC. Diagnosis, receipt of care, retention in care and viral suppression are per CDC definitions.Figure 2.Prevalence-Based Kansas City, MO HIV Care Continuums 2019-2021Local prevalence-based care continuums for 2019-2021 compared with the most recent national HIV surveillance data. Results From 2019 to 2021, receipt of HIV care in KCMA remained stable, while retention in care (49% to 41.6%) and HIV viral suppression (65.6% to 57.2%) decreased (Figure 1). From 2019 to 2021, HIV diagnosis rates in the 3 counties of Kansas City, Missouri, remained stable at about 87%, but receipt of care rates decreased (41.7% to 35.9%), with stable viral suppression rates (∼54%) (Figure 2). Linkage to care improved from 70% to 75% for the 6-county KCMA from 2019 to 2022 (Figure 3).Figure 3.KCMA Linkage to HIV Care 2019-2022Local linkage to HIV care estimates compared with the most recent national linkage to care estimates. Conclusion Knowledge of status appeared to approximate national estimates. However, linkage to care was significantly lower (70-75% vs 82%), which likely negatively impacted downstream stages of the continuum. Local estimates for receipt of care, retention in care, and viral suppression were consistently below national levels. This highlights the importance of ongoing initiatives targeted at the more proximal stages. Reaching undiagnosed PLHIV requires a robust public health infrastructure which utilizes innovative diagnostic approaches to meet at-risk individuals in the spaces where they live and interact. Optimizing more distal stages of the continuum is contingent upon ongoing efforts to ensure all diagnosed PLHIV are efficiently linked to care and started on antiretroviral therapy (ART) in a timely fashion. Disclosures Wissam El Atrouni, MD, ViiV Healthcare: Advisor/Consultant

P-458. Factors Associated with Completion of High-Resolution Anoscopy in a Cohort of Transgender Women – Findings from a Mixed-Methods Study

Abstract Background Guidelines recommend anal cancer screening in transgender women (TGW) – particularly those living with HIV (LWH) - using anal cytology followed by high-resolution anoscopy (HRA) in those with abnormal results. This study examines factors associated with completion of HRA in TGW with abnormal cytology. Methods We recruited 80 TGW using convenience sampling from 4/2021 – 9/2023. We collected survey data, serum samples, and anal swabs for cytology and HPV testing. TGW with abnormal cytology were scheduled for off-site HRA. Non-completion of HRA was defined as being scheduled for HRA but not completing it within 3 months of cytology result. We conducted semi-structured interviews with 8 TGW who completed HRA and 8 who didn’t complete HRA. We used chi-square tests and the weaved approach to compare factors associated with HRA completion from quantitative and qualitative data. Results Of 75 TGW with anal cytology collected, 48% had abnormal results and of those 39% completed HRA (Figure 1). Of 36 TGW with abnormal cytology 97% were black, 61% were unstably housed, 78% were LWH. In the last year, 48% engaged in transactional sex and 69% in receptive anal sex (Table 1). HRA completion was associated with being employed (p=0.01) and, among TGW LWH, an undetectable HIV viral load (p=0.01) (Table 1). Qualitative data identified patient-provider trust as a facilitator to HRA completion and experiences of stigma or discrimination related to gender identity as a barrier to HRA completion (Table 2). Mixed-methods analysis revealed that socio-economic challenges, including housing, and financial factors – notably health insurance - were a barrier to HRA completion (Table 3). Conclusion In a cohort of TGW, we found high rates of abnormal anal cytology and low rates of HRA completion, highlighting missed opportunities for anal cancer prevention. Interventions aimed at improving anal cancer screening and linkage to HRA for TGW must be intentional about eschewing stigma and creating environments affirming of gender identity, while addressing barriers to care due to prevalent socioeconomic challenges. Additionally, TGW LWH with a detectable HIV viral load may require further targeted interventions to improve both the HIV care continuum and the anal cancer screening cascade. Disclosures Shyamasundaran Kottilil, MD PhD, CDA Foundation: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Orsobio: Advisor/Consultant|Orsobio: Stocks/Bonds (Private Company)|Red Queen Therapeutics: Advisor/Consultant Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support

379. Potential clinical and economic impact of cutbacks in the United States President's Emergency Plan for AIDS Relief Program in South Africa: a modelling analysis

Abstract Background The US PEPFAR program is one of the most successful global health initiatives ever undertaken. However, congressional reauthorization is unclear. We evaluate the clinical and economic impact of scaling back PEPFAR funding ($460 million) from South Africa’s HIV budget ($2.60 billion) in 2024. Methods Using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model, we examine 100% (PEPFAR_100%), 50% (PEPFAR_50%), and 0% (PEPFAR_0%) PEPFAR funding cutbacks among South African adults (HIV prevalence: 16.2%; incidence: 0.32/100PY [person-years]) using published HIV care continuum data (Table 1) and PEPFAR funding estimates. We model proportional decreases in HIV diagnosis (26.0, 24.3, 22.6/100PY), treatment (one-year engagement among people with HIV [PWH] on/initiating antiretroviral therapy: 92.2%/80.4%, 87.1%/76.0%, 82.0%/71.5%), and primary prevention (4.0%, 2.2%, 0.5% reduction in incidence with no programming [1.24/100PY]) (Table 2). We project new HIV infections and HIV-related deaths over 10 years, life expectancy and HIV-related lifetime costs in 2023 US dollars from a modified societal perspective. We vary key parameters and assumptions in sensitivity analyses. Results With current HIV programming (PEPFAR_100%), a projected 1,190,000 infections would occur over 10 years (Table 3); life expectancy would be 61.42 years for PWH with lifetime costs of $11,180/PWH. PEPFAR_50% and PEPFAR_0% would add 286,000 and 565,000 infections and worsen HIV care continuum outcomes (Figure 1). PWH would lose 2.02 and 3.71 life-years with nominal lifetime cost reductions of $620/PWH and $1,140/PWH that would be offset at the population level by more PWH requiring treatment for infection. In sensitivity analyses, clinical and epidemiologic impacts of scaling back PEPFAR would remain substantial. Conclusion Abruptly scaling back PEPFAR funding would have a striking, detrimental impact on the progress South Africa has made towards HIV epidemic control. Any total cost reductions would be short-lived and at the expense of up to an additional 565,000 new HIV infections and 601,000 HIV-related deaths in South Africa by 2034. The estimated 2024 HIV care cascade (black bars) is based on published data. The projected HIV care cascade in 2029 is shown for PEPFAR_100% (dark blue bars), PEPFAR_50% (blue bars), and PEPFAR_0% (light blue bars). Each set of bars represents PWH who are aware of their HIV status, receiving ART, and virally suppressed (HIV RNA &amp;lt;20 copies/mL), respectively. The percentages shown are in respect to the conditional UNAIDS’ 95-95-95 epidemic targets (i.e., proportion of all PWH who are aware of their status, proportion of PWH aware of their status who are receiving ART, and proportion of PWH receiving ART who are virally suppressed). The estimated number of PWH alive in South Africa in 2024 is 7,400,000; the projected number of PWH alive in 2029 would be 6,913,000 with PEPFAR_100%, 6,950,000 with PEPFAR_50%, and 6,997,000 with PEPFAR_0%. The number of PWH associated with each bar is labeled at the bottom of Panel B and rounded to the nearest 10,000. Disclosures Linda-Gail Bekker, Gilead Health Sciences: Honoraria|MSD (Pty) Ltd: Honoraria|ViiV Healthcare: Honoraria

To what extent are digital health interventions targeting HIV care cascade among mobile populations feasible, acceptable, and effective? A mixed methods systematic review protocol

IntroductionHuman mobility is associated with an increased risk of HIV acquisition and disengagement from HIV care, leading to poorer health outcomes among highly mobile individuals compared to less mobile individuals. Mobile individuals, broadly defined as those who temporally, seasonally, or permanently move from one place to another for voluntary or involuntary reasons, face many challenges in accessing HIV care services. These challenges include logistical difficulties, interruptions in HIV care continuity, and limited access to services across different locations, which together hinder timely testing, treatment initiation, and viral suppression. Digital health interventions offer flexible approaches that can adjust to the mobile individual’s location to improve HIV care engagement and health outcomes for this underserved and hard-to-reach population. However, evidence on the feasibility, acceptability, and efficacy of digital health interventions across the HIV care cascade among mobile populations has not yet been appraised.ObjectivesWe seek to synthesize empirical evidence on the feasibility, acceptability, and efficacy of digital health interventions targeting the HIV care cascade among mobile populations.MethodsWe will conduct a mixed methods systematic review of peer reviewed studies published between 1 January 2010 and 31 July 2024 that evaluated digital health interventions targeting the HIV care cascade among mobile populations. We will search PubMed, Web of Science, and EBSCOhost (Academic Search Premier, Africa-Wide information, CINAHL, Health Source: Nursing/Academic Edition, APA PsycInfo, APA PsycArticles) electronic databases. Bibliographies of retrieved studies will also be reviewed for relevant citations. Only studies published in English language and involved a digital health intervention, report an outcome related to the HIV care cascade, and involve mobile populations either partially or completely will be included. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full text screening for eligible articles. In case of disagreements, consensus will be sought from a third reviewer. Data synthesis will follow the Joanne Briggs Institute’s convergent segregated approach. If sufficient quantitative studies with comparable outcome measures are available, a meta-analysis will be performed.DiscussionThis review will address a critical evidence gap by consolidating data on digital health interventions’ feasibility, acceptability, and efficacy across the HIV care cascade among mobile populations. The results will inform the development of tailored digital health interventions to enhance HIV care delivery and health outcomes for this hard-to-reach population, supporting global HIV prevention and treatment goals.Systematic review registrationThis protocol is registered on PROSPERO (CRD42024528122).

Updates to HIV transmission rate estimates along the HIV care continuum in the United States, 2019.

In 2019, there were an estimated 1.2 million persons with HIV (PWH) and 35,100 new infections in the United States. The HIV care continuum has a large influence on transmission dynamics. We updated Progression and Transmission of HIV 3.0, an agent-based simulation model, to estimate 2019 HIV transmission rates and distribution of transmissions by the HIV care continuum, race/ethnicity, transmission group, and age group. In 2019, the estimated transmission rate in the United States was 2.94 new infections per 100 person-years (inf /100p-y). Transmission rates decreased along the HIV care continuum; the highest transmission rate was associated with persons with acute HIV infection and unaware of their HIV status at 16.35 inf /100p-y, followed by persons with HIV (non-acute) and unaware of their HIV status (9.52), persons aware of their HIV status and not in care (5.96), persons receiving HIV care (on antiretroviral therapy) but not virally suppressed (4.53), and persons virally suppressed (0). The highest transmission rate by transmission group was among men who have sex with men at 3.68 inf /100p-y. Transmission rates decreased as age increased and are similar by race/ethnicity, after accounting for the HIV care continuum. Our results support a continued emphasis on helping PWH move along the care continuum through early diagnosis, linkage to care, and adherence to ART, resulting in viral suppression to reduce HIV transmissions. Further, efforts should focus on reducing disparities in the provision of HIV prevention and care services, particularly for populations disproportionally affected by HIV.

Access to HIV prevention, testing and care among people with a migration background in Euregio Meuse-Rhine: a needs and assets assessment

ABSTRACT This study addresses disparities among people with a migration background (PMB) and those in less-urban regions, across the HIV prevention and care continuum (HIVPCC). We conducted a needs assessment and assets assessment to identify gaps between existing initiatives and persisting barriers. The research was conducted in the Euregio Meuse-Rhine (EMR), encompassing bordering regions in Belgium, Germany, and the Netherlands, and involved in-depth interviews with fifteen first-generation PMB, including nine with HIV. Six factors influencing PMB access to the HIVPCC were identified: past experiences with sexually transmitted infections (STIs) or HIV; HIV stigma and social dynamics; confidence and communication with healthcare providers and social workers; healthcare system navigation; precarity; and knowledge and beliefs about HIV/STIs. Existing assets mostly target individual or interpersonal levels, are often inaccessible due to language barriers, inadequately match PMB’s living conditions and culture, and are irregular and hyperlocal. Recommendations include enhancing cultural sensitivity, adopting participatory approaches, tailoring outreach activities to legal situations and cultural context, and fostering cooperation between healthcare and social work institutions. This study underscores the importance of considering societal and institutional dynamics in bridging gaps in the HIVPCC for PMB, advocating for targeted interventions that promote inclusivity and equity.

"I'm in the Care Orbit": Unveiling the Enabling Context of the HIV Care Continuum in People Living With HIV.

This study aimed to explore the enabling context of the HIV care continuum as perceived by people living with HIV and healthcare professionals. This qualitative study involved in-depth individual interviews with eight people living with HIV and group interviews with seven nurses and physicians. These interviews took place between March 5, 2021, and July 13, 2022. Thematic analysis was conducted. The main themes that emerged included "network of support and systems," "personal gains from the care continuum," "continuity and practicality of healthcare services," "presence of significant other(s)," and "social belonging." These themes were structured within the five levels of the socio-ecological model (system, individual, organizational, interpersonal, and community levels), and 10 subthemes were identified. With the integration of themes, the enabling context was compared to a "care orbit," indicating that people diagnosed with HIV start treatment at the system level and continue HIV care at other levels. In addition to primary support at the system level, the enabling context also includes individual commitment to care and regular health habits, hospital services, support from significant others, and community culture. Together, the context helps guide people living with HIV into the "orbit" of the care system.

Is racism a barrier to HIV care continuum engagement among Black People in the United States? A scoping review to assess the state of the science and inform a research agenda.

People living with HIV can achieve viral suppression through timely HIV care continuum (HCC) engagement (ie, diagnosis, linkage to HIV care, retention in care, and adherence to prescribed treatment regimens). Black populations have poorer viral suppression, suboptimal HCC engagement, and higher levels of racism-related mistrust. The state of the evidence linking suboptimal HCC engagement to racism among US Black populations is assessed in this article. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 6 English language databases were searched using 3 sets of key terms related to HCC engagement (eg, HIV diagnosis), racism (eg, discrimination), and the population (eg, Black people). To exclude articles, 3 rounds of reviews were conducted and results assessed for interrater reliability (κ=99.00%; P<0.00). From 2027 articles initially retrieved, the final set of analyses (n=32) included clinical and nonclinical samples of people living with or at risk for HIV. Overall, the evidence was conceptually robust but methodologically simple. Studies primarily targeted intrapersonal and interpersonal racism and the late stage of HCC engagement: adherence. Sample-specific prevalence of racism ranged considerably; for example, 20% to 90% of sample members in clinical settings perceived or experienced interpersonal forms of racism. To date, the evidence suggests the relationship between racism and HCC engagement is mixed. Racism is salient among Black people living with or at risk for HIV. It appears not to impede HIV testing, though it may limit retention in HIV care, especially among men who have sex with men.

Humanising and optimising HIV health care for refugees and asylum seekers.

Displaced populations living with HIV, including refugees and asylum seekers, face substantial challenges across various regions globally. The intersection of forced migration and HIV presents both shared challenges and region-specific differences. Key issues include little access to health care, pervasive stigma, discrimination, and disruptions in the continuity of HIV care. Refugees often encounter barriers such as legal, cultural, and economic disparities that impact their overall health outcomes. Although HIV prevalence differs across regions, displaced populations consistently face disproportionate challenges including high-risk environments and little health-care access. Addressing these challenges requires a focus on equitable health-care access, with both actionable local interventions and broader global policy changes and an emphasis on long-term sustainability. Reliable and continuous drug supplies, interagency collaboration, and holistic health-care approaches are essential. International collaboration, robust evidence generation, and comprehensive responses are urgently needed to address the complex interplay between forced migration and HIV among vulnerable populations.

Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis.

International migrants, especially those belonging to key populations, face a considerable HIV burden. However, continuity of HIV care for this group is often challenged along the migration route. We assess the available evidence on the existing interventions that aim to strengthen community and health systems to ensure the continuity of HIV care for international migrants. We did a systematic search of PubMed for publications from 1989 until 2023 focused on different stages of the HIV care continuum regardless of the geographical region. The literature was reviewed with a thematic approach. Globally, legal regulations can restrict access to HIV care and fuel fear of deportation among undocumented migrants. The intersection of HIV-related and migration-related stigma creates further challenges for uninterrupted access to HIV care along the migration route, with negative clinical and public health consequences. Different potential interventions were identified including: provision of HIV care regardless of migration status; utilisation of mobile health, mobile units, and community-led initiatives to bring HIV care to migrants; and utilisation of participatory and co-creation methods to develop tailored and sustainable HIV-related interventions with migrant communities. Improving access to the continuity of care for migrants requires a shift towards intersectional policies rooted in co-creation approaches to address the underlying multiple and mutually reinforcing inequalities.

Transitions through the HIV continuum of care in people enrolling in care with advanced HIV disease in Latin America.

Advanced HIV disease (AHD) at HIV care enrollment is common in Latin America and may bias cross-sectional care continuum estimates. We therefore explored the impact of AHD on HIV care continuum outcomes using a longitudinal approach. We analyzed trajectories of 26,174 adult people with HIV enrolled at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) sites (2003-2019) using multi-state Cox regression across five stages: (i) enrolled without antiretroviral therapy (no-ART); (ii) on ART without viral suppression (viral load ≥200 copies/m; ART + non-VS); (iii) on ART with viral suppression (viral load <200 copies/ml; ART + VS); (iv) lost to follow-up; (v) death. We defined AHD as clusters of differentiation 4+ count <200 cells/µl and/or an AIDS-defining illness at enrollment. People with HIV with AHD had a shorter time with no-ART, a similar time ART + non-VS, but less time ART + VS before 2013 than non-AHD. After 2013, time with no-ART decreased but the 5-year probability of transitioning from no-ART to ART + VS decreased in both groups. The time spent virally suppressed while in care was low, overall. Risk of loss to follow-up and death was persistently worse among adults with AHD. Using a longitudinal approach to assess the HIV continuum of care provided insight into limitations in HIV care provision in our region previously underexplained by cross-sectional assessments.

Impact of the COVID-19 pandemic on the HIV care continuum and associated factors in middle-income countries: A mixed-methods systematic review.

The HIV care continuum during the COVID-19 era faced specific challenges. The pandemic, affecting the delivery of HIV care, exacerbated existing healthcare inequities and vulnerabilities in middle-income countries with limited financial resources. This study aims to set the stage for the systematic review, focusing on the impact of COVID-19 on HIV care in middle-income countries with a focus on barriers and facilitators. A systematic search of relevant literature, including electronic databases and manual assessment of references, was done. The review included quantitative, qualitative and mixed-methods studies conducted in middle-income countries, with no age or gender restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting the results. In the course of our systematic review, a comprehensive examination of the pertinent literature published between 2020 and 2024 yielded a total of 76 studies. This adverse impact was prominently attributed to an amalgamation of factors intrinsically associated with pandemic-induced restrictions, fear of contracting the COVID-19 and fear of disclosing HIV status. Moreover, an emergent theme observed in select studies underscored the enduring trend of HIV treatment continuity, which was facilitated by the burgeoning utilization of telemedicine within this context. The pandemic negatively affected income and increased vulnerability to HIV across all phases of the HIV care continuum, except for viral suppression. Prevention measures, such as pre-exposure prophylaxis (PrEP), were compromised, leading to increased risky behaviours and compromised mental health among people living with HIV. HIV testing and diagnosis faced challenges, with reduced access and frequency, particularly among key populations. The pandemic also disrupted linkage and retention in care, especially in urban areas, exacerbating barriers to accessing necessary HIV treatment. Additionally, this review highlights the complex and multifaceted landscape of the pandemic's impact on HIV medical appointments, adherence and treatment engagement, with various barriers identified, including fear of COVID-19, economic constraints and disruptions in healthcare services. The coexistence of pandemics has had negative effects on the HIV care continuum, with restrictions on services, an increase in care gaps and a break in the transmission chain in middle-income countries.

Unlocking success: community engagement for enhanced HIV care outcomes

BackgroundThough social determinants are the primary drivers of health, few studies of people living with HIV focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team uses linked clinical and multisector non‐clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of individuals living with HIV and other invested community members to guide and inform this research. Our objective is to generate consultant-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same.MethodsOur research team partnered with the Indiana Clinical and Translational Sciences Institute’s Research Jam to develop and implement a human-centered design research plan to engage individuals with experience relevant to our research. We recruited a panel of consultants composed of people living with HIV and/or clinicians and individuals from agencies that provide medical and non-medical services to people living with HIV in Marion County, Indiana. To date, we have used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our future engagement and research activities.ResultsSince the inception of the project, 48 consultants have joined the panel. Thirty-five continue to be actively engaged and have participated in one or more of the six sessions conducted to date. Consultants have helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference.ConclusionsWe utilize community engagement to expand the scope of our research and find that the process provides value to both consultants and the research team. Human-centered design enhances this partnership by keeping it person-centered, developing empathy and trust between consultants and researchers, increasing consultant retention, and empowering consultants to collaborate meaningfully with the research team. The use of these methods is essential to conduct relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community consultants.

Neighborhoods, Networks, and HIV Care Among Men Who Have Sex With Men: Proposal for a Longitudinal Study.

The majority of people living with HIV in the United States are men who have sex with men (MSM), with race- and ethnicity-based disparities in HIV rates and care continuum. In order to uncover the neighborhood- and network-involved pathways that produce HIV care outcome disparities, systematic, theory-based investigation of the specific and intersecting neighborhood and social network characteristics that relate to the HIV care continuum must be engaged. Using socioecological and intersectional conceptual frameworks, we aim to identify individual-, neighborhood-, and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and antiretroviral adherence) among MSM living with HIV in New York City. In the longitudinal cohort study, we assess 3 neighborhoods of potential influence (residential, social, and health care access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (eg, concentrated poverty and racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (eg, crime rates and housing vacancy); (2) alcohol and other drug use; (3) social norms (eg, homophobia and HIV stigma); and (4) community resources (eg, social services and public transit access). We test theoretical pathways of influence, including stress or coping, stigma or resilience, and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit, we locate each participant's reported activity spaces (ie, neighborhoods of potential influence) and collect individual-level data on relevant covariates (including perceptions of or exposure to neighborhoods) and social network inventory data on the composition, social support, and perceived social norms. The outcomes are HIV viral suppression, retention in care, and antiretroviral adherence. These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multilevel modeling are used to test the main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time. The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The median age was 44.1 (SD 11.5) years. Almost all participants self-identified as cisgender men (n=313, 98.1%) and as gay, homosexual, or bisexual (n=301, 94.4%). Overall, 192 (60.1%) participants identified as non-Hispanic Black, and 81 (25.3%) identified as Hispanic. Most (n=201, 63%) reported at least occasional difficulty in meeting basic needs (eg, rent and food) in the past 6 months. The mean number of years living with HIV was 15.4 (SD 10.1). This study will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas. PRR1-10.2196/64358.

Effect of Mental Health Care Visits on HIV Care Outcomes.

To improve the quality of life for people living with HIV (PLWH), it is vital their treatment plans closely follow the HIV care continuum. However, many barriers, such as mental health disorders (MHD), can complicate treatment. Patients being treated for HIV with comorbid MHD are more likely to not be retained in care and maintain an unsuppressed viral load. As PLWH and people vulnerable to acquiring HIV are more commonly diagnosed with MHD in comparison to the general population, it is important that steps to mitigate the possible effects of MHD are addressed during treatment. This study examines how minimal mental health care in a safety-net hospital system in the U.S. South can show benefits in retaining patients throughout their treatment of HIV. The results showed that older individuals retained a higher level of viral suppression when they followed up regularly with a mental health care provider during treatment. In addition, regardless of age, the higher the number of mental health care visits a patient attended during treatment, the higher the likelihood of viral suppression. By incorporating mental health care into the HIV treatment plan, the patients who met at least one of these criteria had better treatment outcomes and progressed further along the HIV care continuum.

Integrating community health workers into HIV care clinics: a qualitative study with health system leaders and clinicians in the Southern United States

BackgroundCommunity health workers (CHWs) can support patient engagement in care for a variety of health conditions, including HIV. This paper reports on the experiences of HIV clinics and health departments that integrated CHWs into their health systems as part of a capacity-building initiative to address HIV-related disparities in the United States.MethodsSemi-structured interviews were conducted with key informants (n = 14) in two Ryan White HIV/AIDS program jurisdictions: Mississippi (jurisdiction covers the entire state) and the city of New Orleans, Louisiana. This work was part of a larger evaluation of an initiative that used a Learning Collaborative model to facilitate the implementation of evidence-informed interventions to address HIV care continuum gaps in four jurisdictions. The two jurisdictions that focused on integrating CHWs into HIV care clinics and support service agencies were selected for this sub-analysis. Interview participants included HIV clinic leaders and staff, health department leaders, and other Learning Collaborative leaders. Interview transcripts were coded and analyzed for themes related to the acceptability, feasibility, and perceived impact of CHW integration.ResultsOverall, participants expressed interest in having support from CHWs at HIV clinics and service agencies to assist with patient retention and engagement efforts. However, there were challenges integrating CHWs into existing systems (e.g., gaining access to electronic health records, changing policies to conduct home visits, and clarifying roles and scope of work). Negotiating contracts and accessing funding for CHW positions presented major challenges that often contributed to turnover and conflicts around scope of practice. When health departments leveraged existing funding streams to support CHW positions, the clinics and agencies where the CHWs worked had limited flexibility over the hiring process.ConclusionsOur findings reinforce the value and acceptability of CHWs as part of the workforce in HIV clinical and support service settings; however, integrating CHWs into clinics and service agencies required effort. Training the CHWs was not sufficient; other staff and clinicians had to understand the role of CHWs to facilitate their integration into health systems. Resources are needed to support organizations in incorporating CHWs effectively, and long-term, flexible sources of funding are necessary for these positions.