Journal of the International AIDS Society最新文献

{"title":"Impact of switching to a dolutegravir-based regimen on body weight changes: insights from West African adult HIV cohorts","authors":"Thierry Tiendrebeogo,&nbsp;Karen Malateste,&nbsp;Armel Poda,&nbsp;Albert Minga,&nbsp;Cecile D. Lahiri,&nbsp;Oliver Ezechi,&nbsp;Didier K. Ekouevi,&nbsp;Igho Ofotokun,&nbsp;Antoine Jaquet,&nbsp;the IeDEA West Africa Collaboration","doi":"10.1002/jia2.26371","DOIUrl":"10.1002/jia2.26371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adverse metabolic effects related to dolutegravir (DTG) are increasingly reported as countries are adopting DTG-based regimens as first-line antiretroviral therapy (ART), but there is limited data from sub-Saharan Africa. We explored changes in body weight pre- and post-switch to a DTG-based regimen and assessed the association between DTG switch and significant weight gain (SWG) defined as a ≥10% increase over a 12-month period in people living with HIV (PLHIV) on ART in West Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We first included all PLHIV followed in the IeDEA West Africa cohorts between January 2017 and June 2021, with a documented switch to DTG during 2019–2021 and in care ≥36 months at the day of switch. Weight change was estimated using a two slope piecewise linear mixed model with change point at the switch date. Secondly, we emulated a sequence of target trials (ETT) based on the observational data, performing pooled logistic regression analysis to compare SWG occurrence between PLHIV who switched to DTG and those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We first included 6705 PLHIV from Burkina Faso, Côte d'Ivoire and Nigeria. Their median age at the time of switch was 48 years (IQR: 42–54) with a median follow-up of 9 years (IQR: 6–12), 63% were female. Most patients switched from efavirenz (EFV)-based ART (56.6%) and nevirapine (NVP)-based ART (30.9%). The overall post-switch annual average weight gain (AAWG) was significantly elevated at 3.07 kg/year [95% CI: 2.33–3.80] compared to the pre-switch AWG which stood at 0.62 kg/year [95% CI: 0.36–0.88]. The post-switch AWG was greater in patients previously on EFV and protease inhibitor (PI)-based ART compared to those on NVP-based ART. The pooled logistic regression analyses of a sequence of 24 ETT, including 9598 person-trials, switching to DTG was significantly associated with an SWG (aOR = 2.54; 95% CI = 2.18–2.97).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In West Africa, a 12-month DTG exposure was associated with substantial weight gain, especially in PLHIV previously on EFV and PI-based ARTs. Continuous weight monitoring and metabolic profiling is imperative in HIV cohorts to delineate the long-term cardiometabolic impact of DTG as patients with, or at elevated risk for cardiovascular diseases might benefit from alternative ART regimens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737945","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":"Adherence measurement considerations for oral antiretroviral medications","authors":"Corwin Coppinger,&nbsp;Peter L. Anderson","doi":"10.1002/jia2.26397","DOIUrl":"10.1002/jia2.26397","url":null,"abstract":"&lt;p&gt;Non-adherence has been, and remains, the most powerful predictor of unfavourable outcomes for both pre-exposure prophylaxis (PrEP) and anti-retroviral therapy. In particular, non-adherence during oral PrEP trials complicated the picture of efficacy, a fact that is again on display following the PURPOSE-1 trial that included daily oral emtricitabine/tenofovir alafenamide (F-TAF) and emtricitabine/tenofovir disoproxil fumarate [&lt;span&gt;1&lt;/span&gt;]. Adherence in early trials was initially measured via self-report, pill counts and medication dispensation records, all suggesting high adherence (&gt;90%) during trial periods [&lt;span&gt;2, 3&lt;/span&gt;]. However, analysis of biological samples from the active arms indicated much lower PrEP use (unquantifiable or low drug concentrations), and particularly low use among participants who seroconverted. The lessons learned from these trials include: objective adherence measures greatly outperformed indirect measures, and many participants, by virtue of repeated undetectable drug concentrations between study visits, likely had little intention of being adherent, and this was unbeknownst to study personnel. Intentionality of non-adherence is difficult to determine and nuanced and likely underappreciated when considering adherence measurements in trials.&lt;/p&gt;&lt;p&gt;In this Viewpoint, we highlight the need for more research to consider adherence measurements when participants have little intention of adhering to the medication. We recognize the only way to differentiate the intentionality of non-adherence is participant self-report, which is subject to social desirability bias [&lt;span&gt;4&lt;/span&gt;]. We also recognize and acknowledge that open communication is critical to this subject and appreciate that the foundation of care requires open and non-judgemental conversations between clients and clinicians. The reasons for participating in trials are complex: for some clients, there may be an initial intent to take the medication, but subsequent side effects or perception of not being at risk anymore may temper their enthusiasm to continue to take the medication; both the incentives of trial participation (financial and access to healthcare) and/or social desirability bias (not wanting to disappoint the study staff) may lead to misreporting of non-adherence. Nevertheless, clinicians and researchers need reliable adherence measurements to properly interpret expected/observed therapeutic outcomes, whether the participant is intentionally or unintentionally non-adherent. Additionally, intent to adhere is important for policymakers who must target appropriate populations for medical interventions (i.e. those who intend to be adherent).&lt;/p&gt;&lt;p&gt;The main adherence assessment in the recently published PURPOSE-1 study was intraerythrocytic tenofovir-diphosphate (TFV-DP), the phosphorylated anabolite of TFV, which is formed and trapped in red blood cells with a 17-day half-life. It accumulates with repeated dosing (i.e. adherence) and provides","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714990","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":"Recent infection testing to inform HIV prevention responses and surveillance in a programme context: lessons from implementation within a nationally scaled female sex worker programme in Zimbabwe","authors":"Harriet S. Jones,&nbsp;Fortunate Machingura,&nbsp;Leah Gaihai,&nbsp;Memory Makamba,&nbsp;Thomas Chanyowedza,&nbsp;Panganai Masvikeni,&nbsp;Edward Matsikire,&nbsp;Primrose Matambanadzo,&nbsp;Sithembile Musemburi,&nbsp;Phillip N. Chida,&nbsp;Jeffery Dirawo,&nbsp;Owen Mugurungi,&nbsp;Sarah Bourdin,&nbsp;Bernadette Hensen,&nbsp;Lucy Platt,&nbsp;Gary Murphy,&nbsp;James R. Hargreaves,&nbsp;Frances M. Cowan,&nbsp;Brian Rice","doi":"10.1002/jia2.26391","DOIUrl":"10.1002/jia2.26391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In the context of key population HIV testing programmes, identifying new HIV acquisitions, tracking incidence, and responding with prevention and treatment interventions will be critical for achieving HIV epidemic control. Laboratory tests for recently acquired HIV used as part of a “recent infection testing algorithm” (RITA), offer a potential tool to support this work. We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. We enrolled 55.5% (1311/2363) of eligible HIV-positive FSWs to our study, of whom 11.7% (153/1311) were identified as having recently acquired HIV. It took a median of 37 days (IQR 20–67) for samples to be processed. Enrolment rates varied between provinces but the proportion of recently acquired HIV was similar (range: 18.4% to 4.0%). Overall HIV incidence was 3.4 (95% CI 2.7−4.0) per 100py. Where results could be linked to routinely collected data, we found no evidence of a difference in test-positivity between the ICT and SNT contacts of those with recently acquired compared to those with long-term HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation of a RITA was possible within a nationally scaled sex worker programme, and while challenging to implement, can provide an understanding of transmission dynamics and HIV incidence in this context. Sub-optimal recruitment and data linkage limited the interpretation of our findings and opportunities for strategic gains though focusing on HIV prevention efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714992","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":"Preferences of people living with HIV for features of tuberculosis preventive treatment regimens in Uganda: a discrete choice experiment","authors":"Hélène E. Aschmann,&nbsp;Allan Musinguzi,&nbsp;Jillian L. Kadota,&nbsp;Catherine Namale,&nbsp;Juliet Kakeeto,&nbsp;Jane Nakimuli,&nbsp;Lydia Akello,&nbsp;Fred Welishe,&nbsp;Anne Nakitende,&nbsp;Christopher Berger,&nbsp;David W. Dowdy,&nbsp;Adithya Cattamanchi,&nbsp;Fred C. Semitala,&nbsp;Andrew D. Kerkhoff","doi":"10.1002/jia2.26390","DOIUrl":"10.1002/jia2.26390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From July to November 2022, we conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. Participants chose between two hypothetical TPT regimens with five different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects), organized across nine random choice tasks. We analysed preferences using hierarchical Bayesian estimation, latent class analysis and willingness-to-trade simulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high-quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6–33.2), followed by frequency (20.5% [95% CI 19.7–21.3]), duration (19.5% [95% CI 18.6–20.5]) and need for ART dosage adjustment (18.2% [95% CI 17.2–19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (<i>N</i> = 222; 57%); another was averse to ART dosage adjustment (<i>N</i> = 107; 27%); and the last prioritized short regimens with fewer side effects (<i>N</i> = 63; 16%). All groups highly valued fewer pills per dose. Overall, participants were willing to accept a regimen of 2.8 months’ additional duration [95% CI: 2.4–3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4–4.8] months for weekly rather than daily dosing and 2.2 [95% CI 1.3–3.0] months to avoid ART dosage adjustment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To align with preferences of PLHIV in Uganda, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714991","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":"Increasing event-driven HIV pre-exposure prophylaxis use among gay, bisexual and other men who have sex with men in Australia: results from behavioural surveillance 2019–2023","authors":"Curtis Chan,&nbsp;Martin Holt,&nbsp;Anthony K. J. Smith,&nbsp;Timothy R. Broady,&nbsp;James MacGibbon,&nbsp;Limin Mao,&nbsp;Ben Wilcock,&nbsp;John Rule,&nbsp;Benjamin R. Bavinton","doi":"10.1002/jia2.26398","DOIUrl":"https://doi.org/10.1002/jia2.26398","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;HIV pre-exposure prophylaxis (PrEP) has been publicly available since 2018 in Australia as a daily regimen. In 2019, clinical guidelines were updated to support guidance on event-driven PrEP (ED-PrEP) use. We assessed trends in the PrEP dosing regimen by comparing daily PrEP use to ED-PrEP among cisgender gay, bisexual and other men who have sex with men (GBMSM).&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;Data from repeated, cross-sectional, national behavioural surveillance surveys were analysed from 2019 to 2023 among participants not living with HIV. Logistic regression models were conducted to assess trends and compared ED-PrEP users to non-PrEP users and daily PrEP.&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 38,880 participants, overall PrEP use with any regimen increased from 27.6% in 2019 to 42.7% in 2023 (OR = 1.16, 95% CI = 1.15−1.18, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among 12,922 participants who reported PrEP use in the last 6 months, the proportion reporting ED-PrEP use increased from 7.6% in 2019 to 27.8% in 2023 (OR = 1.41, 95% CI = 1.37−1.46, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) with those who reported daily PrEP decreasing from 92.4% to 63.3% (OR = 0.64, 95% CI = 0.62−0.66, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In a cross-sectional sub-sample in 2022–2023 (&lt;i&gt;n&lt;/i&gt; = 8840), compared to ED-PrEP users, non-PrEP users were less likely to have received three or more HIV tests in the last 12 months (aRRR = 0.26, 95% CI = 0.22−0.31, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), have 2−10 male sexual partners in the last 6 months (aRRR = 0.24, 95% CI = 0.14−0.41, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) or 11 or more (aRRR = 0.26, 95% CI = 0.15−0.45, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) compared to none, or to report condomless anal intercourse with casual partners (aRRR = 0.38, 95% CI = 0.32−0.46, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Compared to ED-PrEP users, daily PrEP users were more likely to have received three of more HIV tests in the last year (aRRR = 3.73, 95% CI = 3.15−4.40, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and less likely to be born overseas and lived in Australia for less than 5 years compared to being born in Australia (aRRR = 0.64, 95% CI = 0.49−0.83, &lt;i&gt;p&lt;/i&gt; = 0.001).&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 daily PrEP remains the most common PrEP dosing regimen among GBMSM in Australia, there has been a steep increase in the proportion of PrEP users who are taking ED-PrEP. Monitoring of PrEP use should continue to adapt to new dosing methods and future PrEP options. As ED-PrEP use increases, further work is needed to ensure those taking ED-PrEP are taking it effectively to prevent HI","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707987","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":"Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility","authors":"Lao-Tzu Allan-Blitz,&nbsp;Kenneth H. Mayer","doi":"10.1002/jia2.26393","DOIUrl":"10.1002/jia2.26393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>HIV transmission is ongoing in both high- and low-resource settings. Post-exposure prophylaxis (PEP) remains an important tool in preventing HIV; however, PEP is significantly underutilized. The multitude of barriers to PEP implementation include low patient and provider awareness and acceptability, limited access to treatment and prevention services, and high rates of stigma. The World Health Organization (WHO) recently released updated guidance on the delivery of HIV PEP. This commentary aims to highlight the salient changes, evaluate how such recommendations can overcome the existing barriers to PEP implementation and discuss strategies needed to put the updated guidance into practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The 2024 WHO PEP guidelines continue a trend towards increasing access to PEP. Most notably, the WHO now provides strong recommendations that: (1) PEP be delivered in community settings (e.g. pharmacies, police stations and online platforms), and (2) PEP delivery and monitoring be done via task sharing involving non-specialist health workers (e.g. pharmacists or community health workers). The guidelines also emphasize that the PEP encounter is an important educable moment whereby a transition to pre-exposure prophylaxis among individuals at continued risk for HIV infection should be discussed. The decentralization of PEP delivery has the potential to overcome numerous barriers to PEP implementation, reduce time to initiation and support adherence with the 28-day course. To translate the recommendations into delivery programmes, however, much more work is needed. Detailed templates can help overcome the heterogeneity of both the community settings in which PEP can now be provided and the populations (e.g. survivors of sexual assault, healthcare workers, sex workers, etc.) among whom PEP may be indicated. Training of the workforce will be essential, which should include, as emphasized by the WHO, training in trauma-based care. Novel formulations of and delivery mechanisms for PEP are also emerging, and how such iterations can synergize with decentralized PEP delivery programmes remains to be seen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The updated WHO PEP guidelines make major strides towards increasing access to PEP. Realization of such aims will require ongoing evaluation and support given the heterogeneity in who benefits most from PEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685581","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 ground has shifted under PEPFAR: what does that mean for its future?","authors":"Jennifer Kates,&nbsp;Brian Honermann,&nbsp;Gregorio Millett","doi":"10.1002/jia2.26396","DOIUrl":"10.1002/jia2.26396","url":null,"abstract":"&lt;p&gt;PEPFAR, the U.S. global HIV programme, has been credited with saving 25 million lives and changing the trajectory of the HIV/AIDS pandemic [&lt;span&gt;1&lt;/span&gt;]. Last year, more than 20 million people were on antiretroviral therapy with support from PEPFAR, almost 2 million were newly enrolled on pre-exposure prophylaxis and 327,000 healthcare workers were directly supported by the program. PEPFAR also estimates that more than 5 million babies have been born without HIV. In addition, studies have found that PEPFAR funding is significantly associated with several, positive, knock-on effects beyond HIV, including increases in the gross domestic product (GDP) per capita growth rate, educational retention and childhood vaccination rates [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Created in 2003 in the United States by a Republican President, with strong, bipartisan support in Congress at the time, PEPFAR has largely maintained that support across multiple administrations and congresses, often standing outside the political fray in Washington, DC. But the ground upon which PEPFAR sits has shifted in fundamental ways, perhaps most obviously manifest in the challenges it recently faced in securing a 5-year reauthorization [&lt;span&gt;3&lt;/span&gt;]. These shifts are multifaceted and intertwined and, in most cases, not specific to PEPFAR or HIV, but taken together, suggest a “rethink” for PEPFAR's next phase. Here, we explore some of these shifts and the questions they pose going forward, questions that have become even more important given the outcome of the U.S. election; a second Trump administration and a changing balance in Congress likely mean, at a minimum, even greater scrutiny of the programme.&lt;/p&gt;&lt;p&gt;One of the greatest shifts is in the global economy. While recovering, it continues to experience the economic effects of the COVID-19 pandemic, with GDP growth remaining below historic averages. Fiscal space is further strained by high inflation and the ongoing costs of multiple wars and humanitarian assistance [&lt;span&gt;4&lt;/span&gt;]. For donor governments, these fiscal strains present challenges for financing health and development needs, including for HIV, and many are shifting away [&lt;span&gt;5&lt;/span&gt;]. For low- and middle-income countries, rising debt burden threatens their economic recovery, with many poorer now than before COVID-19 [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;More broadly, reports have found that the human rights environment in many countries is deteriorating, with negative effects on health [&lt;span&gt;6&lt;/span&gt;]. This has particular implications for HIV given that many of the populations most affected—men who have sex with men, transgender women, people who use drugs and other marginalized groups—already face human rights barriers that put them at increased risk for HIV and complicate the ability to control HIV [&lt;span&gt;6&lt;/span&gt;]. There is also evidence that civic space is closing in many localities, making it more difficult for civil society organizations to operate and organize and presenti","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685547","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":"High retention among key populations initiated on HIV pre-exposure prophylaxis in Kigali City, Rwanda","authors":"Athanase Munyaneza,&nbsp;Kiran Bhutada,&nbsp;Qiuhu Shi,&nbsp;Natalia Zotova,&nbsp;Etienne Nsereko,&nbsp;Benjamin Muhoza,&nbsp;Gallican Kubwimana,&nbsp;Gad Murenzi,&nbsp;Laetitia Nyirazinyoye,&nbsp;Kathryn Anastos,&nbsp;Viraj V. Patel,&nbsp;Jonathan Ross","doi":"10.1002/jia2.26392","DOIUrl":"10.1002/jia2.26392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Key populations (KPs) including female sex workers (FSWs) and men who have sex with men (MSM) in sub-Saharan Africa are disproportionately impacted by HIV. Despite the increasing availability of pre-exposure prophylaxis (PrEP), data on retention remain limited. This study assessed PrEP retention at 1 and 12 months among Rwandan FSWs and MSM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed routine clinical data on adult FSWs and MSM receiving PrEP care from 11 health facilities in Kigali, Rwanda between 2019 and 2022. Retention was defined as attendance at regularly scheduled appointments for a PrEP refill. We used logistic regression to assess associations between demographic and clinical characteristics and retention at 1 and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2043 PrEP initiators, 1343 (66%) were FSWs and 700 (34%) were MSM. FSWs reported a median number of eight sexual partners in the prior 7 days, 70% reported condomless sex and 94% considered themselves at high HIV risk. About 1239 (92%) and 1032 (77%) were retained at 1 and 12 months, respectively. One-month retention was lower among FSWs living with others (OR 0.59, 95% CI: 0.35−0.99; ref: living alone) or with low HIV risk perception (OR 0.12, 95% CI: 0.04−0.29). At 12 months, low HIV risk perception remained statistically significant (aOR 0.20, 95% CI: 0.12−0.32). At PrEP initiation, MSM reported a median of four sexual partners in the prior 12 months, 88% reported condomless sex and 72% considered themselves at high HIV risk. Retention rates were 96% at 1 month and 82% at 12 months. At 1 month, retention was higher among MSM with some education (OR 12.74, 95% CI: 2.74−70.93; ref: no education). At 12 months, retention was lower among MSM with part-time employment (aOR 0.29, 95% CI: 0.11, 0.76), students (aOR 0.12, 95% CI: 0.04, 0.37) and unemployed (aOR 0.12, 95% CI: 0.05, 0.28); ref: full-employed) and those unaware of PrEP at baseline (aOR 0.15, 95% CI: 0.10, 0.23).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed very high rates of PrEP retention among Rwandan FSWs and MSM. Predictors of retention included living situation, employment status, HIV risk perception and low PrEP awareness, but differed between FSWs and MSM. These findings suggest that targeted awareness campaigns tailored to different KPs could improve PrEP retention in care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680146","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":"Learning from the first: a qualitative study of the psychosocial benefits and treatment burdens of long-acting cabotegravir/rilpivirine among early adopters in three U.S. clinics","authors":"Katerina A. Christopoulos,&nbsp;Mollie B. Smith,&nbsp;Priyasha Pareek,&nbsp;Alicia Dawdani,&nbsp;Xavier A. Erguera,&nbsp;Kaylin V. Dance,&nbsp;Ryan S. Walker,&nbsp;Janet Grochowski,&nbsp;Francis Mayorga-Munoz,&nbsp;Matthew D. Hickey,&nbsp;Mallory O. Johnson,&nbsp;John Sauceda,&nbsp;Jose I. Gutierrez Jr.,&nbsp;Elizabeth T. Montgomery,&nbsp;Jonathan A. Colasanti,&nbsp;Lauren F. Collins,&nbsp;Moira C. McNulty,&nbsp;Kimberly A. Koester","doi":"10.1002/jia2.26394","DOIUrl":"10.1002/jia2.26394","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;Perspectives on long-acting injectable cabotegravir/rilpivirine (CAB/RPV-LA) from HIV health disparity populations are under-represented in current literature yet crucial to optimize delivery.&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;Between August 2022 and May 2023, we conducted in-depth interviews with people with HIV (PWH) at four HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current CAB/RPV-LA use with receipt of ≥3 injections or CAB/RPV-LA discontinuation. We purposefully sampled for PWH who initiated with viraemia (plasma HIV RNA &gt;50 copies/ml) due to adherence challenges, discontinuers, and cis and trans women. Interviews were coded and analysed using thematic methods grounded in descriptive phenomenology. Clinical data were abstracted from the medical record.&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 sample (San Francisco &lt;i&gt;n&lt;/i&gt; = 25, Atlanta &lt;i&gt;n&lt;/i&gt; = 20, Chicago &lt;i&gt;n&lt;/i&gt; = 14 for total &lt;i&gt;n&lt;/i&gt; = 59, median number of injections = 6) consisted of 48 PWH using CAB/RPV-LA and 11 who had discontinued. The median age was 50 (range 25–73) and 40 (68%) identified as racial/ethnic minorities, 19 (32%) cis or trans women, 16 (29%) were experiencing homelessness/unstable housing, 12 (20%) had recently used methamphetamine or opioids and 11 (19%) initiated with viraemia. All participants except one (who discontinued) had evidence of viral suppression at interview. Typical benefits of CAB/RPV-LA included increased convenience, privacy and freedom from being reminded of HIV and reduced anxiety about forgetting pills. However, PWH who became virally suppressed through CAB/RPV-LA use also experienced an amelioration of feelings of shame and negative self-worth related to oral adherence challenges. Regardless of baseline viral suppression status, successful use of CAB/RPV-LA amplified positive provider/clinic relationships, and CAB/RPV-LA was often viewed as less “work” than oral antiretroviral therapy, which created space to attend to other aspects of health and wellness. For some participants, CAB/RPV-LA remained “work,” particularly with regard to injection site pain and visit frequency. At times, these burdens outweighed the aforementioned benefits, resulting in discontinuation.&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;CAB/RPV-LA offers a range of logistical, psychosocial and care engagement benefits, which are experienced maximally by PWH initiating with viraemia due to adherence challenges; however, benefits do not always outweigh treatment burdens ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680150","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":"In-utero exposure to tenofovir-containing pre-exposure prophylaxis and bone mineral content in HIV-unexposed infants in South Africa","authors":"Kerusha Reddy,&nbsp;Kimesh L. Naidoo,&nbsp;Carl Lombard,&nbsp;Zukiswa Godlwana,&nbsp;Alicia C. Desmond,&nbsp;Richard Clark,&nbsp;James F. Rooney,&nbsp;Glenda Gray,&nbsp;Dhayendre Moodley","doi":"10.1002/jia2.26379","DOIUrl":"10.1002/jia2.26379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tenofovir disoproxil fumarate (TDF) is a common drug of choice for pre-exposure prophylaxis (PrEP) or as a combination HIV treatment for pregnant women. In-utero exposure to TDF was found to be associated with lower bone mineral content (BMC) in HIV-exposed uninfected neonates. Data for infants born to women taking TDF-PrEP are lacking. The CAP016 randomized control trial was conducted in South Africa between September 2017 and August 2021 and pregnant women either initiated TDF/FTC PrEP in pregnancy (Immediate PrEP arm-IP) or at cessation of breastfeeding (Deferred PrEP arm-DP). In a secondary data analysis, we evaluated BMC in HIV-unexposed infants in the CAP016 trial in the first 18 months of life in association with maternal TDF-PrEP use during pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Infants born to women randomized to the IP arm or DP arm in the CAP016 clinical trial had BMC measurements of the whole body with head (WBH) and lumbar spine (LS) by dual energy X-ray absorptiometry (DXA) at 6, 26, 50 and 74 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 481 infants born to women enrolled in the CAP016 clinical trial, 335 (69.6%) infants had a minimum of one DXA scan of the WBH and LS between 6 and 74 weeks of age (168 IP and 167 DP). Women in the IP arm received TDF-FTC PreP for a median of 19 weeks between initiation in pregnancy and delivery. Using a mixed linear regression model and adjusted for gestational age, sex and ever-breastfed, the mean difference (95% CI) for BMC of the WBH between IP and DP arms were −0.74 (−8.69 to 7.20), −1.26 (−10.75 to 8.23), −9.17 (−20.02 to 1.69) and 5.02 (−6.74 to 16.78) g at 6, 26, 50 and 74 weeks (<i>p</i> = 0.283). Mean differences in BMC of the LS were 0.07 (−0.10 to 0.23), 0.02 (−0.18 to 0.22), −0.14 (−0.36 to 0.09) and 0.14 (−0.11 to 0.38) g at 6, 26, 50 and 74 weeks, respectively (<i>p</i> = 0.329).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a randomized controlled trial, there were no differences in BMC of the WBH and LS between infants exposed to in-utero TDF-FTC PrEP and unexposed infants in the first 18 months of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613147","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}