ABSTRACT Since the 1980s when the HIV epidemic began, HIV and substance use have been intricately linked. A promising area for improving access to care and treatment for people living and aging with HIV and substance use is through integrated care (i.e., “the systematic coordination of general and behavioral healthcare”). There is a recognized need to increase collaboration and integration of mental health, substance use, and primary care providers, including infectious disease specialties. We conducted in-depth interviews with 15 administrators (e.g., clinic managers and care coordinators) and 21 providers (e.g., Physicians, Advanced Practice Providers (APPs), nurses) across Georgia between January 2021 and November 2022. Interviews explored administrator and provider perceptions of clinic integration and their desire to increase integration. Data were analyzed using inductive and deductive thematic analysis guided by the Consolidated Framework for Implementation Research. Overall, study participants in a variety of public, private, and community healthcare settings across the state recognized the benefits of integrated behavioral and physical healthcare and noted some facilitators. However, they reported significant individual-, organizational-, and community-level barriers to implementing it in practice. Our findings highlight opportunities for improvement at the provider, organization, and policy/system levels.

ABSTRACT The prevalence of behavioral problems in children and adolescents living with HIV is high. We investigate associations between oral microbiota and behavioral problems in children living with HIV (CLWH) and children who are HIV-uninfected (CHU). Oral swab samples, assessment of behavioral functioning using the Strengths and Difficulties Questionnaire (SDQ), and clinical and social data were collected from 477 CLWH and 123 CHU at two sites in Johannesburg, South Africa. DNA was extracted from oral swab samples and the V4 amplicon of the 16S rRNA gene sequenced. Behavioral problems were more prevalent in CLWH than in CHU, and in boys than in girls. Oral microbiota diversity and taxa abundances in CLWH did not differ between those with and without behavioral problems. In contrast, in CHU, those with behavioral problems had higher alpha diversity indices and lower abundances of Rothia and Schaalia than those without behavioral problems. Behavioral problems in CLWH were associated with being male, lower Tanner stage, less maternal education, and dental caries. Markers of poor oral health were associated with behavioral problems in CLWH, and oral microbiota profile correlated with behavioral problems in CHU. Oral health may be a preventable factor that could help reduce behavior problems in CLWH.

ABSTRACT Reengaging patients lost to follow-up (LTFU) is crucial to achieving the UNAIDS 95-95-95 targets. This study analyses an intervention aimed at identifying and reengaging LTFU individuals in the PISCIS Cohort in Catalonia. The cohort included 28,033 people living with HIV (PLWH) across 17 hospitals in Catalonia and two in the Balearic Islands as of 2021. LTFU was defined as no contact with HIV care in any Catalan hospital for ≥12 months between June 2021 and January 2010. At four hospitals, suspected LTFU cases were confirmed through clinical records and followed up via phone calls, text messages and emails. Confirmed cases were invited to reengage in care. A total of 1,411 suspected LTFU individuals were studied. Compared to those in regular follow-up, LTFU individuals were more often male, aged 30-39, born outside Spain (64.8%) and men who have sex with men (70.4%). Of these, 27.3% could not be located, with a higher proportion born outside Spain (74.8% vs. 61.0%). Reengagement rates were low, though older individuals and women were more likely to reengage. These findings underscore the importance of accurate cohort records, systematic tracking and targeted strategies to reengage hard-to-reach LTFU patients.

ABSTRACT Transgender women in South Africa face a heavy HIV burden, but data on key psychosocial and structural factors remain limited. This cross-sectional study examined associations between HIV outcomes and psychosocial (substance use, alcohol use, medical distrust, community connectedness) and structural (education, homelessness, income, sex work, violence) factors. We conducted interviewer-administered surveys with 213 transgender women in Cape Town, Johannesburg, and East London between June and November 2018. Of the 213 participants, 196 knew their HIV status and 67 reported living with HIV. Multivariable logistic regression found homelessness (aOR 4.50 [95%CI: 1.67, 12.23]), sex work (aOR 5.90 [95%CI: 2.14, 16.29]), and earning above the poverty level (aOR 3.08 [95%CI: 1.37, 6.94]) were significantly associated with living with HIV. Among participants with HIV, sex work (aOR 13.39 [95%CI: 1.17, 153.67]) was the only significant predictor of viral suppression. South Africa’s provision of financial support specifically for PHIV may account for associations between income and HIV; while South Africa’s sex-worker specific clinics, tailored to this population’s needs, may account for their higher viral suppression. Study findings highlight the importance of context-specific HIV research with key populations to identify locally relevant strategies to improve HIV outcomes.

ABSTRACT Neurocognitive symptoms persist in many people living with HIV (PLWH). Safe driving practices are dependent on intact cognition. Research in the general driving population suggests that PLWH with neurocognitive impairment (NCI) perform worse on driving assessment tasks than cognitively intact PLWH. We explored the relationship between HIV status, NCI, and driving ability in vocational drivers. Two-hundred-and-four male drivers [68 drivers with HIV] completed neuropsychological testing and two driving simulator tasks assessing driving under routine and challenging circumstances. Drivers with NCI, regardless of HIV status, exhibited worse driving performance than cognitively intact drivers overall (p = .032), and on the challenging drive (p = .048) in particular. Better driving performance was associated with having received professional driver training. Other favorable predictors included being a truck driver and not having HIV. Drivers with NCI are at greater risk of making driving simulator errors, and errors are more evident under challenging driving conditions. Driver training interventions may be effective in remediating poorer driving performance in drivers with NCI. Studying the impact of HIV and cognition in individuals who are working professionally is a complex undertaking that requires consideration of factors (e.g., training and experience) alongside the usual variables considered when studying the general population.

ABSTRACT Fishermen working along Lake Victoria experience high rates of HIV acquisition that can be mitigated by pre-exposure prophylaxis (PrEP), which requires adequate adherence for effective prevention. We evaluated PrEP adherence among Kenyan fishermen using objective metrics and examine non-adherence. Data are from the Owete study (NCT04772469), a cluster randomized-controlled trial using a social network approach among fishermen to increase HIV testing and linkage to care. Survey and lab data were collected from PrEP users. We measured recent objective adherence via a point-of-care tenofovir urine assay. We conducted a logistic regression to assess the relationship between self-reported adherence data and urine tenofovir detection. Among 71 PrEP users, 34% self-reported ≥90% PrEP adherence. Reasons for non-adherence included not feeling at risk (31%), being away and without medication (27%), or feeling they did not need PrEP (24%). Detectable PrEP in urine was low (17%). Self-reported PrEP non-adherence within 30 days was associated with 13.29 times the odds of non-detection of urine tenofovir (95% CI: 2.20, 80.43). The point-of-care tenofovir assay was a valuable tool for objectively measuring PrEP adherence. Interventions to bolster PrEP adherence are needed to prevent HIV acquisition among fishermen, as are longer-acting products with lower demands for adherence.

ABSTRACT Given the current organ shortage crisis, organ transplantation among people with HIV (PWH) has become a reality. To effectively implement this practice, understanding the attitudes and beliefs about organ donation among PWH in Canada is imperative. PWH receiving care at the McGill University Health Centre were recruited to participate in a survey between October 2023-June 2024. The questionnaire assessed knowledge of organ donation and willingness to donate or receive organs from donors with HIV. Descriptive statistics were performed. Of 100 participants, 33.0% knew that PWH can undergo organ transplantation in Canada, and 26.0% knew that PWH in Canada can donate their organs to PWH. Additionally, 74.5% would consider accepting an organ from a deceased donor with HIV, 78.0% would consider accepting an organ from a living donor regardless of HIV status, 78.0% would be willing to be deceased donors, and 44.0% would be willing to be a living organ donor. Female-identifying and African, Caribbean or Black participants showed higher awareness about organ donation, whereas male-identifying and White participants demonstrated higher willingness to donate and receive organs from donors with HIV. While willingness among PWH was high, knowledge of organ transplantation was suboptimal, highlighting the need for increased awareness efforts.

ABSTRACT In South Africa, people living with HIV (PWH) often relocate for work and family obligations, which creates unique challenges for continuous HIV care. We explored the experiences of mobile individuals living with HIV navigating clinic transfers without formal letters. A qualitative study was conducted with PWH on antiretroviral therapy (ART) from two clinics in KwaZulu-Natal. Participants, who had not disclosed their HIV treatment history at registration, were interviewed in-depth between March and October 2023. Content and thematic analyses, informed by Andersen’s behavioral model and self-management domains, were used. This study presents two case studies of individuals who faced challenges with accessing ART after relocating to new areas: a 37-year-old female worker and a 47-year-old male construction worker. Both faced difficulties accessing ART after relocation. When they presented at new clinics, they were told they could not access care without transfer letters. Unable to return to previous clinics, they sought treatment at a third clinic as treatment-naive, changing their names to avoid detection. To cover ART gaps, they also purchased or borrowed ART from others. These individuals developed strategies to overcome barriers. Educating clinic staff on the challenges faced by migrants could help improve transfers.

ABSTRACT People living with HIV (PLWH) face disproportionate rates of suicide death despite improvements in quality of life with antiretroviral therapy. Effective preventative efforts necessitate an understanding of healthcare utilization trends prior to suicide death for PLWH to facilitate the identification of areas for improvement in screening and prevention. The present study aimed to identify patterns of healthcare utilization in PLWH who died by suicide using a population-based cohort design. Administrative datasets from British Columbia, Canada were analyzed using unadjusted and adjusted logistic regression models to assess healthcare utilization in the 90-day period prior to suicide death for 98 PLWH and 170 age- and sex-matched people without HIV (PWoH). PLWH were found to have greater rates of healthcare engagement prior to suicide death, with increased likelihood of any healthcare visit and a greater median count of total healthcare visits compared to controls. Despite this, no significant difference in degree of engagement with mental healthcare and self-harm healthcare services was observed between PLWH and PWoH. These findings suggest that PLWH who die by suicide engage with the healthcare system more than their counterparts without HIV, and point to the importance of differential screening and prevention strategies for PLWH on antiretroviral therapy.

ABSTRACT This study compares pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) with a recent history of incarceration across various factors known to contribute to HIV transmission risk, including sexual identity, race/ethnicity, sexual activity, incarceration history, injection drug use, and internalized homophobia. We analyzed baseline lifetime PrEP use (yes or no) of 170 male-identifying participants enrolled in a randomized-controlled trial in Los Angeles County between 2019 and 2022. Using logistic regression, we assessed the association of PrEP with sexual identity, socio-demographics, and potential confounders. Compared to gay/same-gender loving-identified participants, straight/heterosexual-identified (aOR = 0.10, CI = 0.02–0.49) and bi-pansexual-identified (0.39, 0.16–0.95) participants had reduced odds of PrEP use. Black/African American-identified participants had lower odds (0.15, 0.03–0.78) of PrEP use than White-identified participants. Participants reporting 3+ years cumulative lifetime incarceration had lower odds (0.28, 0.09–0.87) of PrEP use than participants reporting <6 months. Controlling for internalized homophobia rendered differences among sexual identity groups non-significant. A similar effect was not observed for race/ethnicity and lifetime incarceration. Internalized homophobia was an important driver of PrEP use differences among MSM along the lines of sexual identity but not along the lines of race/ethnicity or cumulative incarceration.