Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS

Objectives. We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS.Methods. Data were obtained from a cross-sectional, multisite behavioral survey of adults (N=7925) recently reported to be HIV positive.Results. At the time interviews were conducted, 304 respondents (4%) were homeless. Self-ratings of mental, physical, and overall health revealed that the health status of homeless respondents was poorer than that of housed respondents. Also, homeless respondents were more likely to be uninsured, to have visited an emergency department, and to have been admitted to a hospital. Homeless respondents had lower CD4 counts, were less likely to have taken HIV anti-retroviral medications, and were less adherent to their medication regimen. Homeless respondents needed more HIV social and medical services, but nearly all respondents in both groups had received needed services. Housing status remained a significant predictor of health and medication outcomes after we controlled for potential confounding variables.Conclusions. Homeless people with HIV/AIDS are at increased risk of negative health outcomes, and housing is a potentially important mechanism for improving the health of this vulnerable group.Homeless people are at a disproportionate risk for negative health consequences. For instance, they typically have more chronic diseases and more physical and mental health problems than do the general population, and they are at greater risk for infectious diseases.1^–13 Homelessness is often coincident with poverty, mental illness, and alcohol and drug use, compounding the other health problems experienced by these individuals.14^–17Homeless people are also more likely than other groups to engage in behaviors that place them at risk for HIV infection, including risky sexual practices, injection drug use and needle sharing, and performing sexual acts in exchange for money, drugs, or a place to stay.18^–25 Perhaps not surprisingly, previous research has shown that HIV is 3 to 9 times more prevalent among homeless individuals than among individuals in stable housing situations.18^,20^,21^,26^–29It may be difficult for homeless people, who are often faced with immediate subsistence needs (e.g., finding adequate food and shelter), to obtain medical care and adhere to treatment regimens.30^,31 As a result, homeless individuals are less likely than are the general population to have stable sources of care, and they often rely on emergency departments or ambulatory care settings for their health care needs.32^,33 Delayed medical care or lack of care has negative effects such as delayed HIV diagnoses and higher rates of serious opportunistic infections.7^,31^,34People who are living with HIV/AIDS and are homeless face additional burdens not faced by homeless people without HIV/AIDS. For instance, individuals with HIV/AIDS need greater access to comprehensive health care, and barriers to care—including lack of financial resources, lack of transportation, and insufficient (or nonexistent) health insurance coverage—may be compounded among homeless people living with the disease.30^,34People with HIV/AIDS also may have difficulty adhering to prescribed HIV antiretroviral medication regimens.35^,36 These regimens can be complex and often involve restrictions on when and how the medications should be taken and stored.31^,34 In addition, these medications can have side effects, such as recurring diarrhea, that are especially problematic for homeless individuals. Medical providers may believe that homeless individuals will not be adherent, and thus they may be reluctant to prescribe antiretroviral medications for these individuals37 given that inadequate adherence can lead to drug resistance.34 Despite its importance, few studies have investigated the issue of adherence to antiretroviral medication regimens in this population.35^,36^,38^–42Overall, minimal research has been conducted on the health of homeless people living with HIV/AIDS.15^,43^,44 We used data from a large, multisite investigation to (1) assess differences between homeless and housed persons living with HIV/AIDS regarding sociodemographic, health care, and medication adherence variables and (2) examine associations between housing status and health, and medication adherence outcomes after controlling for potential confounding factors.     

Predictors of intervention adherence among young people living with HIV

OBJECTIVE: To examine adherence to a 23-session intervention for young people living with HIV. METHODS: Two hundred eight HIV-positive youth were assigned by small cohort to a behavioral intervention. RESULTS: Youth with more personal strengths were more likely to attend the intervention; those with more competing environmental demands (eg, employment, school) were less likely to attend the intervention. Using a social support, spiritual hope, or self-destructive and escape coping style was associated with attendance. Youth who reported many sexual partners attended fewer sessions. Adherence varied by cohort assignment. CONCLUSION: When designing future interventions, high attendance should be considered as a goal.     

Peer support to promote medication adherence among people living with HIV/AIDS: the benefits to peers

Since early in the AIDS epidemic, HIV-positive individuals have benefited from the services of peer support or buddy programs. However, little research has focused on the experience of the peer providing support. We conducted qualitative interviews with nine HIV-positive peers who had participated in an intervention designed to provide support to other HIV-positive individuals as one means of promoting antiretroviral therapy adherence. Analyses of the peers' common dialogue about their involvement in the study revealed four main themes: social acceptance, reciprocal support, personal growth and empowerment, and resistance and other challenges. Recommendations for future research and for implementing similar interventions in a health care setting are provided.     

HIV感染者疲劳发病率的Meta分析

[摘要]　目的　采用Meta分析评价1996—2021 年HIV感染者疲劳发病率情况。方法　检索Pubmed、Embase、Cochrane library和PsycINFO 数据库中有关HIV感染者疲劳发病率的观察性研究。使用Stata 16.0软件,计算疲劳合并发病率及其95%CI值,采用敏感性分析和亚组分析探索异质性来源。结果　最终纳入23篇文献,共包括8213例病例。Meta分析显示HIV感染者疲劳合并发病率为62%（95%CI：53%～70%）;亚组分析结果显示HIV感染者年龄较小、总体联合抗反转录病毒疗法接受率低、有睡眠障碍和抑郁的群体疲劳发病率更高（P＜0.05）。结论 　HIV感染者疲劳发病率较高,应引起医务人员重视。     

Conceptual equivalence of WHOQOL-HIV among people living with HIV in Ethiopia

Purpose

The WHOQOL instruments are intended for cross-cultural studies of quality of life (QoL) but African countries have been poorly represented in its development. This study aimed to explore the conceptual equivalence of WHOQOL-HIV in Ethiopia.

Methods

The fieldwork included home visits, interviews, and focus group discussions with HIV patients and caregivers.

Results

We found that although WHOQOL-HIV includes many relevant facets, its applicability has several limitations in the Ethiopian setting. The most salient shortcomings of the instrument relate to the Social, Environmental and Religion/Spirituality/Personal Beliefs domains of the instrument. Themes not captured by the instrument include family responsibilities, disease disclosure, exclusion from common resources, basic needs, adequate food, and job opportunities. In addition, several of the tool’s facets such as dependence on medicine seem less relevant. Also, the role of religion is more complex than captured in WHOQOL-HIV. We found that the tool is based on an individualist focus, which tends to overlook the social context of the patient.

Conclusion

We conclude that the conceptual equivalence of WHOQOL-HIV is only partially attained for use in Ethiopia. The findings from this qualitative study are used in the further process of developing and validating a QoL instrument for use in Ethiopia.     

HIV感染者和AIDS病人自杀意念现状及其影响因素研究

目的了解HIV感染者和AIDS病人（PeopleLivingwithHIV／AIDS,PLWHA）自杀意念现状,探讨其影响因素,为制定关怀干预对策提供客观依据。方法采用《自杀意念自评量表》（SIOSS）和评价方法,以2012年5月至2012年12月在广州市番禺区CDC艾滋病VCT门诊就诊的PLWHA为调查对象,进行面对面问卷调查,调查其人口学特征及对其是否持有自杀意念进行评价。采用多因素logistic回归分析对PLWHA的自杀影响因素进行统计学析。结果在调查的144例PLWHA中,男性占67．36％（97／144）,女性占32．64％（47／144）;平均年龄（36．9±10．8）岁。29．17％（42／144）患者有自杀意念。在自杀意念发生率方面,无业／待业者为（50．00％,9／18）高于有工作者（26．29％,33／126）、中专／高中及以下者为（32．52％,40／123）高于大专及以上者（9．52％,2／21）、独居者为（58．33％,7／12）高于非独居者（26．52％,35／132）、CD。细胞计数~〈200cells／μL者为（47．83％,11／23）高于〉200cells／μL者（25．62％,31／121）,差异均有统计学意义（均P〈0．05）。多因素logistic回归分析结果显示就业状况和居住方式为产生自杀意念的危险因素,其调整的OR值和95％CI分别为：4．813（1．250—18．526）和8．832（1．330～58．661）。结论PLwHA普遍存在自杀意念,应在随访关怀过程中,建立有效的综合支持体系,以改善PLWHA心理状况。     

HIV感染者/AIDS患者危机干预

中国HIV感染者或AIDS患者(PLWHA)数目逐年增长,有关PLWHA的心理健康也成为社会关注的热点。在确诊HIV初期和艾滋病期的心理问题相对而言更严重,容易出现心理危机。目前心理危机干预技术多运用于其他疾病,在PLWHA的运用较少。本研究综述PLWHA危及期的心理特点及危机干预在PLWHA中的应用。     

Breakthrough TB among people living with HIV on TB preventive therapy

BACKGROUND:Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.METHOD:This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.RESULTS:Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4–16).CONCLUSION:Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.     

HIV感染者/AIDS患者的家属及朋友感染HIV的相关因素分析

目的 探讨人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者/获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）患者的家属及朋友感染HIV的现状和相关影响因素。方法 采取横断面研究设计,通过方便抽样方法和自行设计的调查问卷,于2013年3～6月对广州市第八人民医院感染科住院及门诊部的192名HIV感染者/AIDS患者的家属及朋友进行面对面问卷调查。结果 192位HIV感染者/AIDS患者的家属及朋友中,感染者家属占86.5%（166/192）,感染者家属及朋友的HIV感染率为36.5%（70/192）。多因素Logistic回归分析表明,与感染者的关系为配偶或性伴（OR=4.464,95%CI：2.128～9.366）、同性恋/双性恋（OR=4.523,95%CI：1.676～12.209）、吸毒（OR=6.755,95%CI：1.720～26.528）是感染者家属及朋友感染HIV的危险因素;与感染者感情关系亲密（OR=0.229,95%CI：0.097～0.539）是其感染HIV的保护因素。结论 HIV感染者/AIDS患者的配偶或性伴与其存在着性关系,故感染HIV风险较其他亲友高,但与HIV感染者/AIDS患者感情亲密的配偶或性伴较感情疏远者感染HIV风险低。同性恋/双性恋、吸毒是感染HIV的高危因素。关于与HIV感染者/AIDS患者感情关系和除配偶或性伴以外其他亲友感染HIV的相关关系,仍需进一步研究。     

微量营养素对艾滋病病毒感染者体内免疫细胞及微量元素水平影响的研究

目的 研究微量营养素对HIV感染者体内免疫细胞及微量元素水平的影响.方法 选择25～49岁的HIV感染者,试验组服用复合微量营养素片,对照组服用安慰剂.试验开始及结束时分别进行体格测量、免疫细胞及微量元素水平的测定.结果 试验前试验组与对照组的身高、体重和微量营养素摄入、免疫细胞及微量元素水平差异均无统计学意义(P>0.05).6个月后,试验组免疫细胞(CD4+、CD8+、CD3+T淋巴细胞)分别为(2078±108)个/mm3、(582±75)个/mm3、(1287±97)+/mm3,高于对照组的(1436±105)个/mm3、(472±61)个/mm3、(998±84)个/mm3,差异有统计学意义(P<0.05).试验组血清锌、钙、镁、铁分别为(144.89±9.78)μmol/L、(1.89±0.19)μmol/L、(1.68±0.12)μmol/L、(152.61±8.94)μmol/L,高于对照组(102.67±5.45)μmol/L、(1.13±0.07)μmol/L、(0.85±0.05)μmol/L、(89.24±3.91)μmol/L,差异有统计学意义(P<0.05).结论 补充微量营养素能提高HIV感染者体内锌、钙、镁、铁的水平,并能增进免疫功能.     

Sexual risk behavior among people living with HIV/AIDS in Togo

Since HIV in Africa is spread primarily through unprotected sex, safe sex practices such as condom use can reduce HIV spread significantly. Nevertheless, because sexual behavior involves complex dynamics, condom use is not an easy option for many people in Africa despite years of condom distribution intervention. In fact, the complex nature of sexuality complicates efforts to combat HIV spread and limits the effectiveness of many prevention efforts. This paper uses theoretical explanations--social representation theory, situated rationality theory, and social action theory--to examine the patterns of sexual risk behavior and the underlying reasons and rationalization among people living with HIV/AIDS in Lomé, Togo. Qualitative interviews were conducted with 151 people living with HIV/AIDS, recruited from 3 HIV/AIDS centers. The results of this in-depth study suggest that although people living with HIV/AIDS may be aware of the risk of infecting their sexual partners, they deliberately ignore the risk because other considerations, such as wanting a baby, take precedence. Consequently, condom access is inadequate to change risky sexual behavior that spreads HIV. It must be supplemented with adequate empowerment.     

艾滋病病毒感染者/艾滋病患者自杀行为研究进展

艾滋病与自杀是全球面临的两个重大公共卫生问题,严重影响社会和经济的发展[1,2].高效抗反转录病毒疗法(HAART)能有效控制艾滋病,延长艾滋病患者的寿命,提高生活质量,艾滋病已成为慢性疾病.从感染HIV发展为艾滋病约需要3～10年时间.在这期间,感染者具有完好的社会功能,可以继续为社会和家庭创造价值.     

艾滋病病毒感染者生活质量与相关耻辱的关系

目的探讨艾滋病病毒感染者和病人的生活质量与耻辱的关系。方法对215名艾滋病病毒感染者和病人进行匿名问卷调查,采用WHO生活质量简表中文版和BergerHIV耻辱量表测定调查对象的生活质量和感受到的耻辱,对其生活质量和艾滋病相关耻辱感进行典则相关分析。结果艾滋病病毒感染者和病人生活质量各个维度的平均得分为50.74(生理领域)、46.01(心理领域)、53.78(社会关系领域)和43.94(环境领域);耻辱4个维度的得分为49.89(个人耻辱)、29.77(担心公开)、35.18(负面自我印象)和57.80(关注公众态度)。典则相关分析结果显示,自我负面印象和心理领域分别是耻辱和生活质量中起主要作用的因素,两者呈负相关,相关系数为0.4938(P<0.05)。结论艾滋病病毒感染者和病人的负面自我印象越小,生活质量心理方面越好。     

Implementation of tuberculosis preventive treatment among people living with HIV,South Sudan

ObjectiveTo describe an intervention to scale up tuberculosis preventive treatment for people living with human immunodeficiency virus (HIV) in South Sudan, 2017–2020.MethodsStaff of the health ministry and United States President’s Emergency Plan for AIDS Relief designed an intervention targeting the estimated 30 400 people living with HIV on antiretroviral therapy across South Sudan. The intervention comprised: (i) developing sensitization and operational guidance for clinicians to put tuberculosis preventive treatment delivery into clinical practice; (ii) disseminating monitoring and evaluation tools to document scale-up; (iii) implementing a programmatic pilot of tuberculosis preventive treatment; and (iv) identifying a mechanism for procurement and delivery of isoniazid to facilities dispensing tuberculosis preventive treatment. Staff aggregated routine programme data from facility registers on the numbers of people living with HIV who started on tuberculosis preventive treatment across all clinical sites providing this treatment during July 2019–March 2020.FindingsTuberculosis preventive treatment was implemented in 13 HIV treatment sites during July–October 2019, then in 26 sites during November 2019–March 2020. During July 2019–March 2020, 6503 people living with HIV started tuberculosis preventive treatment.ConclusionLessons for other low-resource settings may include supplementing national guidelines with health ministry directives, clinician guidance and training, and an implementation pilot. A cadre of field supervisors can rapidly disseminate a standardized approach to implementation and monitoring of tuberculosis preventive treatment, and this approach can be used to strengthen other tuberculosis–HIV services. Procuring a reliable and steady supply of tuberculosis preventive treatment medication is crucial.     

Pneumococcal vaccination in people living with HIV

Streptococcus pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of Invasive Pneumococcal Disease (IPD), however, it remains 20- to 40-fold greater than that of the general population. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL³.We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by cross-referencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London).Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group.     

农村HIV感染者艾滋病相关知识与安全套认知的随访研究

目的了解农村地区已婚的HIV感染者艾滋病相关知识与安全套认知情况，为进一步获得促进和提高HIv感染者家庭使用安全套的操作可行的综合干预方案提供依据和基础。方法对临泉县HIV感染者采用入户方式进行艾滋病知识宣传和安全套使用技巧培训。在随访前后，对研究对象采用统一问卷进行两次调查。结果研究对象在艾滋病传播途径、非传播途径和预防方法知识方面在随访后有提高。性交时主动提出使用安全套的女性由干预前的33．9％提高到38．7％。结论要进一步加大艾滋病宣传和防治，提高安全套使用率，重点加强女性与性伴商讨安全套使用的能力，克服免费索取安全套时的羞辱感。     

Marital sex among people living with HIV receiving antiretroviral treatment in Northern Thailand

Before the advent of effective antiretroviral treatment (ART), the sexuality of people living with HIV was mostly discussed in terms of risk. To assess the extent to which ART allows people living with HIV to regain a regular sexual life, we surveyed all HIV-infected people treated in four hospitals in Northern Thailand and a control group from the general population matched by sex, age and residence. Data included socio-demographic and health characteristics, frequency of sexual intercourse in the last month and condom use. Our findings indicate that people living with HIV less often live in steady partnership (50% of the HIV-infected people versus 79% of the controls). After adjusting for factors known to influence sexuality, their probability of being sexually active was estimated to be about half that of the controls. When sexually active, men had a reduced sexual activity compared to controls (2.8 intercourse in the last month versus 4.0), while levels of reported sexual activity were similar among women (2.2 versus 2.8, respectively). Consistent condom use was high among people living with HIV (66% for women and 70% for men).     

艾滋病毒感染者/艾滋病患者与其家属艾滋病相关羞辱和歧视的研究

目的 了解某农村社区艾滋病毒感染者/艾滋病患者(HIV/AIDS)与其家属遭遇的羞辱和歧视,并分析造成相关羞辱和歧视的原因.方法 采用自制调查问卷,对某农村艾滋病流行区的117例HIV/AIDS及其相应的190名健康家属进行面对面问卷调查.结果 HIV/AIDS与其家属遭受到的羞辱和歧视可分为两类,即内在的羞辱和歧视及外在的羞辱和歧视;这两种羞辱和歧视在HIV/AIDS与其家属之间的差异有统计学意义(t=-12.540,P=0.000);且HIV/AIDS与其家属遭受的内在的羞辱和歧视要高于外在的羞辱和歧视.艾滋病内在的羞辱和歧视与研究对象的自我效能(OR=0.558,P=0.041)、家庭功能(OR=0.650,P=0.027)、是否感染HIV(OR=2.116,P=0.004)等因素有关.艾滋病外在的羞辱和歧视与研究对象的自我效能(OR=0.468,P=0.028)、家庭功能(OR=0.427,P=0.000)、是否感染HIV(OR=3.412,P=0.001)有关.结论 某农村社区HIV/AIDS与其家属在社会环境中均遭受到一定的内在、外在的羞辱和歧视,应采取有针对性的策略和措施,减少并消除这种羞辱和歧视.