Journal of the International AIDS Society最新文献

{"title":"Impact of point-of-care maternal viral load testing at delivery on vertical HIV transmission risk assessment and neonatal prophylaxis: a cluster randomized trial","authors":"Anange Fred Lwilla,&nbsp;Kira Elsbernd,&nbsp;Siriel Boniface,&nbsp;Raphael Edom,&nbsp;Arlete Mahumane,&nbsp;Bindiya Meggi,&nbsp;W. Chris Buck,&nbsp;Joaquim Lequechane,&nbsp;Kassia Pereira,&nbsp;Nhamo Chiwerengo,&nbsp;Falume Chale,&nbsp;Chishamiso Mudenyanga,&nbsp;Dadirayi Mutsaka,&nbsp;Marianna Mueller,&nbsp;Nyanda E. Ntinginya,&nbsp;Nuno Taveira,&nbsp;Michael Hoelscher,&nbsp;Ilesh Jani,&nbsp;Arne Kroidl,&nbsp;Issa Sabi,&nbsp;and the LIFE Study Consortium","doi":"10.1002/jia2.70021","DOIUrl":"https://doi.org/10.1002/jia2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite global reductions in vertical HIV transmission (VHT), 120,000 children newly acquired HIV in 2023. High maternal viral load (VL) is a major risk factor for VHT. We estimated the impact of point-of-care (PoC) maternal VL testing at delivery in profiling the risk of VHT and its impact on appropriate postnatal prophylaxis for infants born to women living with HIV (WLWH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The cluster-randomized LIFE (Long term Impact on inFant hEalth) study was conducted at 28 health facilities in Tanzania and Mozambique from 2019 to 2021. At delivery, the intervention arm applied PoC maternal VL plus clinical criteria for VHT risk assessment, while the control arm used clinical criteria only. In Tanzania, both arms provided ePNP based on maternal risk factors, while Mozambique provided ePNP universally. We used mixed effects logistic regression to estimate the intervention effect on the proportion of infants at high risk (Tanzania and Mozambique) and infants at high risk receiving ePNP (Tanzania only).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6467 WLWH were enrolled: 66.3% were diagnosed before the third trimester, 99% were on antiretroviral therapy and 78% were virally suppressed at delivery. Of 6564 newborns of WLWH included, 774 (11.7%) were identified to be at a high risk: 629 (19.3%) versus 145 (4.4%) in intervention and control arms, respectively; <i>p</i>&lt;0.0001. In the intervention arm, 520 (82.7%) infants at high risk were classified only based on maternal PoC VL at delivery. In the control arm, 720 (21.8%) additional infants at high risk would have been identified if their mothers had received PoC VL assessment. In Tanzania, infants at high risk in the intervention arm were significantly more likely to receive ePNP: 59.5% versus 31.4% (OR 4.42, 95% CI: 1.09, 17.89). However, 40.5% from intervention arm and 68.6% from control arm did not receive ePNP despite high-risk classification at delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PoC maternal VL testing at delivery significantly increased the proportion of infants identified to be at high risk. Infants at high risk whose mothers received PoC VL at delivery were more often initiated on ePNP. However, the linkage of infants at high risk to appropriate prophylaxis remains suboptimal, warranting consideration of universal ePNP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaches used to monitor the effectiveness of community-led monitoring programmes: a scoping review to inform HIV programmes","authors":"Farihah Malik,&nbsp;Nonna Turusbekova,&nbsp;Susan Perez","doi":"10.1002/jia2.70020","DOIUrl":"https://doi.org/10.1002/jia2.70020","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Community-led monitoring (CLM) for HIV is a technique implemented by local community-led organizations and groups that systematically gather data about HIV services to advocate for improvement. This review was conducted to explore fields other than HIV where CLM or similar approaches have been used, and to identify methods and tools used to monitor the effectiveness of such approaches.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Using a systematic search in PubMed®, Embase® and Web of Science™, we identified publications describing community involvement in the monitoring of public services. We searched for English-language, peer-reviewed articles and abstracts published from inception until 7 March 2024 with search terms covering two broad areas: “community-led monitoring” and “impact/effectiveness.” We double-screened titles and abstracts and single-extracted data on publication type, region and geographic location, field, programme goals, the methods used to monitor the programme, indicators used for monitoring and the frequency with which the programme was monitored. In addition, a web search was conducted to identify relevant grey literature.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 282 records, of which 28 publications were included. Additionally, 24 documents were included through a search of grey literature. Seven peer-reviewed publications related to HIV CLM, 10 were from other health services and 11 were from monitoring of natural resources. No peer-reviewed publications documented results from routine evaluations of CLM programmes or described a monitoring framework for CLM.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Common themes identified across different fields were the role of multi-stakeholder collaboration as an enabling factor for community monitoring, challenges in sustainability due to fragmented funding and the inability of existing evaluation approaches to capture the longer-term impact of community monitoring.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Having a robust monitoring and evaluation system is essential for improving CLM programme operations and demonstrating impact. However, demonstrating the impact of community-led advocacy efforts is complex and more research is needed to assess longer-term impacts. Monitoring of locally led adaptation programmes for climate resilience offers useful examples of impact assessments.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities and challenges for hepatitis B cure in people living with HIV and hepatitis B virus","authors":"Kasha P. Singh,&nbsp;Jennifer Audsley,&nbsp;Wei Zhao,&nbsp;Sharon R. Lewin","doi":"10.1002/jia2.70015","DOIUrl":"https://doi.org/10.1002/jia2.70015","url":null,"abstract":"&lt;p&gt;Despite effective antiviral treatment, hepatitis B virus (HBV) is the leading cause of cirrhosis and liver cancer globally, with over 250 million people living with chronic hepatitis B. Antiviral treatment for people with chronic hepatitis B is usually with just a single tablet a day and, for most people, continues lifelong [&lt;span&gt;1&lt;/span&gt;]. Therefore, similar to HIV, there is high interest in developing a cure for chronic hepatitis B [&lt;span&gt;2&lt;/span&gt;]. Of the 37 million people living with HIV (PWH), 7% are also living with chronic hepatitis B [&lt;span&gt;3&lt;/span&gt;]. People living with HIV and HBV co-infection present both challenges and opportunities to advance the field of HBV cure.&lt;/p&gt;&lt;p&gt;Chronic hepatitis B is defined as persistence of hepatitis B surface antigen (HBsAg) for at least 6 months. The natural history of chronic hepatitis B is characterized initially by high levels of HBV DNA in blood and a normal alanine aminotransferase (ALT), followed by intrahepatic inflammation with increased ALT, which can then progress to fibrosis, cirrhosis and hepatocellular carcinoma [&lt;span&gt;4&lt;/span&gt;]. However, in contrast to HIV, a small percentage of people with chronic hepatitis B can lose HBsAg either spontaneously or following antiviral therapy [&lt;span&gt;4&lt;/span&gt;]. The loss of HBsAg is associated with markedly reduced risk of liver disease and hepatocellular carcinoma [&lt;span&gt;5&lt;/span&gt;], and is, therefore, considered a functional cure.&lt;/p&gt;&lt;p&gt;Multiple strategies are being developed to increase HBsAg loss. These include strategies to better block HBV replication, suppress production of HBsAg (which is immunosuppressive) or enhance HBV-specific immunity (reviewed in [&lt;span&gt;4, 6&lt;/span&gt;]) (Table 1). Some strategies being developed for HBV cure are also being investigated for HIV cure [&lt;span&gt;10&lt;/span&gt;]. Examples include immune modulation with agents such as anti-programmed death-1 and toll-like receptor agonists [&lt;span&gt;10&lt;/span&gt;]. However, unfortunately, most people living with HIV and HBV co-infection are excluded from both HIV and HBV cure clinical trials.&lt;/p&gt;&lt;p&gt;Studies from the early 1990s showed very high liver-related mortality among people living with HIV and HBV co-infection compared to people with HBV mono-infection, especially among those with low CD4+ T-cell counts [&lt;span&gt;11&lt;/span&gt;]. HBV-active antiretroviral therapy (ART) that contains tenofovir (or tenofovir alafenamide), lamivudine (or emtricitabine) or both, suppresses replication of both HIV and HBV and improves health and life expectancy for people living with co-infection. Interestingly, initiation of HBV-active ART results in high rates of HBsAg loss with a prevalence of up to 20% in the first 2 years of treatment [&lt;span&gt;12&lt;/span&gt;]. This is in contrast to HBsAg loss of only 1% per year following initiation of nucleo(s/t)ide reverse transcriptase inhibitors in HBV mono-infection [&lt;span&gt;13&lt;/span&gt;]. Therefore, understanding HBsAg loss in people living with HIV and HBV co-infection could provide import","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rewriting the narrative: resilience of youth in the HIV response","authors":"Fletcher Chiu,&nbsp;Kairon Liu,&nbsp;Ismail Senyonga","doi":"10.1002/jia2.70019","DOIUrl":"https://doi.org/10.1002/jia2.70019","url":null,"abstract":"&lt;p&gt;The United Nations defines “youth” as individuals aged 15–24 years, although some countries extend this range up to 35 years. According to 2024 UNAIDS epidemiologic estimates, young people aged 15–24 years bear a disproportionate burden of new HIV acquisitions, accounting for approximately 28% of all new acquisitions despite representing only 8% of all people living with HIV [&lt;span&gt;1&lt;/span&gt;]. As we commemorate International Youth Day 2025, the global HIV response stands at a critical juncture. Yet, amid adversity, youth-led organizations and young people persist in their fight—not only for survival, but also for dignity, health and a future free from stigma.&lt;/p&gt;&lt;p&gt;Recent policy shifts and funding cuts—especially to the U.S. PEPFAR programme—have severely disrupted youth-led organizations in low- and middle-income countries, jeopardizing critical HIV prevention, treatment, care and support services for young people. A survey conducted by Y+ Global and partners in early 2025 revealed that 60% of youth-led organizations had experienced interruptions in delivering core HIV services as a result of these cuts. Despite the setbacks, they have demonstrated remarkable resilience by uniting to urge stakeholders to take action to preserve youth-led HIV responses. They have also swiftly adapted by exploring alternative funding mechanisms, such as crowdfunding campaigns and partnerships with the private sector [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition to these challenges to healthcare access and advancing youth leadership, people living with HIV continue to face pervasive stigma, resulting in barriers in the workplace, intimate relationships, community settings and beyond. The 2023 People Living with HIV Stigma Index Global Report found that 85% of individuals living with HIV experience internalized stigma, underscoring the profound psychological impact of the epidemic. Notably, this rate is even higher among young people, with 88% reporting internalized stigma [&lt;span&gt;3&lt;/span&gt;]. The growing backlash against Diversity, Equity and Inclusion principles and programmes further exacerbates the potential for stigma and discrimination against HIV and key populations.&lt;/p&gt;&lt;p&gt;In this context, the dual meaning of “ART” as standing for both antiretroviral therapy and artistic creation takes on powerful significance. While ART sustains biological life and can help prevent HIV transmission, art fosters hope and social connection—elements equally essential for thriving with HIV. The HIV Science as Art programme, launched in 2023, has highlighted how art enriches the value of medical approaches by deepening society's understanding of HIV and supporting people living with HIV to tell the stories of their communities [&lt;span&gt;4, 5&lt;/span&gt;]. The initiative, across two editions of the programme, included a total of 24 artists from diverse age groups and regions around the world. Among them, two youth artists—Kairon Liu from the Asia-Pacific region and Ismail Senyonga from the African r","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A thank you note to our peer reviewers (2024)","authors":"Kenneth H. Mayer,&nbsp;Annette H. Sohn,&nbsp;Marlène Bras","doi":"10.1002/jia2.70017","DOIUrl":"https://doi.org/10.1002/jia2.70017","url":null,"abstract":"&lt;p&gt;The &lt;i&gt;Journal of the International AIDS Society&lt;/i&gt; (JIAS) would like to express our gratitude to the peer reviewers who contributed to reviewing articles for the journal in 2024, and to those senior scientists who have mentored early career researchers in reviewing.&lt;/p&gt;&lt;p&gt;Your time and expertise are crucial to upholding the quality of this publication, and we are thankful for your engagement.&lt;/p&gt;&lt;p&gt;We also wish to extend our appreciation to the JIAS Editorial Board members, Deputy Editors, Statistical Committee and Ethical Committee members for their valuable contributions in assessing and reviewing submitted articles.&lt;/p&gt;&lt;p&gt;Kenneth Mayer, co-Editor-in-Chief&lt;/p&gt;&lt;p&gt;Annette Sohn, co-Editor-in-Chief&lt;/p&gt;&lt;p&gt;Marlène Bras, Executive Editor&lt;/p&gt;&lt;p&gt;Aaloke Mody&lt;/p&gt;&lt;p&gt;Abhishek Reddy Mogili&lt;/p&gt;&lt;p&gt;Abiye Kalaiwo&lt;/p&gt;&lt;p&gt;Adiatma Yudistira&lt;/p&gt;&lt;p&gt;Aditya Singh&lt;/p&gt;&lt;p&gt;Akarin Hiransuthikul&lt;/p&gt;&lt;p&gt;Akshay Sharma&lt;/p&gt;&lt;p&gt;Alana Sharp&lt;/p&gt;&lt;p&gt;Alana T Brennan&lt;/p&gt;&lt;p&gt;Alex de voux&lt;/p&gt;&lt;p&gt;Alexandra Calmy&lt;/p&gt;&lt;p&gt;Alison Castle&lt;/p&gt;&lt;p&gt;Alison Kutywayo&lt;/p&gt;&lt;p&gt;Alison Roxby&lt;/p&gt;&lt;p&gt;Alissa Davis&lt;/p&gt;&lt;p&gt;Aliza Monroe-Wise&lt;/p&gt;&lt;p&gt;Allanise Cloete&lt;/p&gt;&lt;p&gt;Amit Achhra&lt;/p&gt;&lt;p&gt;Amy Medley&lt;/p&gt;&lt;p&gt;Amy Zheng&lt;/p&gt;&lt;p&gt;Andrew David Forsyth&lt;/p&gt;&lt;p&gt;Andrew Mujugira&lt;/p&gt;&lt;p&gt;Andrew Wiznia&lt;/p&gt;&lt;p&gt;Angela Bengtson&lt;/p&gt;&lt;p&gt;Angela Colbers&lt;/p&gt;&lt;p&gt;Angela Hutchinson&lt;/p&gt;&lt;p&gt;Ann Gottert&lt;/p&gt;&lt;p&gt;Anna Bershteyn&lt;/p&gt;&lt;p&gt;Anna Bowring&lt;/p&gt;&lt;p&gt;Anna Downie&lt;/p&gt;&lt;p&gt;Anna Klicpera&lt;/p&gt;&lt;p&gt;Anna Yeung&lt;/p&gt;&lt;p&gt;Annaliese M. Limb&lt;/p&gt;&lt;p&gt;Anne Neilan&lt;/p&gt;&lt;p&gt;Antons Mozalevskis&lt;/p&gt;&lt;p&gt;Apostolos Beloukas&lt;/p&gt;&lt;p&gt;Ariane van der Straten&lt;/p&gt;&lt;p&gt;Arman Oganisian&lt;/p&gt;&lt;p&gt;Arturo M. Ongkeko&lt;/p&gt;&lt;p&gt;Assel Terlikbayeva&lt;/p&gt;&lt;p&gt;Audrey Pettifor&lt;/p&gt;&lt;p&gt;Ava Avalos&lt;/p&gt;&lt;p&gt;Ayako Fujita&lt;/p&gt;&lt;p&gt;Barbara A. Friedland&lt;/p&gt;&lt;p&gt;Beatrice Wamuti&lt;/p&gt;&lt;p&gt;Benjamin Brown&lt;/p&gt;&lt;p&gt;Benjamin Ryan Phelps&lt;/p&gt;&lt;p&gt;Bindiya Meggi&lt;/p&gt;&lt;p&gt;Bluma Brenner&lt;/p&gt;&lt;p&gt;Brendan Harney&lt;/p&gt;&lt;p&gt;Brian Honermann&lt;/p&gt;&lt;p&gt;Brian T Foley&lt;/p&gt;&lt;p&gt;Bridget Haire&lt;/p&gt;&lt;p&gt;Bright Ofori&lt;/p&gt;&lt;p&gt;Brittany Moore&lt;/p&gt;&lt;p&gt;Brooke E Nichols&lt;/p&gt;&lt;p&gt;Bruno Spire&lt;/p&gt;&lt;p&gt;Caitlin E. Kennedy&lt;/p&gt;&lt;p&gt;Carlos Cáceres&lt;/p&gt;&lt;p&gt;Carlos E. Rodriguez-Diaz&lt;/p&gt;&lt;p&gt;Carol Strong&lt;/p&gt;&lt;p&gt;Caroline A. Bulstra&lt;/p&gt;&lt;p&gt;Caroline DeSchacht&lt;/p&gt;&lt;p&gt;Carolyn Chu&lt;/p&gt;&lt;p&gt;Caryl Feldacker&lt;/p&gt;&lt;p&gt;Catherine Godfrey&lt;/p&gt;&lt;p&gt;Catherine Koss&lt;/p&gt;&lt;p&gt;Catherine Orrell&lt;/p&gt;&lt;p&gt;Catherine Verde Hashim&lt;/p&gt;&lt;p&gt;Cedric Bien-Gund&lt;/p&gt;&lt;p&gt;Chanda Mwamba&lt;/p&gt;&lt;p&gt;Charles Ssonko&lt;/p&gt;&lt;p&gt;Chen Seong Wong&lt;/p&gt;&lt;p&gt;Chenai Mlandu&lt;/p&gt;&lt;p&gt;Chenglin Hong&lt;/p&gt;&lt;p&gt;Cheryl Case Johnson&lt;/p&gt;&lt;p&gt;Chloe A. Teasdale&lt;/p&gt;&lt;p&gt;Chris Collins&lt;/p&gt;&lt;p&gt;Christian Grov&lt;/p&gt;&lt;p&gt;Christian Stillson&lt;/p&gt;&lt;p&gt;Christiana Noestlinger&lt;/p&gt;&lt;p&gt;Christopher James Hoffmann&lt;/p&gt;&lt;p&gt;Connie Celum&lt;/p&gt;&lt;p&gt;Craig J Heck&lt;/p&gt;&lt;p&gt;Cristina Pimenta&lt;/p&gt;&lt;p&gt;Cuc Tran&lt;/p&gt;&lt;p&gt;Curtis Chan&lt;/p&gt;&lt;p&gt;Dadong Wu&lt;/p&gt;&lt;p&gt;Darrell Tan&lt;/p&gt;&lt;p&gt;Dawn Goddard-Eckrich&lt;/p&gt;&lt;p&gt;Deanna Kerrigan&lt;/p&gt;&lt;p&gt;Debbie Humphries&lt;/p&gt;&lt;p&gt;Debrah Boeras&lt;/p&gt;&lt;p&gt;Denton Callander&lt;/p&gt;&lt;p&gt;Diego Cecchini&lt;/p&gt;&lt;p&gt;Dion Carleen Allen&lt;/p&gt;&lt;p&gt;Divya Ramani Bhamidipati&lt;/p&gt;&lt;p&gt;Dominic Reeds&lt;/p&gt;&lt;p&gt;Dominique Medaglio&lt;/p&gt;&lt;p&gt;Donn Colby&lt;/p&gt;&lt;p&gt;Dumbani Kayira&lt;/p&gt;&lt;p&gt;Dunstan Achwoka&lt;/p&gt;&lt;p&gt;Dusita Phuengsamran","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and clinical flow of point-of-care urine tenofovir testing for treatment monitoring among people living with HIV initiating ART in South Africa","authors":"Melody Wang,&nbsp;Pravikrishnen Moodley,&nbsp;Mlungisi Khanyile,&nbsp;Elliot Bulo,&nbsp;Makhosazane Zondi,&nbsp;Keshani Naidoo,&nbsp;Yukteshwar Sookrajh,&nbsp;Jienchi Dorward,&nbsp;Monica Gandhi,&nbsp;Nigel Garrett,&nbsp;Paul K. Drain,&nbsp;Monisha Sharma","doi":"10.1002/jia2.70004","DOIUrl":"https://doi.org/10.1002/jia2.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Point-of-care (POC) urine tenofovir (TFV) tests can provide timely information regarding antiretroviral therapy (ART) adherence to support management of HIV treatment in clinics. However, there are limited data on the costs and feasibility of integrating POC testing into HIV clinics in sub-Saharan Africa. We characterized clinic flow and implementation costs of POC adherence testing for persons initiating ART in HIV care clinics in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a microcosting within a randomized controlled implementation trial of POC TFV test in government clinics in Durban, South Africa (STREAM HIV). Time-and-motion observation was conducted between 1st March and 31st December 2022, to assess staff and client time needed for POC TFV testing and counselling. We estimated both financial and economic costs for capital, clinic consumables and personnel using a provider (national government) perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The estimated cost of POC TFV was USD $13 per client, assuming a clinic volume of 20 individuals initiating ART per month. The largest component costs of POC TFV testing were the test strip consumables, which accounted for 53% of the test cost. The median total time of a clinic visit with a POC TFV test, starting from client registration, was 49:19 (minutes: seconds) (IQR: 29:19–89:35). TFV testing took 9:22 (IQR: 7:35–14:11), taking up 19% of the total clinic visit time, including sample collection, sample loading, TFV test processing and counselling provision based on test results. Overall, 29% of the clinic visit time included direct clinical care and assessment with a provider, with clients spending a median 14:09 (IQR: 10:35–21:22) getting vitals checked, receiving adherence monitoring via POC TFV testing, and collecting their ART refill. Waiting in line for ART took most (48%) of the clinic visit time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POC TFV testing can be administered at reasonable costs, requires less than 10 minutes of healthcare provider time, and, therefore, may be feasible to implement in South African clinics. Findings can inform policy and budgetary planning for ART monitoring in South Africa and future cost-effectiveness analyses of POC TFV testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>NCT04341779</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 – 17 July, Kigali, Rwanda & Virtual","authors":"","doi":"10.1002/jia2.26518","DOIUrl":"https://doi.org/10.1002/jia2.26518","url":null,"abstract":"","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent sex disparities in access to dolutegravir-based antiretroviral therapy in Latin America and the Caribbean: results from a retrospective observational study using data from 2017 to 2022","authors":"Fernanda F. Fonseca,&nbsp;Paridhi Ranadive,&nbsp;Bryan E. Shepherd,&nbsp;Flavia G. F. Ferreira,&nbsp;Maria F. Rodríguez,&nbsp;Daisy M. Machado,&nbsp;Vanessa Rouzier,&nbsp;Diana Varela,&nbsp;Fernanda Maruri,&nbsp;Peter Ribeiro,&nbsp;Beatriz Grinsztejn,&nbsp;Sandra Wagner Cardoso,&nbsp;Valdiléa G. Veloso,&nbsp;Jessica L. Castilho,&nbsp;Emilia M. Jalil,&nbsp;CCASAnet","doi":"10.1002/jia2.26470","DOIUrl":"https://doi.org/10.1002/jia2.26470","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite its reversal in July 2019, the World Health Organization warning issued in May 2018 of potential teratogenicity associated with dolutegravir (DTG) may have produced persistent sex disparities in access to DTG. We compared DTG uptake of people with HIV (PWH) by sex in Latin America and the Caribbean (LAC) and its potential impact on virologic outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We evaluated DTG initiation among antiretroviral therapy (ART)-naïve and -experienced cisgender PWH ≥16 years of age after DTG availability in Brazil (February/2017), Chile (August/2019), Haiti (November/2018) and Honduras (December/2018). Time was divided into pre- (before May/2018), during- (May/2018−July/2019) and post- (after July/2019) warning periods. We examined interactions of sex, age and calendar era with multivariable modified Poisson regression models and Cox proportional hazard models for the outcomes of DTG initiation among ART-naïve and ART-experienced PWH, respectively, and HIV RNA &lt;50 copies/ml in the first year of therapy among ART-naïve PWH, adjusting for site and tuberculosis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 4622 ART-naïve PWH, 3853 (83%) initiated DTG. ART-naïve females aged 16–49 years were less likely to initiate DTG compared to males of the same age both in the pre/during-warning (adjusted prevalence ratio [aPR]: 0.75 [95% confidence interval (95% CI): 0.71−0.80]) and in the post-warning periods (aPR: 0.97 [95% CI: 0.95−1.00]). Among 16,154 ART-experienced PWH, 9236 (57%) initiated DTG. ART-experienced females 16–49 years were less likely to initiate DTG compared to males of the same age in the pre/during-warning (adjusted hazard ratio [aHR]: 0.69 [95% CI: 0.66−0.73]) and post-warning periods (aHR: 0.79 [95% CI: 0.70−0.90]). This sex difference was not observed among older ART-experienced females and males pre/during-warning (aHR: 1.06 [95% CI: 0.99−1.14]). Compared to starting ART without DTG, DTG-based ART use was associated with a higher likelihood of HIV RNA suppression in the first year (aPR = 1.10 [95% CI: 1.04−1.16]). In the post-warning period, females aged 16–49 years had a likelihood of viral suppression similar to males of the same age (aPR: 1.03 [95% CI: 0.96−1.10]), which did not change after adjusting for DTG use (aPR: 1.03 [95% CI: 0.97−1.11]).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite the updated guidelines recommending DTG for all PWH, there are persistent sex disparities in the access to DTG in LAC, especially among females wit","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The need to differentiate at re-engagement: lessons from South Africa and Zimbabwe's re-engagement algorithms","authors":"Lynne S. Wilkinson,&nbsp;Helen Bygrave,&nbsp;Musa Manganye,&nbsp;Chiedza Mupanguri,&nbsp;Anna Grimsrud","doi":"10.1002/jia2.26466","DOIUrl":"https://doi.org/10.1002/jia2.26466","url":null,"abstract":"&lt;p&gt;As HIV epidemics mature, effectively addressing interruptions in antiretroviral therapy (ART) becomes increasingly critical to reducing morbidity, mortality and transmission [&lt;span&gt;1-3&lt;/span&gt;]. Prolonged disengagement from ART places significant demands on health systems, including the need to manage advanced HIV disease (AHD), higher rates of hospitalisation and preventable new HIV acquisitions.&lt;/p&gt;&lt;p&gt;Disengagement from HIV care is the result of individual, interpersonal and/or structural vulnerabilities combined with life disruptions, such as unexpected travel, that impact a person's ability to remain in care [&lt;span&gt;4, 5&lt;/span&gt;]. Fortunately, many individuals are self-motivated to return to care. However, their timely re-engagement often depends on removing barriers and introducing valued facilitators [&lt;span&gt;6, 7&lt;/span&gt;]. Data from Malawi and South Africa show that the majority of people attempt return within 3 months of missing a scheduled appointment, but more country-specific time-to-return data is needed [&lt;span&gt;8, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Disengagement occurs across the HIV care cascade, with proportionally more people disengaging during early ART but greater numbers disengaging thereafter. In mature, generalised HIV epidemics, disengagement is common among all population groups, reinforcing the need for broad, scalable approaches that improve re-engagement outcomes [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Re-engagement involves two main intervention categories: tracing to encourage return, and enhancing the return experience to reduce interruption length and repeat disengagement [&lt;span&gt;5&lt;/span&gt;]. This viewpoint focuses on the latter by removing barriers and adapting service delivery to support re-engagement.&lt;/p&gt;&lt;p&gt;HIV programmes must first recognise that ART interruptions are common and prioritise facilitating easy, quick and sustained re-engagement [&lt;span&gt;3&lt;/span&gt;]. Some individuals fear returning due to concerns about disappointing healthcare workers and experiencing punitive actions [&lt;span&gt;6, 10, 11&lt;/span&gt;]. Respectful care for returning clients can reduce fear and promote timely return. Re-engagement guidance should emphasise same-day ART provision, avoiding multiple visits [&lt;span&gt;7&lt;/span&gt;] or transfer documentation collection [&lt;span&gt;11&lt;/span&gt;]. Long waiting times and penalisation for missed appointments should be monitored and penalisation [&lt;span&gt;6, 7&lt;/span&gt;]. People re-engaging in care commonly previously struggled with frequent appointments, inconvenient locations and long wait times. Accelerating access to less-intensive differentiated service delivery (DSD) can reduce client burden and help prevent future interruptions [&lt;span&gt;6, 7&lt;/span&gt;]. Frequent clinical visits should be reserved for when clinically necessary.&lt;/p&gt;&lt;p&gt;Ministries of health are starting to implement guidance on managing people returning to care, focusing on respectful care and a shift away from one-size-fits-all intensified clinical management, with its monthly appointments and multiple","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing differentiated service delivery models for tuberculosis treatment: a pilot project to inform national policy in Uganda","authors":"Odile Ferroussier-Davis,&nbsp;Deus Lukoye,&nbsp;Susan Alwedo,&nbsp;Mary N. Mudiope,&nbsp;Joanitah Nalunjogi,&nbsp;James Bruce Kirenga,&nbsp;Joseph N. Kabanda,&nbsp;Julius N. Kalamya,&nbsp;Benson Nasasira,&nbsp;Estella Birabwa,&nbsp;Seyoum Dejene,&nbsp;Miriam Murungi,&nbsp;Immaculate Ddumba,&nbsp;Brittany Moore,&nbsp;Aldomoro Burua,&nbsp;Henry Luzze,&nbsp;Ebony Quinto,&nbsp;Moorine Sekadde,&nbsp;Raymond Byaruhanga,&nbsp;Patrick Ajuna,&nbsp;Ivan Arinaitwe,&nbsp;Cordelia Katureebe,&nbsp;Proscovia Namuwenge,&nbsp;Michelle R. Adler,&nbsp;Stavia Turyahabwe","doi":"10.1002/jia2.26483","DOIUrl":"https://doi.org/10.1002/jia2.26483","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Differentiated service delivery (DSD) models aim to tailor health services delivery to clients’ preferences and clinical characteristics while reducing the burden on health systems. In Uganda, DSD models developed for HIV care were adapted to the tuberculosis (TB) services context to mitigate disruptions from the COVID-19 pandemic and inform national efforts to improve TB care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Beginning in April 2021, four facility-based and five community-based DSD models were implemented in 28 TB clinics in Kampala and Soroti Regions. All clients in the intensive (months 1–2) and continuation (months 3–6) phases of treatment were eligible. Client preference and clinician concurrence determined model choice. All models allowed TB medication dispensing intervals ranging from biweekly to multi-month dispensing (MMD; ≥ 2 months). Data abstracted in December 2022 from TB registers and DSD enrolment tracking tools at 21 of 28 implementing facilities were used to evaluate the intervention. The TB treatment success rate (i.e. proportion cured or who completed treatment, vs. those who died, failed, were lost-to-follow-up or had no recorded outcome) in the DSD cohort was compared to facilities’ 2018–2019 results using Fischer's exact test.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Most facilities offered one (Kampala) or two (Soroti) facility-based models and one community-based model. Among 1864 TB clients enrolled between April 2021 and March 2022, 1822 (97.7%) used ≥ 1 DSD models; 210/1822 (11.5%) ever switched models. Overall, 70.5% (1284/1822) of clients enrolled in ≥ 1 facility-based model and 40.5% (737/1822) in ≥ 1 community-based model. The use of community-based models increased during the continuation phase. Facility-Based Individual Management and Home Delivery were the most-used models. In the intensive phase, the longest medication dispensation interval was biweekly for 50.0% of patients, monthly for 41.3% and MMD for 8.8%. During the continuation phase, the longest interval was biweekly for 0.6%, monthly for 71.7% and MMD for 27.6%. Overall, 1582/1864 (84.9%) clients were successfully treated, compared to 858/1177 (72.9%) in 2018–2019 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Seven (0.4%) patients failed treatment, 32 (1.7%) were lost to follow-up, 101 (5.4%) died and 142 (7.6%) were not evaluated.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;TB DSD models were successfully implemented. TB treatment outcomes under DSD compared favourably to historical outcomes. Investigating facto","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}