Rate Of New HIV Infections Research Articles

Awareness of, willingness to use, and experiences with Pre-exposure prophylaxis among youth in Nigeria

BackgroundYouth (ages 14–24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria.MethodsThis is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables.ResultsOf the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20–24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis.ConclusionNigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population.Trial RegistrationNCT04070287, the Date of registration of the trial is 20-07-2019.

A qualitative study identifying implementation strategies using the i-PARIHS framework to increase access to pre-exposure prophylaxis at federally qualified health centers in Mississippi

BackgroundMississippi (MS) experiences disproportionally high rates of new HIV infections and limited availability of pre-exposure prophylaxis (PrEP). Federally Qualified Health Centers (FQHCs) are poised to increase access to PrEP. However, little is known about the implementation strategies needed to successfully integrate PrEP services into FQHCs in MS.PurposeThe study had two objectives: identify barriers and facilitators to PrEP use and to develop tailored implementation strategies for FQHCs.MethodsSemi-structured interviews were conducted with 19 staff and 17 PrEP-eligible patients in MS FQHCs between April 2021 and March 2022. The interview was guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework which covered PrEP facilitators and barriers. Interviews were coded according to the i-PARIHS domains of context, innovation, and recipients, followed by thematic analysis of these codes. Identified implementation strategies were presented to 9 FQHC staff for feedback.ResultsData suggested that PrEP use at FQHCs is influenced by patient and clinic staff knowledge with higher levels of knowledge reflecting more PrEP use. Perceived side effects are the most significant barrier to PrEP use for patients, but participants also identified several other barriers including low HIV risk perception and untrained providers. Despite these barriers, patients also expressed a strong motivation to protect themselves, their partners, and their communities from HIV. Implementation strategies included education and provider training which were perceived as acceptable and appropriate.ConclusionsThough patients are motivated to increase protection against HIV, multiple barriers threaten uptake of PrEP within FQHCs in MS. Educating patients and providers, as well as training providers, are promising implementation strategies to overcome these barriers.

Impact of the COVID-19 and War Migration on HIV/AIDS Epidemiology in Poland.

Objectives: This study analyzed trends in HIV/AIDS in Poland over the time period of 2009-2021 and the potential impact of COVID-19 and the migration of war refugees from Ukraine. Methods: Long-term trends were assessed by joinpoint regression using data from Polish HIV/AIDS registries. The HIV/AIDS burden was also compared before and during the pandemic and refugee migration. Results: In 2009-2021, the upward tendency in the rate of new HIV infections until 2017 and decrease after 2017 was accompanied by a downward trend in new HIV/AIDS diagnoses and mortality. From the pandemic's beginning until March 2022, rates of new HIV/AIDS diagnoses dramatically decreased to later increase to pre-pandemic levels, which partially coincided with the wave of migration of refugees from Ukraine. Conclusions: Long-term analysis of HIV/AIDS in Poland showed a downward trend in new HIV/AIDS diagnoses and related mortality in 2009-2021. While the pandemic has reduced the number of detected HIV/AIDS cases, a subsequent increase in new HIV diagnoses in 2022 may be related to lifting the COVID-19 restrictions and war refugees' migration. These observations have implications for the WHO European Region, seeking to end AIDS as a public health problem by 2030.

Facilitating Access to Art and Pre-exposure Prophylaxis for LGBTQ Individuals in Combating HIV in Malaysia: An Analysis from a Shariah Perspective

The increasing rate of new HIV infections poses a significant public health challenge, particularly among young individuals engaging in high-risk sexual behaviours, including male-to-male interactions. Effectively addressing HIV prevention and management within the LGBT community in Malaysia necessitates a comprehensive approach that considers both medical and socio-cultural aspects. This academic inquiry seeks to comprehensively evaluate the progress in HIV preventive measures and therapeutic interventions in the Malaysian context, examining their effectiveness within the affected communities and their adherence to Sharia principles despite religious barriers to modern medical approaches. The findings of this study indicate that the implementation of Antiretroviral Therapy (ART) and Pre-Exposure Prophylaxis (PrEP) measures, supported by the Ministry of Health, align with Sharia principles, underscoring the importance of disease prevention, treatment, and harm reduction. Nonetheless, the research emphasises the vital role of integrating Islamic practices as a preventive measure against HIV transmission. Consequently, this study advocates for improving HIV prevention and treatment strategies pursued by the Ministry of Health by integrating Islamic ethical considerations into Malaysia’s public health policies.

Exploring Barriers and Facilitators That Influence Uptake of Oral Pre-Exposure Prophylaxis Among Men Who Have Sex With Men in Bulawayo, Zimbabwe: Key Stakeholder's Perspectives.

The world has been on the path to ending HIV and AIDS as a global threat by 2030; despite these efforts, the rate of new HIV infections among men who have sex with men remains very high. This study sought to explore the perceptions of key stakeholders on the potential barriers and facilitators of pre-exposure prophylaxis use among this key population. An exploratory, descriptive (through interviews) qualitative study was conducted on 10 key informants who were purposively selected and snowballed based on their knowledge and experience toward pre-exposure prophylaxis programming among men who have sex with men. The interviews were recorded, transcribed verbatim, coded, and thematically analyzed on MAXQDA. Stated barriers were stigma, lack of information, wrong messaging around pre-exposure prophylaxis, hearing negative things about the pills, the burden of taking pills daily, negative attitudes from health care providers, non-friendly health care facilities, pre-exposure prophylaxis not being affordable, and lack of flexibility and privacy from public hospitals. Identified facilitators were correct messaging on pre-exposure prophylaxis, long-lasting injectable pre-exposure prophylaxis, improved packaging, de-stigmatization, more friendly facilities, differentiated service approach, community groups, engagement, and partnership. To address these barriers and leverage the facilitators, it is imperative to have accessible, affordable services, non-judgmental health care providers, and peer support networks to empower men who have sex with men to make informed decisions regarding their sexual and reproductive health. Continued efforts to remove barriers and promote facilitators are crucial for maximizing the potential of pre-exposure prophylaxis as an effective HIV prevention tool among this population.

Risky sexual behaviors and associated factors among adult patients on antiretroviral treatment at Mankweng Hospital in Limpopo Province, South Africa.

Worldwide, it is estimated that 38 million people are HIV-positive and that over 36 million people have died from the virus. In South Africa, the prevalence of HIV was reported to be 20.6% with Limpopo Province having 17% HIV. Given the high rate of new HIV infection in Limpopo, there is therefore a need to assess factors promoting risky sexual behavior among people living with HIV in order to help design and develop behavioral interventions aimed at reducing risky behaviors among people living with HIV. This was a quantitative cross-sectional prospective study, conducted in Mankweng Hospital. The study consisted of 116 participants of which 40 were males and 76 were females aged 18 years and above. The participants were selected using purposive sampling. The data was analyzed using Statistical Package for Social Sciences version 27. A comparison of proportions was performed using Chi-Square. The association between risky sexual practice and sociodemographic factors was analyzed using multivariate logistic regression. The proportion of risky sexual practices in the total population was 48.3%. Participants who were married, those aged 35-44, and those with tertiary qualifications were more likely to engage in risky sexual practices. Multivariate logistic regression showed widowed participants were less likely to practice risky sexual practices. The present study reported a high prevalence of risky sexual practices of 48.3%. Risky sexual behavior was determined by age, marital status, and level of education. The proportion of married participants was higher in risky sexual behavior. Based on the findings of the present study, it is recommended that targeted interventions and educational programs should be implemented to reduce risky sexual behavior among married individuals, individuals aged 35-44, and individuals with tertiary qualifications.

HIV infection rate, high-risk behavior and pre-exposure prophylaxis/post-exposure prophylaxis in men who have sex with men in Beijing

Objective: To understand the incidence of HIV infection, high risk behaviors and pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) utilization in men who have sex with men (MSM) in Beijing. Methods: Sample size was estimated to be 1 227 persons and 207 person year respectively in the survey and the cohort by using Epi Info 7.0 software. Using convenient sampling method, MSM were recruited by using Wechat app. Questionnaire was completed online to collect the information about demographic characteristics, high risk behavior, and utilization of PrEP/PEP of the MSM. MSM collected dry blood spot (DBS) samples by themselves, and mailed the DBS samples to laboratory for HIV nucleic acid testing. Open cohort was established and those with HIV negative nucleic acid testing results were followed up. Non-conditional binary logistic regression method was used to identify the associated factors for high risk anal sex in the last month and having multiple homosexual partners in the last month. Results: A total of 1 147 MSM were recruited, and follow up for 236 person years was conducted in 956 MSM with negative HIV nucleic acid testing results. The detection rate of new HIV infection was 1.3 per 100 person-years (3/236). During the last month, the proportions of consistent condom use in anal sex and oral sex were 50.7% (238/469) and 4.9% (23/469). In the MSM, 5.9% (43/723) had sex with HIV positive partners in the last month. 9.8% (103/1 049) used PrEP, and 8.7% (91/1 049) used PEP. The proportion of consistent condom use in PrEP and PEP were 34.3% (24/70) and 72.2% (39/54) respectively. Logistic regression analysis revealed that compared with those who used no PrEP/PEP, those who used PrEP/PEP were more likely to have unprotected anal sex in the last month (aOR=3.16, 95%CI:1.45-7.18), and more likely to have multiple homosexual partners in the last month (aOR=2.64, 95%CI:1.19-6.30), and compared with those who used no Rush Popper or drugs in the last month, those who used Rush Popper or drugs in the last month were more likely to have unprotected anal sex in the last month (aOR=2.34, 95%CI:1.67-3.30), and more likely to have multiple homosexual partners (aOR=2.42,95%CI:1.76-3.33). Conclusions: It is necessary to strengthen the health education to promote condom use and introduce the harm of drug use in MSM. In PrEP and PEP services, it is still necessary to suggest consistent condom use for MSM.

Hold the phone! A cross-national analysis of Women's education, mobile phones, and HIV infections in low- and middle-income countries, 1990–2018

Despite remarkable progress in the fight against HIV, the number of new infections remains unacceptably high, epidemics continue to grow in certain communities, and therefore AIDS continues to be one of the deadliest pandemics of our times. This study analyzes the rate of new HIV infections over almost 30 years in low- and middle-income countries. Previous research identifies two critical ways to address HIV prevention in developing countries: educating women and using mobile phones to improve health literacy and access to virtual healthcare. Our study bridges these literatures by evaluating how women's education and mobile technology work together to support the goals of HIV prevention in low- and middle-income countries. Using two-way panel fixed effects regression models of HIV incidence across 76 developing countries, we find that both increasing access to women's education and increasing access to mobile phones are associated with fewer HIV infections over time. Furthermore, we discover that women's education moderates the relationship between mobile phones and HIV. More specifically, mobile phones seem to be more beneficial for HIV prevention in cases where rates of formal schooling are low. However, at higher levels of women's education, the impact of mobile phones on new HIV infections is substantially reduced. Our findings have important policy implications for Information and Communications for Development (ICT4D) programs.

Oral Pre-Exposure Prophylaxis Accessibility, Knowledge, Barriers, and Facilitators Among Men Who Have Sex With Men in Bulawayo, Zimbabwe.

Great strides have been made globally toward ending HIV and AIDS as a threat by 2030, although the rate of new HIV infections among men who have sex with men remains very high. Due to their risk of getting HIV and AIDS, utilization of pre-exposure prophylaxis (PrEP) can potentially reduce the risk of HIV transmission among this population. This study sought to analyze the accessibility, knowledge, and potential barriers and facilitators to assessing PrEP by men who have sex with men. The quantitative method was conducted on 65 men who have sex with men through questionnaires loaded on Kobo Collect. Chi-square test, odds ratios, and logistic regression were used to associate different demographic characteristics with knowledge and significance of barriers in PrEP access using STATA 15. A hotspot map of PrEP and locations was created using QGIS. About 84% of respondents accessed pills from friendly facilities. The remaining accessed them from public hospitals, namely Mpilo and United Bulawayo Hospitals. Over 90% of the respondents were found to be highly knowledgeable. Notably, barriers included lack of information, fear of side effects, pills not accessible, pill taste, odor and size, stigma, and lack of protection from other sexually transmitted infections. Facilitators were educated about PrEP, the existence of friendly health facilities, making pills available at all times, partner support, increased number of friendly health facilities and support groups. Maximizing the potential of PrEP as an efficient HIV-prevention intervention among this population requires ongoing efforts to remove barriers and promote facilitators.

Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study.

In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV.

Individual and Health System Factors for Uptake of Pre-exposure Prophylaxis Among Young Black and Latino Gay Men.

Young Black and Latino men who have sex with men (YBLMSM) have the highest rates of new HIV infections in the USA and use PrEP at lower rates than White MSM. To explore YBLMSM's perspectives and experiences of PrEP use to identify factors enabling or impeding uptake. Qualitative study using semi-structured interviews conducted between August 2015 and April 2016. Black and Latino MSM, 18-20years of age, who live, socialize, or work in the Bronx, and were fluent in English or Spanish. We used a thematic analysis to identify themes related to not taking PrEP and PrEP uptake. Half the participants (n = 9) were currently using PrEP, a majority had Medicaid (n = 13), all reported having a PCP, all identified English as their primary language (n = 15), and all identified as gay. Salient themes included concerns over-side effects, stigma related to HIV and sexuality, mistrust of medical providers, provider's refusal to prescribe PrEP, and insurance and cost. Modifiable barriers for PrEP uptake and persistence were reported by most participants, with an emphasis on PrEP misinformation and the pervasiveness of intersectional stigma, providers' low awareness, and hesitant attitudes towards PrEP and barriers created by insurance companies. Supportive infrastructures for PrEP providers and patients are needed.

Trends in HIV/AIDS incidence rate in Mississippi, 2008-2019

Background and objectives: Despite the decline in new HIV infection across the United States, Mississippi is still experiencing high rates of new HIV infections. Reports highlighted significant variations by geographical locations and socio-demographic factors. This study examined trends of HIV/AIDS incidence rates in Mississippi from 2008 to 2019. Materials and methods: Data on HIV/AIDS diagnosis were extracted from Mississippi Enhanced HIV/AIDS Reporting System database. Data were cleaned and de-identified using Microsoft Excel and SAS 9.4. Overall and annual age-adjusted HIV and AIDS incidence rates were calculated by sex, race, and age using 2000 US population. Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) were analyzed using Joinpoint regression models. Results: Overall, HIV incidence rate declined from 25.0 in 2008 to 18.79 per 100,000 population in 2019 (24.8% decrease) while AIDS incidence increased from 6.4 in 2008 to 8.2 per 100,000 population in 2019 (28.1% increase). Comparison between sexes of all age groups showed a downward trend of new HIV infection (AAPC: Male:-1.50, Female:-5.17) and an upward trend of AIDS incidence (AAPC: Male: 1.90, Female: 3.70). Age adjusted HIV incidence declined by 26.8% and 12.4% among blacks and whites respectively (AAPC: Blacks: -2.8, Whites:-1.0) but there was no significant change in age-adjusted AIDS incidence among both races from 2008-2019. Conclusion: This study indicated that age-adjusted HIV incidence rate is declining in Mississippi but trends differ by race, gender, and age. More interventions aimed at ensuring early diagnosis, proper linkage to care and preventing the progression of HIV to AIDS particularly among at-risk population are needed in Mississippi. IMC J Med Sci. 2023; 17(2):002. DOI: https://doi.org/10.55010/imcjms.17.012 *Correspondence: Adetoun F. Asala, Department of Epidemiology and Biostatistics, School of Public Health, 350 W Woodrow Wilson Dr, Jackson, MS 39213. Email: adetoun.f.asala@students.jsums.edu

Development of an acceptance based PrEP intervention (ACTPrEP) to engage young black MSM in the South utilizing the Adaptome Model of intervention adaptation

ObjectivesHIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses. MethodsTwenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed. ResultsPatients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP. ConclusionsInterview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals’ willingness to initiate and maintain PrEP care.

2088. Real-World Geographic Variations of HIV Diagnosis Rates among Individuals Prescribed and not Prescribed Oral HIV Pre-Exposure Prophylaxis (PrEP) Regimens in the United States

Abstract Background Declines in the diagnoses of new HIV infections have been reported in geographic areas with higher uptake of PrEP among persons who would benefit from PrEP (PWBP). In the present analysis, we examined the rate of new HIV diagnoses in PWBP prescribed PrEP and those not prescribed PrEP in order to understand the current and potential impact of PrEP in differing geographies. Methods We estimated the rate of new HIV infections among PWBP not prescribed PrEP with a previously described model (Mera et al. 2019) using a combination of published reports and a claims database. HIV rates for individuals prescribed F/TAF or F/TDF (including brand and generic) for PrEP between 10/3/2019 (F/TAF approval) and 6/30/2021 were analyzed from claims data. For those prescribed PrEP, new infections included new HIV diagnosis or addition of HIV treatment within 10 days of PrEP discontinuation. Results Overall, the US HIV diagnosis rate was 61% lower among PWBP prescribed PrEP (1.33 per 100-person year [95%CI: 1.24 – 1.42]) compared to those not prescribed PrEP (3.38 [3.35 – 3.42]). New HIV diagnosis rates by state among PWBP not prescribed PrEP ranged from 0.41 (0.22 – 0.78) in Vermont to 9.96 (9.53 – 11.54) in Mississippi (Figure). The Southern US had the highest regional HIV diagnosis rate among PWBP not prescribed PrEP (4.20 [4.14 - 4.26], Table). HIV diagnosis rates by state among PWBP prescribed PrEP were lower, ranging from 0 to 2.40 (0.05 – 4.75). Eleven states had a greater than 85% lower HIV diagnosis rate among PWBP prescribed PrEP versus those who were not prescribed PrEP, and the greatest differences in diagnosis rates by PrEP prescription status were observed in the Southeastern US states. Figure:The estimated rates of new HIV diagnosis (per 100 person-years) among PWBP who were not prescribed PrEP in 2019 (A) and those prescribed PrEP from 10/3/2019 to 6/30/2021 (B) in the United States.Table:Regional variations of new HIV diagnosis rates among PWBP who were not prescribed PrEP in 2019 and those prescribed PrEP from 10/3/2019 to 6/30/2021 in the United States. Conclusion This study suggests that substantial reductions in HIV diagnosis rates have occurred in people prescribed PrEP in the US. We found large geographic variations in HIV diagnosis rates, with the largest differences by PrEP prescription status occurring in the Southeast US, underscoring the need for PrEP expansion and its potential impact on the HIV epidemic in that region. Furthermore, our findings demonstrate an approach of estimating HIV rates for PWBP prescribed and those not prescribed PrEP, which may be useful in supporting targeted delivery of HIV prevention services in the US. Disclosures Li Tao, MD, PhD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds Jen Thorburn, n/a, Gilead Sciences: Grant/Research Support Amanda Kong, DrPH, Gilead Sciences: Grant/Research Support Debra Irwin, PhD, Gilead Sciences: Grant/Research Support Christoph C. Carter, MD, PhD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds Moupali Das, MD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds Julie Paone, MPH, Gilead Sciences: Grant/Research Support.

Hypo-osmolar rectal douche tenofovir formulation prevents simian/human immunodeficiency virus acquisition in macaques.

In spite of the rollout of oral pre-exposure prophylaxis (PrEP), the rate of new HIV infections remains a major health crisis. In the United States, new infections occur predominantly in men having sex with men (MSM) in rural settings where access to PrEP can be limited. As an alternative congruent with MSM sexual behavior, we have optimized and tested tenofovir (TFV) and analog-based iso-osmolar and hypo-osmolar (HOsm) rectal douches for efficacy against rectal simian/human immunodeficiency virus (SHIV) infection of macaques. Single TFV HOsm high-dose douches achieved peak plasma TFV levels similar to daily oral PrEP, while other formulations yielded lower concentrations. Rectal tissue TFV-diphosphate (TFV-DP) concentrations at the portal of virus entry, however, were markedly higher after HOsm douching than daily oral PrEP. Repeated douches led to significantly higher plasma TFV and higher TFV-DP concentrations in rectal tissue at 24 hours compared with single douches, without detectable mucosal or systemic toxicity. Using stringent repeated intrarectal SHIV exposures, single HOsm high-dose douches delivered greater protection from virus acquisition for more than 24 hours compared with oral PrEP. Our results demonstrate a rapid delivery of protective TFV doses to the rectal portal of virus entry as a potential low-cost and safe PrEP alternative.

A longitudinal interprofessional case based learning experience: The HIV/AIDS care continuum in the rural South

HIV/AIDS remains a significant public health issue in the United States. Recent advances in prophylactic treatment coupled with comprehensive interventions that enhance patient care provide promise. While new treatments and interventions are important, the US still needs to increase the size and strength of the HIV clinical workforce. As a member of the Southeastern AIDS Education Training Center, we developed an online, three-module, longitudinal case-based curriculum to facilitate interprofessional learning for students from multiple health professions related to contemporary issues associated with HIV/AIDS in the United States. This curriculum was designed to introduce students to clinical, psychosocial-behavioral and social determinants of health issues associated with HIV care. It is intended to provide foundational learning to reduce HIV-related stigma, educate about the challenges associated with HIV care in the Southeastern United States, and empower healthcare professions to continue their HIV specific education and training with the goal of reducing the rate of new HIV infections. The activities draw from aspects of team-based and problem-based learning to facilitate interprofessional learning for a large cohort of learners in a resource efficient manner. The modules include pre-readings, and collaborative activities for students to complete in interprofessional teams. Assessment methods consist of knowledge-based assessments and team-based learning products. Instructional Management Systems Common Cartridge File (IMSCC). This file is included in the supplementary materials and is compatible with a range of learning management learning management systems (LMS). By downloading this file and importing it into your LMS, the curriculum will be ready for use, though syllabus materials, due dates and other minor details will need to be adapted based upon institutional standards. Analysis of data from learners provides evidence of perceived increased knowledge of professional roles, increased understanding related to teamwork and patient safety and positive changes in attitudes relative to HIV care.

Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing.

BackgroundHIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior.ObjectiveTo address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing.MethodsBuilding on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview.ResultsTT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI.ConclusionsTT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression.Trial RegistrationClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372

HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.

Adverse Childhood Experiences among a Sample of Youth Living with HIV in the Deep South.

The southern region of the United States, often referred to as the Deep South, is disproportionately affected by HIV. In fact, the highest rates of new HIV infections occur in the Deep South. Approximately one in five new HIV infections are among youth. Youth living with HIV (YLWH) have several behavioral health risks, including co-occurring mental health and substance abuse disorders, which negatively affect medication adherence, contribute to less engagement in HIV care, and result in poor health outcomes. Research suggests that adverse childhood experiences (ACEs) contribute to HIV risk behaviors and that people living with HIV may be more vulnerable to the negative health outcomes and adverse effects of stressors. Using existing program evaluation data, we examined data from 41 YLWH aged 17–24 screened for ACEs in an integrated care setting. Most participants were Black/African American young men who identified as homosexual, bisexual, or questioning, and who acquired HIV behaviorally. Approximately, one-third of YLWH screened positive or in the high-risk range on an ACEs screener. Scores fell in the intermediate range for nearly half of the sample. Results did not reveal a significant relationship between ACEs and HIV biological indicators. In this paper, we describe these findings and the importance of incorporating trauma-informed approaches into HIV prevention and treatment programs targeting youth in the Deep South.

Fryer Lecture Awardee: HIV Epidemic Revealed Inequities That Persist Today

Back to table of contents Previous article Next article Annual MeetingFull AccessFryer Lecture Awardee: HIV Epidemic Revealed Inequities That Persist TodayMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Jun 2022https://doi.org/10.1176/appi.pn.2022.07.7.29AbstractKenneth Bryan Ashley said that the South is home to the highest percentage of gay and bisexual men living with HIV. Poverty, lack of health insurance, lack of education, low household income, and food insecurity—which are more pronounced in the South—affect the health of people living with HIV.HIV/AIDS, like COVID-19, has revealed health inequities and the influence of social determinants of health on disease, said Kenneth Bryan Ashley, M.D., who delivered this year’s John Fryer Award Lecture at APA’s Annual Meeting in New Orleans.He is an associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai, an attending psychiatrist in the Division of Consultation-Liaison Psychiatry at Mount Sinai Beth Israel, and director of Outpatient C-L Psychiatry at Mount Sinai Beth Israel. He is also the psychiatric liaison to the Mount Sinai Center for Transgender Medicine and Surgery Post-Surgical Gender Affirmation Surgery Service.Amir Ahuja, M.D., president of the Association of LGBTQ+ Psychiatrists (right), presents the John Fryer Award to Kenneth Bryan Ashley, M.D.Oscar & AssociatesAshley provided an overview of the history of the HIV/AIDS epidemic and its changing demographics and regional incidence. “The HIV epidemic epicenter in the U.S. began in coastal major metropolitan areas,” he said. “The current HIV epidemic in the U.S. is focused in the South.”Ashley said the South (Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Washington, D.C.) accounted for 53% of all new HIV cases in 2019. Within that region, Black people, who represent 19% of the population, accounted for 50% of all new HIV cases in 2019. Hispanic people accounted for 24% of all new cases. White people and others accounted for 26%.Citing statistics from AIDSVu, an interactive online mapping tool that visualizes the impact of the HIV epidemic on communities across the United States, Ashley said that the South is home to the highest percentage of gay and bisexual men (44%) living with HIV and that they are more likely to experience discrimination. Moreover, negative social determinants of health—poverty, lack of health insurance, lack of education, low household income, and food insecurity—are more pronounced in the South, and all of them affect the health of people living with HIV. For instance, 14.3% of people in the South lack health insurance compared with 10.4% of people nationwide.Ashley also discussed “Ending the Epidemic: A Plan for America (ETE),” initiated in 2019 by the Department of Health and Human Services. The multi-year program will infuse 48 counties; Washington, D.C.; San Juan, Puerto Rico; and seven states that have a substantial rural HIV burden with the additional expertise, technology, and resources needed to end the HIV epidemic in the United States. The goal is a 75% reduction in new HIV cases in five years and a 90% reduction in 10 years.“ETE can reduce rates of new HIV infections in targeted groups, but it will not resolve inequities,” Ashley said. “Structural racism and social determinants of health must be addressed as part of the ETE to hope to address health inequities. Engagement with community-based HIV and health organizations will be vital to addressing health inequities.”Ashley has been active in APA at both the district branch and the national levels. He is an Assembly representative of the New York County Psychiatric Society and former president. He is also co-chair of the New York State Psychiatric Association Committee on Structural Racism. He is active in the APA mentors program, as well as a member of APA’s National Minority Mentor Network, and serves on APA’s Council on Consultation-Liaison Psychiatry.He is the former president of the Association of LGBTQ+ Psychiatrists and the Society for Liaison Psychiatry, the New York regional organization of the Academy of Consultation-Liaison Psychiatry. He is a senior fellow of the Group for the Advancement of Psychiatry (GAP) and a member of the LGBTQ Committee.The John Fryer Award, sponsored by APA and the Association of LGBTQ+ Psychiatrists, is given to individuals whose work has contributed to the improvement of mental health of sexual minority communities. It is named in honor of the psychiatrist who was part of the protest by gay psychiatrists at APA’s 1972 Annual Meeting that led to the removal of homosexuality from DSM the following year. John Fryer, M.D., appeared at the meeting in a mask as Dr. Henry Anonymous and testified about the barriers confronting gay psychiatrists. ■ResourcesInformation about Ending the HIV Epidemic ISSUES NewArchived