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Memphis, Tennessee is second in the nation for HIV incidence, with one in three diagnoses among youth. Psychological trauma disproportionately impacts youth with HIV, compared with HIV-negative counterparts, requiring community-led and trauma-informed solutions to address mental wellness among youth with HIV. However, a dearth of research concentrates on trauma-informed care (TIC) for this population, with little exploration among youth-centered HIV care settings or into strategies for mobilizing communities to develop solutions. Research co-production, an approach in which research beneficiaries engage in research as cooperative partners, aligns with the TIC focus on collaborative decision-making and could be an effective strategy for facilitating collaborative TIC adoption, but formative research is needed to explore this potential. We sought to explore TIC implementation determinants and contextual factors that might influence research co-production as a strategy for implementation, including appetite for evidence-based approaches, support for co-production, and resources for capacity building. We applied an exploratory sequential mixed methods design to identify potential barriers and facilitators to TIC implementation in a youth-focused clinic and contextual factors relative to co-production. All clinic personnel were purposively invited to complete semistructured interviews. Thematic analysis, via four cycles of coding, was applied using the Consolidated Framework for Implementation Research 2.0 to qualitative data. Subsequently, a steering committee of clinic personnel was invited to complete surveys, applying the Research Quality Plus for Co-Production framework to explore co-production factors. A deliberative dialog approach was applied to analyze these findings and synthesize them with Consolidated Framework for Implementation Research. A total of 20 personnel completed interviews, and 9 completed surveys. Potential facilitators included perceived clinic cohesiveness, equity focus, and prioritization or compatibility of TIC. Potential barriers included perceived disconnect between the clinic and larger hospital (in which youth with HIV were seen as stigmatized in other areas of the hospital), sustainability concerns related to a perceived lack of championing by leaders, insufficient mental health protocols, a lack of formal patient feedback procedures, and a lack of protected time for personnel activity engagement. Survey responses suggested that the clinic is likely supportive of evidence-based approaches (mean 3.6, SD 0.70) and collaborative research (mean 3.1, SD 0.31) and empowers personnel to participate (mean 3.1, SD 0.22). Conducive to co-production, the environment was seen as learning-centered, where evidence and standardized or validated approaches are prioritized, and there is an openness for innovation, with a focus on health disparities and quality improvement. Potential barriers included change-resistant staff, role silos, and underutilization of staff skills, coupled with a lack of formal research training and time constraints. Findings suggested that TIC implementation is likely to be embraced in the clinic, with co-production perceived as useful and fitting. However, greater effort is needed to integrate patient experiences and test co-production as a TIC implementation strategy.

Highly active antiretroviral therapy (HAART) nonadherence is related to negative health outcomes and is well-documented in adolescents and young adults (AYAs) with behaviorally acquired HIV. Few studies describe methods to improve adherence in this population. This retrospective study describes placebo pill trial use (ie, pills with inert substance prescribed to practice taking HAART) in AYAs initiating HAART and its relation to disease outcomes. Sixty-two AYAs initiated HAART during the review period. Disease outcomes during the first year of standard clinical care were abstracted from medical records. In all, 72.6% of participants received ≥1 pill trial and 27.4% received ≥2 trials. Placebo trial use was not independently related to adherence post-HAART initiation. “Prescription” of a second trial was related to less optimal disease status over the first 6 months of treatment. Placebo trials have the potential to inform clinical care, aid in identifying AYAs at risk for nonadherence, and may provide a novel intervention strategy before/after HAART initiation.

Improving mental health, body image, and financial stability is paramount to achieving viral suppression and maintaining HIV-negative status for minoritized communities. The purpose of this paper is to describe the lessons learned from maintenance of an HIV prevention and wellness program during the COVID-19 pandemic. A three-session program was implemented in a hybrid format to account for county-wide restrictions and reopening processes. Lessons learned include the utility of a hybrid format, importance of CBPR partnership, innovation in virtual platform, value of social media presence and upkeep, and use of multiple methods to ascertain evaluative data. Sustaining an HIV prevention and wellness program requires strong research collaborations and ongoing engagement with priority populations and the flexibility to pivot as needed.

To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. A cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey - Adolescent and Surrogate Versions-Revised. Adolescents' mean age was 18 years (range ≥14-<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% ; 85% ; ; 71% and 77% . Best timing for end-of-life (EOL) decisions was (38%), (17%), (4%), (8%), (4%) and (19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that (PABAK=0.83), and (PABAK=0.92) were very important or important. There was discordance about (PABAK=0.08) and (PABAK=0.32). Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes. NCT01289444; Results.

Antiretroviral (ARV) adherence is critical in monitoring disease response in youth with perinatally-acquired HIV (PHIV). We used pharmacy refill (PR) information for PHIV youth from the PHACS Memory Sub-study to calculate medication availability over 2, 4, and 6 months. PR, a proxy of adherence, was compared with self-reported 7-day adherence in predicting suppressed viral load (SVL < 400 copies/mL) and higher CD4% (≥ 25%). Among 159 PHIV youth, 79% were adherent by 7-day recall, and 62, 55, and 48% by PR over 2, 4, and 6 months, respectively. Agreement between 7-day recall and PR adherence was weak (Kappa = 0.09–0.25). In adjusted logistic regression models, adherence showed associations with SVL for 7-day recall (OR 2.78, 95% CI 1.08, 7.15) and all PR coverage periods (6-month: OR 3.24, 95% CI 1.22, 8.65). Similar associations were observed with higher CD4%. PR measures were predictive of study retention. Findings suggest a possibly independent role of PR adherence measures.

Improvement in treatment has led to decreased death in youth with human immunodeficiency virus (HIV) in developed countries. Despite this, youth with HIV are still at risk for increased mortality and morbidity compared with their uninfected counterparts. In developing countries, high numbers of youth die from acquired immune deficiency syndrome (AIDS)-related illnesses due to lack of access to consistent antiretroviral treatment. As a result, pediatric palliative care is a relevant topic for those providing care to youth with HIV. A systematic review was conducted to gather information regarding the status of the literature related to pediatric palliative care and medical decision-making for youth with HIV. The relevant literature published between January 2002 and June 2012 was identified through searches conducted using PubMed, CINAHL, Scopus, and PSYCInfo databases and a series of key words. Articles were reviewed by thematic analysis using the pillars of palliative care set out by the National Consensus Project. Twenty-one articles were retained after review and are summarized by theme. In general, few empirically based studies evaluating palliative care and medical decision-making in youth with HIV were identified. Articles identified focused primarily on physical aspects of care, with less attention paid to psychological, social, ethical, and cultural aspects of care. We recommend that future research focuses on broadening the evaluation of pediatric palliative care among youth with HIV by directly evaluating the psychological, social, ethical, and cultural aspects of care and investigating the needs of all involved stakeholders.

Emerging research in adults with HIV suggests negative body image may be found at a higher rate in this group. To date, few studies have examined body image in adolescents living with HIV. This exploratory study aimed to characterize body image perceptions among youth living with HIV. Adolescents ( n  = 143; age range 16–24 years; 69 % male) completed an Audio Computer Assisted Self-Interview Questionnaire that assessed body image, psychosocial, medical and sociodemographic information. Medical history and physical functioning information were abstracted from medical records. Results showed normative global body image on the Multidimensional Body Self-Relations Questionnaire-Appearance Scales. Some subscale elevations were observed; including decreased interest in self-care and appearance, as well as concerns with individual body areas. Overall, youth reported preference for own body shape on the Figure Rating Scale; however, 41 % of youth classified as “overweight” per CDC body mass index reported contentment with current body size. Further, 47 % of youth classified as “normal” weight desired to have larger body size. Youth identified as men who have sex with men most often reported desiring larger body size. Implications for clinical care are discussed.

A collaborative approach that uses problem-solving strategies and includes families, school staff members, and medical and mental health providers is necessary to provide appropriate school intervention for students with BD. School-based interventions for these students can include different levels of special education services, specific classroom modifications, and direct services provided by school counselors and psychologists. To provide this support, administrators should continue to seek information about BD, help and support teachers and other school staff members in identifying and devising appropriate intervention techniques for problem behaviors, consult with parents to support their needs in dealing with educational issues of students with BD, work with school staff members and community providers to de-stigmatize mental health problems and treatment, and forge positive relationships and model productive interactions with the student's entire treatment team.

A collaborative approach that uses problem-solving strategies and includes families, school staff members, and medical and mental health providers is necessary to provide appropriate school intervention for students with BD. School-based interventions for these students can include different levels of special education services, specific classroom modifications, and direct services provided by school counselors and psychologists. To provide this support, administrators should continue to seek information about BD, help and support teachers and other school staff members in identifying and devising appropriate intervention techniques for problem behaviors, consult with parents to support their needs in dealing with educational issues of students with BD, work with school staff members and community providers to de-stigmatize mental health problems and treatment, and forge positive relationships and model productive interactions with the students entire treatment team.