AIDS and Behavior

This study aimed to learn clinicians perspectives on PrEP initiation, the HIV risk assessment process, perceived barriers to PrEP implementation, and how a potential EHR-based PrEP clinical decision support (CDS) tool can help improve their practices. Data were collected between October 2021 and November 2021 via three remote focus groups with 15 clinicians with experience prescribing PrEP. The focus groups were audio recorded, transcribed, and analyzed using thematic analysis. Five themes emerged from the qualitative analysis: (1) PrEP initiation is a joint effort between patients and clinicians; (2) Electronic health records (EHRs) are helpful but insufficient for identifying PrEP candidates; (3) Patient-clinician conversations are key for identifying PrEP candidates; (4) Patient, clinician, and system-level barriers deter PrEP implementation; and (5) Adopting technological innovations in health care can improve PrEP prescribing. Our analysis suggests that implementing effective communication strategies and behavioral interventions can improve PrEP awareness and reduce barriers in patient-clinician discussions of sexual history and substance use.

BackgroundWomen comprise 19% of new HIV infections in the U.S. Many women, particularly women of color, are unaware of pre-exposure prophylaxis (PrEP) as an HIV prevention option. We conducted a pilot randomized controlled trial (RCT) to assess feasibility and acceptability of a theory-based, contextually-relevant behavioral intervention, Just4Us, to promote PrEP initiation and adherence among women in New York City and Philadelphia. MethodsEligibility criteria included: cisgender women, aged 18-55, not living with HIV, not currently taking PrEP, and meeting PrEP eligibility guidelines. Participants were randomized 3:1 to the Just4Us Education and Activities (E&A) arm or to the Information arm (Info); all were provided with PrEP information and a referral list. E&A arm participants received an individually-delivered session with a counselor-navigator, who provided information, motivation enhancement, skills-building, problem-solving, and referrals. Between baseline and 3-month follow-up, E&A arm participants received phone calls to support linkage to care and text-messages to promote adherence. Feasibility and acceptability were assessed. ResultsEighty-three women were enrolled (61 intervention; 22 Info); 79% were Black, 26% Latina, exceeding diversity and enrollment targets. Attendance rate for the initial E&A and Info intervention session was 100%. Three-month retention rate was high at 90%. E&A arm participants reported feeling "very satisfied/satisfied with the following: overall session, 95%; discussion with counselor-navigator, 97%; tablet activities, 95%; text-messaging set-up, 93%.; and video, 90%. Among Info and E&A arms, 78% felt the session length was just right, and 95% stated that they would recommend/strongly recommend Just4Us to others. ConclusionsThe pilot RCT demonstrated feasibility and acceptability of the Just4Us E&A intervention, a promising intervention to increase uptake of PrEP among cisgender women. The team was able to recruit, implement the interventions with a high degree of fidelity, and retain the target number of PrEP-eligible socially disadvantaged women. Overall, participant feedback indicated they were generally very satisfied with their intervention.

BackgroundPrEP uptake among Black and Latino gay, bisexual, and other men who have sex with men (GBM) remains low in the United States. The design and implementation of PrEP delivery programs that incorporate the preferences of Black and Latino GBM may overcome barriers to uptake. We aimed to identify preferences for PrEP care among high-priority GBM in the U.S. with a large discrete choice experiment. MethodsWe conducted two discreet choice experiments (DCE) to elicit care preferences for (1) Starting PrEP and (2) Continuing PrEP care among GBM clinically indicated for PrEP. The DCE web-based survey was nested in a longitudinal cohort study of GBM in the U.S., implemented with video and audio directions among 16-49 year-old participants, not using PrEP, and verified to be HIV-negative. All participants were presented with 16 choice sets, with choices determined by BLGBM and PrEP implementation stakeholders. We calculated overall utility scores and relative importance and used latent class analyses (LCA) to identify classes within the Starting and Continuing PrEP DCE. Multivariable analysis was performed to identify factors associated with class membership. FindingsAmong 1514 participants, mean age was 32 years; 46{middle dot}5% identified as Latino, 21{middle dot}4% Black, and 25{middle dot}2 White; 37{middle dot}5% had an income less than USD $20,000. Two latent classes were identified for Starting PrEP: Class 1 (n=431 [28{middle dot}5%]) was driven by preference for more traditional in-person care, and Class 2 (n=1083 [71{middle dot}5%]) preferred flexible care options and on-demand PrEP. In a multivariable model, having a sexual health doctor (adjusted OR 0{middle dot}7, CI 0{middle dot}5, 0{middle dot}9), having a primary care provider (OR 0{middle dot}7,CI 0{middle dot}5, 0{middle dot}9, p= 0{middle dot}023), and concerns over PrEP side effects (OR 1{middle dot}1, CI 1{middle dot}0,1{middle dot}2, p= 0{middle dot}003) were all associated with class membership. InterpretationThe different preferences identified for PrEP care indicate the need for diverse care and formulation choices to improve PrEP uptake and persistence. Addressing these preferences and understanding the factors that shape them can inform the implementation of programs that increase PrEP uptake.

BackgroundDespite Pre-exposure prophylaxiss (PrEP) demonstrated effectiveness, Black cisgender women continue to be at an elevated risk for HIV acquisition and uptake of daily oral PrEP is low in this population in the US. As advancements in PrEP delivery options continue, it is important to understand womens acceptability of these additional options, specifically Black cisgender women, in order to inform uptake and adherence among this population at increased need of HIV prevention options. SettingA cross-sectional survey among Black cisgender women ages 13-45 (inclusive) attending womens health clinics in Chicago, IL, prior to the approval of CAB-LA. MethodsDescriptive statistics were used to describe the sample and bivariate analysis was used to detect differences between categorical and outcome variables using chi-square test. Responses to open-ended questions were thematically coded to explore Black cisgender womens attitudes and preferences between the three methods of PrEP delivery including: vaginal ring, long-acting injectable, and a combined method that would prevent both pregnancy and HIV. ResultsIn total, 211 cisgender women and adolescents responded to the survey. Both injections and combination pills were popular among participants, with 64.5% and 67.3% expressing interest in these forms of PrEP, respectively. The least popular method was the vaginal ring option, with 75.4% of respondents indicating that they would not consider using this modality. Overall, responses were not statistically different between the two surveys administered (Chi square p-values for injection PrEP method 0.66, combination PrEP method 0.93, and ring PrEP method 0.66) suggesting that the popularity of each method was not dependent on clinic location or age of participants. ConclusionThis research provides important insights into the preferences and attitudes of different PrEP modalities among Black cisgender women. As different modalities continue to be approved for use among cisgender women, more research is needed to investigate the acceptability and preferences of these different modalities in order to improve uptake and adherence among this population.

BackgroundLittle is known regarding the degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication adherence. We hypothesized that the total effects of such use are mediated through adherence. MethodsWe included patients with HIV (PWH) receiving care at an urban academic HIV clinic between 2014 and 2018. Eligible patients were those prescribed antiretroviral therapy who completed both patient reported outcome (PRO) questionnaires, and had subsequent plasma viral load (pVL) measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (ASSIST), and self-reported adherence. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE) and percentage mediated. ResultsAmong 3125 Patients who met eligibility criteria, percentages of current use by category were: hazardous alcohol 25.8%, cannabis 27.1%, amphetamines 13.1%, inhalants 11.9%, cocaine 5.3%, sedative-hypnotics 4.5%, opioids 2.9%, and hallucinogens 2.3%. Excellent adherence was reported in 58% and 10% had detectable pVL. Except for sedatives use of other ascertained substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR(95% CI)]: amphetamine use 2.4 (1.8 -3.2) and opioid use 2.3 (1.3 - 4.0). The percentage mediated by adherence was 36% for amphetamine use, 26.5% for opioid use, and 39% for multiple substance use. ConclusionUse of amphetamines, opioids, and multiple substances predicted detectable pVL. However, less than 40% of effects were mediated by self-reported adherence. SummaryWe examined adherence-mediated effects of hazardous alcohol and substance use on HIV viral suppression. Use of amphetamines, opioids, and multiple substance predicted detectable viral load, however, less than 40% of effects were mediated by self-reported antiretroviral adherence.

Women comprise 20% of new HIV diagnoses in the U.S. with 86% attributed to heterosexual contact, but HIV pre-exposure prophylaxis (PrEP) uptake is low. OB/GYN clinics are ideal settings to increase HIV prevention counseling for cisgender women, as patients are more likely to discuss their sexual behavior, undergo sexually transmitted infection screening, and receive risk reduction counseling. Our study will assess the feasibility, acceptability, and effectiveness of a registered nurse (RN)-led PrEP project in OB/GYN clinics. Microlearning and Plan-Do-Study-Act cycles will be performed, followed by a randomized controlled trial (RCT). A total of cisgender women determined to be at-risk for HIV will be randomized to standard of care with electronic medical record enhancements (e-SOC) or e-SOC with contact and PrEP counselling by an RN, who will be able to prescribe PrEP under protocol guidance. By shifting HIV PrEP counselling to a nurse, clinics may be able to increase PrEP awareness and uptake. Registered with clinicaltrials.gov: NCT05095818

Although 22% of new HIV diagnoses in the United States are attributed to heterosexual contact, uptake of pre-exposure prophylaxis (PrEP) remains low among heterosexually active women and men, and information about PrEP considerations in this population is scarce. We report on a cross-sectional qualitative study that explored attitudes towards PrEP among a diverse sample of 50 heterosexually active cisgender adults (31 women, 19 men) in New York City. We categorized factors influencing PrEP attitudes along social-ecological levels: societal (e.g., social marketing), community (e.g., health care organizations and providers), interpersonal (e.g., friends and sexual partners), and individual (e.g., personal beliefs and preferences). About two-thirds had previously heard of PrEP, but a few had inaccurate or lacking knowledge of it, and none had ever used it. Many participants had learned about PrEP through marketing and social interactions, from which many perceived that PrEP was mainly indicated for gay or bisexual men and transgender individuals. Most participants had never discussed PrEP or received information about it in health-care settings, even though the majority had recently been screened for HIV or sexually transmitted infections. Participants generally felt PrEP was not relevant to them because they perceived themselves at low risk for HIV, thinking PrEP would be indicated for people who have high numbers of sex partners or partners with HIV. Some participants said they would view a potential partner using PrEP positively (e.g., as responsible), while others raised concerns (e.g., about their presumed behaviors). Concerns with side effects and long-term drug toxicity were common, and a few participants expressed anti-medication beliefs. Although awareness seems high, PrEP appears to not have yet entered the repertoire of HIV prevention options for heterosexually active New Yorkers. PrEP promotion among this population could benefit from: messaging targeted to heterosexual adults; ensuring health-care providers inform all sexually active patients about PrEP; and clarifying for practitioners and the public that PrEP is an option for any sexually active person, even those who do not report substantial HIV risk.

We piloted a Motivational Interviewing (MI) training program for lay counsellors in South Africa (SA) to assess its impact on retention and viral suppression among newly diagnosed individuals living with HIV (PLHIV) at 12 months post-diagnosis. We randomized eight primary healthcare clinics (PHC) in Johannesburg to either the intervention clinics (n=4) where all lay counsellors were supported for 12 months before the PLHIV enrolment or the standard of care (n=4 clinics). Overall, 548 adults ([&ge;] 18 years) PLHIV were recruited after HIV diagnosis from March 2020 to August 2021 (n=291 intervention, n=257 control). We conducted Poisson regression modelling to assess the intervention effect on patient attendance status (out of care - being [&ge;]28 days late for the last appointment) and viral suppression (<50 copies/ml) at 12 months, reporting risk ratios (RR) with 95% confidence intervals (CIs). Of the 548 eligible participants enrolled, 56.3% were [&ge;]28 days late (52.9% intervention vs 60.9% controls, RR 0.9, 95% CI: 0.7-1.0). Retention at 12 months positively correlated with baseline counselor MI skill levels (Cultivating change talk, RR 1.6, 95%CI: 1.1-2.5; Softening sustain talk, RR 1.5, 95%CI: 0.8-2.9; Empathy, RR 1.4, 95%CI: 1.0-1.8; Partnership RR 1.5, 95%CI: 1.2-1.9). Among those retained at 12 months, 65.3% of intervention participants were virally suppressed compared to 49.3% controls (RR 1.3, 95%CI: 1.0-1.7). Compared to control participants, the intervention group reported more positive counseling experiences, fewer concerns about HIV disclosure (RR 0.8 for high vs low-medium concerns, 95% CI: 0.7-1.0) and ART (RR 0.8, 95% CI: 0.7-1.0), and were more likely to express high confidence to take treatment in public (47.4% vs 28.8%, RR 1.4, 95% CI: 1.0-1.8) after counselling.

ObjectiveThe aim of this systematic review is to provide some evidence on the use of mobile phone communication for improving ARV adherence during pregnancy, as well as to investigate whether text messaging on mobile phones could improve follow-up in HIV-exposed infants. MethodsWe did a systematic review and meta-analysis, using CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, MEDLINE via PubMed, Web of Science, and CINAHL to search for studies in English published between 5 may 2016 to May 2021 that assessed the effects of mobile phone in HIV-infected pregnant women. We used MetaPro version 3.0 to compute the OR and RR and their 95%CI. We performed random-effects model meta-analysis for estimating pooled outcomes. ResultsNine studies were included in the meta-analysis. The pooled maternal post-partum retention was (OR 2.20, 95%CI: 1.55 - 3.13, I2 = 53.20%, P < 0.001). In the same line, the pooled odds of ART uptake was (OR 1.5, 95%CI: 1.07-2.11, I2 =0%, P = 0.020) and we found statistically significant impact of mobile phone on HIV testing at 6 weeks and above among HIV exposed children (OR 1.89, 95%CI: 1.04 - 3. 48, I2 = OR 1.89, 95%CI: 1.04 - 3. 48, I2 =88.04%, P = 0.032). ConclusionIn comparison to our previous review, this updated review focuses on moderate evidence for mobile phone communication in HIV-infected pregnant women. The results showed that using a mobile phone improved maternal post-partum retention, ART uptake, and infant HIV testing at 6 weeks and older.

Substance use remains a robust predictor of HIV infection, as well as a serious impediment to progress across the HIV care continuum for people living with HIV. As such, the careful design and implementation of interventions uniquely tailored to target substance use and HIV care behaviors remain paramount. A necessary step in these efforts is to understand the extent to which HIV care interventions have been efficacious in helping people who use substances progress across the HIV care continuum. Using PubMed and ProQuest databases, we performed a systematic review of randomized trials of HIV care continuum interventions among people who use substances published between 2011 and 2021, the treatment-as-prevention era. Existing systematic reviews and studies in which less than half of those sampled reported substance use were excluded. We identified ten studies (total N=5410; range: 210-1308), nine of which intentionally targeted substance-using populations. Four of these studies involved use of at least one of several substances, including alcohol, opioids, stimulants, and/or marijuana, among others; three involved injection drug use only; one involved methamphetamine use only; and one involved alcohol use only. One study targeted a population with incidental substance use, which involved use of alcohol, injection drug use, and non-injection drug use. Viral suppression was targeted in 8/10 studies, followed by uptake/initiation of antiretroviral therapy (ART; 6/10), ART adherence (6/10), retention to care (4/10), and linkage to care (3/10). For each outcome, intervention effects were found in roughly half of the studies in which a given outcome was assessed. Mediated (2/10) and moderated (2/10) effects were minimally examined. The diversity of substances used in and across studies, as well as other characteristics that varied across studies, prevented broad deductions or conclusions about the amenability of specific substances to intervention. Moreover, study quality was mixed due to varying attrition and assessment measures (self-report vs biological/clinical). More coordinated, comprehensive, and targeted efforts are needed to disentangle intervention effects on HIV care continuum outcomes among populations using diverse substances.

IntroductionAdolescents living with HIV are at an increased risk of experiencing mental health challenges, which may impact their overall well-being and adherence to treatment. Evidence-based interventions are crucial to addressing these issues; however, the effectiveness of these interventions remains unclear. This scoping review aimed to synthesize all interventions that tested either the prevention or improvement of mental health for adolescents living with HIV. MethodsWe used PubMed, PsycINFO, CINAHL, Embase, and Cochrane to identify RCTs evaluating mental health interventions for HIV-infected adolescents. ResultsA scoping review included 13 out of 1015 studies demonstrating the global relevance of addressing mental health in this population. Interventions were diverse and showed mixed effectiveness in improving mental health outcomes such as depression, anxiety, trauma, and behavioural symptoms. Factors contributing to mixed results included variations in intervention design, study characteristics, and contextual factors. Identified gaps in the literature encompassed the limited number of studies in some regions and the lack of research on specific subpopulations and long-term intervention effectiveness. ConclusionA mixed result needs to be confirmed in future RCTs. This review provides valuable insights into improving the mental health of HIV-infected adolescents and can guide further research and practice in this area.

BackgroundThe prevalence of HIV is higher in the transgender population. Recently, the preexposure prophylaxis (PrEP) intervention has been proven successful in reducing HIV acquisition in trials among men who have sex with men (MSM), and heterosexual couples. This research aims to investigate the adherence to PrEP by HIV-negative transgender women (TW). MethodsWere followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. Research in WoS, Ovid, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases for studies that involved HIV-negative TW population and focused on their adherence to PrEP intervention and condom use after the treatment. Results11 studies were included. TW sample sizes were low in comparison to the total sample, which often included men who have sex with men (MSM) population. The participation and adherence to the intervention was low compared to MSM, and it was measured mainly by self-report (72.7%) or by Tenofovir-diphosphate (TFV-DP)/ Emtricitabine triphosphate (FTC-TP) dried blood spot (DBS) (45.5%). ConclusionsIt is important to increase awareness and explain the effect of PrEP on feminizing hormone therapy at the beginning of the trials. Nevertheless, the low adherence may be affected by the interaction between drugs and the barriers faced to use the health services.

BackgroundHeavy drinking among People Living With HIV (PLWH) reduces antiretroviral adherence and worsens health outcomes. Lengthy interventions to reduce drinking and improve adherence are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed and tested HealthCall as an electronic (smartphone) means of increasing patient involvement in brief intervention to reduce drinking and improve medication adherence without making unfeasible demands on providers. MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinicians Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline interventions targeting drinking reduction and medication adherence were [~]25 minutes, with brief (10-15 min) booster sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking, medication adherence, and other aspects of the prior 24 hours. Our outcome, assessed at 30 and 60 days, and 3, 6 and 12 months, was ART adherence (using unannounced phone pill-count method; possible adherence scores: 0%-100%). Analysis: generalized linear mixed models with pre-planned contrasts. ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. ART adherence was generally high throughout follow-up, with some decline by 12 months. Although both CG+HealthCall and MI+HealthCall evidenced benefits early in follow-up, by 6 months, ART adherence was 11% better among patients in CG+HealthCall than in CG-only (p=0.03) and 9% better than among patients in MI+HealthCall (p=0.07). Efficacy differed slightly by gender (p=.09). ConclusionHealthCall paired with CG resulted in better ART adherence than CG alone. MI+HealthCalls early benefits diminished over time. Given the importance of ART adherence and drinking reduction among PLWH, and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

ObjectivesTo develop and implement a community pharmacy pre-exposure prophylaxis (PrEP) awareness raising and initiation pilot, informed by a literature review and interviews with pharmacists and community members. MethodsUsing the Person-Based Approach and the Capability, Opportunity, Motivation- Behaviour change (COM-B) model, the pilot aimed to improve HIV/PrEP knowledge/capability and motivation through pharmacist and community awareness-raising. Opportunity was addressed by integrating PrEP consultations into pharmacy services and offering STI, HIV, and estimated glomerular filtration rate (eGFR) home test kits. Financial incentives also aimed to motivate pharmacists. Pharmacists identified eligible community members, initiated PrEP discussions, and provided home testing kits. Individuals opting to start PrEP completed the tests and posted them to a local sexual health clinic, where staff reviewed the results, confirmed eligibility, and prescribed PrEP remotely. NHS policy restrictions on pharmacies stocking NHS-procured PrEP informed the delivery model. The pilot evaluation focused on staff training impact, number/type of consultations, and feasibility and acceptability of pharmacy PrEP delivery for staff and community members. ResultsThe pilot was conducted in five pharmacies across Bristol, North Somerset, and South Gloucestershire from October 2024 to April 2025. A total of 55 consultations were held with individuals aged 18-69 (n=23 male, n=31 female, n=1 transgender). Visit reasons included emergency contraception (n=14), PrEP (n=14), and opioid substitution therapy (n=11). Twenty-eight community members expressed interest in PrEP; 22 accepted a home testing kit, seven returned it, and four were prescribed PrEP. Pharmacists and community members viewed the service positively. Barriers included pharmacists initial lack of confidence initiating PrEP discussions and limited public awareness of PrEP availability in pharmacies. ConclusionCommunity pharmacies represent a promising site for PrEP delivery. Successful scale-up requires pharmacist training, public health education, structural and policy changes to support accessible PrEP provision beyond sexual health clinics to reduce inequities. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSThere are inequities in access to and uptake of PrEP due to a lack of awareness of PrEP, stigma, geographical proximity and access to sexual health clinics. PrEP awareness raising and initiation via community pharmacies could improve access and uptake. What this study addsThis is the first UK pharmacy-based PrEP awareness raising and initiation pilot targeting underserved community members not currently accessing PrEP. Findings show pharmacy PrEP awareness raising and initiation to be acceptable and feasible for pharmacists and community members. Pharmacies have the potential to be valuable community assets for PrEP in addition to traditional sexual health clinics, particularly for underserved community members. Improved community awareness of PrEP and pharmacist confidence in delivering the service could help optimise pharmacy PrEP delivery. How this study might affect research, practice or policyCommunity pharmacy PrEP delivery needs to be supported by appropriate training that equips pharmacists with the capabilities and confidence required to provide a comprehensive service. This should be facilitated by policy frameworks and funding that allow provision of PrEP outside of sexual health clinics.

BackgroundSeveral clinical prediction models have been developed using electronic health records data to help inform decisions about HIV pre-exposure prophylaxis (PrEP) prescribing, but the characteristics and quality of these models have not been systematically assessed. We identified and critically appraised the characteristics and quality of studies reporting the development of electronic health records (EHR)-based models predicting HIV risk to inform decisions about PrEP prescribing. MethodsWe searched PubMed and the CINAHL databases between January 1, 2013 and June 19, 2023, with keywords related to EHR, HIV, and clinical prediction. We extracted data using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and assessed risk of bias using the Prediction model Risk Of Bias Assessment Tool (PROBAST) short form. We used narrative synthesis to describe characteristics and quality of eligible models. ResultsWe identified 324 studies, of which 7 studies (resulting in 7 models) were eligible for our review. Several studies inadequately reported key components of the corresponding model. Most models were developed in the United States and used machine learning methods. The area under the receiver operating characteristic curve was reported for six models, which ranged between 0.77 and 0.89. All models had high risk of bias, primarily because of low events per variable and risk of overfitting. ConclusionsWe observed inadequate reporting of key components and high risk of bias across all EHR-based models. Future studies would benefit from following standard reporting guidelines and best practices for developing prediction models, which may strengthen the validity and applicability of EHR-based prediction models for informing decisions about HIV PrEP prescribing. Trial registrationThe review protocol was registered and published in PROSPERO (CRD42023428057)

IntroductionBuprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD when implemented in the primary care setting. HIV prevention, particularly pre-exposure prophylaxis (PrEP), represents a vital service for persons with OUD due to HIV risk associated with injection drug use and condomless sex. Evaluating the existing integration of BUP treatment and HIV prevention is an important step to further optimize comprehensive care for patients with OUD. MethodsThis retrospective cohort study used pharmacy claims from the Merative MarketScan(R) Research Databases, 2014 - 2022, to examine use of PrEP among new BUP treatment episodes over the first 63 days of treatment. We excluded BUP episodes from individuals with probable HIV (based on diagnosis or medications indicated for HIV in the past 365 day). Clinical indications for PrEP were identified based on past 365-day diagnosis of sexually transmitted infections (STIs) or serious injection-related infections (SIRIs). ResultsOf 123,740 BUP episodes representing 76,377 individuals, 104 (0.1%) involved PrEP during BUP treatment. Most of these episodes (71%) involved PrEP in the 30 days prior to BUP initiation. Only 6% of the sample exhibited diagnoses indicating risk for HIV. Of these, only 0.2% involved PrEP during the BUP treatment episode. BUP episodes involving PrEP tended to be disproportionately male (89% compared with 63%) and from the Northeast (27% vs. 18%) or West (30% vs. 16%). ConclusionsFindings from this retrospective cohort study identify a major gap in PrEP use for individuals with OUD and documented HIV risk. Aligning HIV prevention and BUP treatment is an important opportunity to enhance health for patients with OUD.

BackgroundDaily oral pre-exposure prophylaxis (PrEP) provides effective protection against HIV. Since September 2019, the costs of PrEP have been reimbursed by statutory health insurance in Germany. While a considerable fraction of PrEP-eligible individuals receives PrEP, coverage is inhomogeneous across Germany. This study aims to identify potential barriers associated with PrEP non-use. MethodsBased on the PrApp online cross-sectional study, we analyzed 1,027 PrEP users and 431 non-PrEP users. A PrEP indication was assumed for cis-MSM with an STI diagnosis (12 months), [&ge;] 2 sex partners or sexualized drug use (6 months). Characteristics between PrEP users and PrEP non-users were compared descriptively and using multivariable logistic regression. ResultsNon-PrEP users were more likely to be aged 18-29 years old (P < 0.05) and to use drugs during sex (P < 0.01). The highest PrEP prescriber density (P < 0.01) was associated with PrEP use. Fear of side effects (54.5%) was the most common barrier. Persons with sexualized drug use were more likely to report daily PrEP use as a barrier (34.3% vs. 16.9%, P < 0.01, adjusted P < 0.05). ConclusionsOur analyses indicated structural barriers to PrEP use in federal states with a low HIV-specialists density. For those engaging in sexualized drug use, daily PrEP uptake could potentially be overcome by long-acting PrEP.

BackgroundRates of intimate partner violence (IPV) and HIV in South Africa are among the highest globally. IPV is associated with a range of adverse mental health and HIV outcomes. The Common Elements Treatment Approach (CETA) is a transdiagnostic, evidence-based intervention delivered by lay providers. ObjectiveTo compare the effectiveness of CETA to active attention control in reducing IPV, depression, Post-Traumatic Stress Disorder (PTSD), and substance use among women at risk of poor HIV outcomes who have experienced IPV. MethodsWomen living with HIV with an unsuppressed viral load or at risk for poor adherence and experienced past 12-month IPV were recruited from Johannesburg-area clinics and randomised 1:1 to CETA or control (SMS HIV appointment reminders plus safety checks and planning). The primary trial outcome was HIV retention and viral suppression, reported elsewhere. This paper reports secondary outcomes, evaluated at three and 12 months: IPV, depression, PTSD, and substance use. FindingsParticipants were enrolled between November 11, 2021 to July 19, 2023 and randomised to CETA (N=202) or control (N=197). In the intent to treat analysis, the Cohens d treatment effect for depression at three months was 0.24 (difference in mean change -3.1; 95% CI: -6.1, 0.1) and 0.48 at 12 months (-6.2; 95% CI: -9.5, -2.8). The PTSD treatment effect was 0.39 at three (-0.3; 95% CI: -0.5, -0.1) and 0.47 at 12 months (-0.3; 95% CI: -0.5, -0.2). Effect sizes were larger in a subgroup of participants with the top 50% of baseline symptom scores (depression: d=0.50, d=0.74; PTSD: d=0.58, d=0.94, at three and 12 months, respectively). There were no statistically significant differences in change for substance use or IPV. At baseline, only 12% of participants had past 3-month substance use and 32% had past 3-month or ongoing experiences of IPV, which made these outcomes challenging to evaluate. ConclusionsCETA was effective for reducing depression and PTSD including among high severity participants and at an extended follow-up. Future studies with increased power for substance use and IPV outcomes are warranted. Clinical implicationsCETA is a recommended treatment for depression and PTSD among this population. Trial registration numberClinicaltrials.gov NCT04242992, registered January 27, 2020 Key MessagesO_ST_ABSWhat is already known about this topic?C_ST_ABSIntimate partner violence (IPV) and related mental health problems are common in South Africa and can lead to poor HIV outcomes, such as low retention in care and viral non-suppression. There is a lack of evidence-based mental healthcare options for women living with HIV who have experienced IPV. What this study addsAmong women living with HIV and past-year IPV experiences, we found that Common Elements Treatment Approach (CETA) was an effective treatment for depression and PTSD compared to a control condition. How this study might affect research, practice, or policyCETA is recommended to treat common mental health problems among women with HIV and experiences of IPV.

BackgroundPre-exposure prophylaxis (PrEP) is a safe and effective medication for preventing HIV acquisition. We examined Australian general practitioners (GP) knowledge of PrEP efficacy, characteristics associated with ever prescribing PrEP, and barriers to prescribing. MethodsWe conducted an online cross-sectional survey of GPs working in Australia between April and October 2022. We performed univariable and multivariable logistic regression analyses to identify factors associated with: 1) the belief that PrEP was at least 80% efficacious; and 2) ever prescribed PrEP. We asked participants to rate the extent to which barriers affected their prescribing of PrEP. Results407 participants with a median age of 38 years (interquartile range 33-44). Half of the participants (50%, 205/407) identified how to correctly take PrEP, 63% (258/407) had ever prescribed PrEP, and 45% (184/407) felt confident with prescribing PrEP. Ever prescribing PrEP was associated with younger age (AOR 0.97, 95%CI: 0.94-0.99), extra training in sexual health (AOR 2.57, 95%CI: 1.54-4.29), and being a S100 Prescriber (OR 2.95, 95%CI: 1.47-5.90). The main barriers to prescribing PrEP included: Difficulty identifying clients who require PrEP/relying on clients to ask for PrEP (76%, 310/407), Lack of knowledge about PrEP (70%, 286/407), and Lack of time (69%, 281/407). ConclusionLess than half of our GP respondents were confident in prescribing PrEP, and most had difficulty identifying who would require PrEP. Specific training on PrEP, which focuses on PrEP knowledge, identifying suitable clients, and making it time efficient is recommended, with GPs being remunerated for their time.

BackgroundMethamphetamine (MA) use is disproportionately higher among people living with HIV (PWH) and contributes to adverse clinical outcomes. Accurate measurement of MA use is essential for research and care but remains inconsistent. MethodsA systematic review of PubMed, Embase, and CINAHL identified 22 peer-reviewed studies (2019-2024) assessing MA use in HIV-positive adults. Data were extracted on measurement methods, demographic composition, and HIV outcomes. ResultsStudies employed self-report, urine or hair toxicology, and medical record review. Reporting varied widely in timeframe, frequency, and specificity, with limited detail on route of administration. Most studies were U.S.-based, disproportionately male, and rarely included women or gender-diverse participants. Inconsistent definitions and reliance on broad stimulant categories limited comparability. ConclusionsCurrent methods for assessing MA use in PWH lack standardization. Greater consistency, inclusion of biological validation, and expanded demographic representation are needed to strengthen research and clinical interventions.