Conectar
by Tamar Zurashvili, Mariam Pashalishvili, Akaki Abutidze, Fiona Evelene, Nino Chikhladze, Mamuka Djibuti
IntroductionHIV status disclosure decision-making is a complex process influenced by stigma, relationship dynamics, and anticipated social consequences. Although decision aids can support individuals in navigating such decisions, no disclosure decision-support interventions have been adapted for use in the Georgian context. This study aimed to identify and prioritize an existing evidence-based intervention for adaptation to support HIV disclosure decision-making among people living with HIV (PLWH) in Georgia.
MethodsWe used the Nominal Group Technique (NGT), a structured consensus method, to elicit and prioritize stakeholder perspectives. Two separate NGT sessions were conducted with HIV care providers (n = 12) and PLWH (n = 10), followed by a joint session to reach consensus. Prior to the sessions, nine evidence-based disclosure decision-support interventions from HIV, mental health, and substance use fields were identified through a desk review and grouped into session-based, paper-based, and digital formats. Participants generated ideas, discussed advantages and limitations, and ranked intervention formats and specific interventions. Descriptive content analysis was used to summarize discussion themes.
ResultsProviders prioritized digital interventions, emphasizing accessibility and scalability, whereas PLWH preferred session-based interventions, highlighting the importance of trust, individualized support, and peer involvement. Within these formats, providers favored a structured digital program, while PLWH selected an individual session-based intervention focused on disclosure to family members. Adaptation priorities included incorporating peer educators, addressing disclosure to different social and healthcare contexts, and including locally relevant content on legal issues, treatment adherence, and available support services. In the joint session, consensus was reached to prioritize the intervention selected by PLWH.
ConclusionsThis study identified a priority disclosure decision-support intervention for adaptation to the Georgian context, emphasizing the importance of patient-centered and contextually tailored approaches. Future research will focus on adapting the selected intervention and identifying appropriate implementation strategies to support pilot testing and integration into HIV care services.
Early open fracture management aims to minimise the risk of complications. For the most severe open fracture wounds, multiple irrigation and debridement surgeries are required to overcome severe wound contamination, to reassess the evolving tissue injury or to temporise and plan further surgery. When multiple irrigation and debridement surgeries are needed, uncertainty remains about how the open fracture wound should be managed to best minimise complications. The primary aim of this trial is to compare the antibiotic cement bead pouch vs negative pressure wound therapy in the management of patients with severe open tibia fracture wounds.
BvV is a multicentre, pragmatic, parallel arm randomised controlled trial that aims to enrol 312 adult patients admitted to a participating centre with a severe open tibia fracture requiring multiple irrigation and debridement surgeries. Participants will be randomly allocated on a 1:1 basis to either antibiotic cement bead pouch or negative pressure wound therapy. The primary outcome will be a composite outcome to evaluate clinical status 6 months after randomisation. Using the win ratio approach, we will hierarchically assess the composite outcome in the following order: (i) all-cause mortality, (ii) injury-related amputation of the lower extremity, (iii) unplanned reoperation to manage wound complications, an infection or promote fracture healing and (iv) clinical fracture healing assessed using the Functional IndeX for Trauma (FIX-IT) instrument.
The BvV trial has been approved by a central institutional review board (IRB) (Advarra) for clinical sites in the USA, the ethics board at the coordinating centre at McMaster University (Hamilton Integrated Research Ethics Board), and participating sites not using the central institutional IRB (Fraser Health Research Ethics Board, The University of British Columbia Clinical Research Ethics Board, Newfoundland and Labrador Health Research Ethics Board, University of Manitoba Biomedical Research Ethics Board). Additional clinical sites who are in the start-up phase, as well as any new selected clinical sites, will obtain local approvals prior to initiating trial activities. This will include a clinical site in the UK who is in the process of obtaining the necessary approvals. Recruitment began in November 2023. Both interventions are frequently used to manage severe open fracture wounds, ensuring that the trial results can be easily transitioned into clinical practice. The results of this trial will be disseminated to national and international partners through peer-reviewed publications, academic conferences and stakeholder engagement activities.
by Tamar Zurashvili, Maia Kajaia, Oluwabusayomi Akeju, Jack DeHovitz, Mamuka Djibuti
People who inject drugs (PWID) are at a heightened risk of contracting and transmitting HIV due to shared needles and unsafe sexual practices. Evidence on what shapes condom use among PWID in Georgia is limited. We conducted qualitative study among PWID recruited from two harm-reduction organizations in Tbilisi and Samegrelo between June-August 2025. Interviews were guided by the COM-B framework and analyzed thematically. Reduced sexual pleasure emerged as a dominant capability-related barrier to condom use. Knowledge of risks, benefits, and where to obtain condoms supported condom use, although participants noted that some community members lacked such knowledge. Opportunity factors were mixed. The convenient access to condoms, whether purchased at pharmacies or available for free at harm-reduction centers, created opportunity for condom access, and facilitated condom use; the factors impeding the use included the cost of purchase as well as long distance to and restricted hours of outlets, and occasional stock-outs and concerns about quality of condoms at harm-reduction centers. Social dynamics emerged as essential factors. Partner pressure, coercion, and persuasion, often intensified by alcohol or drug use, limited condom negotiation, whereas partner support, preparedness, and peer information sharing facilitated condom use. Motivation-related barriers included being under the influence of alcohol or stimulants and “heat of the moment” impulsivity, alongside low perceived risk with regular partners. Motivators included a strong desire for self and partner protection, heightened risk perception with casual or commercial partners, fear of infection, and past negative experiences including infections or unintended pregnancy. Findings indicate that condom use among PWID in Georgia is shaped by interplay of capability, opportunity, and motivation factors. Culturally sensitive, locally adapted strategies addressing pleasure-related concerns through education, strengthening negotiation and refusal skills, including couple-focused approaches can improve consistent condom use in Georgia and may benefit other countries in Eastern Europe and Central Asia.
FreshRSS 