Journal of the International AIDS Society最新文献

{"title":"Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study","authors":"Jeremy L. Ross, Dhanushi Rupasinghe, Thida Chanyachukul, Brenda Crabtree Ramírez, Gad Murenzi, Edith Kwobah, Fiona Mureithi, Albert Minga, Ivan Marbaniang, Hugo Perazzo, Angela Parcesepe, Suzanne Goodrich, Cleophas Chimbetete, Ephrem Mensah, Fernanda Maruri, Dung Thi Hoai Nguyen, Alvaro López-Iñiguez, Kathryn Lancaster, Helen Byakwaga, Mpho Tlali, Marie K. Plaisy, Smita Nimkar, Rodrigo Moreira, Kathryn Anastos, Aggrey Semeere, Gilles Wandeler, Antoine Jaquet, Annette Sohn, the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS","doi":"10.1002/jia2.26434","DOIUrl":"https://doi.org/10.1002/jia2.26434","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm<sup>3</sup> and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m<sup>2</sup>, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16−2.09, <i>p</i> = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30−0.77, <i>p</i> = 0.009).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries,","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554242","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":"Socio-economic status and adherence to HIV preventive and therapeutic interventions: exploring the mediating role of food insecurity among men who have sex with men and transgender and non-binary persons from Brazil","authors":"Paula M. Luz, Thiago S. Torres, Victor C. Matos, Giovanna G. Costa, Brenda Hoagland, Cristina Pimenta, Marcos Benedetti, Beatriz Grinsztejn, Valdilea G. Veloso","doi":"10.1002/jia2.26432","DOIUrl":"https://doi.org/10.1002/jia2.26432","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Brazil offers free-of-charge antiretroviral therapy (ART) for people living with HIV (PLWH) as well as oral pre-exposure prophylaxis (PrEP) through its national health system. Adherence to ART and to PrEP is essential to achieving the expected benefits of virologic suppression and prevention of HIV acquisition, respectively. Brazil has experienced worsening social inequalities, exacerbated by the COVID-19 pandemic, leading to increases in food insecurity especially among vulnerable populations. We explored whether food insecurity mediated the association of socio-economic status on adherence to ART/PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult men who have sex with men (MSM) and transgender and non-binary persons (TGNB) living in Brazil (May−September/2021) voluntarily participated in a cross-sectional online study advertised on dating apps and social media. Participants living with HIV reporting ART use and participants with HIV-negative status reporting daily oral PrEP use were eligible for the analysis. Self-report of ART adherence was measured by the WebAd-Q instrument (3-items/past week) plus a visual analogue scale. Self-report of PrEP adherence was measured by the number of days the person took PrEP in the past week. The 8-item Brazilian Scale of Food Insecurity (EBIA) was used to measure food insecurity (higher scores indicate more severe food insecurity). Two structural equation models were used to assess the direct and indirect effects of variables on ART adherence among PLWH and on PrEP adherence among people using PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 1230 PLWH were using ART, and 991 individuals with HIV-negative status were using daily oral PrEP. The median age of PLWH was 37 years (HIV negative: 34 years), most were cismen (98%). More PLWH reported moderate/severe food insecurity (21.7%; HIV negative: 12.9%). Self-report of ART adherence (measured by WebAd-Q, past 7 days) was 55.7% (PrEP adherence: 93.3%). In the two models, socio-economic status had an effect on adherence that was mediated through food insecurity: higher socio-economic status was associated with lower food insecurity, and higher food insecurity was associated with lower adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that the provision of socio-economic support could help PLWH and people at higher vulnerability to HIV acquisition by improving their adherence to ART or PrEP, and ultimately populations through decreased HIV transmissions.</p>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554241","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":"We will not end AIDS: addressing the anti-rights movements","authors":"Allan Maleche, Wame Jallow, Jerop Limo, Timothy Wafula, Solomon Wambua","doi":"10.1002/jia2.26429","DOIUrl":"https://doi.org/10.1002/jia2.26429","url":null,"abstract":"<p>In 2015, global leaders made an ambitious commitment to end the AIDS epidemic under the 2030 Agenda for Sustainable Development, through political will, investments and rights-based approaches [<span>1</span>]. On Zero Discrimination Day 2025, we sound the alarm on the growing wave of anti-rights and anti-gender movements that now threaten to roll back of these gains, putting millions of lives at risk. Anti-gender movements refer to organized efforts aimed at opposing gender equality and the rights of marginalized groups, particularly those advocating for sexual and reproductive health rights and the rights of LGBTIQ+ communities. These movements often target policies and programmes that promote gender inclusivity, comprehensive sexuality education and equal access to healthcare, using narratives that reject evolving gender norms and human rights frameworks.</p><p>The UNAIDS 2024 report emphasized that the global momentum in ending AIDS hinges on sustained political and financial investments [<span>2</span>]. It highlighted the need to protect human rights, warning that any backtracking will undermine gains in the HIV response. This echoes the Global Commission on HIV and the Law (2012) [<span>3</span>] and the UN Secretary-General's report (2016) [<span>4</span>], which both reaffirmed that access to HIV services must be ensured for marginalized populations, including people living with HIV, young women in sub-Saharan Africa, sex workers, men who have sex with men (MSM), transgender people and people who inject drugs.</p><p>However, despite it being an established fact that rights-based strategies are important in ending HIV, 2024 witnessed merciless backlash on those rights. Conservative governments around the world are increasingly posing a threat to human rights, with suppression of human rights defenders, and universal human rights principles and laws being attacked and undermined by these governments.</p><p>Most troubling of these trends is the increased criminalization and exclusion of LGBTIQ+ people from healthcare services. In Kenya, for instance, a 2023 Supreme Court decision enabled the registration of the National Gay and Lesbian Human Rights Commission—a landmark victory for human rights [<span>5</span>].</p><p>But instead of promoting progress, political and religious leaders utilized the ruling to fuel public outrage, which led to a rise in violence towards the LGBTIQ+ community, closures of health service organizations (mainly drop-in centres led by MSM) and interruption of outreach initiatives to key population communities.</p><p>Uganda took it a step further. The passing of the Anti-Homosexuality Act in 2024 effectively criminalized LGBTIQ+ livelihoods, with disastrous consequences for HIV prevention and treatment. East African civil society groups warned that such laws push people underground, where they cannot access basic health services [<span>6</span>]. Ghana followed the same route with a similar bill, which was not sig","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513853","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":"Rapid development of an online tracker to communicate the human impact of abruptly halting PEPFAR support","authors":"Brooke E. Nichols, Elvin H. Geng, Eric Moakley, Andrew N. Phillips, Jeffrey W. Imai-Eaton, John Stover, Edinah Mudimu, Anna Grimsrud","doi":"10.1002/jia2.26433","DOIUrl":"https://doi.org/10.1002/jia2.26433","url":null,"abstract":"<p>On 24 January 2025, the global HIV community was confronted with the abrupt announcement that the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a programme with longstanding bipartisan support, would be paused for 90 days following an executive order to halt all foreign aid [<span>1, 2</span>]. For the over 20 million individuals worldwide receiving HIV treatment through PEPFAR-supported programmes, the potential consequences were severe and immediate. As the public health community sought mechanisms to respond, an accurate, quantitative and science-based understanding of the potential magnitude of this pause was urgently needed. Systematic quantification of the potential impacts would allow the public health community to plan harm reduction strategies, advocate for policy responses and effectively communicate the severity of the situation to stakeholders, including government officials, civil society leaders, media outlets and advocacy groups.</p><p>To provide a rapid assessment, we undertook a near real-time modelling effort. We leveraged existing modelling work, publicly available data and expert consensus to generate projections. Complex mathematical modelling typically requires weeks to generate robust projections, limiting its utility for real-time decision-making. Our focus was on answering the most pressing question—the potential health consequences of this funding pause—using the most parsimonious model possible.</p><p>To facilitate accessibility and dissemination, we collaborated with a product development expert to translate these calculations into an interactive website, now available at https://pepfar.impactcounter.com/. The site launched on 28 January 2025, 4 days after the funding freeze was announced [<span>10</span>]. The platform provides an intuitive tool for users to quickly understand the potential consequences of the PEPFAR funding freeze.</p><p>As the tool gained visibility and traction, we continued to refine the modelled estimates through additional expert review. Members of the HIV modelling community, including those affiliated with the HIV Modelling Consortium, independently assessed the calculations, refined assumptions and incorporated the latest available data. This collaborative process ensured that the estimates remained as accurate and reliable as possible while maintaining clarity in communication.</p><p>The current estimates on adult deaths presented on the website are informed by detailed modelling projections from five well-established HIV mathematical models [<span>11</span>]. We used estimates from Jewell et al. on the number of excess deaths expected to occur over a 1-year time horizon associated with complete ART service disruptions over a 90-day period—as a reduction in ART is what specifically drives short-term mortality. This number was multiplied by the percent of HIV programmes funded by PEPFAR (47%) [<span>12</span>]. We assumed a linear distribution of deaths over the year, resulting","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497040","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":"Knowledge as resistance: advancing global health in challenging times","authors":"Marlène Bras, the Editors of the Journal of the International AIDS Society","doi":"10.1002/jia2.26430","DOIUrl":"https://doi.org/10.1002/jia2.26430","url":null,"abstract":"<p>These are extraordinary times, with daily assaults on public health principles. The sudden de-funding of life-saving programmes like PEPFAR poses existential threats to achieving the goals of effective control of the HIV epidemic, which had been predicated on increasing testing, engagement in care, and uptake of evidence-based treatment and prevention. The censorship of terms related to sex, gender, diversity, equity, and inclusion in public health reports and scientific publications is chilling and negates decades of thoughtful scholarship that has demonstrated the relevance of these issues in the lived experiences and health outcomes of people affected by HIV.</p><p>The leadership of IAS – the International AIDS Society – has expressed deep concern over the rhetoric surrounding funding cuts, which has misrepresented the use of international development support and needlessly further stigmatized vulnerable populations. As editors of the <i>Journal of the International AIDS Society</i>, we affirm that the journal will not change our mission nor our standards for evidence-driven and person-centred reporting. We recognize that programmes funded with public money should be subject to government review. However, the acute pause in US funding for global health, along with statements and policy shifts targeting key populations, represent unprecedented attacks on initiatives that have saved millions of lives and prevented millions of new HIV acquisitions.</p><p>JIAS will continue to welcome research that is of interest to our diverse readership, can inform the development of effective strategies to decrease HIV transmission, and improve the health and wellbeing of people living with HIV across the globe. Our core principles continue to include an understanding that sex and gender are distinct, and that rigorous science respects the diversity of human experience.</p><p>As researchers, clinicians and public health practitioners, we must respond to the challenges posed by recent policy measures while also documenting their intended and unintended consequences. JIAS welcomes submissions that present empirical data, model potential outcomes of resource constraints and policy shifts or highlight best practices and innovative solutions that address current challenges.</p><p>We have received requests from authors of manuscripts under peer review to have their names removed or manuscripts withdrawn from further consideration in order to comply with the US administration's recent executive orders. Although we are very concerned about this, we will respect author requests in agreement with our policy on authorship changes.</p><p>This is a difficult time, but the global struggle to address the HIV epidemic has faced and overcome existential challenges before. We feel that the best way to counter misinformation is to continue to generate and disseminate new knowledge that provides a compelling, evidence-based narrative. While an instinctive response to such an un","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497041","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":"By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding","authors":"Khai Hoan Tram, Jirair Ratevosian, Chris Beyrer","doi":"10.1002/jia2.26431","DOIUrl":"https://doi.org/10.1002/jia2.26431","url":null,"abstract":"<p>On 20 January 2025, the first day of his second term in office, President Donald Trump issued an executive order instating a 90-day pause on new U.S. foreign assistance, pending a review for alignment with U.S. foreign policy. Four days later, the U.S. State Department issued a “stop order” directive, expanding the pause to include a freeze on all foreign aid programmes, including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) [<span>1</span>]. By 1 February, PEPFAR received a limited waiver for life-saving HIV care and treatment services and prevention programmes to prevent vertical transmission [<span>2</span>]. While this waiver signalled hope to millions, it did not release immediate funding to implementing partners, prolonging confusion and disruption on the ground [<span>3, 4</span>]. Ongoing uncertainty around PEPFAR funding has interfered with critical HIV programmes that rely on long-term planning, making it impossible to operate effectively and sustain life-saving services.</p><p>First announced under President George W. Bush in 2003 and reauthorized regularly since with bipartisan support in Congress, PEPFAR has been critical not only in the global response against the HIV epidemic but also in strengthening overall health systems in over 50 countries worldwide [<span>5</span>]. Over the past 21 years, PEPFAR has supported antiretroviral treatment (ART) for over 20 million people living with HIV (PLWH), including 566,000 children; reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services; supported 6.6 million orphans, vulnerable children and caregivers; enrolled 2.5 million people on HIV pre-exposure prophylaxis; provided 83.8 million people with HIV testing services; and directly supported 342,000 health workers [<span>5</span>]. Since its inception, PEPFAR is estimated to have saved 26 million lives and prevented 7.8 million infants from being born with HIV [<span>5</span>]. Additionally, in PEPFAR-supported countries, new HIV infections have been reduced by half since 2010 [<span>5</span>].</p><p>The deadly consequences of even brief pauses in foreign aid cannot be overstated. At stake with the stoppage of U.S. foreign aid is PEPFAR's ability to continue its indispensable work of delivering life-saving HIV treatment to millions of people and supporting local health system capacity. HIV treatment interruption leads to not only loss of virological control but also reversal of immune recovery for PLWH, the potential for viral resistance, the emergence of opportunistic infections, increased risk of tuberculosis and other co-infections, and ultimately increased morbidity, mortality and onward transmission [<span>6</span>]. Based on previously described mathematical models of HIV epidemiology and intervention programmes in sub-Saharan Africa, a 90-day disruption of HIV treatment and care programmes modelled as discontinuation of ART to 50% of people is expected to lead to a median inc","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481373","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 thresholds for anticipated long-acting HIV pre-exposure prophylaxis products in Eastern and Southern Africa: a mathematical modelling study","authors":"David Kaftan,&nbsp;Monisha Sharma,&nbsp;Danielle Resar,&nbsp;Masabho Milali,&nbsp;Edinah Mudimu,&nbsp;Linxuan Wu,&nbsp;Cory Arrouzet,&nbsp;Ingrida Platais,&nbsp;Hae-Young Kim,&nbsp;Sarah Jenkins,&nbsp;Anna Bershteyn","doi":"10.1002/jia2.26427","DOIUrl":"https://doi.org/10.1002/jia2.26427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Affordable HIV prevention tools are needed in Eastern and Southern Africa (ESA). Several promising long-acting pre-exposure prophylaxis (LA-PrEP) products are available or in development. However, ESA settings face severe healthcare resource constraints. We aimed to estimate the threshold price at which LA-PrEP products could be cost-effective in three ESA settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We adapted an agent-based model, EMOD-HIV, to simulate LA-PrEP (monthly oral, 2- and 6-monthly injectable) rollout in South Africa, Zimbabwe and Kenya. Due to uncertainties about LA-PrEP use, we examined a range of coverages (5%−20% of HIV-negative sexually active adults) and extents to which LA-PrEP use will be concentrated among those most at risk (prioritized rollout from higher- to lower-risk groups vs. uniform rollout among sexually active adults). To evaluate a 20-year commitment to LA-PrEP delivery, we assumed LA-PrEP was scaled up to target coverage from 2025 to 2030 and maintained at target levels before ending in 2045. We estimated maximum per-dose and per-year LA-PrEP costs that achieve cost-effectiveness (&lt;US$500 per disability-adjusted life-year averted) over 35 years (until 2060), compared to a scenario of daily oral PrEP only. Sensitivity analyses varied PrEP scale-up speeds and eligible populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Risk-prioritized LA-PrEP for 5% of adults was projected to avert 11–21% of HIV acquisitions across settings, with 3–5 times more HIV acquisitions averted and 3–5 times higher maximum cost compared to non-prioritized rollout. Six-monthly injectable PrEP supported the highest per-dose cost: in the scenario with the most cost-effective LA-PrEP use (5% risk-prioritized rollout), the maximum per-dose price in South Africa was $52.99 (95% CI: $48.82–$57.21), in Zimbabwe $14.64 (95% CI: $12.04–$17.38) and in western Kenya $7.50 (95% CI: $6.73–$8.27). For monthly oral PrEP, corresponding per-dose costs were $5.02 (95% CI: $4.67–$5.37), $1.45 (95% CI: $1.10–$1.79) and $0.87 (95% CI: $0.80–$0.93). Results were sensitive to eligible population and prioritization, and moderately sensitive to scale-up speed and product effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA-PrEP is likely to require reduced pricing and/or risk-prioritized rollout to be cost-effective in ESA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481314","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":"Characterizing HIV seroconversions among a cohort of oral PrEP users in South Africa","authors":"Catherine E. Martin,&nbsp;Hlologelo Ramatsoma,&nbsp;Glory Chidumwa,&nbsp;Laura Ashleigh Cox,&nbsp;Saiqa Mullick","doi":"10.1002/jia2.26421","DOIUrl":"https://doi.org/10.1002/jia2.26421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There has been significant progress in the rollout of oral pre-exposure prophylaxis (PrEP) for the prevention of HIV. The introduction of long-acting prevention methods holds the potential to improve HIV prevention uptake and use, however, presents unique complexities regarding HIV diagnosis and potential for resistance. Quantifying and understanding the scenarios within which seroconversions occur may help to inform approaches to identifying acute HIV in programmes delivering PrEP at scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper documents ctra series of seroconversions within a large implementation study conducted in eight Department of Health facilities and four linked mobile clinics in four areas of South Africa. Using routinely collected data, we conducted a descriptive analysis of clients who seroconverted after initiating oral PrEP and determined the distribution of time from oral PrEP initiation to seroconversion as well as the proportion of days covered by oral PrEP. A seroconversion was defined as any HIV-positive diagnosis after initiation of PrEP. Time to seroconversion was calculated as the number of days between the first PrEP initiation and the date of HIV diagnosis. The proportion of days covered by PrEP was calculated as the number of days of PrEP prescribed over the number of days between PrEP initiation and HIV seroconversion. We conducted a logistic regression to determine factors associated with seroconversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 11,882 clients initiated on PrEP between January 2019 and October 2022 who attended at least one follow-up visit, 112 (0.9%) seroconverted after PrEP initiation. Among those who seroconverted, the median proportion of days covered by PrEP between initiation and seroconversion was 33%. In the period between PrEP initiation and seroconversion, almost all (<i>n</i> = 93, 83.0%) had not used PrEP consistently, with only 19 (17.0%) having consistent PrEP use, all of whom were identified at the 1-month follow-up visit and were likely missed acute acquisitions. Younger age and geographical area were associated with seroconversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study reports a low number of seroconversions among a large cohort of PrEP users in a real-world implementation study, the majority of which occurred among clients who had interrupted or discontinued PrEP use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466101","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":"Acceptability of an annual tenofovir alafenamide implant for HIV prevention in South African women: findings from the CAPRISA 018 Phase I clinical trial","authors":"Tanuja N. Gengiah,&nbsp;Craig J. Heck,&nbsp;Lara Lewis,&nbsp;Leila E. Mansoor,&nbsp;Ishana Harkoo,&nbsp;Nqobile Myeni,&nbsp;Marc M. Baum,&nbsp;John A. Moss,&nbsp;James F. Rooney,&nbsp;Catherine Hankins,&nbsp;Bruno Pozzetto,&nbsp;Salim S. Abdool Karim,&nbsp;Quarraisha Abdool Karim","doi":"10.1002/jia2.26426","DOIUrl":"https://doi.org/10.1002/jia2.26426","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;Long-acting HIV pre-exposure prophylaxis promises to improve uptake, adherence and persistence challenges experienced with daily oral tablets. We assessed the acceptability of an annual tenofovir alafenamide (TAF) implant in South African women enrolled from 9 July 2020 until 31 May 2022 in a Phase I trial.&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;Six women received one TAF implant for 4 weeks (Group 1), after which 30 women were randomized (4:1, TAF to placebo ratio) to receive 1 or 2 TAF or placebo implants for 48 weeks (Group 2), before trial discontinuation. Acceptability assessments were conducted pre- and post-implant removal. Implant attributes (size, quantity, insertion site, palpability, visibility) and physical experiences (insertion/removal procedures, implant site reactions [ISRs]) were rated on a scale of 1 (highly unacceptable) to 6 (highly acceptable), with 4 being the acceptability threshold. The mean (range) of the mean acceptability scores across all pre-removal visits were calculated, including stratification by removal timing (early vs. scheduled). Implant likes and dislikes were also assessed.&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;The median participant age was 26 years. Prior to implant removal, the mean (range) acceptability scores were 5.4 (3.6–6.0) for product attributes and 5.1 (1.7–6.0) for physical experiences. Eleven (31%) participants had early implant removals, occurring on average 19 weeks (range 2–27 weeks) after insertion. The proportion of study visits reporting adherence measure as unacceptable in early versus scheduled removals: ISRs (50% vs. 19%), visibility (30% vs. 15%), palpability (14% vs. 8%), pain (16% vs. 4%) and implant quantity (13% vs. 1%). Pre-removal acceptability scores for ISRs (&lt;i&gt;p&lt;/i&gt; = 0.003) and physical experiences (&lt;i&gt;p&lt;/i&gt; = 0.05) were significantly associated with early removal. Overall, mean (range) acceptability scores were 5.8 (4.0–6.0) and 5.9 (4.7–6.0) for lifestyle compatibility and likelihood of recommendation, respectively. After removal, 39% of participants found ISRs unacceptable, followed by 22% citing implant visibility. Potential for long-term HIV protection, followed by discreet and convenient use, were most liked, while ISRs were the most disliked aspect.&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;While implant attributes, physical experiences and insertion/removal procedures were largely acceptable, local ISRs significantly reduced tolerability and acceptability, resulting in higher-than-expected early removals.","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455863","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":"Early impacts of the PEPFAR stop-work order: a rapid assessment","authors":"Elise Lankiewicz,&nbsp;Alana Sharp,&nbsp;Patrick Drake,&nbsp;Jennifer Sherwood,&nbsp;Brian Macharia,&nbsp;Michael Ighodaro,&nbsp;Brian Honermann,&nbsp;Asia Russell","doi":"10.1002/jia2.26423","DOIUrl":"https://doi.org/10.1002/jia2.26423","url":null,"abstract":"&lt;p&gt;On 20 January, the Trump Administration issued an Executive Order freezing all foreign assistance funds for 90 days, to assess their alignment with the Administration's foreign policy priorities [&lt;span&gt;1&lt;/span&gt;]. The freeze included funds disbursed under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a historically bipartisan programme that has provided lifesaving HIV services since 2003. PEPFAR programmes are implemented primarily by the U.S. Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID) and delivered by more than 450 prime implementing partners and around 850 sub-recipients in 55 countries. Following this order, all U.S. embassies were ordered to immediately suspend all foreign assistance, with only limited exceptions for emergency food assistance and military financing for Egypt and Israel, as well as some administrative costs [&lt;span&gt;2&lt;/span&gt;]. This sudden cessation of services, including HIV treatment, put millions of people at risk. Estimates predict that each day of the freeze about 220,000 people, including over 7000 children, will be unable to access their needed treatment [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;On 1 February, a waiver was granted to PEPFAR, allowing the resumption of life-saving humanitarian assistance during the review period [&lt;span&gt;4&lt;/span&gt;]. The exemption was limited to diagnostics, treatment, management of opportunistic infections, supply chain support and certain human resources [&lt;span&gt;4&lt;/span&gt;]. All HIV prevention activities, including the provision of pre-exposure prophylaxis, were excluded from the waiver, except for those aimed at preventing mother-to-child transmission [&lt;span&gt;4&lt;/span&gt;]. Further details on activities covered by the waiver were outlined in a Global Health Security and Diplomacy memo on 6 February [&lt;span&gt;5&lt;/span&gt;]. However, the process for resuming services under the waiver still requires notification from a contracting or agreement officer and approval of a modified workplan and budget. As of 21 January, the CDC has been under orders not to communicate with external partners, and as of 8 February, almost all USAID staff were put on administrative leave [&lt;span&gt;6, 7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Measuring and urgently addressing the disruption to PEPFAR-supported programmes is critical to save lives and mitigate the impact of the funding freeze, particularly given PEPFAR's own data systems have been shut down, eliminating their ability to track impacts on services [&lt;span&gt;3, 8&lt;/span&gt;]. We surveyed PEPFAR funding recipients the week immediately following the funding freeze and stop-work order (24 January−28 January 2025) using a web-based survey tool available in English, French, Spanish, Portuguese, Russian and Thai. Respondents were recruited via listservs and WhatsApp groups relevant to the global HIV response. All individuals employed by a PEPFAR prime implementing partner or sub-recipients were eligible to participate. Respondents were ask","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431587","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}