Publications by authors named "Katerina Christopoulos"

Background: Long-acting injectable cabotegravir and rilpivirine (CAB/RPV-LA) may overcome adherence barriers and provide treatment choice among people with HIV (PWH). However, little is known about the factors most likely to facilitate CAB/RPV-LA use.

Methods: We conducted a discrete choice experiment (DCE) at three urban U.

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We describe referrals and uptake of long-acting injectable cabotegravir/rilpivirine at an academic clinic in Chicago. In a pharmacy-led model, 118 (18%) people with HIV were referred and 78 (12%) initiated long-acting injectable cabotegravir/rilpivirine from 1 January 2021 to 31 May 2023. Implementation, especially for people with HIV who were not virally suppressed, requires further support for patients, providers, and clinic systems.

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Type 2 diabetes (T2DM) and depressive symptoms frequently co-occur among people with HIV (PWH). Depression may impact diabetes management in PWH. This study evaluated the prevalence of concurrent T2DM and depression among PWH and the impact of depression and HIV symptoms on glycemic outcomes (hemoglobin A1c [A1c], blood glucose [BG]) among people with both HIV and T2DM.

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Background: Long-acting injectable cabotegravir-rilpivirine (CAB/RPV-LA) is a promising treatment alternative for people with HIV (PWH) who face adherence challenges with oral antiretroviral therapy (ART). While its clinical efficacy is well-documented, cost-effectiveness data from real-world settings remain limited.

Objective: To evaluate the incremental first-year cost and cost-effectiveness of CAB/RPV-LA versus standard of care (SoC) oral ART among PWH with adherence challenges, from the perspective of a healthcare payer.

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Background: National US data on the burden and risks for hepatitis C virus (HCV) infection in people with human immunodeficiency virus (HIV) during the direct-acting antiviral (DAA) era are limited. These data are important to understand current progress and guide future efforts toward HCV microelimination.

Methods: We evaluated (1) HCV prevalence (2011-2013, 2014-2017, 2018-2022) using a serial cross-sectional design and (2) correlates for HCV viremia (2018-2022) in adult people with HIV (PWH) within the Centers for AIDS Research Network of Integrated Clinic Systems (CNICS) cohort using multivariable adjusted relative risk regression.

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Long-acting injectables (LAIs) for HIV prevention and treatment could dramatically improve health outcomes and health equity for people with HIV and those who could benefit from pre-exposure prophylaxis. Despite widespread acceptability and demand by providers and potential users of LAIs, implementation has been extremely limited since the introduction of cabotegravir/rilpivirine, the first LAI for HIV treatment, in January 2021, and long-acting cabotegravir, the first LAI for HIV prevention, in December 2021. We report results of a provider survey, conducted by the HIV Medicine Association, which identified LAI implementation barriers related to health insurance processes, staffing and administrative support, drug costs and acquisition, and access for individuals who are uninsured.

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Background: Point-of-care HIV viral load testing may enhance patient care and improve HIV health services. We aimed to evaluate the feasibility and acceptability of implementing such testing in a high-volume community sexual health clinic in the United States.

Methods: We conducted a cross-sectional, mixed-methods study.

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Article Synopsis
  • Findings indicate that higher cumulative HIV viral load (VL) and lower CD4 cell counts are significantly linked to an increased risk of developing venous thromboembolism (VTE) in people living with HIV (PWH).
  • A study involving over 21,000 PWH over nearly five years revealed that those with higher cumulative VL had a 45% increased risk of VTE compared to those with lower VL. Additionally, a CD4 count below 100 cells/mm³ was associated with a fourfold increase in risk.
  • The research suggests that managing HIV viral load and maintaining CD4 levels could be crucial strategies to lower the risk of VTE in PWH.
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  • Recent guidelines now support the use of long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) for people with HIV who struggle with adherence, especially those experiencing viremia.
  • Studies show that while LA-CAB/RPV offers good viral suppression outcomes, the rate of treatment failure is higher compared to more stable patients, but alternative treatments like lenacapavir can still achieve viral suppression post-failure.
  • Effective implementation strategies include multidisciplinary clinic teams, patient incentives, flexible injection scheduling, and collaboration with various health services to help support HIV patients facing adherence issues.
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Introduction: Perspectives on long-acting injectable cabotegravir/rilpivirine (CAB/RPV-LA) from HIV health disparity populations are under-represented in current literature yet crucial to optimize delivery.

Methods: Between August 2022 and May 2023, we conducted in-depth interviews with people with HIV (PWH) at four HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current CAB/RPV-LA use with receipt of ≥3 injections or CAB/RPV-LA discontinuation.

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Background: Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts.

Methods: From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes toward doxy-PEP for STI prevention.

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Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care.

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Article Synopsis
  • Monkeypox (mpox) has become more common and serious for people with HIV since 2022, with researchers looking into why some get sick and how others can protect themselves.
  • From a study of nearly 20,000 people living with HIV, 413 cases of mpox were found, with specific groups being more at risk, like younger people and those not on treatment for HIV.
  • The monkeypox vaccine was shown to be very effective, especially for people with a healthy immune system, but a lot of Black individuals with HIV were not getting vaccinated as often as others.
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  • A study at the Ward 86 HIV clinic in San Francisco investigated the effectiveness of long-acting cabotegravir/rilpivirine (LA-CAB/RPV) in rapidly achieving and maintaining viral suppression in people with HIV who initially had high viral loads.
  • Out of 59 participants who started LA-CAB/RPV with detectable viremia, 80% achieved sustained viral suppression after 48 weeks, while overall 92% had viral suppression when considering those who switched treatments.
  • The findings suggest that LA-CAB/RPV can significantly aid individuals struggling with adherence to oral HIV medications, highlighting its potential as an effective long-term treatment option.
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HIV stigma has a negative influence on antiretroviral therapy (ART) initiation and persistence and viral suppression. Immediate access to ART (RAPID ART) has been shown to accelerate viral suppression (VS) that is sustained up to one year after HIV diagnosis. Little is known about the role of RAPID ART in reducing individual-level stigma.

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  • The study examines the impact of the COVID-19 pandemic on substance use disorders (SUD) in people with HIV, highlighting a significant increase in SUD risk post-pandemic shelter-in-place orders.
  • Data from over 7,000 participants revealed that moderate/high SUD risk rose from 24% pre-pandemic to 43% post-pandemic, with notable increases in the use of drugs like heroin and methamphetamine.
  • The findings suggest that increased social isolation and reduced access to treatment during COVID-19 exacerbated SUD among people with HIV, emphasizing the need for better integrated treatment solutions moving forward.
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The purpose of this article is to describe a model of chronic disease self-management that incorporates the complexity of social and environmental interactions experienced by people who self-manage chronic conditions. This study combines quantitative data from a large national research cohort and qualitative interviews to test and refine a self-management model. The self-management within a syndemic model depicts the contextual, psychological, and social factors that predict self-management behaviors and clinical and long-term outcomes.

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Objective: The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects.

Design: Longitudinal observational clinical cohort of patients in HIV care in the US.Methods: Data from the CFAR Network for Integrated Clinical Systems (2016-2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence.

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The HIV Index is a validated self-report scale of engagement in HIV care previously correlated with future retention and virologic suppression. However, its performance in a monoethnic Latinx population has not been studied. We evaluated the HIV Index among Latinx persons living with HIV in the Centers for AIDS Research Network of Integrated Clinical Systems cohort and performed multivariable logistic regression to estimate its association with primary outcomes of suboptimal retention (not keeping 100% of HIV clinic appointments) and virologic suppression (HIV viral load <200 copies/mL).

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Article Synopsis
  • - A study involving 3,288 people with HIV (PWH) found that 27% were unvaccinated against COVID-19, with approximately 9% reporting vaccine hesitancy, particularly among women, younger individuals, and Black PWH.
  • - Factors influencing vaccine hesitancy included being female (2.3 times more likely), identifying as Black (1.7 times more likely), being younger (1.4 times more likely), and having an unsuppressed viral load (1.9 times more likely).
  • - The study highlights the need for targeted efforts to address vaccine concerns in the PWH community to improve vaccination rates as the pandemic evolves and prepare for future public health challenges.
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Background: Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug delivery option for persons with human immunodeficiency virus (PWH) but requires administration every 4 or 8 weeks by a medical professional.

Methods: To facilitate LAI antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across 3 US HIV clinics. We surveyed PWH (December 2021 to May 2022) on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored associated characteristics.

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Doxycycline postexposure prophylaxis (doxy-PEP) reduces sexually transmitted infections (STIs) in men who have sex with men (MSM) and transgender women (TGW). In a clinical trial of doxy-PEP, we sought to assess acceptability, impact, and meaning of doxy-PEP use among MSM/TGW. We conducted semistructured, in-depth 1:1 interviews with MSM and TGW enrolled in the intervention arm of the Doxy-PEP study.

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Understanding the acceptability of long-acting injectable antiretroviral therapy (LAI-ART) among people with HIV (PWH), especially priority populations, is essential for effective implementation. We conducted semi-structured interviews with patients in three Ryan White-funded HIV clinics in San Francisco, Chicago, and Atlanta. We employed maximal variation sampling across age, gender, race, ethnicity, and time living with HIV and oversampled for individuals with suboptimal clinical engagement.

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