Human Immunodeficiency Virus Prevention Research Articles

Opioid Dependence Syndrome and Quality of Life: A Facility-based Exploratory Study among Drug Addicts at a Tertiary Care Hospital of Kolkata, India

Introduction: Opioid dependence syndrome is considered a chronic-relapsing medical illness that can affect the Quality of Life (QoL) of Injecting Drug Users (IDUs). They are at risk of contracting Human Immunodeficiency Virus (HIV) due to unsafe injection practices. Opioid Substitution Therapy (OST) is an effective treatment option for opioid dependence as well as HIV prevention and intervention among IDUs, subsequently improving their QoL. Aim: To identify the opioids injected by addicts and evaluate QoL across different life areas among IDUs attending an OST centre. The authors also aimed to determine the factors affecting QoL regarding relationships with family and friends. Materials and Methods: A facility-based, observational crosssectional study was conducted on 168 IDUs at an OST centre in Calcutta National Medical College from April 2016 to March 2018. A predesigned and pretested structured schedule was used, which included socio-demographic characteristics, pattern of substance abuse, and HIV status. To evaluate QoL, the authors used a Likert scale with five domains specific to chronic diseases. Logistic regression was employed to determine associated factors with two QoL domains regarding relationships with family and friends. The Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Results: The mean age {Standard Deviation (±SD)} of the study participants was 36.53±9.514 years. The most common opioids injected by IDUs were buprenorphine (89.2%). Although QoL scores varied across different domains, it can be interpreted that the majority of participants had poor QoL. When assessing QoL in terms of relationships with family and friends, there was a significant association between better QoL and financial support {Adjusted Odds Ratios (AOR) Confidence Intervals (CI)} 2.550 (1.431-6.082), favourable living arrangements AOR(CI) 2.450 (1.010-4.443), and absence of seropositivity AOR(CI) 2.462 (1.141-7.476). Conclusion: Buprenorphine was the most common substance of abuse among IDUs. The study revealed a high proportion of IDUs with poor QoL. The findings of the study might be helpful in designing appropriate strategies to improve personal relationships and social situations among IDUs.

Economic Evaluation of the Comprehensive AIDS Prevention and Control Program - Tianjin Municipality, China, 2011-2022.

Acquired immunodeficiency syndrome (AIDS) represents a significant public health challenge globally, not only inflicting harm on the health of individuals but also placing a considerable economic strain on society. This study represents the inaugural report on the potential reduction in economic burden attributable to human immunodeficiency virus (HIV) prevention strategies in Tianjin. Between 2011 and 2022, it is estimated that effective measures could prevent 2,965 new HIV infections and avert 658 deaths, resulting in an economic benefit of approximately 14.437 billion Chinese Yuan. The findings of this study offer valuable evidence to inform the development of localized HIV prevention and control strategies, as well as to guide public health policymaking.

Black Adolescent Females' Perceptions of PrEP for HIV Risk Reduction.

Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is approved for use in adolescents, though uptake remains low. Black adolescent females experience higher rates of HIV transmission compared to adolescent females of other racial/ethnic groups. Increasing PrEP awareness and education among this population may be an effective strategy to mitigate disparities in HIV transmission among Black adolescent females. Twenty-seven Black adolescent females participated in focus groups which were coded using the constant comparative method of qualitative analysis to identify major themes: (1) PrEP is not commonly framed as an HIV prevention strategy for heterosexual Black adolescent females, (2) PrEP use among peers is perceived as mostly positive, (3) Adoption of PrEP among Black adolescent females is impeded by perceived barriers such as stigma, negative side effects, and adherence concerns. These findings may inform the development of targeted culturally tailored marketing and educational campaigns centered on Black heterosexual adolescent females to increase PrEP awareness and uptake in this population disproportionately affected by HIV.

Behavioral response for condom use messages to prevent human immunodeficiency virus/acquired immune deficiency syndrome among Bahir Dar City High School students, North West Ethiopia, 2022: Application of the extended parallel process model

Objective: The human immunodeficiency virus has become one of the world’s most serious health and development challenges. Human immunodeficiency virus prevention has not received sufficient attention, and the prevalence of human behavioral virus infections among Ethiopian high school and preparatory students has also increased. The aim of this study was to assess behavioral responses to condom use messages to prevent human immune virus/acquired immune deficiency syndrome among Bahir Dar city high school and preparatory students using the extended parallel process model, Bahir Dar, Ethiopia, 2022. Methodology: This institution-based cross-sectional study was conducted from 15 November to 15 December 2022, in Bahir Dar city. The data were collected from 601 participants. A multi-stage sampling technique was used to select the study participants. Data were entered into Epi-Info version 7.2.5 and exported to SPSS version 26 for analysis. Descriptive statistics, percentages, and frequencies were calculated. Bivariable logistic regression was performed to identify variables candidates for multivariable logistic regression at p-values less than 0.25, and multivariable logistic regression was performed to identify factors associated with the outcome variable at p-values < 0.05. A 95% confidence interval and odds ratio were used for the interpretation of the association. Result: The response rate of the respondents was 94.9%. The behavioral response for condom use messages was affected by grade level adjusted odds ratio, 0.473, 95% CI (0.252–0.886), knowledge adjusted odds ratio, 2.627, 95% CI (1.788–3.859), attitude adjusted odds ratio, 3.19, 95% CI (2.145–4.744), efficacy adjusted odds ratio, 3.286, 95% CI (2.03–5.339), and threat adjusted odds ratio, 0.249, 95% CI (0.167–0.369). The behavioral response for condom use messages was associated with danger control. Conclusion: The danger control response is 60.9%. Grade level, knowledge, attitude, and perceived and threat efficacies were independent predictors of danger control. Therefore, messages must aim to enhance threat component perception with appropriate efficacy to control danger and developed using scientific health communication strategies to promote behavioral change.

Understanding the potential implementation determinants of Our Plan: a couples-based digital human immunodeficiency virus prevention intervention for same-gender male couples.

There has been a proliferation of digital health interventions (DHIs) focused on addressing human immunodeficiency virus (HIV) prevention and treatment outcomes, including couples-based interventions with same-gender male couples. However, the barriers and facilitators of implementing couples-based HIV and sexually transmitted infection (STI) prevention interventions using digital platforms in community-based organizations remains largely unknown. The goal of this study was to explore the implementation determinants of Our Plan, a couples-based DHI designed for new relationships of same-gender male couples and dyadic, sexual partnerships. Qualitative interviews were conducted with 40 organization leaders, healthcare providers, and staff at acquired immunodeficiency syndrome (AIDS)-service and community-based organizations in 13 states serving populations in Ending the HIV Epidemic jurisdictions. Interview items and follow-up questions were guided by the Consolidated Framework for Implementation Research (CFIR) to inquire about implementation determinants of Our Plan. Most participants highlighted several relative advantages of Our Plan: increasing capacity to support couples, potential synergy with existing programs, and opportunities to increase patient engagement. Participants also discussed relative disadvantages: misalignment with organizational values in the provision of patient-centered models of care and low interest from some priority populations. Participants emphasized the need for adaptability of Our Plan to fit within their local contexts, which encompassed support for both implementers and end-users, cultural tailoring, and privacy and security features. The desired evidence needed to implement Our Plan focused on data on impact, acceptability, and usability and functionality from communities most heavily impacted by the HIV epidemic. The majority of participants described how Our Plan could be integrated within service delivery and aligned with their organization's aspirational values; however, some noted that their organizational culture valued in-person interactions, particularly among patients experiencing structural vulnerabilities. Finally, participants discussed how the implementation of Our Plan would require additional training and funding for staff to support end-users and a relationship with the developers so that they could demonstrate their investment in the communities that their organizations served. Our Plan was deemed a promising tool among potential implementers. To ensure optimal implementation and organizational fit, Our Plan refinement and evaluation must include implementers and end-users most impacted by the HIV epidemic throughout the entire process.

The imbalance of body electrolytes in HIV patients using highly active antiretroviral therapy

The retrovirus named HIV (Human Immunodeficiency Virus) targets the immune system, which makes it more vulnerable to numerous illnesses and some cancers that healthy immune systems can combat. The worst phase of HIV infection, AIDS (Acquired Immunodeficiency Syndrome), can take a variety of people between one and twenty years to emerge if untreated. HIV is frequently spread by unprotected sexual contact, blood transfusions, mother-to-child transmission, etc. HIV/AIDS symptoms include weight loss, skin problems, achy muscles, recurrent fevers. Prevention of HIV/AIDS includes use of condom, avoidance of exposure to implicated body fluids, HIV prevention programs to stop vertical HIV transmission. Highly active antiretroviral therapy (HAART), which reduces the disease's progression, is the main form of treatment. The HAART's effect on the kidney results in electrolytes imbalance. Electrolytes are substances that, when dissolved in water, transmit electricity and control blood pressure, pH level, neuron and muscle activity, and maintain tissues hydrated. Irregularity in the body's electrolyte content is known as an electrolyte imbalance which can be caused by fluid lose, inadequate water consumption, certain medications. Symptoms of electrolyte imbalances include, irregular heartbeat, fatigue, headaches, confusion, numbness and tingling. Diagnosis of Electrolyte Imbalance in HIV/AIDS Patients are done using kidney function test, pinch test and electrocardiogram. Treatment and management of electrolytes imbalance in HIV/AIDS patients include drinking water, oral rehydration drinks, sodium chloride, intravenous fluids, oral medications and supplements such as gluconate, magnesium oxide, use of dialysis. HAART induced electrolytes imbalance are seen in Tenofovir, which is associated with severe hypokalemia and hypophosphatemia.

Utilization of antiviral for HIV prevention

Acquired immunodeficiency disease syndrome (AIDS) and AIDS-related illnesses continue to cause a public and economic burden on any given community. Different preventive strategies have been reported, which vary in their effectiveness and safety to limit human immunodeficiency virus (HIV) transmission, the causative virus of AIDS. Antiretroviral therapy (ART) is the main agent used for HIV treatment, and it has been used as a prevention method, or prophylaxis, to prevent HIV transmission. This review was conducted to evaluate clinical trials, and updated recommendations for preventing HIV infection for individuals at risk using ART. We reviewed the literature, and six studies responded to our inclusion criteria. Most of the recent studies that used ART seemed effective in preventing HIV infection among seronegative individuals. Further studies on a larger and different population are recommended to ensure the best preventive methods against HIV.

The Stopping the Spread of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome through Relationship Engagement Study: An Opportunity for Human Immunodeficiency Virus Prevention in African American Adolescents with HIV-Positive Mothers

In 2018 Blacks/African Americans made up 13% of the female population but accounted for 58% of diagnoses of human immunodeficiency virus (HIV) infection among females.1 Studies show that women have always been underrepresented in HIV/acquired immune deficiency syndrome (AIDS) studies, however, the coronavirus disease-2019 (COVID-19) pandemic has further exacerbated the existing barriers in HIV research.2 Additionally, with social distancing guidelines in place due to COVID-19, research that requires partnership development with gatekeepers and community-based organizations may not effectively transition to virtual or other remote settings.2 Black women’s underrepresentation in HIV research is in part due to inadequate recruitment strategies.3 While we use technology to try to compensate for the lack of human connection in research due to the COVID-19 pandemic, it has made recruitment more difficult.

HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007-2018.

Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057-0.23], representing 35,900 (95% CI 16,300-55,600) new infections per year in Kenya among persons aged 15-64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25-34 versus 35-64 years (aOR = 4.2, 95% CI 1.4-13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6-17 for 2-3 partners and aOR = 8.6, 95% CI 2.8-26 for ≥4 partners vs. 0-1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5-11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.

Insight into Sexual Risk Reduction for College-Entering Males Reacting to Gender-Tailored Role Play Scenarios

Background: College represents a time of independent decision making, increased exposure to substances, and new, less supervised, opportunities for sexual behaviors and new partners. Despite the high prevalence of sexual risk behaviors in adolescent males pursuing higher education, there are still limited evidence-based interventions for sexually transmitted infections (STI), human immunodeficiency virus (HIV), and pregnancy prevention tailored for this population. Aim: The aim of this study was to gain insight into the perspectives of males on role play situations used in a sexual risk reduction program tailored for adolescent girls to obtain feedback on creating effective prevention programs for males. Methods: We conducted a focus group with males entering college. We analyzed the transcribed data to assess the relevance, realism, and utility of role-playing and to gain insight into the participant’s communication styles and approaches to risk reduction. Results: Four major themes were identified using conventional content analysis: (1) Non-verbal responses and “the vibe” are the go ahead for consent for sex, (2) Jokes and excuses are common communication skills used for risk reduction, (3) Prevention of pregnancy is more of a concern than STI or HIV prevention, and (4) Being gaslighted regarding mental health issues by girls was not uncommon. Conclusions: Findings from this pilot study can help inform sexual risk reduction intervention programming for males entering new environments such as the college-setting.

Black Sexual Minority Men's Stigma-Based Experiences Surrounding Pre-exposure Prophylaxis in the Southern United States.

Purpose: Intersecting experiences of stigma related to pre-exposure prophylaxis (PrEP) influence PrEP uptake among Black sexual minority men (BSMM) living in the southern United States; however, it is unclear what stigmatized identities and behaviors are impacted when accessing human immunodeficiency virus prevention options. To inform identity-specific PrEP interventions, this study examined stigma in BSMM's lives relating to intersecting experiences of PrEP stigma. Methods: We conducted 32 virtual, semistructured qualitative interviews with BSMM residing in the southeastern United States between February and April 2019. Results: We identified three themes (anticipated stigma, experiences of prejudice and stereotyping, and negative attitudes) and one subtheme within negative attitudes (othering social/sexual groups). Across all themes, PrEP stigma was often manifested through stigma against BSMM's sexual orientation or sexual behavior. BSMM in othering social/sexual groups displayed instances of cognitive dissonance by regularly expressing negative attitudes about and explicitly distancing themselves from social/sexual groups based on sexual orientation and sexual behavior. BSMM's race and gender were rarely mentioned as being stigmatized. Conclusions: Interventions focused on PrEP use could benefit from expanding their definition of PrEP stigma to include a stronger emphasis on intersecting identities and work to reduce cognitive dissonance in BSMM in the form of internalized homophobia.

Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas: Insights From a Modeling Study.

Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021. An agent-based model that incorporated the sexual networks of YBMSM was used to simulate improved antiretroviral treatment and pre-exposure prophylaxis (PrEP) engagement through Medicaid expansion in Houston, TX. Analyses considered the HIV incidence (number of new infections and as a rate metric) among YBMSM over the next 10 years under Medicaid expansion as the primary outcome. Additional scenarios, involving viral suppression and PrEP uptake above the projected levels achieved under Medicaid expansion, were also simulated. The baseline model projected an HIV incidence rate of 4.96 per 100 person years (py) and about 368 new annual HIV infections in the 10th year. Improved HIV treatment and prevention continua engagement under Medicaid expansion resulted in a 14.9% decline in the number of annual new HIV infections in the 10th year. Increasing viral suppression by an additional 15% and PrEP uptake by 30% resulted in a 44.0% decline in new HIV infections in the 10th year, and a 27.1% decline in cumulative infections across the 10 years of the simulated intervention. Simulation results indicate that Medicaid expansion has the potential to reduce HIV incidence among YBMSM in Houston. Achieving HIV elimination objectives, however, might require additional effective measures to increase antiretroviral treatment and PrEP uptake beyond the projected improvements under expanded Medicaid.

Implementation strategies to promote linkage to care for key populations after HIV self-testing: a scoping review

Background In human immunodeficiency virus (HIV) care, key populations are sex workers, people who inject drugs, prisoners, transgender people, and men who have sex with men (MSM), who are at high risk and burden of HIV infection but face barriers to HIV prevention, treatment, and health services. HIV self-testing (HIVST) is effective in scaling up HIV testing uptake among key populations due to its cost-effective, confidential, and convenient feature. However, lacking linkage to care support remains a key challenge. This scoping synthesised the global evidence regarding implementing strategies to promote linkage to care for key populations after HIVST. Methods This scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. A data search was conducted on September 1, 2021. The searched databases were PubMed, Embase, EBSCOhost, Cochrane Library, Wan Fang Data (Chinese), China National Knowledge Infrastructure (Chinese), and Japan Medical Abstracts Society (Japanese). Results Twenty studies from 2011 records met the eligibility criteria and were included for review. The study populations were MSM (9), mixed high-risk populations (7), female sex workers (3), and transgender youth (1). Implementation strategies to promote linkage to care for key populations after HIVST were classified into seven categories: 1) HIVST kits with linkage-to-care information, 2) web-based or mobile app-guided HIVST, 3) remote HIVST counselling, 4) intensive follow-up, 5) HIVST promotion through social media and key opinion leaders, 6) community engagement in HIVST and 7) financial incentive. The digital-supported intervention mainly targeted MSM in high-income settings, and the community-based approach and financial incentive strategies were mainly implemented in low and middle-income settings. Comparison of linkage outcomes between studies is problematic due to mixed interpretation and measurement of linkage to care after HIVST. Conclusions Implementation strategies to promote linkage to care for key populations are diverse and should be incorporated in different settings and backgrounds. Innovative digital-supported HIVST research for female sex workers and high-risk populations in low and middle-income settings is warranted. A standardised definition of linkage to care following HIVST and a unified measurement of linkage outcomes should be developed and applied in future research.

Persistently Elevated Risk of Syphilis Among Human Immunodeficiency Virus-Positive Men Receiving Care in a Status-Neutral Setting: A Retrospective Analysis.

Over the past decade, the incidence of primary and secondary syphilis has increased dramatically in the United States and Western Europe. Men living with human immunodeficiency virus (HIV) and those at risk of HIV infection experience disproportionately high rates of early syphilis (ES). We compared the odds of ES among HIV-positive and HIV-negative men participating in a status-neutral comprehensive HIV prevention and treatment program (CHP). We conducted a retrospective analysis of men aged 18 to 65 years with ≥ 1 CHP visit and ≥2 rapid plasma reagin (RPR) tests performed between January 1, 2018, and December 31, 2021. Early syphilis was defined as newly reactive RPR with a minimum titer of ≥1:4 or a ≥ 4-fold increase in the RPR titer. Multiple logistic regression analyses were performed to determine predictors of ES. A total of 2490 men met the inclusion criteria, of whom 1426 (57.3%) were HIV-positive and 1064 (42.7%) were HIV-negative. Of the 393 men with ES, 284 (72.3%) were HIV-positive and 109 (27.7%) were HIV-negative. Human immunodeficiency virus-positive men had higher adjusted odds of ES (adjusted odds ratio, 2.86; 95% confidence interval, 2.45-3.27) than HIV-negative men did. Chlamydia or gonorrhea infection did not differ according to HIV status (adjusted odds ratio, 0.93; 95% confidence interval, 0.82-1.04). In our status-neutral care setting, HIV-positive status was associated with significantly higher odds of ES, but not chlamydia or gonorrhea. Our findings emphasize the vulnerability of HIV-positive men to syphilis in an era of effective HIV biomedical prevention.

Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India

People who inject drugs (PWID) are India's third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.

Fabrication of PEGylated Chitosan Nanoparticles Containing Tenofovir Alafenamide: Synthesis and Characterization

Tenofovir alafenamide (TAF) is an antiretroviral (ARV) drug that is used for the management and prevention of human immunodeficiency virus (HIV). The clinical availability of ARV delivery systems that provide long-lasting protection against HIV transmission is lacking. There is a dire need to formulate nanocarrier systems that can help in revolutionizing the way to fight against HIV/AIDS. Here, we aimed to synthesize a polymer using chitosan and polyethylene glycol (PEG) by the PEGylation of chitosan at the hydroxyl group. After successful modification and confirmation by FTIR, XRD, and SEM, TAF-loaded PEGylated chitosan nanoparticles were prepared and analyzed for their particle size, zeta potential, morphology, crystallinity, chemical interactions, entrapment efficacy, drug loading, in vitro drug release, and release kinetic modeling. The fabricated nanoparticles were found to be in a nanosized range (219.6 nm), with ~90% entrapment efficacy, ~14% drug loading, and a spherical uniform distribution. The FTIR analysis confirmed the successful synthesis of PEGylated chitosan and nanoparticles. The in vitro analysis showed ~60% of the drug was released from the PEGylated polymeric reservoir system within 48 h at pH 7.4. The drug release kinetics were depicted by the Korsmeyer-Peppas release model with thermodynamically nonspontaneous drug release. Conclusively, PEGylated chitosan has the potential to deliver TAF from a nanocarrier system, and in the future, cytotoxicity and in vivo studies can be performed to further authenticate the synthesized polymer.

Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling.

Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania. This study was a secondary analysis of the 2016-17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants' characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys. A total of 2605 older adolescents (15-19 years) and 1296 young adolescents (10-14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28-0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23-0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23-0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11-0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48-0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44-0.70) were also found to have lower uptake of MMC. To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.

Preexposure Prophylaxis for HIV Prevention in a Rural Southern Clinic.

Little is known about implementing preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) in the rural US South, where most HIV infections occur. To investigate how to better reach the at-risk population in rural eastern North Carolina (ENC), the characteristics and clinical courses of those receiving PrEP from our clinic were reviewed and analyzed. A retrospective study was used to describe the characteristics and outcomes of PrEP participants in rural ENC. Thirty-five patients were included whose median age was 37 years (range 22-69). The majority of patients tolerated PrEP well and continued the medication, with only 6 (17%) discontinuations; the reasons for discontinuing included partner mistrust, intolerance to medication, and pregnancy. Patients who initiated PrEP in ENC were more likely to be insured (89%), White (66%), and male (69%). Average travel time to the clinic was 34 minutes (range 2-123 minutes) and the average travel distance was 23 mi (range 1-93 mi). The study results were noteworthy given that in North Carolina, young Black men have the highest estimated rates of HIV infection. The reasons behind this discrepancy are likely multifactorial, and this study highlights the need for future programs and research to make PrEP more widely accessible to the at-risk population in this rural ENC community.

Could Vhavenda initiation schools be a panacea for HIV and AIDS management in the Vhembe district of South Africa?

Several human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevention strategies have been implemented to counteract the impact of the disease, including the use of condoms, social marketing, testing, voluntary counselling and education programmes. One of the platforms which has not been fully explored is that of traditional initiation schools. This study aimed to explore and discuss Vhavenda traditional initiation schools, which can be used as panacea for HIV and AIDS management in the Vhembe district of South Africa. This ethnographic study was conducted in the Vhembe district of South Africa, among nine purposively sampled key informants drawn from a cohort of Vhavenda traditional healers and leaders. Data were collected using semistructured face-to-face interviews and analysed using ethnographic content analysis. The results indicate that Vhavenda traditional initiation schools positively affect the management of HIV and AIDS. Initiation schools are centres for cultural education and the formation of a cultural identity. During the initiation process, initiates are taught social norms, customs and values which will serve them well in adulthood. They are also taught matters of sexuality, courtship, marriage and respect for others. The positive attributes of Vhavenda initiation schools should be accommodated and implemented in curricula from the primary school level up to the tertiary level to reduce and curb the spread of HIV infection.Contribution:Improved expertise at the initiation schools will aid the Department of Health and Education and Training to develop and implement suitable cultural contextualised HIV and AIDS prevention strategies.

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China

Pre-exposure prophylaxis (PrEP) is an effective strategy to prevent uninfected individuals from contracting human immunodeficiency virus (HIV), however it must be acceptable to stakeholders in order to be effective. This study aimed to assess the acceptability of PrEP and related influencing factors. A cross-sectional survey was conducted among female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM) using respondent driven sampling. Factors influencing PrEP acceptability were estimated using ordinal logistic regression and Bayesian networks. The survey included 765 eligible participants. The mean score of the perceived acceptability index was 3.9 (SD = 1.97). Multivariable logistic regression analysis revealed a higher acceptance of PrEP was associated with elder age, having other medical insurance, higher perceived utility of PrEP in facilitating prevention of HIV, higher perceived ease of use, higher perceived risk of increased risk behavior, higher perceived privacy problem in using PrEP, higher perceived comparative advantage over condom use, higher perceived comparative advantage of having sex when the urge arises, and higher perceived image of PrEP user as having sexual risky behavior, as public-minded and as health-conscious. The Bayesian network model showed perceived ease of use, perceived image of user as health-conscious, and perceived comparative advantage of having sex when the urge arises were directly associated with acceptability of PrEP. If these three factors were at a high level, 74.6% of the participants would have a high level of acceptability of PrEP. Effective education strategies to promote the acceptance of PrEP are needed. Implementation strategies should incorporate more inclusive messaging and build positive publicity for PrEP to reduce the stigma that PrEP use indicates risky behavior.