Journal of the International AIDS Society最新文献

{"title":"PrEP preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study","authors":"Nafisa Wara, Carey Pike, Elzette Rousseau, Pippa Macdonald, Pakama Mapukata, Bryan Leonard, Keitumetse Lebelo, Risa Hoffman, Catherine Orrell, Linda-Gail Bekker, Dvora Joseph Davey","doi":"10.1002/jia2.26492","DOIUrl":"https://doi.org/10.1002/jia2.26492","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15–29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From February to August 2024, we enrolled 58 PLP (<i>n</i> = 30 pregnant, <i>n</i> = 28 breastfeeding). Median age 23 years (IQR 19.5−26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, <i>n</i> = 13 pregnant, <i>n</i> = 23 breastfeeding) completed the acceptability survey. Of these, 83% (<i>n</i> = 12/13 pregnant, <i>n</i> = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (<i>n</i> = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; <i>n</i> = 22/32) and long-acting protection (44%; <i>n</i> = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (<i>n</i> = 13/32) described no CAB-LA dislikes. Almost all (97%; <i>n</i> = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (<i>n</i> = 31/36) did not want to try the dapivirine vaginal ring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.</p>\u0000 </section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524761","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":"Strategies for implementing long-acting cabotegravir for PrEP in US clinics serving Black women: interim healthcare provider findings from the EBONI study","authors":"Katherine L. Nelson, Tammeka Evans Cooper, Yolanda Lawson, Dylan Baker, Satish Mocherla, Megan Dieterich, Theo Hodge, Alftan Dyson, Denise Sutherland-Philips, Heidi Swygard, Lisa Petty, Peter Jeffery, Kenneth Sutton, Courtney Peasant Bonner, Sara M. Andrews, Samantha Chang, Piotr Budnik, Kimberly Smith, Annemiek de Ruiter, Maggie Czarnogorski, Nanlesta Pilgrim","doi":"10.1002/jia2.26497","DOIUrl":"https://doi.org/10.1002/jia2.26497","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to Black cis- and transgender (cis-and-trans) women in clinics located in the United States, including infectious disease (ID), primary care (PC) and women's health (WH) clinics. We present interim perspectives, considerations and strategies from healthcare professionals’ (HCPs’) experiences during the initial implementation stages of administering CAB LA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From August 2022 to June 2024, through quantitative surveys (prior to implementation [baseline] and Month 4 [M4]) and/or structured qualitative interviews (M4), HCPs provided their perceptions and experiences of integrating CAB LA in their clinical settings that served Black cis-and-trans women. Monthly implementation monitoring (IM) calls were also conducted. Survey data were analysed using descriptive statistics. Qualitative and IM data were coded and analysed using a Framework Analysis approach grounded in the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-two HCPs across 20 sites completed baseline and M4 surveys; 57% were cisgender female and 43% were Black. HCPs across clinic types developed innovative approaches to support CAB LA implementation, with few HCPs (< 10%) reporting concerns about practice preparation. Initial HCP considerations related to patient adherence, insurance verification and patient identification reduced by M4 (absolute % reduction: 5–14%; 5–9%; and 4–12%, respectively). HCPs across clinic types serving Black women reported successful implementation strategies, including addressing medical mistrust and patient miseducation, staff training and reminder or tracking systems. Useful implementation strategies unique to clinic types included using electronic medical records to document whether patients were offered CAB LA (PC), designating specific days for administering injections (WH) and creating time for discussion with patients (ID).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A range of strategies across clinics that routinely serve Black cis-and-trans women were used to support CAB LA implementation. Implementing CAB LA in clinical settings can be bolstered by addressing population-specific concerns, increasing staff/patient education about CAB LA and modifying clinical flows. Lessons learned in EBONI can help suppor","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524763","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":"Finally, PrEP choices! But will clients ever have a choice?","authors":"Kimberly E. Green, Kenneth Ngure, Robyn Eakle, Nittaya Phanuphak, Jason Reed","doi":"10.1002/jia2.26505","DOIUrl":"https://doi.org/10.1002/jia2.26505","url":null,"abstract":"<p>Ten years after the World Health Organization (WHO) recommended tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) as an additional HIV prevention option, the world is, or rather should be, on the cusp of a biomedical HIV prevention choice revolution. Although oral PrEP scale-up started slow, particularly in low- and middle-income countries, uptake grew exponentially in Africa and elsewhere to 3.5 million people by 2023 [<span>1</span>]. The end of 2024 represented a convergence of excellence in HIV prevention science, large-scale country and community leadership in designing and delivering differentiated PrEP services, and visionary financing and programmatic commitment by the President's Emergency Fund for AIDS Relief (PEPFAR) and the Global Fund for AIDS, TB and Malaria (GFATM). By December 2024, two additional products, the dapivirine vaginal ring and long-acting injectable cabotegravir (CAB-LA), were newly available in 10 and 12 countries, respectively, and the PURPOSE-1 and -2 trials on a longer-acting injectable, lenacapavir (LEN), reported astounding near-perfect efficacy in preventing HIV [<span>2</span>].</p><p>Why is choice in PrEP products so anticipated? Several studies have measured substantial unmet PrEP need across populations and geographies when oral PrEP was the only option available. Unmet need is inclusive of those that report intention to start PrEP and/or who report risk factors but who remain PrEP naïve; those that discontinue PrEP but report continued need for PrEP; and individuals using oral PrEP but who prefer a different PrEP product type (e.g. a longer-acting option). These studies—such as PrEP APPEAL in the Asia-Pacific and a discrete choice study among women and girls in Kenya, Eswatini and South Africa—measured substantial unmet PrEP need among populations surveyed and preference for a long-acting product over oral PrEP [<span>3-5</span>]. Their authors theorized that where a choice in PrEP products was on offer, unmet need would be reduced, PrEP uptake and continuation would be increased, and HIV incidence would fall.</p><p>As CAB-LA and the ring were introduced into the PrEP method mix in countries like Brazil, South Africa and the United States, fairly consistent real-world PrEP uptake trends emerged indicating a pattern of strong preference for long-acting injectable PrEP (from 68% to 83% of individuals), and more modest preferences for oral PrEP (17–26%), and the ring (under 5% where included as a PrEP option) [<span>6-8</span>]. The Dynamic Choice HIV Prevention study in Kenya and Uganda found when services were optimized to provide product choice and service flexibility, PrEP uptake more than doubled. Offering a choice of both CAB-LA and oral PrEP resulted in 70% of participants opting for any biomedical HIV prevention compared to 13% in the standard of care arm—a 56% difference [<span>9</span>]. While in Brazil, 83% of participants opted for CAB-LA over oral PrEP as part of the ImPr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524835","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":"“People have options”: a qualitative study of experiences and influences of PrEP choice among women in South Africa","authors":"Siphokazi Dada, Faith Mary Musvipwa, Fatima Abegail Cholo, Melanie Pleaner, Alison Kutywayo, Vusile Butler, Catherine Elizabeth Martin, Saiqa Mullick","doi":"10.1002/jia2.26462","DOIUrl":"https://doi.org/10.1002/jia2.26462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable cabotegravir and dapivirine vaginal ring were recently introduced in South Africa through demonstration projects, providing additional HIV prevention options to oral pre-exposure prophylaxis (PrEP). PrEP choice marks a pivotal moment in HIV prevention, potentially increasing PrEP uptake and use by offering women a choice of methods best suited to their individual needs. Understanding experiences of PrEP choice in real-world settings is critical to informing the introduction of PrEP choice at scale. This study, embedded within an implementation science study introducing new PrEP methods, explores women's experiences of PrEP choice counselling, and factors influencing PrEP choice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between April and May 2024, we conducted 12 focus group discussions with a sub-set of 126 women (18–57 years) enrolled in a parent cohort study delivering PrEP choice at six fixed and three roving mobile clinics in three areas of South Africa. Cohort participants are HIV-negative men and women ≥ 15 years interested in HIV prevention services. At the time of data collection, non-pregnant and lactating women ≥ 18 years enrolled in the cohort were provided PrEP choice counselling and offered a choice of oral PrEP or dapivirine vaginal ring. Discussions explored women's experiences of PrEP choice counselling and influences of PrEP choice. They were audio recorded, transcribed verbatim and translated into English for thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women reported positive choice counselling experiences, particularly when it was supplemented by pamphlets, demonstration rings and pelvic models. Participants valued learning about alternative PrEP methods and appreciated friendly healthcare providers who answered their questions. Privacy and emotional support were also crucial. However, negative experiences included the use of complex scientific jargon and insufficient information on PrEP's potential drawbacks. PrEP choices were mainly influenced by concerns about intravaginal products, distrust of new methods, prior oral PrEP experiences, and partner and family opinions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings will guide strategies for PrEP delivery, emphasizing provider training, effective counselling tools and tailored communication. Women valued clear, jargon-free information, visual aids and a welcoming environment, which supported open dialogue. The influence of prior oral PrEP experiences on PrEP choice highli","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525022","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":"HIV-1 testing in the context of expanding PrEP modalities","authors":"Urvi M. Parikh,&nbsp;Jana L. Jacobs,&nbsp;Njambi Njuguna,&nbsp;Kristine Torjesen,&nbsp;John W. Mellors","doi":"10.1002/jia2.26491","DOIUrl":"https://doi.org/10.1002/jia2.26491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multiple effective antiretroviral-based pre-exposure prophylaxis (PrEP) modalities for HIV-1 prevention are now available or under investigation but their safe rollout requires implementable HIV-1 testing strategies that accurately identify rare cases of HIV-1 acquisition. Current PrEP testing guidelines and testing algorithms in PrEP studies are varied, using single or combinations of rapid antibody-based diagnostic testing, qualitative or quantitative nucleic acid testing, and/or sample collection for retrospective analyses with sensitive research assays for HIV-1 nucleic acid detection. The objective of this commentary is to summarize current and alternative HIV testing approaches for PrEP implementation to guide best practices for individual programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Diagnosing HIV-1 in PrEP users is challenging because (1) rarity of breakthrough HIV-1 in individuals on PrEP that increases the risk of a false-positive test; (2) modification of acute HIV infection by PrEP; and (3) PrEP delivery in community settings with inadequate testing infrastructure. Current best practices indicate the use of rapid diagnostic tests or self-testing as recommended by national testing algorithms and the World Health Organization (WHO). The use of nucleic acid testing such as plasma HIV-1 RNA polymerase chain reaction may allow earlier detection of HIV-1 but feasibility and risk of false positive are downsides. Sensitive tests to detect single-copy HIV-1 RNA in plasma and integrated proviral DNA in blood mononuclear cells may be important methods to resolve ambiguous HIV-1 diagnosis in research settings. Delayed diagnoses could lead to drug resistance emergence under long-acting PrEP selection, whereas single unconfirmed false-positive tests could create diagnostic challenges in users of long-acting PrEP. The cost, feasibility and positive predictive value of HIV tests are important considerations for PrEP programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimal strategies to detect HIV-1 acquisition among users of different PrEP modalities are evolving. While new guidance from the WHO recommends HIV-1 testing by serological assays or self-testing with PrEP use, feasible plans for clinical management of rare cases of breakthrough on PrEP and ambiguous diagnoses are still needed. The data from PrEP studies and scale-up will help us assess the value of different tests and testing approaches for their inclusion in HIV detection algorithms across PrEP modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524834","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":"Expanding access to a choice-based multi-method PrEP market for HIV prevention","authors":"Nicolette P. Naidoo,&nbsp;James Ayieko,&nbsp;Virginia A. Fonner","doi":"10.1002/jia2.26512","DOIUrl":"https://doi.org/10.1002/jia2.26512","url":null,"abstract":"&lt;p&gt;In the last decade, pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention. The World Health Organization first recommended daily oral PrEP containing tenofovir as an additional prevention option for all populations at substantial risk of HIV in 2015 [&lt;span&gt;1&lt;/span&gt;], then added a recommendation for event-driven or “on-demand” PrEP for men in 2019 [&lt;span&gt;2&lt;/span&gt;], the monthly dapivirine vaginal ring for women in 2021 [&lt;span&gt;3&lt;/span&gt;] and long-acting injectable cabotegravir (CAB-LA) in 2022 [&lt;span&gt;4&lt;/span&gt;]. More PrEP options are becoming available, such as lenacapavir, which is administered as a sub-cutaneous injection. Recent clinical trial results suggest lenacapavir injections every 6 months are highly efficacious [&lt;span&gt;5, 6&lt;/span&gt;], and early safety and pharmacokinetic data show potential for once-yearly dosing [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite the promise of PrEP and the recent proliferation of products, the programmatic rollout of PrEP has been challenging, as system-level constraints (e.g. cost, policy, operational barriers), social-level factors (e.g. stigma and lack of normalization of HIV prevention) and individual behaviours (e.g. adherence) have all contributed to limiting overall impact [&lt;span&gt;8-10&lt;/span&gt;]. However, more countries have recently adopted PrEP into national guidelines, and global use of PrEP has increased substantially over the last several years [&lt;span&gt;11&lt;/span&gt;]. Research suggests that expanding the menu of PrEP options to better meet the diverse needs and preferences of end users could improve uptake and use [&lt;span&gt;12&lt;/span&gt;]. The advent of PrEP methods with different administration routes, discreet formulations and less frequent dosing will potentially enable easier access, more effective use, reduce stigma and, in some cases, allow for the implementation of more flexible delivery channels.&lt;/p&gt;&lt;p&gt;To collate early evidence related to expanding access to a choice-based HIV prevention market, we invited investigators and research teams across the globe to submit multidisciplinary articles for this supplement, designed to speak to the evaluation and delivery of PrEP choice in diverse settings and for varied populations. After careful consideration, the editorial team selected 15 contributions that illustrate current evidence, implementation learnings and challenges associated with the introduction, uptake and continued use of PrEP within the context of an expanded HIV prevention method-mix.&lt;/p&gt;&lt;p&gt;Choice in PrEP methods and service delivery approaches have the potential to improve prevention coverage. In a commentary by Schmidt et al. [&lt;span&gt;13&lt;/span&gt;], the authors highlight that despite the significant strides made in accelerating oral PrEP scale-up, it is unlikely that global PrEP targets will be met. In the era of PrEP choice, the authors remind readers that choice is not only about PrEP methods, but also service delivery approaches that have the potential to transform global HIV prevention efforts and m","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525020","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":"User and healthcare provider early experiences with the PrEP ring: a quantitative study on the introduction of a new PrEP method in Eswatini","authors":"Anita Hettema,&nbsp;Siphesihle Shongwe,&nbsp;Haley Sisel,&nbsp;Mxolisi Khumalo,&nbsp;Ncediso Gama,&nbsp;Nolwazi Khanyile,&nbsp;Buyile Mahlalela,&nbsp;Sindy Nana Matse,&nbsp;Jill M. Peterson","doi":"10.1002/jia2.26490","DOIUrl":"https://doi.org/10.1002/jia2.26490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Eswatini prepared for the national rollout of HIV pre-exposure prophylaxis (PrEP) choice through a mixed-method demonstration study introducing the PrEP dapivirine vaginal ring in 12 Ministry of Health-supported sites. The Eswatini PrEP Ring Study aimed to describe user preferences for, and experiences with, the PrEP ring, and provider impressions. The objective was to provide real-world data on client preferences and experiences related to PrEP choice, and healthcare provider perspectives on the feasibility and acceptability of offering PrEP choice. A subset of quantitative findings is presented here.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>During May 2023–August 2024, 12 study sites in Eswatini began offering a choice between the PrEP ring and oral PrEP to women 18 years and older who were HIV negative, not pregnant or breastfeeding, and interested in PrEP. Current oral PrEP users who were satisfied with the method were not recruited. Users’ early experiences with the PrEP ring were assessed through structured enrolment and follow-up questionnaires. Factors associated with choosing the PrEP ring at enrolment were assessed using logistic regression. During the first 2 months of offering PrEP choice, providers (<i>n</i> = 16) completed a structured questionnaire on the feasibility and acceptability of PrEP choice service delivery. Clinical Trial Number: NCT05889533</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At enrolment, 69% (<i>n</i> = 625/904) chose the PrEP ring. Predictors for choosing the ring included ages 25+ (25–34 years AOR = 1.44, 95% CI [1.03, 2.02]; ages 35+ years AOR = 1.69, 95% CI [1.07, 2.68]), higher education (AOR = 1.71 for some/completed high school, 95% CI [1.20, 2.43]; AOR = 1.87 for vocational/tertiary education, 95% CI [1.21, 2.90]) and using either longer-acting (AOR = 2.23, 95% CI [1.28, 3.89]) or shorter-acting contraceptives (AOR = 1.63, 95% CI [1.14, 2.32]) versus no modern family planning method. Participants reported high levels of ease and confidence (98%) in using the ring. Ninety-four percent of PrEP counsellors (<i>n</i> = 8) and nurses (<i>n</i> = 8) felt prepared to offer PrEP choice and liked choice counselling but had concerns about clients’ ability to return on time for refills of either method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many women in Eswatini were willing to try the PrEP ring. Providers were enthusiastic about counselling on PrEP choice and introducing women to the ring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525021","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":"Leveraging existing market incentives to increase HIV pre-exposure prophylaxis access in the United States","authors":"Jirair Ratevosian,&nbsp;Caroline Piselli,&nbsp;Patrick Sullivan,&nbsp;LaRon E. Nelson","doi":"10.1002/jia2.26504","DOIUrl":"https://doi.org/10.1002/jia2.26504","url":null,"abstract":"&lt;p&gt;Pre-exposure prophylaxis (PrEP) is a highly effective tool in the response to end the HIV epidemic, reducing transmission risk when taken consistently [&lt;span&gt;1&lt;/span&gt;]. First approved by the U.S. Food and Drug Administration in 2012, PrEP has become a cornerstone of HIV initiatives in the United States. In 2025, a key policy change to improve the financial incentives for health insurers to cover PrEP could significantly boost access to HIV prevention, bringing national health financing policy in line with public health priorities.&lt;/p&gt;&lt;p&gt;Inadequate access to and substantial inequities in uptake are currently limiting the full positive impacts of PrEP on the health of Americans [&lt;span&gt;2&lt;/span&gt;]. In 2023, only approximately one-third of people who would benefit from PrEP were using it [&lt;span&gt;3&lt;/span&gt;]. Further, the patterns of PrEP usage were not always trending towards the populations with the highest likelihoods of exposure to HIV. For example, PrEP use was not proportionate to the risk of HIV for women, Black and Hispanic communities, and adolescents [&lt;span&gt;2&lt;/span&gt;]. These inequities in PrEP use are attributable to many factors, including lower coverage of health insurance for these groups and a lack of local policies that result in high out-of-pocket costs for those without insurance coverage for PrEP [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;According to the U.S. Census Bureau, in 2023, approximately 92.0% of Americans had health insurance coverage at some point during the year. Private health insurance was more prevalent, covering 65.4% of the population, primarily through employer-sponsored plans (53.7%). Public insurance programmes, including Medicare, Medicaid and the Veterans Health Administration, covered 36.3% of individuals [&lt;span&gt;6&lt;/span&gt;]. These gains in coverage are largely attributable to the Affordable Care Act (ACA), which became law in 2010. The ACA introduced insurance marketplaces, expanded Medicaid eligibility and mandated coverage of essential health benefits, including preventive services.&lt;/p&gt;&lt;p&gt;The ACA also requires coverage for preventive services, including PrEP since 2021. Yet, insurers have traditionally imposed cost-related policies that limited access to the medication, and many also view PrEP medication and related services, like routine lab tests and provider visits, as financial liabilities that increase their costs relative to the reimbursements they may receive from the government. As a result, individuals with high HIV exposure probabilities frequently encounter high insurance deductibles, limited provider networks and burdensome prior authorizations that impede PrEP access [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;According to a recent analysis, 13% of private U.S. insurance plans in 2024 did not list PrEP as no-cost to enrolees in their prescription drug formularies, 31% did not list PrEP in their no-cost preventive services list and 66% failed to clearly indicate whether essential services were covered without cost-sharing by the enro","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524765","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":"Transforming PrEP marketing: understanding the place of PrEP in the hearts and minds of adolescent girls and young women in sub-Saharan Africa","authors":"Emily de Lacy Donaldson,&nbsp;Elmari Briedenhann,&nbsp;Patriciah Jeckonia,&nbsp;Casey Bishopp,&nbsp;Anelde Greeff,&nbsp;Definate Nhamo","doi":"10.1002/jia2.26480","DOIUrl":"https://doi.org/10.1002/jia2.26480","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;Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remain one of the populations most affected by HIV. As HIV prevention options expand—such as the introduction of the dapivirine ring, long-acting injectable cabotegravir and other potential long-acting methods—alongside oral pre-exposure prophylaxis (PrEP), AGYW will have a choice of PrEP methods for HIV prevention, referred to as the PrEP category. Marketing and demand generation must evolve to communicate this choice to AGYW in real-world settings across SSA.&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 phased approach to learn, build, iterate and validate, we developed a brand positioning strategy for the PrEP category for AGYW. In 2022, a review of existing and historic oral PrEP campaigns informed initial insights (learn). In 2023, these were further explored and developed with eight young women representatives under the age of 30 (build), then refined with PrEP implementers and Ministry of Health representatives from eight SSA countries (iterate), through five consultative virtual workshops of up to 25 participants each. Insights were funnelled through a private sector marketing framework—the 4C's—to develop a single key brand benefit (KBB), ensuring it was culturally relevant, category-specific, consumer-driven and product (company)-true. The KBB was then creatively applied to posters, narratives and key messages for validation with AGYW (validate). From July to August 2023, 121 AGYW aged 18–24 participated in 16 group discussions to validate the brand positioning strategy; 44 in South Africa (6 groups), 32 in Zimbabwe (4 groups) and 45 in Kenya (6 groups).&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;Post-validation, an optimized KBB emerged: PrEP affirms that self-love is strength—positioning PrEP as a way for AGYW to prioritize their physical health and mental wellbeing, and live a life uninterrupted by HIV. We developed a deeper understanding of the influences shaping AGYW's relationship with the PrEP category, answering: &lt;i&gt;What do AGYW feel in their hearts and think in their minds about PrEP?&lt;/i&gt;&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;This strategic, evidence-informed brand positioning—developed with AGYW, confirms that communication to promote PrEP uptake and continued use must resonate with AGYW's inner strength and frame PrEP use as an act of self-love. It offers a powerful foundation for clear, consistent and inspiring communication that engage and retain AGYW's attention.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524831","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":"Estimated impact of long-acting injectable PrEP in South Africa: a model comparison analysis","authors":"Sarah E. Stansfield,&nbsp;Mia Moore,&nbsp;Lise Jamieson,&nbsp;Gesine Meyer-Rath,&nbsp;Leigh F. Johnson,&nbsp;David Kaftan,&nbsp;Anna Bershteyn,&nbsp;Jennifer Smith,&nbsp;Valentina Cambiano,&nbsp;Loveleen Bansi-Matharu,&nbsp;Andrew Phillips,&nbsp;Jesse Heitner,&nbsp;Ruanne V. Barnabas,&nbsp;Brett Hanscom,&nbsp;Deborah J. Donnell,&nbsp;Marie-Claude Boily,&nbsp;Dobromir Dimitrov","doi":"10.1002/jia2.26453","DOIUrl":"https://doi.org/10.1002/jia2.26453","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) in two clinical trials. This analysis projects the impact of expanding PrEP coverage with CAB-LA in South Africa between 2022 and 2042.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three independently calibrated models of HIV transmission in South Africa (Synthesis, EMOD-HIV, Thembisa) projected HIV acquisitions and effective coverage (average PrEP coverage across exposure groups, weighted by HIV incidence in the absence of PrEP in each group) over 20 years under multiple scenarios of PrEP expansion compared to no PrEP expansion. PrEP expansion scenarios differed in targeted overall coverage, speed of expansion, coverage of high-exposure groups, and relative coverage of women and men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Achieving 5% PrEP coverage with CAB-LA by 2032 prioritizing high-exposure groups resulted in 49% (Synthesis), 18% (EMOD-HIV), and 8% (Thembisa) effective coverage and averted a median of 43%, 29% and 10% of new HIV acquisitions, respectively. Similar expansion with TDF/FTC resulted in lower impact by 19 percentage points (pp), 18pp and 3pp, respectively. Increasing CAB-LA coverage to 15% led to an additional 7pp, 12pp and 16pp, respectively, of HIV acquisitions averted. Achieving 5% CAB-LA coverage expanding to women only resulted in a lower impact by 16pp (Synthesis) and 13pp (EMOD-HIV), and a higher impact by 2pp (Thembisa). Scenarios with similar effective coverage resulted in comparable impact estimates across models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Offering CAB-LA in South Africa may substantially impact the HIV epidemic based on these projections. Effective coverage proved to be a good predictor of intervention effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524833","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}