Risultati per: Linee guida su HIV, epatite e malattie sessualmente trasmissibili.

The evidence suggests that DREAMS results in a reduction in HIV incidence and STI symptoms. DREAMS may result in a slight increase in the uptake of HIV testing and a large increase in awareness of HIV status. DREAMS may also reduce the number of sexual partners. Developing a unified and granular evaluation framework would be beneficial in advancing research and generating evidence on DREAMS.

Objective
To assess HIV testing and status disclosure rates and explore their associated predictors among young adolescents (10–17 years) who received health education through the Orphans and Vulnerable Children programme in Nimule, South Sudan.

Design
A pre–post evaluation study with data collected at baseline (December 2020) and at the endline (December 2022).

Setting
The study was conducted in Nimule, a densely populated periurban town characterised by high HIV prevalence and substantial cross-border movement between Uganda and South Sudan, making it a relevant setting for an HIV prevention project.

Intervention
The primary intervention was HIV risk education delivered through forty peer-led health clubs. Adolescents were screened for HIV risk factors and referred for HIV and other sexually transmitted infection testing at health facilities.

Participants
The study included young adolescents aged 10–17 years recruited from HIV-affected households within 17 neighbourhoods in Nimule periurban town. Informed consent was obtained from both caregivers and adolescents.

Primary and secondary outcome measures
The primary outcome was self-reported HIV testing and status disclosure. Binary logistic regression was used to assess the association between the study outcome variables and associated sociodemographic factors.

Results
A total of 557 (73.0%) of the 768 enrolled adolescents were surveyed at baseline and endline, including 301 (54.0%) females and 276 (46.0%) males. The median age was 14 years (IQR: 11–16) at baseline and 15 years (IQR: 12–17) at endline.
HIV testing increased from 315 (56.7%) at baseline to 557 (100%). The odds of undisclosed HIV status were 49% lower at endline adjusted OR (aOR) 0.51 (95% CI 0.92, 0.67; p

New England Journal of Medicine, Volume 392, Issue 13, Page 1344-1345, April 3, 2025.

Annals of Internal Medicine, Ahead of Print.

Un ANSA Incontra con i ricercatori sulla ricerca di frontiera

Dalla scuola al welfare aziendale fino alla vita nei borghi

Objectives
Older people living with HIV (PLWH) globally are experiencing a combination of both communicable and non-communicable disease (NCD) morbidities. Vascular contributions to cognitive impairment and dementia (VCID) can contribute to adverse ageing brain health. This study aimed to measure VCID and HIV-related factors and evaluate their association with cognitive performance.

Design
A cross-sectional study.

Setting
Five cities in the country of Georgia.

Participants
We enrolled PLWH age ≥40 years. Recruitment and data collection were carried out between February and September 2023. We conducted face-to-face interviews and collected data on sociodemographic characteristics, medical history, HIV history, cardiovascular health, mental health, clinical measurements and cognitive performance.

Primary outcome measures
We calculated the estimated 10-year cardiovascular risk using the Framingham risk score (FRS). Descriptive analyses were conducted using the frequency distributions of relevant categorical variables and median and IQR for continuous variables. Multivariable linear regression analyses were conducted separately for each cognitive assessment score.

Results
A total of 125 PLWH aged ≥40 years were enrolled in the study. The median FRS was 9% (IQR: 4, 15), with 37 (30%) participants having intermediate risk and 17 (14%) with high risk of cardiovascular event. In univariate correlation analysis, FRS was associated with worse cognitive performance. The FRS remained associated with worse performance on the Trails Making Test B and Grooved Pegboard Test using multivariable models. On average, every 1 per cent increase in FRS corresponded to an increase of 1.65 s (95% CI: 0.11, 3.19, p=0.04) for completing the Trails Making Test B and an increase of 1.02 s (95% CI: 0.43, 1.60, p=0.001) for completing the Grooved Pegboard Test.

Conclusions
We found a high prevalence of cardiovascular risk and an association between this risk and cognitive performance in our sample. Our findings provide a baseline that can be further investigated in larger-scale studies with longitudinal assessment of cardiovascular risk factors and cognitive performance. Furthermore, it can inform the development of policies and programmes to mitigate adverse effects of VCID on the health of PLWH in Georgia and the Eastern Europe and Central Asia region.

Introduction
Data are limited on the impact of stigma (stigma associated with HIV and/or stigma related to old age (ageism) or both) on linkage to the HIV care cascade among older persons (aged 50 years and older) in sub-Saharan Africa (SSA). Studies have documented the prevalence and determinants of HIV testing, antiretroviral therapy (ART) use and viral load suppression among older people in Africa. However, there is a need to conduct a systematic review to synthesise the findings on the impact of stigma on the HIV care cascade among older people in SSA. The objective of this systematic review is to collate the findings on the impact of stigma on the HIV care cascade among older people aged 50 years and older in SSA. The major research question is: what is the impact of stigma on the HIV care cascade among older persons aged 50 years and older in SSA?

Methods and analysis
We will search MEDLINE via PubMed, Web of Science Collection, Academic Search Premier from the EBSCO platform, Cochrane Central, JBI EBP, Global Health, Social Policy and Practice and Health Management Information Consortium for articles published in English from 2000 to June 2024. The search strategy will include variations of the following terms: HIV, HIV cascade, HIV testing, HIV care or linkage to care, retention in care, viral suppression, older persons, stigma, HIV-related stigma, age-related stigma, ageism, discrimination and intersectional stigma. In terms of study characteristics, the following will be included: epidemiological studies/observational studies/randomised controlled trials and qualitative studies on the HIV care cascade (ie, HIV testing, linkage to care, retention and viral suppression). We will restrict eligibility by focusing on the older population (older persons aged 50 years and older living with HIV) in SSA. The planned limits include timing (2000–2024), geographical coverage (SSA), language (English), copyright (open access publications) and age of the population (50 years and older). The primary and secondary outcomes are drawn from the HIV care cascade, including HIV testing, linkage to care, retention in care and adherence to ART.

Ethics and dissemination
Ethics approval is not needed since this is a systematic review based on published data. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will also present the results at relevant conferences and meetings.

PROSPERO registration number
CRD42024534675.

Objectives
This study explores factors affecting community-level demand for assisted partner services (APS) and HIV testing services (HTS) in western Kenya.

Design
This is a multilevel qualitative analysis conducted as part of the APS Scale-up Study, a hybrid type 2 implementation-effectiveness study of APS integrated within routine HTS. For this analysis, in-depth phone interviews assessed demand for APS and factors influencing decisions to participate in APS.

Setting
Participants were recruited from eight healthcare facilities and (for APS stakeholders) from affiliated healthcare institutions in western Kenya (Kisumu and Homabay). Interviews were conducted by phone in 2019 and 2020.

Participants
67 participants were interviewed: 14 APS providers, 16 female index clients, 17 male sexual partners and 20 community members. Participants were recruited using criteria-based purposive sampling to represent different types of facilities and to include indexes who named different numbers of partners and stakeholders representing all Kenyan healthcare system levels.

Results
Collectively, participants perceived that demand and uptake of APS could be impacted by multiple stigmas related to HIV, sexual behaviours and identities; long clinical wait times; certain gender norms and expectations; and fear of relationship dissolution, loss of financial support and intimate partner violence. However, different stakeholder groups generally focused on different factors; women focused more on gender dynamics and family roles; male sexual partners on stigma and structural barriers; HTS providers focused on HIV testing accessibility; and community-level stakeholders focused on low community awareness of APS.

Conclusions
Stigma reduction, awareness about APS, creation of male entry points at the facility level and provision of social support mechanisms have the potential to increase demand for APS.

Migliaia volontari in piazza dal 4 al 6 aprile in tutta Italia

Intesa di tre anni per finanziare e promuovere la ricerca

Intesa di tre anni per finanziare e promuovere la ricerca

Objectives
Extended life expectancy due to treatment improvements has increased the diagnosis of cancer among people living with HIV (PLWH) in Africa. Despite documented impacts of stigma on cancer preventive behaviours and care, little is known about the intersections of cancer and HIV stigma and the effects on prevention and care behaviours for both conditions. This study aims to examine experiences and drivers of cancer stigma and their associations with access to and utilisation of cancer prevention services among PLWH.

Design
This was a qualitative study consisting of eight focus group discussions with PLWH and 14 key informant interviews with HIV healthcare providers collected in January 2024.

Setting
Data were collected from two districts of Uganda and Zambia. In Uganda, the two selected districts were Arua, in the northern West Nile region, and Moroto, in the northeast Karamoja region. In Zambia, the study districts were Mongu, in the Western Province, and Chipata in the Eastern Province.

Participants
Each study district held two PLWH focus groups (one male, another female) with 5–7 participants per group and 3–4 key informant interviews for a total of 55 participants. PLWH and healthcare providers were eligible if they were (1) aged 18 years or older and (2) an HIV-positive client receiving antiretroviral therapy services at the participating clinic or working in a health services capacity at the clinic.

Results
Cancer stigma drivers included widespread misconceptions about disease origins and outcomes, associations with other stigmatising conditions and behaviours such as HIV, TB, and substance use, limited treatment options that heightened fears of diagnosis and inadequate training of healthcare providers. Study participants noted that experiences of stigma led to reduced treatment-seeking behaviours among PLWH, increased social isolation, and poor cancer-related care practices within clinics. Recommended interventions to combat stigma included improved education for providers and patients, private counselling, and peer support.

Conclusions
Results underscore the presence and impacts of stigma in the study population, emphasising the need for research informing culturally sensitive interventions that enhance educational outreach and promote engagement in care among targeted populations.

Trial registration number
This article is linked to an ongoing clinical trial registered on clinical trials.gov (clinical trial No: NCT05487807; Registration date: 27 November 2023) and relates to the pre-results stage.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.