Older people living with HIV (PLWH) in Georgia experience a high rate of behavioral health disorders, the treatment for which requires an integrated approach. However, these older PLWH experience unmet needs for behavioral health services. We aimed to explore barriers for older PLWH to access behavioral healthcare services in Georgia. In 2024, we conducted 28 in-depth interviews with PLWH aged ≥40 years in four major Georgian cities. Participants were purposefully selected from a cross-sectional study sample based on their screened behavioral health disorders. We employed an inductive-deductive thematic analysis approach guided by the Ecological-Behavioral Framework for Healthcare Access and Navigation. Our study found that older PLWH face significant barriers to accessing mental health services, including different types of stigma, cultural beliefs about behavioral health disorders, mistrust in mental healthcare professionals, and a lack of patient-centered care. Fragmented healthcare systems also hindered access to care, particularly for those with substance use disorders. Social support and family responsibilities were key motivators for seeking help. A complex interplay of sociocultural, political, and individual factors hindered PLWHs' access to behavioral health services. Addressing stigma through targeted interventions, raising awareness about behavioral health services, and constructing differentiated service models are crucial to improving access.
Background and objective: Recent clinical trials have shown improvement in progression-free survival in men with metastatic prostate cancer (mPC) treated with combination poly-ADP ribose polymerase (PARP) inhibitors (PARPi) and novel hormonal therapy (NHT). Regulatory bodies in the USA, Canada, Europe, and Japan have recently approved this combination therapy for mPC. Common adverse events (AEs) include fatigue, nausea and vomiting, and anemia. Nuanced AE management guidance for these combinations is lacking. The panel objective was to develop expert consensus on AE management in patients with mPC treated with the combination PARPi + NHT. Methods: The RAND/University of California Los Angeles modified Delphi Panel method was used. AEs were defined using the Common Terminology Criteria for Adverse Events. Twelve experts (seven medical oncologists, one advanced practice registered nurse, three urologists, and one patient advocate) reviewed the relevant literature; independently rated initial AE management options for the agent suspected of causing the AE for 419 patient scenarios on a 1-9 scale; discussed areas of agreement (AoAs) and disagreement (AoDs) at a March 2023 meeting; and repeated these ratings following the meeting. Second-round ratings formed the basis of guidelines. Key findings and limitations: AoDs decreased from 41% to 21% between the first and second round ratings, with agreement on at least one management strategy for every AE. AoAs included the following: (1) continue therapy with symptomatic treatment for patients with mild AEs; (2) for moderate fatigue, recommend nonpharmacologic treatment, hold treatment temporarily, and restart at a reduced dose when symptoms resolve; (3) for severe nausea or any degree of vomiting where symptomatic treatment fails, hold treatment temporarily and restart at a reduced dose when symptoms resolve; and (4) for hemoglobin 7.1-8.0 g/dl and symptoms of anemia, hold treatment temporarily and restart at a reduced dose after red blood cell transfusion. Conclusions and clinical implications: This expert guidance can support management of AEs in patients with mPC receiving combination PARPi + NHT therapy. Patient summary: A panel of experts developed guidelines for adverse event (AE) management in patients with metastatic prostate cancer treated with a combination of poly- ADP ribose polymerase inhibitors and novel hormonal therapy. For mild AEs, continuation of cancer therapy along with symptomatic treatment is recommended. For moderate or severe AEs, cancer therapy should be stopped temporarily and restarted at the same or a reduced dose when AE resolves. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Objectives This scoping review aimed to map the literature on depression and anxiety among people living with HIV and key populations in the Eastern European and Central Asian (EECA) region. The review assessed the burden of these disorders, identified inconsistencies in measurement approaches and highlighted gaps to inform future research and policy efforts.Design A scoping review was conducted using Arksey and O’Malley’s framework, involving a systematic search, screening and synthesis of published and grey literature in EECA Data sources: a comprehensive search was performed across five databases (CINAHL, PubMed, MEDLINE, Web of Science and PsycINFO) between July 2023 and February 2024. Additional sources were identified through Google Scholar and hand searches of reference lists from relevant research groups. Eligibility criteria: Original research articles published between January 2013 and July 2023, involving participants aged 16 years or older and reporting data from one or more EECA countries were included. Eligible studies were in English, Georgian or Russian. Excluded were reviews, editorials, treatment outcome studies, pooled data from other regions, conference materials and dissertations.Data extraction and synthesis Data extraction was performed independently by team members using a Covidence template. Studies were categorised based on target populations, measurement approaches and reported prevalence of depression and anxiety. Narrative synthesis was conducted due to the heterogeneity of study designs and outcomes.Results Of 3514 articles identified, 58 met inclusion criteria. Depression prevalence ranged from 8.5% to 88.0% and anxiety from 3.0% to 74.0%. Depression was assessed using 15 different scales, while anxiety was measured with eight tools. Reported prevalence exceeded global estimates, highlighting the need for targeted interventions.Conclusion The review highlights the burden of depression and anxiety in EECA, variability in measurement approaches and a lack of longitudinal and implementation research. Future efforts should standardise measurement tools, develop cohort studies and address implementation barriers to improve mental health and HIV outcomes in the region.
BACKGROUND:HIV status disclosure to sexual partner plays an important role in fostering transparency and reducing stigma, yet it remains a complex issue influenced by various sociodemographic, psychosocial, and experiential factors. This study investigated factors associated with HIV status disclosure to sexual partner among people living with HIV (PLHIV) in Georgia. METHODS:We conducted a secondary analysis of data from the PLHIV Stigma Index 2.0 study conducted in 2022-2023. Participants were recruited from HIV care centers and community-based organizations. Data collection utilized standardized questionnaires assessing sociodemographic factors, stigma, discrimination, and interactions with the healthcare system. Statistical analysis employed descriptive statistics, bivariate, and multivariate logistic regression to examine associations between stigma, sociodemographic factors, and status disclosure to sexual partner. RESULTS:Out of 765 participants, the mean age was 40.6 years, with a majority being male (67.4%). More than a fifth of respondents reported treatment interruptions, with 35.3% not disclosing their status to sexual partner. Disclosure was more common to close contacts than to others. Indicators of internalized stigma were common, with participants reporting feelings of guilt (40.1%), shame (36.1%), worthlessness (28.4%), and feeling 'dirty' (12.4%). Common behavioral reactions to stigma included avoiding medical visits (13.1%) and refraining from social support (10.5%). Over 40% did not disclose their status to sexual partner. Logistic regression highlighted that older age, knowing partner's HIV status, positive disclosure experiences and enacted stigma were positively associated with status disclosure. CONCLUSION:The complex dynamics between stigma and HIV status disclosure highlight the importance of providing decision support to PLHIV, helping them navigate disclosure process while considering potential risks and benefits. The findings emphasize the need for focused interventions that promote disclosure to sexual partner, especially among individuals with treatment interruptions, as it can significantly impact personal health and broader public health objectives, including the prevention of HIV transmission.
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.
