Project title
愛滋病防治整合型研究計畫
Internal ID
MOHW114-CDC-C-114-000101
Principal Investigator
Start Date
January 1, 2025
End Date
December 31, 2025
Organizations
Partner Organizations
Ministry of Health and Welfare
HIV/AIDS Control and Study Center = 愛滋病防治整合型研究計畫
Description
Subproject One Since the 1990s, there has been an increasing trend in sexually transmitted infections (STIs) due to increased risk behaviors and changing patterns. Gay, bisexual, and other men who have sex with men (GBMSM) are particularly affected by HIV and many other bacterial STIs. With advancements in anti-HIV medications and the use of HIV pre-exposure prophylaxis (HIV PrEP), the risk of HIV transmission has significantly decreased, and its incidence has also declined. However, the incidence of other bacterial STIs (including syphilis, gonorrhea, and Chlamydia) continues to rise. This is due to factors such as lack of sexual health awareness, social stigma, insufficient screening coverage, limited diagnostic tools, and lack of effective medications or vaccine prevention measures. In recent years, the use of doxycycline as post-exposure prophylaxis for bacterial STIs after high-risk sexual behaviors (doxycycline PEP) has been proven effective in research. However, studies on the effectiveness and feasibility of doxycycline PEP in clinical settings are still rare and have not been sufficiently promoted to high-risk individuals. Thus, appropriate treatment and care models should be planned for those engaging in high-risk behaviors. This subproject will establish a comprehensive STI prevention and integrated medical service model for high-risk individuals, including STI screening (such as HIV, syphilis, other bacterial pathogens, and viral hepatitis), STI treatment and follow-up, promotion of HIV PrEP, doxycycline PEP, and STI-related vaccine administration. Additionally, we will establish an interdisciplinary collaboration model among different departments or medical institutions to provide more timely and specialized STI care models for high-risk groups. Subproject Two According to the current "Prescription Use Guidelines for ART," PWH in Taiwan can choose from four thriple-drug or one dual-drug single-tablet regimens (STRs) as the first-line treatment. The four thriple-drug STRs include TAF/FTC/RPV (Odefsey), TDF/3TC/DOR (Delstrigo), ABC/3TC/DTG (Triumeq), and TAF/FTC/BIC (Biktarvy), while the dual-drug STR is DTG/3TC (Dovato). These combination drugs mainly consist of nucleoside reverse transcriptase inhibitors (NRTIs) combined with non-nucleoside reverse transcriptase inhibitors (nNRTIs) or integrase strand transfer inhibitors (INSTIs). According to our previous studies, most patients respond well to treatment, but a small number may experience treatment failure due to poor medication adherence, insufficient drug concentrations, or infection with drug-resistant viral strains. Without effective viral control, drug-resistant mutations may emerge in the infected population, potentially affecting subsequent drug choices. As the number of people receiving ART increases, the demand for effective treatment regimens will continue to grow in the coming decades, making it crucial to understand the prevalence of drug-resistant mutations in PWH with treatment failures and their impact. This subproject aims to provide drug resistance testing for newly-diagnosed and untreated PWH to guide subsequent drug adjustments and understand the prevalence of primary drug resistance in Taiwan and its impact on treatment effectiveness in newly-diagnosed patients. We will use Stanford University's "HIV Drug Resistance Database" for genotypic resistance analysis, analyzing drugs covering the first-line prescriptions, including reverse transcriptase inhibitors (RTIs), protease inhibitors, and INSTIs. We expect the results of this study to provide insights into the prevalence of primary drug resistance in Taiwan and the effectiveness of the first-line triple-drug or dual-drug STRs. For treatment failures, we will test for viral drug resistance to improve clinical treatment and provide policy references for the Taiwan Centers for Disease Control. Subproject Three With the advancement of antiretrovial therapy (ART), the survival rate of people with HIV (PWH) has greatly increased. However, if patients have low medication adherence, it can lead to uncontrolled viral loads, poor health status, and even viral drug resistance and/or increased risk of HIV transmission. In the era of highly effective ART, factors affecting medication adherence are divided into four categories: personal, medication-related, service and structural factors, and other factors. Research has shown that effective interventions to improve ART adherence have multiple aspects, including providing education, counseling, family and social support, feedback, and additional supervision. Services provided through various 3C electronic devices and information sent via text messages can intervene in multiple factors affecting medication adherence to improve drug compliance. Additionally, collaborating with community pharmacies to jointly supervise and remind patients of medication pick-up can also improve patient medication adherence. According to the results of a 2024 questionnaire study on difficult cases at the National Taiwan University Hospital, the majority (31.5%) stated that the reason for not returning for follow-up was "no time for follow-up," followed by emotional depression (23.6%). As for reasons for wanting to return for follow-up, over half (65.4%) stated "I should come back to face it myself," followed by (22.0%) "case managers or health center staff found me for follow-up." The main reason (62.2%) for patients missing doses was "forgetting to take medications," followed by (21.3%) "too tired and fell asleep." This subproject is a prospective study. If feasible, when the hospital opens video consultations in 2025, we will apply for video consultations for PWH, initially focusing on providing infectious disease clinic consultations, developing weekday morning and afternoon video consultations, recruiting willing infectious disease physicians, and then scheduling according to physician availability, coordinating with HIV case managers for follow-up. In addition, we will ask patients who meet the inclusion criteria if they are willing to participate in video consultations. If patients agree, video consultations will be completed according to the hospital's video consultation and medication dispensing procedures. At the same time, we will assist patients in obtaining medications smoothly in coordination with the hospital pharmacy's dispensing times. Furthermore, we will ask patients if they are willing to join a five-day-a-week communication device video or recorded directly observed therapy (DOT) to remind patients to take their medications, thereby developing a habit of taking medication on time. Subproject Four Given that comprehensive HIV screening and treatment are the focus of global efforts to control the HIV epidemic, despite continued promotion of HIV screening and PrEP use domestically and internationally, high-risk groups still cannot timely access HIV-related educational information, leading to delayed diagnosis. Among HIV PrEP users, personal, social, and structural barriers prevent potential PrEP users from obtaining information or leading to HIV infection after discontinuation of PrEP use. This subproject aims to utilize the LINE official platform and artificial intelligence technology to improve the accessibility of HIV screening, enhance PrEP medication adherence, and construct a case management model for high-risk groups. The main objectives include: (1) Enabling high-risk groups to easily access HIV screening information and schedule screenings through the LINE platform; (2) Providing PrEP users with medication reminders and intelligent response systems to help patients take medication on time and reduce discontinuation; (3) Establishing personalized intervention measures to ensure that the health needs of high-risk individuals are continuously offered and monitored. This subproject will develop a LINE platform combined with chatbots to provide 24-hour HIV screening, counseling, and PrEP use support, and promote related information to willing medical units. By leveraging the peer effect of high-risk groups, the platform's influence will be expanded to increase HIV screening rates and HIV PrEP knowledge prevalence, thereby effectively reducing the delayed HIV diagnosis and improving medication adherence issues. This subproject will also provide more extensive HIV prevention and treatment resources for the high-risk groups, such as sex workers, transgender individuals, and women, promoting increased screening rates and early diagnosis and treatment. Subproject Five As the global Mpox epidemic continues to develop, prevention and control strategies and their implementation effectiveness are the topics of concern. Vaccine administration and reducing intimate contact with the infected individuals are the most direct strategies for preventing Mpox transmission. However, these preventive behaviors are influenced by multiple factors, including individual demographic characteristics and health beliefs. Although international studies have proposed the potential influence of specific Mpox-related health beliefs on preventive behaviors, there is still a lack of systematic research on how health beliefs drive or hinder actual behaviors. This subproject aims to explore the health beliefs and needs of diverse gender groups regarding Mpox and their impact on Mpox-related preventive behaviors using a mixed-method approach. Among the populations that Mpox vaccination is recommended, detailed objectives include investigating and analyzing their (1) perceived susceptibility and perceived severity regarding Mpox, (2) perceived benefits, perceived barriers, self-efficacy, and cues to action regarding Mpox-related preventive behaviors, (3) implementation rates of safe sexual behaviors and Mpox vaccine uptake, (4) correlations between perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, cues to action, and safe sexual behaviors and Mpox vaccine uptake, and (5) Mpox vaccine-related experiences and needs. Our team aims to achieve these objectives through a mixed-method study with an embedded design. The approach involves the National Taiwan University Infectious Diseases team first identifying potential research participants (i.e., individuals aged 18 and above who are eligible for publicly funded Mpox vaccination) from their patients, inviting them to complete an online questionnaire on Mpox-related health beliefs and behaviors, and then conducting purposeful sampling based on participants' willingness to participate in a subsequent qualitative descriptive study. Data collection for the qualitative research will involve semi-structured interviews to investigate participants' experiences, feelings, and needs regarding Mpox prevention and control. The estimated sample sizes for the quantitative and qualitative parts are 112 and 20 participants, respectively. The results of this subproject will provide a status report on Mpox-related health beliefs and preventive behavior implementation among diverse gender groups and attempt to identify their correlations to suggest the more precise prevention strategies. The qualitative data will complement the quantitative survey, aiming to bridge the gap between current strategies and public needs.