Project title
愛滋病防治整合型研究計畫 (VI)
Internal ID
MOHW113-CDC-C-114-000104
Principal Investigator
Start Date
January 1, 2024
End Date
December 31, 2024
Organizations
Partner Organizations
Ministry of Health and Welfare
HIV/AIDS Control and Study Center (VI) = 愛滋病防治整合型研究計畫 (VI)
Keywords
HIV testing
sexually transmitted disease
post-exposure prophylaxis
substance addiction
contingency management
genotypic resistance test
community pharmacies
monkey pox
Description
Global efforts to control the HIV epidemic is comprehensive HIV screening and treatment. However, delayed HIV diagnosis has been a persistent issue both domestically and abroad. Literature indicates that delayed HIV diagnosis accounts for 46-60% of new HIV diagnoses, and annually, the proportion of AIDS notifications (including HIV cases reported in previous years but not yet progressed to AIDS) among new HIV infection notifications is approximately 55%-61%. Based on research results, expanding HIV screening services is one of the ways to reduce delayed HIV diagnoses. Subproject 1 will conduct interviews with medical institutions, county and city health bureaus, private organizations, and other institutions in Taiwan that either provide or do not yet provide HIV testing and counseling services. The aim is to understand the problems or obstacles encountered during service provision and propose ways to address these challenges. For the institutions willing to cooperate in providing HIV testing and counseling services, an assessment of their performance, the target population reached, and the test kit distribution rate will be conducted. Sexually transmitted infections (STIs) have been on the rise since the 1990s, primarily due to increased risky sexual behaviors. With advancements in antiretroviral therapy for HIV and the use of pre-exposure prophylaxis (PrEP), the risk of HIV transmission has significantly decreased. However, the incidence of other bacterial STIs, including syphilis, gonorrhea, and chlamydia, continues to rise. Due to factors such as a lack of sexual health awareness, social stigmatization, insufficient screening coverage, limited diagnostic tools, and the absence of effective vaccines, controlling STIs remains challenging. In recent years, the use of doxycycline as post-exposure prophylaxis (doxycycline PEP) for bacterial STIs following risky sexual behaviors has been supported by multiple studies. However, researches on its effectiveness, acceptability, feasibility, tolerance, and cost-effectiveness of doxycycline PEP as part of STI prevention in clinical settings remain limited. Subproject 2 will establish a comprehensive STI integrated care model for individuals engaged in risky sexual behavior, including STI screening (including HIV, syphilis, gonorrhea, other bacterial STIs, and viral hepatitis), STI treatment and follow-up, and partner referral. Additionally, we will assess the acceptability of doxycycline PEP and its impact on STI incidence, side effects, sexual behavior patterns, and subsequent drug resistance of other bacteria. To understand substance use disorders of people living with HIV (PLWH) and or individuals taking PrEP for HIV and to establish a comprehensive mental health evaluation and case management tracking model for PLWH and PrEP users with non-opioid substance use, Subproject 3 plans to enroll PLWH or PrEP users with non-opioid substance use for the one-year mental health care intervention. This intervention will include interdisciplinary team medical intervention, fostering alternative activities and interests, education on substance use with high-risk sexual behaviors (i.e., chemsex), drug treatment, and cessation techniques. Their recurrence will be monitored during the intervention period. Based on their recurrence status, participants will be categorized into non-recurrent and recurrent groups, and a descriptive analysis will compare sociodemographic characteristics, substance use variables, and mental health variables between the two groups. Initiation of antiretroviral therapy (ART) within seven days of HIV diagnosis in 2018 to achieve optimal care and treatment outcomes is recommended in Taiwan. Currently, PLWH in Taiwan can choose between a one-pill with three-drug or two-drug combinations as the first-line treatment. According to our previous research results, most patients have responded well to treatment, but some individuals may experience treatment failure due to poor medication adherence, suboptimal drug concentrations for various reasons, or initial infection with drug-resistant HIV strains, leading to the development of drug resistance and ultimately treatment failure. Subproject 4 plans to provide drug resistance testing for newly diagnosed or treatment-naive PLWH in Taiwan as a reference for subsequent medication changes. This will help us understand the prevalence of drug resistance in Taiwan and its impact on treatment outcomes for newly-diagnosed patients. When treatment failure occurs, we will collect blood samples from the patients on the day of their clinic visit to perform HIV drug resistance gene testing, analyzing the genetic changes in drug resistance that commonly occur after treatment failure. This project will use the Stanford University "HIV drug resistance database" to analyze drug resistance genotypes, including reverse transcriptase inhibitors (RTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), which are the current first-line and second-line prescription drugs. We hope that the research results can help us understand the prevalence of primary drug resistance in Taiwan and the treatment effectiveness of newly diagnosed cases receiving the recommended single-tablet regimens, thereby improving clinical treatment outcomes and providing guidance for the epidemic prevention policy of the Taiwan Centers for Disease Control (CDC). With the advancement of antiretroviral therapy, the survival rate of PLWH has significantly increased. However, if individuals have poor medication adherence, they may experience higher viral loads, poorer health, the development of drug-resistant viruses, and/or an increased risk of HIV transmission. Subproject 5 plans to conduct a cross-sectional study to collect data on PLWH from National Taiwan University Hospital (NTUH) and Taipei Veterans General Hospital in 2023. For eligible participants, discussions will be conducted during their clinic visits or hospitalizations in 2024 to understand the reasons for poor medication adherence and missed clinic visits. Individualized education and follow-up methods will be provided based on the specific circumstances of each participant. Through these discussions, a practical collaborative approach will be established between the participants and healthcare providers. In addition, qualitative interviews will be conducted with patients who had viral loads greater than 1,000 copies/ml during their visits to NTUH between 2019 and 2023. These interviews, whether conducted in person or through video calls, will explore their medication history and thoughts when their viral loads were elevated and how they subsequently reduced and stabilized their viral loads through treatment. The goal is to understand the reasons for patients' inability to consistently seek medical care and adhere to medication and to identify suitable and applicable coping strategies. The World Health Organization (WHO) declared Monkeypox (Mpox) as a "Public Health Emergency of International Concern (PHEIC)" on July 23, 2022, and it remains so to date. In March 2023, Taiwan's CDC reported several local cases of Mpox without any travel history, signifying the official onset of community transmission. Given the relatively low vaccination coverage for Mpox and the close association of this outbreak with high-risk exposure, Subproject 6 aims to collaborate with multiple HIV-designated hospitals to conduct retrospective research on the clinical manifestations of adults with Mpox, thereby establishing a local database of Monkeypox cases. Simultaneously, it will prospectively monitor the antibody changes in high-risk populations at NTUH receiving the Monkeypox vaccine, conduct online surveys to gauge the awareness of the high-risk groups regarding the Monkeypox outbreak, and provide the relevant authorities with up-to-date clinical information for epidemic prevention.