Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV.

Objective: Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods: A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results: The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion: Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation: Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.

Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature.

ABSTRACT: Peer health workers (peers) are commonly engaged interventionists in the HIV care spectrum. The objective of this scoping review was to examine the range of evidence on training strategies and approaches for peer-led HIV behavioral interventions in the United States. Four electronic databases (Medline, CINAHL, EMBASE, and PsycINFO) were searched for peer-reviewed published literature (2010-2021) of peer-led HIV behavioral interventions directed to improving antiretroviral therapy adherence and/or retention in care. Eighteen studies met the inclusion criteria. Eleven studies referenced manualized training materials, and nine used role-play as part of their curricula. Peer training content and duration varied across studies, as well as evaluation of intervention fidelity, and peer competency. Findings highlight heterogeneity in peer training strategies and approaches. The expansion and sustainability of peer engagement in the HIV care continuum will require greater consensus among members of the research community on best practices for training.

Rapid or Immediate ART, HIV Stigma, Medical Mistrust, and Retention in Care: An Exploratory Mixed Methods Pilot Study.

Rapid or immediate antiretroviral therapy (iART) after HIV diagnosis improves linkage to care and time to viral suppression. However, iART may affect or be affected by HIV-related stigma and medical mistrust. In this mixed-methods pilot study, we examined the bi-directional role of HIV stigma, medical mistrust, and visit adherence (VA) in the context of iART in a diverse, newly diagnosed patient population. Participants were recruited from an HIV clinic in New York City and we utilized a convergent parallel design integrating quantitative data from demographic surveys, the HIV Stigma Survey (HIVSS), the Medical Mistrust Index (MMI) and electronic medical records, and qualitative data from in-depth interviews. Among the sample (N = 30), 26% (N = 8) initiated ART same-day or within 3 days, while the majority (N = 17) initiated between 4 and 30 days, and 17% (N = 5) initiated ART > 30 days. The median (range) age was 35, and most were English-speaking, Black or Hispanic men and identified as gay. Time to ART initiation was associated with time to linkage to care and time to viral suppression. Day 0-3 group's major theme was iART as stigma prevention, and they had the highest mean HIVSS, lowest MMI score, and a visit adherence of 0.86. Day 4-30 group's major theme was alleviation of internalized stigma, and they had the lowest mean HIVSS score, and highest visit adherence of 0.91. Day > 30 group's major theme was exacerbation of perceived or anticipated stigma, had the highest MMI score and a visit adherence of 0.85. iART implementation requires equitable strategies that address HIV-stigma and mistrust.

Use of adrenaline continuous infusion to treat hypotension during general anaesthesia in a cow and a calf.

BACKGROUND: Hypotension is one of the most common complications observed during inhalation anaesthesia in veterinary patients. Treatment of hypotension in cattle is more challenging than in other species, owing to the limited number of drugs licensed in food producing animals. The use of adrenaline as an infusion to support blood pressure has not been described previously in bovines. CASE PRESENTATION: A cow and a calf presented to University College Dublin Veterinary Hospital for bilateral mandibular fracture repair and bladder rupture repair respectively, developed severe anaesthetic related hypotension unresponsive to conventional treatments. In both cases an adrenaline infusion was started and slowly increased to effect, with infusion rates ranging from 0.01 to 0.25 µg/kg/min. Blood pressure increased as the adrenaline infusion rate increased, but clinically significant improvements in blood pressure were only observed with infusion rates exceeding 0.05 µg/kg/min. The side effect observed with adrenaline infusion was an increase in plasma lactate levels in both cases. Both animals were euthanised due to non-anaesthetic related complications. CONCLUSIONS: Maintenance of normotension is important during bovine anaesthesia to prevent the development of post-anaesthetic complications. In the cases described here, adrenaline was effective as an additional treatment of anaesthetic related hypotension. Further research is required to establish the recommended infusion rates, cardiovascular effects and possible side effects of adrenaline infusion administration as a treatment for hypotension in bovines.

Maternal and fetal arterial blood gas data in normotensive, singleton, isoflurane anesthetized sheep at 124-126 days of gestation.

The aim of this case series was to describe the differences between maternal and fetal blood-gas results during anesthesia. Sixteen singleton adult merino ewes weighing 60.1 ± 5.1 kg at 125.7 d (124 to 126 d) gestation were anesthetized. Maternal (radial) and fetal (umbilical) arterial blood gas samples were collected 79 ± 6 min after the start of anesthesia if maternal mean arterial pressure (MAP) was stable and > 65 mmHg. Fetal pH, partial arterial pressure of oxygen (PaO2), glucose, arterial hemoglobin oxygen saturation (SaO2), sodium, and chloride were significantly lower and fetal partial arterial pressure of carbon dioxide (PaCO2), lactate, hematocrit, total hemoglobin, potassium, and calcium were significantly higher than maternal blood-gas values. Fetal pH, PaO2, and BE were lower and fetal lactate was higher than fetal umbilical arterial samples previously reported, which may indicate a non-reassuring fetal status. Further refinement of the ovine experimental model is warranted with fetal monitoring during maternal anesthesia.

L'objectif de l'étude était de décrire les différences dans les résultats d'analyse des gaz sanguins maternel et foetal durant l'anesthésie. Seize brebis mérinos primipares pesant 60,1 ± 5,1 kg à 125,7 j (124 à 126 j) de gestation ont été anesthésiées. Des échantillons de sang artériel maternel (radiale) et foetal (ombilicale) ont été prélevés 79 ± 6 min après le début de l'anesthésie si la pression artérielle moyenne (PAM) maternelle était stable et > 65 mmHg. Pour le sang foetal, les valeurs de pH, de la pression artérielle partielle en oxygène (PaO2), du glucose, de la saturation en oxygène de l'hémoglobine artérielle (SaO2), du sodium, et du chlorure étaient significativement inférieures, et les valeurs de la pression artérielle partielle en dioxyde de carbone (PaCO2), du lactate, de l'hématocrite, de l'hémoglobine totale, du potassium, et du calcium étaient significativement supérieures que celles du sang maternel. Les valeurs foetales du pH, de la PaO2, et de BE étaient plus basses et le lactate foetal étaient plus élevées que les valeurs d'échantillons provenant du sang artériel ombilical foetal rapportées précédemment, ce qui pourrait indiquer un statut foetal non-rassurant. Des améliorations de ce modèle expérimental ovin sont souhaitées avec un suivi foetal durant une anesthésie maternelle.(Traduit par Docteur Serge Messier).

Unilateral retrobulbar hematoma following maxillary nerve block in a dog.

OBJECTIVE: To describe the clinical findings and management of a case of retrobulbar hematoma formation secondary to performance of a maxillary nerve block in a dog. CASE SUMMARY: An 11-year-old dog was presented for a routine dental procedure including dental extraction to be performed under general anesthesia. After premedication with intramuscular methadone, anesthesia was induced with intravenous alfaxalone until depth of anesthesia was sufficient to allow orotracheal intubation. Anesthesia was maintained with isoflurane delivered in 100% oxygen. A bilateral maxillary nerve block was performed. During administration of the left nerve block, blood was aspirated. Twenty minutes after placement of the left maxillary nerve block, exophthalmos, periorbital swelling, extensive scleral hemorrhage, and ecchymosis with a 2 × 2 cm region of moderate swelling on the palatal mucosa around the injection site were noted. These lesions were the result of retrobulbar hematoma formation following vessel puncture. Treatment included immediate creation of a drainage tract and administration of anti-inflammatories (carprofen 2 mg/kg PO q 12 h for 7 days), broad spectrum antimicrobial therapy (cefovicin 8 mg/kg SC once), and eye drops (viscotears, 2 drops OS q 12 h for 7 days). The periorbital swelling was significantly reduced within 1 hour of drainage and had almost completely resolved 1 week later. NEW OR UNIQUE INFORMATION PROVIDED: This clinical report details the development and successful management of a unilateral retrobulbar hemorrhage following maxillary nerve block. Management of this condition requires prompt recognition and treatment to prevent permanent damage to the eye. The cornerstone of treatment is drainage, which rapidly decreases the increased intraorbital and intraocular pressure. To our knowledge, this is the first documentation of this complication in the English language literature.