Veronique Martin

Objectives: People with HIV on effective treatment can expect a normal life expectancy, though they may experience increased prevalence of other chronic health conditions. We assessed among people with HIV, non-HIV health care usage and variation by sociodemographic and lifestyle factors. Methods: Positive Voices 2022 is a national UK questionnaire study of people with HIV (April 2022-March 2023). Participants self-reported on use of a range of health services. Associations of sociodemographic and lifestyle factors with five specific services were assessed using modified Poisson regression. Prevalence ratios(aPRs) adjusted for age, demographic group and year of HIV diagnosis and 95% confidence intervals [95%CIs] are given. Results: Among 4451 people with healthcare use data, 79.0% attended their GP service in the past year, and 54.9%, 46.2%, 21.0%, and 10.0% attended dental, sexual health, accident and emergency (A&E) and mental health services, respectively. Use varied across sociodemographic groups. Older people were less likely to use mental health and sexual health services, but more likely to use GP and dentists. Black African men, other heterosexual men and Black African women were significantly less likely to use mental health services: aPR 0.19 95%CI[0.09–0.43], aPR 0.49 95%CI[0.31–0.78] and aPR 0.48 95%CI[0.34–0.68] respectively, compared to gay/bisexual/other men-who-have-sex-with-men. Participants without money for basic needs were much more likely to use mental health services (aPR 3.41, 95%CI[2.54–4.59] versus enough money) and A&E (aPR 2.00, 95%CI[1.65–2.45]), but less likely to use dentists (aPR 0.84 95%CI[0.73–0.96]). Obesity, smoking and comorbidities were also associated with higher use of A&E and mental health services. Conclusion: Healthcare service use among people with HIV varies across sociodemographic groups. Results suggest the need for interventions and policies to improve physical and mental health and access to timely care among people with socioeconomic disadvantage and to enable greater access to mental health services for Black African people.

Objectives: This national cross‐sectional observational study aimed to assess mental health, quality of life, supportive network, experiences of HIV‐related stigma in healthcare and unmet service need among trans and gender‐diverse people with HIV, compared to cisgender people with HIV. Methods: Positive Voices 2022 is a questionnaire survey of people accessing HIV care in England, Scotland and Wales carried out in 2022 and 2023 that included measures of depression and anxiety symptoms and suicidal ideation (PHQ‐9 and GAD‐7), health‐related quality of life (EQ‐5D‐5L), supportive network (modified Duke FSSQ), experiences of HIV‐related stigma in healthcare and service needs. Logistic and ordinal logistic regression assessed the association of gender identity with these measures unadjusted and adjusted for age group and ethnicity. Results: Overall, 67 trans or gender‐diverse and 4551 cisgender people with HIV participated. Compared to cisgender participants, trans and gender‐diverse participants were younger, more likely to be Asian and less likely to be black. They were less likely to be in employment, homeowners and financially secure. Trans and gender‐diverse participants had a higher prevalence of depression symptoms (35.5% [22/62] vs. 20.5% [865/4219], adjusted odds ratio [aOR] [95% confidence interval, CI] = 1.96 [1.15, 3.34]; p = 0.014) and suicidal ideation (37.1% [23/62] vs. 14.6% [616/4219]; aOR = 3.09 [1.85, 5.17]; p < 0.001) compared to cisgender participants. They also had poorer health‐related quality of life for three domains (anxiety and depression, usual activities and self‐care) and lower levels of supportive network in unadjusted and adjusted analyses. A higher proportion of trans and gender‐diverse participants than cisgender participants had unmet needs for health services, including mental health services (49.2% [31/63] vs. 30.2% [1310/4343]; aOR = 2.02 [1.22–3.35]; p = 0.007), lifestyle services, and welfare and social services. Conclusions: Trans and gender‐diverse people with HIV have poorer mental health and wellbeing than cisgender people with HIV, and a higher prevalence of unmet service needs, highlighting the need for access to culturally competent mental health and other health and welfare services.

Objectives: SHIELD is a London‐based study of engagement in HIV clinical care during and after the COVID‐19 pandemic. We document the characteristics of service users who either re‐engaged or disengaged with HIV care, together with reflections of HIV clinical service‐providers to inform recommendations that address care retention for the long term. Methods: Using an exploratory mixed methods approach, service‐users aged ≥18 years who re‐engaged (1 March 2020–31 August 2020) or disengaged from clinical care (no contact with service 1 March 2020–28 February 2021) at 8 London HIV services were identified by retrospective records review. Demographics and clinical data were summarized descriptively. For people who re‐engaged, follow‐up data were collected at 24 months and in those who disengaged, at a single timepoint (1 March 2023). Semi‐structured interviews with clinic staff were analysed thematically. Results: There were 122 people disengaged and 89 re‐engaged. In those who re‐engaged, a 24‐month follow‐up showed 71.3% on antiretrovirals, 63.6% virally suppressed and 67.9% had a future clinician appointment booked. For people who disengaged, by 1 March 2023, 21% were on antiretrovirals and 27% had a future appointment booked. Interviews with 11 service providers explored COVID‐19's impact on clinical services, multilevel interactions that influenced engagement, and approaches to re‐engaging people. Conclusions: We found that COVID‐19 exposed existing vulnerabilities deterring access to HIV clinical care, as well as being itself an additional factor. For some people, the pandemic provided an opportunity to re‐engage. We recommend that retention in care is prioritized in policy and financially, that clinical services provide holistic person‐centred care, and improve ways to identify those who leave care.

Objectives: Late HIV diagnosis increases the risk of premature mortality and onward transmission. We analyzed the risk factors for late diagnosis in England to inform future testing strategies. Methods: We extracted data from the national HIV surveillance system on all new HIV diagnoses in England residents aged 15 years and older reported between 2015 and 2023 and classified as likely acquiring HIV via sexual transmission. Late diagnosis was defined as a CD4 count 3 within 91 days of diagnosis and no evidence of recent infection. Using multivariable logistic regression, we estimated associations between late diagnosis and age, gender, ethnicity, deprivation, rurality, region of residence, birth in the United Kingdom, likely route of exposure and diagnosis year. Results: A total of 18 217 diagnoses were included, of which 7177 (39%) were late. Key time‐invariant risk factors for late diagnosis included older age (adjusted odds ratio: 1.44 per 10 years, 95% confidence interval: 1.40–1.49) and, for individuals born outside the United Kingdom, Asian (aOR: 1.69, 95% CI: 1.44–1.98) and Black African (aOR: 1.43, 95% CI: 1.28–1.61) ethnicity. The predicted probability of late diagnosis in men likely exposed via sex with men increased from 21% in 2015 to 32% in 2023, although it was consistently lower than individuals likely exposed through sex between men and women. Conclusion: Targeted and accessible HIV testing approaches, which extend beyond sexual health services, should be prioritized for older adults, individuals exposed via sex between men and women, and non‐UK‐born ethnic minority groups.

[This corrects the article DOI: 10.2196/58531.].

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Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. Objective: This paper aimed to describe the methodology, recruitment strategies, and key demographic features of participants recruited for the second national round of Positive Voices (PV2022). Methods: PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire. At the start of 2023, due to under-recruitment mainly due to the impact of the monkeypox (Mpox) outbreak, a separate sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were men, 2991 were White, and 1121 were Black. Conclusions: PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. International Registered Report Identifier (IRRID): RR1-10.2196/58531

BACKGROUND Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. OBJECTIVE This paper aimed to describe the methodology, recruitment strategies, and key sociodemographic features of participants recruited for the second national round of Positive Voices (PV2022). METHODS PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire 'on the web' to online. At the start of 2023, the study was underrecruiting, mainly due to the mpox outbreak, and a separate sequential recruitment strategy was initiated in 14 of the largest and most demographically diverse clinics to increase participant numbers. RESULTS Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were male, 2991 were of White ethnicity, and 1121 were of Black ethnicity. CONCLUSIONS PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. INTERNATIONAL REGISTERED REPORT RR1-10.2196/58531

Thermobacillus xylanilyticus is a thermophilic and hemicellulolytic bacterium able to use several lignocelluloses as its main carbon source. This draft genome sequence gives insight into the genomic potential of this bacterium and provides new resources to understand the enzymatic mechanisms used by the bacterium during lignocellulose degradation and will allow the identification of robust lignocellulolytic enzymes.