Explore the vast range of titles available.

HIV remains a global challenge, with stigma, financial constraints, and psychosocial barriers preventing people living with HIV from accessing health care services, driving them to seek information and support on social media. Despite the growing role of digital platforms in health communication, existing research often narrowly focuses on specific HIV-related topics rather than offering a broader landscape of thematic patterns. In addition, much of the existing research lacks large-scale analysis and predominantly predates COVID-19 and the platform's transition to X (formerly known as Twitter), limiting our understanding of the comprehensive, dynamic, and postpandemic HIV-related discourse. This study aims to (1) observe the dominant themes in current HIV-related social media discourse, (2) explore similarities and differences between theory-driven (eg, literature-informed predetermined categories) and data-driven themes (eg, unsupervised Latent Dirichlet Allocation [LDA] without previous categorization), and (3) examine how emotional responses and temporal patterns influence the dissemination of HIV-related content. We analyzed 191,972 tweets collected between June 2023 and August 2024 using an integrated analytical framework. This approach combined: (1) supervised machine learning for text classification, (2) comparative topic modeling with both theory-driven and data-driven LDA to identify thematic patterns, (3) sentiment analysis using VADER (Valence Aware Dictionary and sEntiment Reasoner) and the NRC Emotion Lexicon to examine emotional dimensions, and (4) temporal trend analysis to track engagement patterns. Theory-driven themes revealed that information and education content constituted the majority of HIV-related discourse (120,985/191,972, 63.02%), followed by opinions and commentary (23,863/191,972, 12.43%), and personal experiences and stories (19,672/191,972, 10.25%). The data-driven approach identified 8 distinct themes, some of which shared similarities with aspects from the theory-driven approach, while others were unique. Temporal analysis revealed 2 different engagement patterns: official awareness campaigns like World AIDS Day generated delayed peak engagement through top-down information sharing, while community-driven events like National HIV Testing Day showed immediate user engagement through peer-to-peer interactions. HIV-related social media discourse on X reflects the dominance of informational content, the emergence of prevention as a distinct thematic focus, and the varying effectiveness of different timing patterns in HIV-related messaging. These findings suggest that effective HIV communication strategies can integrate medical information with community perspectives, maintain balanced content focus, and strategically time messages to maximize engagement. These insights provide valuable guidance for developing digital outreach strategies that better connect healthcare services with vulnerable populations in the post-COVID-19 pandemic era.

Mobile phones have become popular tools to support public health interventions (mobile health [mHealth]). Text messaging, including SMS, is a simple, low-cost approach for health communication to a large population and offers valuable tools in improving health outcomes. Despite the global advances in HIV treatment and prevention, the HIV epidemic continues to disproportionately affect certain populations such as men who have sex with men (MSM) and transgender women, including in Latin America. This study aimed to evaluate the effectiveness of SMS text messaging in improving adherence after 1-year provision of oral pre-exposure prophylaxis (PrEP) among MSM and transgender women in Brazil. Pilot randomized controlled trial nested in the PrEP Brasil study, a prospective, multicenter, open-label implementation study assessing PrEP delivery in the context of the Brazilian Public Health System. Those who agreed to participate in the pilot trial were randomized 1:1 to standard-of-care (SOC) or intervention (SMS text messaging) arm. SMS text messages were launched fully automated weekly to participants for 48 weeks. Adequate adherence to PrEP has been defined as having (1) tenofovir-diphosphate concentration of ≥700 fmol/punch, (2) medication possession ratio of ≥1.07, (3) pill count of ≥90.1%, and (4) self-report (structured questionnaire) of ≥99.9%. Adequate adherence outcomes at week 48 were compared between arms (SMS text messaging vs SOC) using univariate logistic regression. Comparisons were also performed for young MSM aged 18-24 years and transgender women. From 450 participants enrolled on PrEP Brasil, 417 (92.7%) were randomized to the pilot trial: 210 to SOC and 207 to SMS arm. Until week 48, participants received a total of 14,099 SMS with the text message: \"Are you okay?,\" and 6959 (49.4%) messages were replied. Of these, the vast majority replied \"Yes\" (6762/6959, 97.2%). A total of 347 (83.2%) participants completed the study with no difference between arms for the 4 adherence outcomes. Conversely, young MSM who received SMS text messages had 2.50 increased odds of having adequate PrEP adherence measured by medication possession ratio (P=.05). Most participants found SMS text messaging very useful or useful (127/167, 76.0%) and would recommend SMS text messaging as a support strategy for persons using PrEP (134/167, 80.2%). Most participants think that SMS text messaging should be offered to all persons using PrEP (129/167, 77.2%), and 16.2% (27/167) think that SMS text messaging should be offered only to those persons using PrEP with adherence problems. Weekly messages were found adequate by 80.2% (134/167). SMS text messaging intervention improved adequate PrEP adherence among young MSM and can be a useful tool for PrEP coverage and persistence. Future interventions using other mHealth tools such as WhatsApp messages and apps tailored to support PrEP adherence should be evaluated among MSM and transgender women in Brazil.

Mpox has reemerged as a global public health concern. With the growing reliance on social media for health information dissemination, understanding public perception through these platforms is essential for designing effective health promotion strategies. This study analyzes TikTok data related to mpox using Latent Dirichlet Allocation (LDA) topic modeling. This paper aims to extract key topics and inform targeted health promotion strategies for mpox prevention and control. Using the \"Aisou Jisou\" system, we collected TikTok data containing the keyword \"Mpox\" from April 1, 2022, to March 31, 2025. The dataset comprised 25,672 text data and associated search terms. We analyzed trends in the Search Index and Target Group Index (TGI) across time, gender, age groups, and provinces. LDA topic modeling was applied to identify latent topics within the text data, and topic evolution was examined during 4 peak months of the Search Index. A total of 4 major Search Index peaks were identified on TikTok in China, which are May 2022, July 2023, August 2024, and February 2025. These peaks aligned with key global and national mpox events, including WHO's declaration of a global mpox outbreak in May 2022 and the detection of the clade Ib Mpox in China in January 2025. TGI analysis revealed that users aged 18-23 years exhibited the highest engagement. Spatially, Beijing, Tianjin, and Jilin recorded the highest cumulative TGI values (5922.38, 5692.41, and 3579.90, respectively). LDA topic modeling identified 8 primary topics, including transmission and prevention, vaccine concerns, and misinformation, etc. Public attention evolved from general disease knowledge toward issues of stigmatization and vaccine distrust over time. Sankey diagrams illustrated shifts in public attention across topics at different Search Index peaks, with \"Mpox Transmission and Prevention\" receiving the most attention in May 2022 and \"Mpox Vaccination and Infection Prevention\" in February 2025. TikTok provides real-time insights into public attention during mpox outbreaks, but can also propagate misinformation and stigmatizing narratives. Public health authorities should leverage these platforms for timely communication, actively address misinformation, and mitigate social bias. Tailored strategies are needed to enhance health literacy, minimize stigma, and strengthen outbreak preparedness and response. This study highlights the dual role of social media as both an information source and a potential vector for misinformation, emphasizing the necessity for active monitoring and regulation by health authorities to ensure the accuracy and reliability of disseminated health information.

Electronic health record (EHR) data are widely used in public health research, including in HIV-related studies, but are limited by potential bias due to incomplete and inaccurate information, lack of generalizability, and lack of representativeness. This study explores how workflow processes among HIV health care providers (HCPs), data scientists, and state health department professionals may potentially introduce or minimize bias within EHR data. One focus group with 3 health department professionals working in HIV surveillance and 16 in-depth interviews (ie, 5 people with HIV, 5 HCPs, 5 data scientists, and 1 health department professional providing retention-in-care services) were conducted with participants purposively sampled in South Carolina from August 2023 to April 2024. All interviews were transcribed verbatim and analyzed using a constructivist grounded theory approach, where transcripts were first coded and then focused, axial, and theoretically coded. The EHR data lifecycle originates with people with HIV and HCPs in the clinical setting. Data scientists then curate EHR data and health department professionals manage and use the data for surveillance and policy decision-making. Throughout this lifecycle, the three primary stakeholders (ie, HCPs, data scientists, and health department professionals) identified challenges with EHR processes and provided their recommendations and accommodations in addressing the related challenges. HCPs reported the influence of socio-structural biases on their inquiry, interpretation, and documentation of social determinants of health (SDOH) information of people living with HIV, the influence of which is proposed to be mitigated through people living with HIV access to their EHRs. Data scientists identified limited data availability and representativeness as biasing the data they manage. Health department professionals face challenges with delayed and incomplete data, which may be addressed statistically but require consideration of the data's limitations. Overall, bias within the EHR data lifecycle persists because workflows are not intentionally structured to minimize bias and there is a diffusion of responsibility for data quality between the various stakeholders. From the perspective of various stakeholders, this study describes the EHR data lifecycle and its associated challenges as well as stakeholders' accommodations and recommendations for mitigating and eliminating bias in EHR data. Based upon these findings, studies reliant on EHR data should adequately consider its challenges and limitations. Throughout the EHR data lifecycle, bias could be reduced through an inclusive, supportive health care environment, people living with HIV verification of SDOH information, the customization of data collection systems, and EHR data inspection for completeness, accuracy, and timeliness. Future research is needed to further identify instances where bias is introduced and how it can best be mitigated and eliminated across the EHR data lifecycle. Systematic changes are necessary to reduce instances of bias between data workflows and stakeholders.

The DC Cohort is a longitudinal HIV cohort study of people with HIV receiving care at 14 clinical sites in Washington, DC, led by George Washington University. Data are routinely linked to the DC Department of Health (DC Health) HIV surveillance databases to increase data completeness and accuracy and to help identify people with HIV enrolled at multiple sites. The ATra Black Box (Black Box henceforth) is a novel privacy technology developed by Georgetown University, which is currently deployed in 40 public health jurisdictions. The Black Box provides a secure mechanism to link private health information across data systems. The Black Box was modified for the purposes of linking data from the DC Cohort to DC Health surveillance data and increasing the ease, feasibility, accuracy, and timeliness of future linkages. These modifications included providing deidentified data to George Washington University and developing analytic code to compare data between the DC Cohort and DC Health to report on data discrepancies. This paper reports on the results of the initial linkage using the Black Box. DC Cohort data on all consented participants from January 2011 through September 2022 were submitted to the Black Box. Simultaneously, all DC Health HIV surveillance data were also submitted to the Black Box. The data were matched using a predetermined algorithm, match-level scores were assigned, and matches were manually verified. The new Black Box graphical user interface allows users to check files for errors and easily track the Black Box processes and provides analytic plugins for running SAS code. A total of 9744 records of DC Cohort participants were submitted for matching to DC Health. Of these, 9060 participants (93.0%) matched to surveillance data and were validated through manual review. Match-level scores ranged from 20 to 100, and the validation found that scores of 61 and above were true matches. The SAS output files provided information on missing or conflicting data, including lab records, date of HIV diagnosis, and other key demographics. The linkage resulted in the addition of 48,970 CD4 T-lymphocyte counts, 33,413 viral load lab records, and 767 previously unrecognized deaths. Among the DC Cohort participants, 470 were enrolled at more than one site and 17 at more than two sites. The implementation of the Black Box for sharing DC Cohort and DC Health data resulted in better capture of HIV lab records, improved vital status information, and enhanced characterization of care patterns for people with HIV enrolled in the DC Cohort. Future linkages will include DC Health data on diagnoses of sexually transmitted infections, hepatitis, and tuberculosis.

Young men who have sex with men (YMSM) have a higher risk of HIV infection. However, evidence of HIV incidence from large cohort studies is limited in this key population, particularly among Chinese YMSM. This study aimed to investigate the HIV incidence and associated risk factors among YMSM aged 16-24 years in Tianjin, China. We conducted a retrospective cohort study among men who have sex with men aged 16-24 years from October 2017 to December 2022 through the largest local nongovernmental organization serving men who have sex with men in Tianjin. Participants who responded to the investigations at least twice during the study period were included. They completed questionnaires on demographic information, sexual behaviors, psychoactive substance use, and sexually transmitted infection status. Simultaneously, their blood samples were collected for HIV testing. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-years (PYs). A Cox proportional hazards regression model was used to identify risk factors associated with HIV incidence. A total of 1367 HIV-negative YMSM were included in the cohort, among whom 62 seroconversions occurred, contributing 2384.2 observed PYs; the total incidence was 2.6 (95% CI 2.0-3.2) per 100 PYs. The segmented HIV incidence rates were 3 (95% CI 1.5-4.5), 2.4 (95% CI 1.5-3.3), and 2.7 (95% CI 1.5-3.9) per 100 PYs for 2017-2018, 2019-2020, and 2021-2022, respectively. Compared to YMSM who had been followed up fewer than three times, those followed up three or more times had a relatively lower risk of HIV infection (Adjusted hazard ratio [AHR] 0.553, 95% CI 0.325-0.941). YMSM who preferred finding sexual partners offline had a higher risk of HIV infection compared to those who preferred finding sexual partners online (AHR 2.207, 95% CI 1.198-4.066). Compared to YMSM without syphilis, those infected with syphilis had an increased risk of HIV infection (AHR 2.234, 95% CI 1.137-4.391). Additionally, YMSM who used psychoactive substances had a higher risk of HIV infection compared to those who did not use such substances (AHR 2.467, 95% CI 1.408-4.321). Our study complements data on HIV incidence among YMSM in large cities across China. Syphilis infection and the use of psychoactive substances were risk factors associated with HIV occurrence, demonstrating an urgent need for tailored prevention and control interventions for this key population.

It remains unclear whether the existing health care services reflect the HIV care continuum, which underscores the need for integrated care beyond viral suppression. This study aimed to analyze the literature on health care services for people living with HIV to enhance the understanding of trends and knowledge structures. A literature review was conducted using BERTopic, an advanced machine learning-based topic modeling technique. We searched PubMed, CINAHL, EMBASE, and Cochrane databases for English-language studies published between 2013 and 2023. Analyses were performed twice: first, to gain a broad understanding of the literature, and second, to examine the specific details of health care services described. Among the 11,269 articles screened, 204 studies met the inclusion criteria. Within the HIV care continuum, most studies focused on the treatment retention stage, while studies focusing on the long-term stage were limited. A broad literature analysis identified five key topics, with \"ART adherence\" emerging as the most prominent topic. A more comprehensive analysis of health care services within the literature revealed 7 topics, reflecting diverse delivery methods and content in providing health care services for people living with HIV. The predominant topic, \"ART adherence and counseling,\" encompassed the largest number of studies, indicating the strongest emphasis in the field. Notably, the distribution of topics exhibited a distinct pattern: while health care service diversity was the highest in the earlier stages of the HIV care continuum, it became increasingly limited in the later stages. This study provides valuable insights into current HIV care services and highlights areas for future research and intervention. Despite the shift toward lifelong HIV management, existing literature remains heavily focused on medication treatment, overlooking the multifaceted health care needs of people living with HIV. Research disparities, particularly concerning vulnerable populations, underscore the need for more inclusive studies and tailored health care services. Efforts should be intensified to bridge these gaps, ensuring inclusive and equitable health care services across diverse populations and fostering interdisciplinary collaboration to meet the evolving needs of people living with HIV, thereby enhancing the HIV care continuum for all.

Malaysia, an upper middle-income country in the Asia-Pacific region, has an HIV epidemic that has transitioned from needle sharing to sexual transmission, mainly in MSM. Men who have sex with men (MSM) are the most vulnerable population for HIV in Malaysia. In 2022, our team developed a web-based artificial intelligence (AI) chatbot and tested its feasibility and acceptability among MSM in Malaysia to promote HIV testing. To enhance the usability of the AI chatbot, we made it accessible to the public through the website called MYHIV365 and tested it in an observational study. This study aimed to test the usability of an AI chatbot in promoting HIV testing among MSM living in Malaysia. An observational study was conducted from August 2023 to March 2024 among 334 MSM. Participants were recruited through community outreach and social-networking apps using flyers. The interactions between participants and the AI chatbot were documented and retrieved from the chatbot developer's platform. Data were analyzed following a predefined metrics using R software (Posit Software, PBC, Boston, USA). The AI chatbot interacted with 334 participants, assisting them in receiving free HIV self-testing kits, offering information on HIV, PrEP, and mental health, and providing details of 220 MSM-friendly clinics, including their addresses, phone numbers, and operating hours. After the study, 393 human-chatbot interactions were documented on the chatbot developer's platform. Most participants (304/334, 91%) interacted with the AI chatbot once, 30 (9%) engaged 2 or more times at different intervals. Participants' interaction time with the chatbot varied, ranging from 1 to 31 minutes. The AI chatbot properly addressed most participants' questions (362/393, 92.1%) about HIV and PrEP. However, in 31 interactions, participants posed additional questions to the chatbot that were not programmed into the chatbot algorithm, resulting in unanswered interactions. The web-based AI chatbot demonstrated high usability in delivering HIV self-testing kits and providing clinical information on HIV testing, PrEP, and mental health services. To enhance its usability in community and clinical settings, the chatbot must offer personalized health information and precise interaction, powered by a sophisticated machine learning algorithm. Additionally, establishing an effective connection between the AI chatbot and healthcare systems to eliminate stigma and discrimination towards MSM is crucial for the future implementation of AI chatbots.

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.

Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.