Rationale
Effective human immunodeficiency virus (HIV) prevention requires a coordinated continuum of services to foster early diagnosis and treatment. Early linkage to care (LTC) is critical, yet ...programmes differ in strategies to monitor LTC.
Methods
In 2014, we visited 23 HIV testing and care service delivery points in Mozambique to assess programme strategies for monitoring LTC. We interviewed key informants, reviewed forms, and matched records across service points to identify successful models and challenges.
Results
Forms most useful for tracking LTC included individual identifiers, eg, patient name, unique identifier (ie, National Health Identification Number NID), sex, and date of birth. The majority (67%) of records matched occurred in the presence of a unique NID. Key informants described challenges related to processes, staffing, and communication between service delivery points to confirm LTC.
Conclusions
While tracking clients from HIV testing to care is possible, programmes with insufficient tracking procedures are likely to underreport LTC. Adoption of additional patient identifiers in testing registers and standardized protocols may improve LTC programme monitoring and reduce underreporting.
Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) ...living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it.
Highlights • Lack of a proper occupational exposure management system exposes health care workers to bloodborne pathogen infection. • Multicomponent interventions improve occupational exposure ...reporting and case management. • Reporting is vital for counseling, treatment, and follow-up of occupational exposures.
Among persons with HIV (PWH), homelessness is associated with poorer health. From 2009 to 2014, national HIV prevention goals included a reduction in homelessness among PWH. We sought to examine ...social ecological factors associated with homelessness among PWH at a sub-national level during that period. National data identified Delaware as the only jurisdiction where homelessness among PWH declined from 2009 to 2014. We analyzed population-level indicators and conducted telephone interviews with 6 key stakeholders to further examine this trend. Overall homelessness, household poverty, and median housing price were associated with homelessness among PWH in Delaware. Key stakeholders highlighted centralized services as program strengths, and pointed to common challenges, e.g., long wait lists, limited availability of units, and complex procedures. In addition to broader social and economic factors, coordinated program strategies may improve housing outcomes for PWH. Monitoring trends at sub-national levels can help identify successful approaches as well as ongoing challenges.
Positive Health Check (PHC), an interactive, web-based intervention, provides tailored behavioral health messages to support people with HIV in their HIV care. Users interact with a virtual doctor ...and based on responses to tailoring questions, PHC delivers relevant content modules addressing treatment initiation, medication adherence, retention in care, sexual risk reduction, mother-to-child transmission, and injection drug use. During a one-month feasibility pilot of PHC, patients in four HIV primary care clinics were invited to use PHC and tool usage metrics were collected and assessed. Descriptive analyses were conducted to characterize how the tool was used based on behavioral risk scenarios presented.
Ninety-seven patients accessed PHC as part of the pilot, with 68 (70.1%) completing the intervention on average in 15 min. Out of 85 patients who viewed behavioral tips and commitments, 66 (77.7%) selected at least one tip to practice and 41 (48.2%) made at least one commitment to ask their provider a question. Patients spent the most time with adherence and sexual risk reduction content. The high level of tool engagement suggests that PHC was acceptable to patients regardless of length of time since diagnosis. PHC can be completed within a single visit and is a promising tool for PWH.
To evaluate Chicas Creando Acceso a la Salud (Girls Creating Access to Health; ChiCAS), a Spanish-language, small-group intervention designed to increase preexposure prophylaxis (PrEP) use, ...consistent condom use, and medically supervised gender-affirming hormone therapy use among Spanish-speaking transgender Latinas who have sex with men.
Participants were 144 HIV-negative Spanish-speaking transgender Latinas, aged 18 to 59 years, living in North and South Carolina. From July 2019 to July 2021, we screened, recruited, and randomized them to the 2-session ChiCAS intervention or the delayed-intervention waitlist control. Participants completed assessments at baseline and 6-month follow-up. Follow-up retention was 94.4%.
At follow-up, relative to control participants, ChiCAS participants reported increased PrEP use (adjusted odds ratio AOR = 4.64; 95% confidence interval CI = 1.57, 13.7;
< .006). However, ChiCAS participants did not report increased use of condoms or medically supervised gender-affirming hormone therapy. ChiCAS participants reported increases in knowledge of HIV (
< .001), sexually transmitted infections (
< .001), and gender-affirming hormone therapy (
= .01); PrEP awareness (
< .001), knowledge (
< .001), and readiness (
< .001); condom use skills (
< .001); and community attachment (
< .001).
The ChiCAS intervention was efficacious in increasing PrEP use among Spanish-speaking, transgender Latinas in this trial. (
2024;114(1):68-78. https://doi.org/10.2105/AJPH.2023.307444).
Strategic, high quality HIV testing services (HTS) delivery is an essential step towards reaching the end of AIDS by 2030. We conducted HTS Data Use workshops in five African countries to increase ...data use for strategic program decision-making. Feedback was collected on the extent to which workshop skills and tools were applied in practice and to identify future capacity-building needs. We later conducted six semistructured phone interviews with workshop planning teams and sent a web-based survey to 92 past participants. The HTS Data Use workshops provided accessible tools that were readily learned by most respondents. While most respondents reported increased confidence in interpreting data and frequency of using such tools over time, planning team representatives indicated ongoing needs for more automated tools that can function across data systems. To achieve ambitious global HIV/AIDS targets, national decision makers may continue to seek tools and skill-building opportunities to monitor programs and identify opportunities to refine strategies.
Homelessness affects HIV risk and health, but little is known about the longitudinal effects of rental assistance on the housing status and health of homeless and unstably housed people living with ...HIV/AIDS. Homeless/unstably housed people living with HIV/AIDS (
N
= 630) were randomly assigned to immediate Housing Opportunities for People with AIDS (HOPWA) rental assistance or customary care. Self-reported data, CD4, and HIV viral load were collected at baseline, 6, 12, and 18 months. Results showed that housing status improved in both groups, with greater improvement occurring in the treatment group. At 18 months, 51% of the comparison group had their own housing, limiting statistical power. Intent-to-treat analyses demonstrated significant reductions in medical care utilization and improvements in self-reported physical and mental health; significant differential change benefiting the treatment group was observed for depression and perceived stress. Significant differences between homeless and stably housed participants were found in as-treated analyses for health care utilization, mental health, and physical health. HOPWA rental assistance improves housing status and, in some cases, health outcomes of homeless and unstably housed people living with HIV/AIDS.
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