JAIDS: Journal of Acquired Immune Deficiency Syndromes

Stevenson, Meg; Cooney, Erin; Borquez, Annick; Radix, Asa E.; Poteat, Tonia C.; Linton, Sabriya; Wawrzyniak, Andrew J.; Pontes, Ceza; Brown, Carter; Miller, Marissa; Lint, Arianna; , ; Reisner, Sari L.; Wirtz, Andrea L.

doi: 10.1097/qai.0000000000003776pmid: 41051867

Introduction:Transgender women experience health care barriers that can impede HIV status awareness, increasing the risk of delayed diagnosis. We sought to characterize undiagnosed HIV among transgender women in the United States.Methods:We used data from a hybrid cohort using digital and in-person strategies for transgender women in the United States who are not living with HIV. Assessments include a sociobehavioral questionnaire and HIV testing. Using baseline screening data, we identified undiagnosed HIV among transgender women who self-reported no HIV testing history or a negative result at last test. Bivariate and multivariable Firth-penalized logistic regression models were fit to assess correlates of undiagnosed HIV.Results:A total of 2547 participants completed HIV testing. Forty-three participants tested positive, 15 of whom disclosed during post-test counseling they had been previously diagnosed and were excluded from this sample. Of the 2532 with no previous HIV diagnosis, 28 (1.1%) were estimated to have undiagnosed HIV at baseline. Correlates of undiagnosed HIV included identifying as a person of color (aOR = 4.8; 95% CI: 2.1 to 11.1) and past 6-month stimulant use (aOR = 2.8; 95% CI: 1.2 to 6.4). Among transgender women of color, correlates of undiagnosed HIV were past 6-month stimulant use (OR = 2.5; 95% CI: 0.9 to 6.7), no lifetime HIV testing history (OR = 3.8; 95% CI: 1.4 to 10.8), and no insurance (OR = 4.5; 95% CI: 1.0 to 20.5) or public health insurance (OR = 4.4; 95% CI: 1.1 to 17.1) vs. private insurance.Conclusions:Undiagnosed HIV among transgender women is concerning and disproportionately affects transgender women of color. Addressing stimulant use is important for HIV prevention. Findings underscore the urgent need for free, accessible HIV testing with linkage to HIV prevention and care to achieve HIV strategy goals.

Weinstein, Elliott R.; Kirakosian, Norik; Chen, Yumei O.; Bharat, Bharat; Safren, Steven A.

doi: 10.1097/qai.0000000000003777pmid: 41114723

Background:Structural life instability may negatively affect HIV-care outcomes in people living with HIV (PLWH), particularly in South Florida, a US HIV epidemic “hotspot” with high rates of poverty, immigration, and inconsistent health care access.Setting:PLWH (N = 241) receiving care at a community clinic in Miami were assessed at 2 points.Methods:Sequential mediation regression analyses were used to explore the relationships between additive indices of structural life instability (indicators: unemployment, low educational attainment, incarceration history, history of immigration as an adult, housing instability, and lack of a significant other) and psychosocial syndemic burden (indicators: depression, anxiety, trauma history, interpersonal violence, and substance use), self-reported antiretroviral therapy (ART) adherence, and documented HIV RNA viral load (VL) collected through medical records.Results:Participants reported an average of 2.23 indicators of life instability at baseline and 3.05 psychosocial syndemic problems at follow-up. Each additional indicator of life instability at baseline predicted a 0.23 increase in syndemic count at follow-up and each additional psychosocial problem at follow-up was associated with a 1.37 percentage point decrease in self-reported ART adherence covarying for baseline life instability. Self-reported adherence was, in turn, significantly inversely associated with participants' continuous log RNA VL when holding variables constant. Finally, there was a significant indirect effect of baseline structural life instability on log RNA VL at follow-up sequentially through psychosocial syndemic burden and ART adherence.Conclusions:Results suggest a temporal relationship between baseline life instability and psychosocial problems that negatively affects HIV-related care outcomes among PLWH in South Florida.

Chandran, Aruna; Olson, Sarah; Edmonds, Andrew; Moran, Caitlin A.; Lake, Jordan E.; Tien, Phyllis; Marques, Ernesto; Sharma, Anjali; Alcaide, Maria; Brown, Todd; Gustafson, Deborah; Palella, Frank; Plankey, Michael; Shankaran, Shivanjali; Wise, Jenni

Bhushan, Nivedita L.; Boudewyns, Vanessa; Getachew-Smith, Hannah; Stryker, Jo Ellen; Uhrig, Jennifer D.

doi: 10.1097/qai.0000000000003774pmid: 41051884

Introduction:Pre-exposure prophylaxis (PrEP) prescription rates in the United States remain suboptimal despite its high efficacy in HIV prevention. Health care provider (HCP) awareness of PrEP guidelines is crucial, yet limited data exist on guideline-specific awareness versus general PrEP knowledge. This study examined PrEP guideline awareness, prescribing behaviors, and associated HCP characteristics using 2022–2024 DocStyles data to inform targeted interventions.Methods:Data were drawn from the 2022–2024 DocStyles surveys of US HCPs (N = 4507). χ2 tests and generalized linear models assessed relationships between PrEP guideline awareness, prescribing behaviors, and HCP demographic and clinical characteristics.Results:PrEP guideline awareness increased from 44% (2022) to 57% (2023), then declined to 50% (2024; P <0.001). HCPs older than 44 years and OB/GYNs were more likely to be aware of PrEP guidelines than younger HCPs and family practitioners. Guideline awareness did not differ by region, sex, race/ethnicity, or clinical setting. PrEP prescribing to all sexually active individuals increased from 23% (2022), 29% (2023) to 33% (2024; P <0.001). Non-White HCPs were more likely to prescribe PrEP than White HCPs. Compared with HCPs in the south, those in the northeast and west were more likely to prescribe PrEP, while midwestern HCPs were less likely. OB/GYNs, nurse practitioners, and PAs were less likely to prescribe PrEP than family practitioners.Conclusions:Significant variations in PrEP guideline awareness and prescribing behaviors exist among US HCPs. Targeted communication campaigns and tailored interventions are essential to address these differences, enhance guideline adherence, and optimize PrEP uptake to reduce HIV incidence nationally.

Ndlovu, Nkosiphile; Plagianos, Marlena; Palanee-Phillips, Thesla; Reddy, Krishnaveni; Zulu, Sihle K.; Kgoa, Reolebogile F. O.; Irene, Bruce; Shale, Lerato R.; Burnett-Zieman, Brady J.; Sigcu, Nompumelelo S.; Mathur, Sanyukta; Haddad, Lisa B.; Friedland, Barbara A.

doi: 10.1097/qai.0000000000003780

Keddem, Shimrit; Sorrentino, Anneliese; Agha, Aneeza Z.; Colt, Susannah F.; Dixon, Tammara; Caceres, Omaris; Van Epps, Puja; Beste, Lauren A.

doi: 10.1097/qai.0000000000003782pmid: 41134619

Supplemental Digital Content is Available in the Text.

Islek, Duygu; Sanchez, Travis; Baral, Stefan; Caldwell, Joanna A.; Glick, Jennifer L.; Lucas, Irah; Sarkar, Supriya; Ragone, Leigh; de Ruiter, Annemiek; Valentine-Graves, Mariah; Winter, Savannah; Vannappagari, Vani

Rosenberg, Nora E.; Young, Amber M.; Zou, Yating; Justman, Jessica; Charurat, Manhattan E.; Moyo, Sizulu; Zuma, Khangelani; Bekker, Linda-Gail; Stranix-Chibanda, Lynda; Phiri, Sam J.; Sam-Agudu, Nadia A.; Yotebieng, Marcel; Hudgens, Michael G.; Chi, Benjamin H.;

Kerrigan, Deanna; Ruiz, Carolina; Castonguay, Breana J. Uhrig; Rodriguez Gonzalez, Humberto; Mayer, Kenneth; Fleming, Julia; Peretti, Matteo; Cachay, Edward; Bamford, Laura; Agans, Robert; Barrington, Clare; Cole, Stephen; Wohl, David

Larson, Michaela E.; Pan, Yue; Lakhani, Fatima; Chavez, Jennifer V.; Santana, Andrea; Nogueira, Nicholas Fonseca; Lieberman, Adam; Riley, Elise D.; Wu, Katherine C.; Tien, Phyllis; Kizer, Jorge; Floris-Moore, Michelle; Pyslar, Nataliya; Palella, Frank J.; Witt, Mallory D.;