Background. Few evidence-based interventions have been successfully scaled up and sustained long-term. Within an implementation trial testing strategies for scale-up of the Systems Navigation and Psychosocial Counseling (SNaP) intervention for people who inject drugs (PWID) with HIV across HIV testing clinics in Vietnam, we sought to assess: 1) if the implementation of SNaP was sustained after study support ended and 2) to identify factors, including adaptations, that affected SNaP sustainment. Methods. Across all 42 SNaP clinics, we surveyed clinic staff using the Provider Report of Sustainment Scale (PRESS) at 6-10 months post-study completion to assess SNaP sustainment. Based on PRESS score, we purposively selected 6 high and 6 low-sustaining clinics, and between October and November 2022, conducted 31 in-depth interviews with clinic staff (n=23) and clinic directors (n=8) who had been involved with the SNaP study. Interviews were audio-recorded, transcribed, translated, coded, and analyzed using thematic analysis informed by the Integrated Sustainability Framework. Matrices were used to compare themes across high and low-sustaining clinics. Results. While no clinics sustained all of SNaP’s core components, many continued conducting a modified version of SNaP, including shorter or fewer SNaP sessions, tailoring SNaP to participants’ specific needs, and conducting SNaP-style counselling for all clients. Facilitators of sustainment included shortening sessions or reducing the number of sessions, leadership directives to clinic staff around SNaP sustainment, clinicians’ belief in SNaP’s effectiveness, and SNaP’s perceived fit with clinic activities and mission. Major barriers to SNaP sustainment included lack of funding for PWID outreach activities, time, staff, training continuity, and systemic challenges with getting PWID into care, such as poverty and lack of transportation. Conclusions. This work responds to calls for research applying and testing sustainment frameworks and contributes to a better understanding of how constructs within these frameworks work to impact sustainment. We identified the challenge of sustaining the SNaP intervention long-term, the ubiquity of intervention adaptations, and multi-level barriers and facilitators to intervention sustainment. These findings demonstrate the need for sustainment strategies and could inform trials of strategies to improve longevity of effective HIV interventions for populations that are disproportionately affected by this epidemic.

Background: Research suggests that Mexican labor migrants in the US are at greater risk of living with HIV. Migration to the U.S. has also been linked to HIV rates in rural Mexico. Increased risk for HIV in migrants may result from the interplay between individual characteristics and the broader contextual, structural factors in migration between Mexico and the U.S. The objective of this study was to examine the HIV/STI infection rates among migrants crossing the US-Mexico border region and describe potential associated risk factors.

Methods: This was a cross-sectional study utilizing a probability-based survey of migrant flows traveling across the US-Mexico border at three border cities (Tijuana, Matamoros, and Ciudad Juarez) between 2020-2021 (N=1,398). Respondents included three migrant flows. Northbound: migrants traveling north arriving at the border from other Mexican regions; Southbound: Migrants traveling from the Mexico side of the Mexico-US border farther south or Migrants returning to Mexico from the U.S. voluntarily; Deported: Migrants returning to Mexico from the U.S via deportation. Standard descriptive statistics were estimated using Stata v16.0.

Results: Migrants were primarily men (1044;75%) born in Mexico (1320;94%) and identified as heterosexual (1251;89%). Seven people (0.5%) had a reactive HIV rapid test, with the Northbound flow representing the highest prevalence (3;0.86%). Among these reactive results, four (57%) were new diagnoses. Similarly, eight (0.6%) people had reactive syphilis tests, with the Southbound flow representing the highest prevalence (4;0.6%). Few reported being tested for HIV (193;13%) or STIs (68;4.8%) in the last 12 months. Most respondents had not been tested before because they did not think they needed to be tested (402;28.7%).

Conclusions: Our data reveal significant gaps in HIV and STI testing among migrants on the move at the US-Mexico border. Almost all of the new HIV/STI diagnoses were identified as migrants were crossing the US-Mexico border, emphasizing the need for targeted interventions. Low self-reported testing rates, coupled with instances of undiagnosed infections and risky sexual behaviors, underscore the complex interplay of individual, contextual, and structural factors contributing to heightened HIV risk along the migration corridor and the need to deploy HIV prevention interventions for these underserved population.

Background:

People who inject drugs (PWID) remain at substantial risk of HIV infection, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. PrEP’s efficacy was demonstrated a decade ago using daily oral tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC). In 2019, co-formulated tenofovir FTC and alafenamide fumarate (TAF) became the second approved daily oral PrEP regimen. However, FTC/TAF is only approved for the prevention of sexually transmitted HIV, excluding individuals at risk of receptive vaginal sex, including PWID. This study explored FTC/TAF feasibility and acceptability for daily oral PrEP among PWID.

Methods:

This single-arm, observational, open-label study enrolled 100 PWID to receive FTC/TAF for daily oral HIV prevention. Inclusion criteria were: age ≥18, HIV negative, injection drug use (in the past 6 months), and meeting DSM-V criteria for opioid dependence. Participants meeting clinical criteria received a 90-day supply of FTC/TAF from a community-based syringe services program (SSP). Behavioral and biomedical data were collected at baseline, 3, and for 6 months. Descriptive statistics were used to estimate feasibility, acceptability, side-effects, adherence, and persistence on FTC/TAF.

Results:

Participants were mostly male (63.0%) and non-Hispanic White (52.0%), with a mean age of 44.4 (SD=9.9). Participants reported injecting drug behavior at least once per day (37.0%) and engagement in condomless sex (78.0%) in the past 6 months. Prior use of daily oral PrEP was reported by 21% of participants (TDF/FTC: 14.0%; FTC/TAF: 3%; unknown: 4.0%). Although all participants were prescribed FTC/TAF, only 60.0% picked up the drug. Of those, 70% picked up once, 26.7% twice, and only 3.3% at all follow-up visits. Self-reported adherence was high (>90%) across all time points but discordant with urine-based quantification of FTC. Acceptability was high (range: 8-32): 3-months [24.9 (±3.1)]; 6-months [24.4 (±3.4)]. The most frequently reported side effects were tiredness (18.4%) and nausea (17.2%). There were no HIV seroconversions.

Conclusion:

FTC/TAF PrEP was positively received among opioid-dependent PWID. Implementation through SSP was feasible and acceptable, suggesting its viability as an HIV prevention tool for PWID. Poor adherence, as indicated in earlier studies of PWID using TDF/FTC PrEP, emphasizes the need for enhanced adherence counseling tailored for PWID.

Introduction: The emergence of the COVID-19 infection has raised concerns about the impact of underlying medical conditions on the health outcomes of people living with HIV (PLWH). This study aimed to assess how pre-existing chronic medical conditions influence the health outcomes of PLWH infected with COVID-19.

Methods: A retrospective study was conducted using data from the Minnesota Fairview network spanning from January 1, 2020, to December 31, 2022. Fisher’s Exact Test and ordinal logistic regressions were utilized to determine the effect of chronic systemic conditions on COVID-19 severity, including hospitalization and death, while adjusting for patient age and gender.

Results: Among 216 records analyzed, significant differences in the distribution of stroke, chronic kidney disease, lung disease, and neurologic conditions were found (p<0.05). Type 1 diabetes distribution was marginally significant (0.05<p<0.1). After adjusting for baseline age and sex, patients with stroke (p=0.0008) or chronic kidney disease (p=0.0003) exhibited a significantly increased risk of more severe COVID-19 outcomes among PLWH. Additionally, type 1 diabetes (p=0.0931) and heart conditions (p=0.0895) showed marginal significance in predicting a higher risk of severe COVID-19 outcomes in this population.

Conclusion: The findings underscore the importance of considering pre-existing medical conditions in guiding clinical management and public health interventions for PLWH infected with COVID-19. Tailored strategies aimed at mitigating the heightened risk of severe COVID-19 outcomes in PLWH with specific chronic comorbidities are warranted to improve overall health outcomes and reduce mortality in this vulnerable population.

Background: The coexistence of HIV and TB presents significant challenges to public health systems globally, particularly in resource-constrained settings. With TB being a leading cause of morbidity and mortality among people living with HIV/AIDS, understanding the intersection of these diseases is critical for developing targeted interventions to improve health outcomes. Understanding the epidemiology and burden of these comorbidities is crucial for informing targeted interventions and improving patient outcomes. This study aims to explore the intricate relationship between HIV and Tuberculosis (TB) comorbidities, recognizing the significant burden they pose on global public health.

Methods: A cross-sectional study is conducted across multiple LMICs, involving participants diagnosed with either HIV or TB or both. Participants were recruited from healthcare facilities and community settings. Data on socio-demographic characteristics, clinical history, HIV/TB diagnosis, treatment status, and comorbidities were collected through structured interviews, medical records review, and laboratory tests. Statistical analyses were performed to assess the magnitude of associations and identify significant predictors of HIV/TB comorbidities. Descriptive statistics were used to summarize the prevalence of HIV, TB, and their comorbidities, while logistic regression analysis was employed to assess factors associated with the co-occurrence of HIV and TB.

Results: Preliminary results indicate a high prevalence of comorbid HIV and TB cases among the study population, with variations observed across different geographic regions and demographic groups. Individuals living with HIV were found to be at increased risk of developing TB, and vice versa. Additionally, certain socio-economic and clinical factors were identified as significant predictors of HIV/TB comorbidities.

Conclusions: This study underscores the substantial burden of HIV and TB comorbidities in LMICs and highlights the need for integrated approaches to address these dual epidemics. Addressing social determinants of health, strengthening health systems, and promoting collaborative efforts between HIV and TB control programs are essential steps towards reducing the burden of HIV/TB comorbidities and advancing global health equity. The findings have implications for public health policy and program planning, emphasizing the importance of collaborative efforts to strengthen HIV and TB control strategies and improve health outcomes for affected populations.

In Uganda, approximately 27,000 adolescent males and 46,000 adolescent females are currently living with HIV, with around 870 male and 6,500 female adolescents newly infected each year. The COVID-19 pandemic exacerbated psychosocial issues among young people living with HIV (YPLHIV). This study aimed to explore Ugandan YPLHIV experiences during the pandemic and identify coping and resilience skills. Methods: This study is a quantitative descriptive cross-sectional study that evaluated the experiences of YPLHIV (ages 15-20 years old) during the COVID-19 Pandemic in Kampala, Uganda. The study recruited and collected a convenience sample at Nsambya Home Care Department, an infectious disease clinic. The Covid-19 Impact of the Pandemic Questionnaire asked about psychosocial and practical experiences that YPLHIV had during the Covid-19 pandemic. We conducted descriptive and Chi-Square analyses to explore participants’ experiences. Results: 154 participants completed questionnaires during their regularly scheduled HIV health appointments. The mean age was 18 years old and 52% were female. They were then divided into age groups from 15-17 years old and 18-20 years old. Reported medication adherence showed 61% aged 15-17 and 44% aged 18-20 as missing taking their ART medication. Many experienced anxiety about the future, 36% of 15-17 years old and 55% of 18-20 years old. Participants had feelings of depression, 48% of 15-17 years old and 65% of 18-20 years old. Numerous participants used their experience of coping with HIV to deal with Covid-19, 63% of 15-17 years old and 80% of 18-20 years old. Conclusions: This study sheds light on YPLHIVs’ psychosocial experiences during COVID-19, revealing high levels of anxiety and depression. It highlights that many reported utilizing coping strategies that were acquired as a result of being HIV-positive to manage during the pandemic. Importantly, it emphasizes that increased scores related to coping and resilience factors do not necessarily indicate less mental health distress. These findings emphasize the importance of comprehensive support for YPLHIV during challenging times.

Keywords: Young people, HIV, Strength-based skills, resilience

Background: The CDC recommends annual HIV and HCV testing and reducing testing barriers. Rural communities in Indiana face high levels of substance use disorder, indicating a need for accessible HIV and HCV testing given the increased likelihood of comorbid conditions. In preparation for developing HIV and HCV testing initiatives in rural Fayette County, the Connection Café, an organization integrating harm reduction, recovery, and community support, collaborated with Indiana University academics to better understand the testing intentions and beliefs of community members to tailor future testing services.

Methods: Administered by peer recovery coaches, a cross-sectional survey was conducted prioritizing individuals utilizing current Connection Café services through onsite and street outreach initiatives. The Health Belief Model was used as a theoretical framework to explore participants' testing intentions and beliefs, particularly through the examination of perceived benefits, perceived barriers, perceived susceptibility, and perceived severity.

Results: Of 185 participants, 60 reported being unaware of their HIV status and 50 of their HCV status. There was low perceived susceptibility to HIV and HCV infections, with 93% and 87% of respondents respectively feeling unlikely to contract these conditions. Perceived severity was high, with 89% of participants deeming HIV and HCV infections serious. Facilitators to testing included being free and done by Connection Café staff, in addition to knowing one’s status and treatment initiation if needed. Perceived barriers included stigma, time constraints, transportation, and fear of positive results.

Conclusion: Addressing perceived barriers and tailoring interventions to promote testing uptake based on community member input is critical for successful testing initiatives. The findings underscore the need to raise awareness about HIV and HCV given the low perceived susceptibility despite existing risk factors, particularly among people with substance use disorder. The community-academic partnership holds promise for developing effective HIV and HCV prevention strategies sensitive to the unique needs of at-risk populations in rural settings.

Objective: Less knowledge about the factors driving the risk of cardiovascular disease (CVD) among individuals who were diagnosed with HIV at older ages. The present study aimed to investigate the predictors of CVD among people diagnosed with HIV aged 50 and over.

Method: This is a statewide population-based cohort study, with data retrieved from integrated electronic health records in South Carolina (SC). SC residents who were diagnosed with HIV at age 50 and above between 2006 and 2016 with the follow-up record until 2020 and were CVD free before HIV infection were included. The first diagnosis of CVD after HIV diagnosis was defined as outcome. The traditional risk factors, comorbidities, and HIV-related risk factors were examined as predictors of CVD occurrence by Cox proportional hazards models.

Results: Among 783 participants with the mean age at HIV diagnosis of 56 years old (SD = 5.5), we reported a high proportion of CVD occurrence with 60.5%. Compared with age at HIV diagnosis between 50-53, patients aged 54-57 and ≥ 58 years old showed a lower risk for CVD with adjusted Hazard Ratio (aHR) of 0.50 (95% confidence interval [CI]: 0.40-0.63) and 0.24 (95% CI: 0.18-0.30) respectively. People with pre-HIV traditional risk factors and comorbidities including diabetes mellitus (DM), chronic kidney disease (CKD), dyslipidemia, liver disease, and tobacco use are at an increased risk of CVD after HIV diagnosis with aHR range from 1.30 to 1.73. Besides, people with the most recent CD4 cell count within the 90 days of HIV diagnosis greater than 200 cells/mm³ have a lower risk of CVD (aHR = 0.71, 95% CI: 0.52-0.96) compared with patients with CD4 cell count less than 200 cells/ mm³.

Conclusion: Regular and routine monitoring of traditional risk factors to prevent CVD development is important among people diagnosed with HIV aged 50 and over. Focused interventions of risk factors are recommended for those patients with DM, CKD, dyslipidemia, liver disease, and tobacco use before HIV infection. Enhancing immune recovery and maintaining a high CD4 cell counts are important strategies to lower the CVD risk in this vulnerable population.

Background: The intricate interplay among Human Immunodeficiency Virus (HIV), mental health challenges, and Non-Communicable Diseases (NCDs) forms a syndemic nexus, presenting a formidable obstacle to public health endeavors in Africa. Within the demographic of People Living with HIV (PLWH), prolonged exposure to these intertwined factors perpetuates disparities in NCD prevalence and mental well-being on a population scale. This review aims to shed light on the multifaceted relationship between HIV and mental health, encompassing various aspects such as mental disorders, mental illness, stigma, and their connections with Non-Communicable Diseases (NCDs). Findings from this review will provide empirical insights into the interplay between mental health challenges among People Living With HIV (PLWH) and the increasing incidence of NCDs within the African context.

Methods: For this scoping review, we searched PubMed, Embase, Cochrane library, Web of science (all databases), Global Health, APA PsycINFO, and CINAHL for scientific publications related to HIV, NCDs, and Mental Health within Africa. We are also searching national and international governmental and non-governmental reports published on these three factors within this region.

Preliminary Results: The preliminary search yielded an extensive pool of 4,888 citations, which was refined to 3,409 after the elimination of duplicates. Initial scrutiny of titles and abstracts revealed a glaring deficiency in the incorporation of mental health considerations into the management protocols for NCDs within the framework of HIV care. Noteworthy early observations indicate a pronounced association linking HIV infection with adverse mental health outcomes and an augmented susceptibility to NCDs, particularly cardiovascular diseases (CVDs) and kidney disease. While further analysis is anticipated to unveil more nuanced insights, these initial findings underscore the intricate interplay among these health factors, emphasizing the pressing necessity for holistic, integrated care models tailored to the African context.

Conclusions: This scoping review endeavors to unveil profound insights into the intricate syndemic dynamics intertwining mental health, HIV, and NCDs among PLWH in Africa. Early indications underscore the importance of integrated public health initiatives and policies capable of confronting the dual challenges posed by HIV and NCDs, while duly recognizing the compounded influence of mental health.

Background: While long-acting injectable PrEP (LAI-PrEP) has the potential to reduce inequities in PrEP uptake and retention, effective implementation of LAI-PrEP requires a comprehensive understanding of the socio-structural vulnerabilities faced by prospective PrEP patients from underserved populations. Here, we present findings describing the prevalence of socio-structural vulnerabilities among patients initiating LAI-PrEP at a large, public hospital in New York City.

Methods: Data are from EquiPrEP–an ongoing, equity-focused LAI-PrEP implementation project focused on increasing LAI-PrEP uptake and adherence among Black and/or Latine cisgender men who have sex with men (CGMSM), Black and/or Latine cisgender women (CGW), and transgender and nonbinary persons (TGNBP). Upon enrollment, participants provide information on demographic, socioeconomic, and relationship characteristics. Descriptive statistics were used to summarize prevalence of socio-structural vulnerabilities from the following domains: economic/financial, housing, legal, and social/relational networks. Patients reporting vulnerabilities were offered additional counseling, referrals, and/or resources as appropriate.

Results: To date, n=115 participants have enrolled in EquiPrEP (61.7% CGMSM; 14.8% CGW; 23.5% TGNBP). In terms of economic/financial vulnerability, over one quarter of participants reported recently delaying/missing rent payments (25.2%), delaying/missing utility payments (27.0%), or worrying about food accessibility (26.1%). For housing vulnerability, 14.8% reported recently experiencing a time where they lacked a steady place to sleep while 7.0% reported an eviction in the past 3-years. For legal vulnerabilities, 2.6% reported previous incarceration and 23.5% reported their immigration status as undocumented. Finally, for social/relational network vulnerabilities, social support was low with 31.3% reporting no person who would accompany them to medical appointments and 29.6% reporting no person who would lend them money if needed. Additionally, 10.4% reported feeling unsafe in a current relationship and 9.6% believed their current sexual partner(s) would not support their PrEP use.

Conclusions: The high prevalence of socio-structural vulnerabilities in this racially, sexually, and gender diverse sample of prospective LAI-PrEP patients demonstrates the importance of examining factors beyond the individual-level that could affect patients’ retention in care and overall wellbeing. By considering such factors prior to LAI-PrEP initiation, providers may be better prepared to support patients in addressing more distal barriers to HIV prevention care.