Journal of the International AIDS Society最新文献

{"title":"Current drug use patterns and HIV and HCV prevalence among people who inject drugs in suburban areas of Malaysia","authors":"Joselyn Pang,&nbsp;Mahmoud Danaee,&nbsp;Vicknasingam Balasingam Kasinather,&nbsp;Don Des Jarlais,&nbsp;Adeeba Kamarulzaman,&nbsp;NA Mohd Salleh","doi":"10.1002/jia2.26420","DOIUrl":"https://doi.org/10.1002/jia2.26420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>National surveillance data in Malaysia has observed a marked reduction in the number of new HIV cases among people who inject drugs (PWID) in the past decade. This study sought to estimate the current prevalence and associated risk factors of HIV and hepatitis C virus (HCV) among PWID in suburban areas of Klang Valley, Malaysia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between September 2021 and March 2022, a cross-sectional, respondent-driven sampling survey was conducted. Participants completed rapid HIV and HCV testing as well as social and behavioural assessments. Factors associated with HIV- and HCV-positive results were estimated using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four-hundred individuals were recruited in the study, of whom 382 (94%) were men. The prevalence of HIV and HCV was 5.5% (95% confidence interval [95% CI]: 3.6–8.3) and 40.5% (95% CI: 35.7–45.5), respectively. Current heroin and amphetamine-type stimulant (ATS) use, regardless of injection or non-injection use, were reported by 340 (85.0%) and 328 (82.0%) individuals, respectively. Past exposure to the criminal justice system (lock-ups, prison and compulsory drug detention centres) was associated with both HIV (Adjusted odds ratio [aOR] = 3.47, 95% CI: 1.33–10.2) and HCV (aOR = 3.32, 95% CI: 2.06–5.39)-positive results. Additionally, HIV-positive results were associated with current ATS use (aOR = 0.31, 95% CI: 0.12–0.86). Meanwhile, HCV-positive results were associated with current heroin use (aOR = 2.44, 95% CI: 1.16–5.48), lifetime enrolment in methadone treatment (aOR = 2.30, 95% CI: 1.23–4.27), current methadone treatment (aOR = 0.46, 95% CI: 0.23–0.92) and current mixing of drugs through injection use (aOR = 1.80, 95% CI: 1.08–3.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study observed low HIV prevalence among PWID, primarily associated with ATS use, while HCV prevalence, linked to heroin use, remained high. Higher odds of being HCV positive among PWID who reported to have ever but not currently enrolled in methadone programmes indicate that treatment may not be continuous once initiated, potentially due to exposure to the criminal justice system. These findings underscore the need for a dual approach: enhanced harm reduction programmes for PWID and a legal reform to address potential barriers posed by criminalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 5","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875489","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 key design features and effectiveness of social network interventions for HIV testing and linkage services in low- and middle-income countries: a systematic review and meta-analysis","authors":"Madalo Mukoka,&nbsp;Takondwa C. Msosa,&nbsp;Hussein H. Twabi,&nbsp;Robina Semphere,&nbsp;Marriott Nliwasa,&nbsp;Guy Harling,&nbsp;Alison Price,&nbsp;Katherine Fielding,&nbsp;Augustine T. Choko","doi":"10.1002/jia2.26458","DOIUrl":"https://doi.org/10.1002/jia2.26458","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 remains a global health challenge with a reported 39 million people living with HIV (PLHIV) in 2022. Sub-Saharan Africa, Asia and the Pacific are home to 82% of PLHIV, where limited access to healthcare resources underscores the urgency of innovative strategies to combat the epidemic effectively. Social network interventions (SNIs) hold promise for improving HIV testing and linkage services by engaging populations at greatest risk. This review evaluates the key design features and effectiveness of SNIs for HIV testing and linkage in low- and middle-income countries (LMICs).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We searched four databases (Medline, Embase, Global Health, Web of Science) for the period from 1st January 2003 until 16th June 2023. A combination of the terms “Social Network,” “HIV,” “testing” and “linkage” with an LMIC filter was used. We included interventional study designs that compared an SNI for HIV testing and/or linkage to care against non-network comparator approaches. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results.&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;Of the 6763 records, 13 studies met the inclusion criteria; eight were randomized controlled trials, and five were non-randomized designs. Nine studies engaged key populations. The most common strategy involved recruiting and training seeds, who then delivered HIV services to network members. The use of networks varied significantly across the papers. The network approaches used were induction (&lt;i&gt;n&lt;/i&gt; = 11), alteration (&lt;i&gt;n&lt;/i&gt; = 1) and a combination of individual and segmentation approaches (&lt;i&gt;n&lt;/i&gt; = 1). The pooled estimates showed that SNIs had a modest effect on the uptake of HIV testing RR 1.12 [95% CI 1.08−1.17) but the directionality of effect for the proportion newly diagnosed positive (RR 0.88 [95% CI 0.74−1.04]) and linkage to care (RR 0.98 [95% CI 0.86−1.08]) was towards the null.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;SNIs improved the uptake of HIV testing and exhibit important variability in their design.&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;There is a need for more studies designed to capture the complex relational dynamics of network interventions and to provide strong evidence on their isolated effects. Additionally, it is necessary to expand the use of network approaches to other priority populations.&lt;/p&gt;\u0000 &lt;/sectio","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 5","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875598","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":"“It gives me the strength and courage to take care of myself”: a qualitative exploration of experiences with STI testing among women who initiated PrEP during pregnancy in Western Kenya","authors":"Jerusha N. Mogaka,&nbsp;Tessa Concepcion,&nbsp;Felix Abuna,&nbsp;Eunita Akim,&nbsp;Chelsea Morroni,&nbsp;Aamirah Mussa,&nbsp;Melissa Mugambi,&nbsp;Helen Aketch,&nbsp;Sarah Obatsa,&nbsp;Allison R. Webel,&nbsp;John Kinuthia,&nbsp;Kenneth Ngure,&nbsp;Kristin M. Beima-Sofie,&nbsp;Grace John-Stewart,&nbsp;Jillian Pintye","doi":"10.1002/jia2.26464","DOIUrl":"https://doi.org/10.1002/jia2.26464","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;Sexually transmitted infections (STIs) in pregnancy contribute to poor perinatal outcomes and increased HIV acquisition risk, underscoring the importance of delivering STI/HIV services within antenatal care. Few studies evaluate women's perspectives on the co-delivery of antenatal STI testing and HIV pre-exposure prophylaxis (PrEP). We sought to understand motivations for and experiences with STI testing among pregnant women who initiated HIV PrEP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted semi-structured in-depth interviews (IDIs) among a subset of women enrolled in a randomized trial in Western Kenya (NCT04472884) who initiated PrEP within antenatal clinics and tested for &lt;i&gt;Chlamydia trachomatis&lt;/i&gt; (CT) and &lt;i&gt;Neisseria gonorrhoeae&lt;/i&gt; (NG) in pregnancy and/or postpartum. As part of parent study procedures, IDIs were conducted between September 2023 and April 2024. Interviews were recorded, transcribed and thematically analysed using deductive and inductive methods. The Health Belief Model guided exploration of STI testing experiences, motivations for testing and the impact of testing on PrEP use.&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;Overall, 39 women who initiated PrEP during pregnancy and tested for CT/NG participated in IDIs; six tested positive for CT and/or NG. Median age was 26 years (IQR 21–29), 77% of participants had &gt;8 years of education, 15% were employed and 72% were married. Most (86%) did not know their partner's HIV status, and 82% persisted with PrEP use at 9 months postpartum. Perceived vulnerability to STI/HIV acquisition, fear of adverse outcomes from untreated infections (e.g. pregnancy loss or harm to baby) and desire to alleviate symptoms (e.g. abnormal discharge) motivated STI testing uptake when offered during antenatal visits. Provision of STI-related education, availability of STI services (i.e. immediate treatment, expedited partner therapy) and supportive interactions with providers promoted positive experiences with STI testing. STI testing encouraged health-promoting behaviours, including sustained PrEP use, even when STI results were negative, as testing made women feel proactively involved in preventing HIV/STI complications for themselves and their infants.&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;In this qualitative evaluation among women who initiated PrEP in pregnancy, STI testing encouraged PrEP use, even when results were negative. Incorporating STI testing within PrEP delivery in antenatal care represents an opportunity for add","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865926","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":"Machine learning to improve HIV screening using routine data in Kenya","authors":"Jonathan D. Friedman,&nbsp;Jonathan M. Mwangi,&nbsp;Kennedy J. Muthoka,&nbsp;Benedette A. Otieno,&nbsp;Jacob O. Odhiambo,&nbsp;Frederick O. Miruka,&nbsp;Lilly M. Nyagah,&nbsp;Pascal M. Mwele,&nbsp;Edmon O. Obat,&nbsp;Gonza O. Omoro,&nbsp;Margaret M. Ndisha,&nbsp;Davies O. Kimanga","doi":"10.1002/jia2.26436","DOIUrl":"https://doi.org/10.1002/jia2.26436","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;Optimal use of HIV testing resources accelerates progress towards ending HIV as a global threat. In Kenya, current testing practices yield a 2.8% positivity rate for new diagnoses reported through the national HIV electronic medical record (EMR) system. Increasingly, researchers have explored the potential for machine learning to improve the identification of people with undiagnosed HIV for referral for HIV testing. However, few studies have used routinely collected programme data as the basis for implementing a real-time clinical decision support system to improve HIV screening. In this study, we applied machine learning to routine programme data from Kenya's EMR to predict the probability that an individual seeking care is undiagnosed HIV positive and should be prioritized for testing.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We combined de-identified individual-level EMR data from 167,509 individuals without a previous HIV diagnosis who were tested between June and November 2022. We included demographics, clinical histories and HIV-relevant behavioural practices with open-source data that describes population-level behavioural practices as other variables in the model. We used multiple imputations to address high rates of missing data, selecting the optimal technique based on out-of-sample error. We generated a stratified 60-20-20 train-validate-test split to assess model generalizability. We trained four machine learning algorithms including logistic regression, Random Forest, AdaBoost and XGBoost. Models were evaluated using Area Under the Precision-Recall Curve (AUCPR), a metric that is well-suited to cases of class imbalance such as this, in which there are far more negative test results than positive.&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;All model types demonstrated predictive performance on the test set with AUCPR that exceeded the current positivity rate. XGBoost generated the greatest AUCPR, 10.5 times greater than the rate of positive test results.&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;Our study demonstrated that machine learning applied to routine HIV testing data may be used as a clinical decision support tool to refer persons for HIV testing. The resulting model could be integrated in the screening form of an EMR and used as a real-time decision support tool to inform testing decisions. Although issues of data quality and missing data remained, these challenges could be addressed using sound data preparation techniques.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 &lt;/div","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853039","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":"Prevalence, correlates and solutions to people with HIV in China being refused treatment for diseases not related to HIV: a mixed-methods study","authors":"Yuqing Hu,&nbsp;Xinyi Zhou,&nbsp;Xinxue Fan,&nbsp;Rongjun Bi,&nbsp;Yingqi Deng,&nbsp;Hui Li,&nbsp;Xin Peng,&nbsp;Dan Luo,&nbsp;Heping Zhao,&nbsp;Zhihui Guo,&nbsp;Longtao He,&nbsp;Huachun Zou","doi":"10.1002/jia2.26443","DOIUrl":"https://doi.org/10.1002/jia2.26443","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;Existing studies on treatment refusal towards people with HIV (PWH) lack focus on the Chinese context and key factors. We aimed to elucidate the prevalence, correlates and solutions to PWH being refused treatment for diseases not related to HIV (DNRH) in China.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a mixed-methods study of PWH and healthcare providers (HCPs) between April 2021 and June 2022. An online survey of PWH assessed the prevalence and correlates of treatment refusal for DNRH during their most recent outpatient or inpatient visit. Semi-structured telephone interviews were conducted with PWH and HCPs to understand their experiences of treatment refusal and to generate potential solutions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We included 35 PWH and 30 HCPs in the interviews, and 902 PWH in the survey. In the survey, 42.2% and 63.0% of PWH reported treatment refusal for DNHR during their most recent outpatient and inpatient visit, respectively. Among outpatients, PWH who were &lt;30 years old (AOR: 0.43, 95% CI: 0.25−0.73), acquired HIV through male-male sex (0.56, 0.35−0.90) and did not disclose their HIV status to HCPs (0.64, 0.42−0.96) were less likely to report treatment refusal. PWH who were not adherent to antiretroviral therapy (10.66, 1.16−98.20), had their outpatient visit before the COVID-19 pandemic (1.74, 1.00−3.00) and received care at a surgical department (2.10, 1.23−3.60) were more likely to report treatment refusal. Among inpatients, PWH who received care from a male HCP (2.31, 1.27−4.22) and were hospitalized in central provinces of China (2.60, 1.07−6.31) had higher odds of treatment refusal. In semi-structured interviews, we found HCP refusal to treat PWH for DNRH could be influenced by stigma against HIV, concerns about HIV acquisition, limited knowledge of HIV post-exposure prophylaxis and insufficient protection from health authorities against discrimination by HIV status. Participants identified several solutions that may help mitigate treatment refusal, including supporting PWH to achieve virologic suppression, HIV education for HCPs, employment protections and compensation for HCPs who acquire HIV in the workplace, and the establishment of dedicated government offices and laws to address treatment refusal.&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;Treatment refusal for DNRH was common among PWH in China. Factors contributing to treatment refusal involve PWH, HCPs and health authorities. Systematic interventions involving all stakeholders, p","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26443","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818609","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":"Differences in clinical characteristics between adolescents and young adults with perinatally and sexually acquired HIV in the Asia-Pacific region","authors":"Phatharajit Phatharodom,&nbsp;Alan Maleesatharn,&nbsp;Tavitiya Sudjaritruk,&nbsp;Suwimon Khusuwan,&nbsp;Kathy Petoumenos,&nbsp;Linda Aurpibul,&nbsp;Romanee Chaiwarith,&nbsp;Michelle L. Giles,&nbsp;Du Tuan Quy,&nbsp;Smita Nimkar,&nbsp;Alvina Widhani,&nbsp;Junko Tanuma,&nbsp;Matthew Law,&nbsp;Annette H. Sohn,&nbsp;Kulkanya Chokephaibulkit,&nbsp;IeDEA Asia-Pacific","doi":"10.1002/jia2.26400","DOIUrl":"https://doi.org/10.1002/jia2.26400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We assessed the long-term HIV-related health outcomes of young adults with perinatally acquired HIV (PHIV) compared with those who acquired HIV through sexual transmission in the Asia-Pacific region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study using data from three paediatric and adult cohorts within the International epidemiology Databases to Evaluate AIDS (IeDEA) Asia-Pacific consortium. This study included data from 12 countries, collected between 1991 and 2021. Young adults with available data who had been on antiretroviral therapy (ART) for at least 1 year were included. Analyses were conducted at ages 18 and 25 years and compared by route of HIV acquisition. Factors associated with viral suppression (&lt;200 copies/ml) at age 25 were identified using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 1333 individuals included at age 18 (96% with PHIV: 46% male) and 305 at age 25 (27% with PHIV; 75% male). Compared to those with sexually acquired HIV at age 18, those with PHIV had a longer median duration of ART (10 vs. 4 years, <i>p&lt;</i>0.001), higher current CD4 count (606 vs. 462 cells/mm³, <i>p =</i> 0.001), were shorter (height 158 vs. 166 cm, <i>p&lt;</i>0.001), with more hypercholesterolemia (20% vs. 5%, <i>p</i> = 0.031) and hypertriglyceridemia (29% vs. 6% mg/dl, <i>p</i> = 0.003). At age 25, differences in duration of ART (15 vs. 3 years, <i>p&lt;</i>0.001), male height (165 vs. 173 cm, <i>p =</i> 0.009) and proportion with hypertriglyceridemia (38% vs. 15%, <i>p =</i> 0.002) were observed. HIV viral suppression did not vary by mode of acquisition (89% vs. 87% at age 18; 91% vs. 85% at age 25). At age 25, living in Thailand (adjusted odds ratio [AOR] 6.05, 95% confidence interval [CI] 1.95−18.80) and use of integrase inhibitor-based regimens (AOR 5.20, 95% CI 1.62−16.65) or protease inhibitor-based regimens (AOR 2.62, 95% CI 1.01−6.79) were associated with viral suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Young adults with PHIV who survived to ages 18 and 25 were more likely to have stunted growth but had similar viral suppression to those with sexually acquired HIV in our regional cohorts. However, viral suppression rates remained lower for all relative to the UNAIDS goal of 95%, and measures to improve treatment outcomes are needed for young adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801519","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":"Exploring potential drug−drug interactions between masculinizing hormone therapy and oral pre-exposure prophylaxis (F/TDF and F/TAF) among transgender men (iMACT study): a randomized, open-label pharmacokinetic study in Thailand","authors":"Akarin Hiransuthikul,&nbsp;Narukjaporn Thammajaruk,&nbsp;Stephen Kerr,&nbsp;Rena Janamnuaysook,&nbsp;Siriporn Nonenoy,&nbsp;Piranun Hongchookiat,&nbsp;Rapee Trichavaroj,&nbsp;Yardpiroon Tawon,&nbsp;Jakkrapatara Boonruang,&nbsp;Nipat Teeratakulpisarn,&nbsp;Tim R. Cressey,&nbsp;Peter L. Anderson,&nbsp;Nittaya Phanuphak,&nbsp;the iMACT study team","doi":"10.1002/jia2.26445","DOIUrl":"https://doi.org/10.1002/jia2.26445","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;Concerns regarding potential drug−drug interactions (DDIs) between hormone therapy and pre-exposure prophylaxis (PrEP) may hinder PrEP use among transgender persons. Transgender men have often been overlooked in biomedical HIV research, and potential DDIs between masculinizing hormone therapy (MHT) and PrEP have not been addressed. We aimed to assess the potential DDIs between MHT and daily oral PrEP among transgender men.&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;Transgender men without HIV who never underwent oophorectomy were enrolled between May and October 2022. Participants were randomly assigned to receive emtricitabine-tenofovir disoproxil fumarate (F/TDF) or emtricitabine-tenofovir alafenamide (F/TAF) for daily oral PrEP. Intramuscular testosterone enanthate 200 mg was administered every 2 weeks from baseline to week 12, while oral PrEP was initiated at week 6 and continued until week 16. Pharmacokinetic (PK) sampling was conducted at weeks 4 and 12 to assess the impact of PrEP on MHT and at weeks 12 and 16 to evaluate the impact of MHT on PrEP. Plasma total testosterone, TAF, tenofovir (TFV) and FTC; tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) concentrations in peripheral blood mononuclear cells (PBMCs) were measured in all participants. Cervical and rectal tissues were obtained in a subset of 20 participants (10 per group) to measure TDF-DP and FTC-TP.&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;Thirty-nine participants (19 F/TDF and 20 F/TAF) completed the PK visits. No significant changes in the PK parameters of plasma total testosterone, TFV, FTC and TAF (for F/TAF group); urine TFV and FTC; and PBMC and rectal tissue TFV-DP and FTC-TP were observed when MHT and PrEP were administered together. Both TFV-DP and FTC-TP concentrations in cervical tissue were significantly lower when MHT was co-administered with F/TAF (TFV-DP: median [IQR] of 12.9 [6.78–14.56] fmol/mg at weeks 12 vs. 20.63 [7.47–53.43] fmol/mg at week 16, &lt;i&gt;p&lt;/i&gt; = 0.04; and FTC-TP: 67.05 [27.24–77.24] fmol/mg vs. 120.43 [65.98–245.76] fmol/mg, &lt;i&gt;p&lt;/i&gt; = 0.02).&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;Our findings across multiple anatomical compartments suggest that oral PrEP should not affect the effectiveness of MHT and that F/TDF-based PrEP should be effective when taken with MHT. However, further research is needed to assess the effectiveness of TAF-based PrEP in transgender men.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Clin","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793504","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 adolescent and youth-friendly HIV services: a cross-sectional assessment across 16 global sites","authors":"Lonnie Embleton,&nbsp;Tavitiya Sudjaritruk,&nbsp;Daisy Maria Machado,&nbsp;Belinda Chihota,&nbsp;Françoise Musabyimana,&nbsp;Julie Jesson,&nbsp;Edith Apondi,&nbsp;Thanyawee Puthanakit,&nbsp;Marco Tulio Luque,&nbsp;Nicola Ellen van Dongen,&nbsp;Gad Murenzi,&nbsp;Madeleine Amorissani-Folquet,&nbsp;Zachary Kwena,&nbsp;Nicole Perreras,&nbsp;Vanessa Rouzier,&nbsp;Rita Lyamuya,&nbsp;Kim Anderson,&nbsp;Batya Elul,&nbsp;Valériane Leroy,&nbsp;Leslie A. Enane,&nbsp;Roxanne Martin,&nbsp;Kathryn Lancaster,&nbsp;Angela M. Parcesepe,&nbsp;Rachel Vreeman,&nbsp;IeDEA","doi":"10.1002/jia2.26437","DOIUrl":"https://doi.org/10.1002/jia2.26437","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 and youth-friendly health services (AYFHS) have been promoted as a best practice for adolescents and young people living with HIV (AYLH). However, thorough descriptions of AYFHS for AYLH remain scarce. We sought to characterize adolescent-friendly HIV services in a global paediatric research consortium.&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;Cross-sectional data were collected from 16 global sites in the Adolescent and Young Adult Network of IeDEA (AYANI) of the International epidemiology Databases to Evaluate AIDS consortium between August 2020 and October 2022 using a standardized site assessment tool that collected data on clinic, patient and provider characteristics, differentiated care, and transition to adult services processes. Descriptive analyses characterized the health services available across the participating sites, using frequencies and proportions for categorical variables and medians and interquartile range for continuous variables. Data were analysed using RStudio.&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;Overall, 13 of 16 sites (81%) reported having dedicated adolescent services, which most often consisted of dedicated clinic days (62%, &lt;i&gt;n&lt;/i&gt; = 8/13), primarily offered on weekdays. Across all sites, nurses and counsellors delivered services to adolescents. Over half of all clinics (69%, &lt;i&gt;n&lt;/i&gt; = 11/16) reported offering health education to adolescents to facilitate adolescent health literacy. Peer educators and navigators were involved in delivering services at 62% of sites, primarily in those with dedicated adolescent services (69%, &lt;i&gt;n&lt;/i&gt; = 9/13). There was limited integration of sexual and reproductive health services into HIV clinics for adolescents. With 63% of clinics conducting pregnancy screening, 50% providing family planning methods and 38% providing cervical cancer screening. Under half of all HIV clinics screened for physical abuse or violence (44%, &lt;i&gt;n&lt;/i&gt; = 7/16) and sexual abuse or rape (38%, &lt;i&gt;n&lt;/i&gt; = 6/16). A low proportion of clinics screened for risk factors related to young key populations, including drug use (56%, &lt;i&gt;n&lt;/i&gt; = 9/16), homelessness (38%, &lt;i&gt;n&lt;/i&gt; = 6/16) young men having sex with men (31%, &lt;i&gt;n&lt;/i&gt; = 5/16) and transactional sex (31%, &lt;i&gt;n&lt;/i&gt; = 5/16). Mental health screening for concerns was variable.&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;Findings suggest gaps in AYFHS for AYLH across the HIV clinics included in this analysis. There is a vital need to design health services for AYLH that are accessible, equitabl","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770069","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":"PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey","authors":"Gede Benny Setia Wirawan,&nbsp;Heather-Marie Schimdt,&nbsp;Curtis Chan,&nbsp;Doug Fraser,&nbsp;Jason J. Ong,&nbsp;Michael Cassell,&nbsp;Lei Zhang,&nbsp;Warittha Tieosapjaroen,&nbsp;Nittaya Phanuphak,&nbsp;Weiming Tang,&nbsp;Nicky Suwandi,&nbsp;Kimberly A. Green,&nbsp;Timothy Dobbins,&nbsp;Benjamin R. Bavinton","doi":"10.1002/jia2.26438","DOIUrl":"https://doi.org/10.1002/jia2.26438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PrEP APPEAL survey was a cross-sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self-identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower-middle-income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (<i>n</i> = 11,427/13,899) of participants were aware of PrEP, 35.0% (<i>n</i> = 4000/11,427) had used it before and 70.1% (<i>n</i> = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (<i>n</i> = 4068/7427) PrEP-naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (<i>n</i> = 2996/4068) of them expressed willingness to use PrEP and 83.0% (<i>n</i> = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system-level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual-level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale-up efforts. Future PrEP programmes should address system-level barriers to support PrEP uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726848","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":"Evidence from high-income countries on the effectiveness of psychosocial interventions to improve mental health, wellbeing and quality of life for adults living with HIV: a systematic review and meta-analysis","authors":"Ada R. Miltz,&nbsp;Janey Sewell,&nbsp;Fumiyo Nakagawa,&nbsp;Sophia M. Rein,&nbsp;Lorraine Sherr,&nbsp;Alison Rodger,&nbsp;Andrew N. Phillips,&nbsp;Sanne vanLuenen,&nbsp;Nadia Garnefski,&nbsp;Vivian Kraaij,&nbsp;Colette J. Smith,&nbsp;Valentina Cambiano,&nbsp;Fiona C. Lampe","doi":"10.1002/jia2.26424","DOIUrl":"https://doi.org/10.1002/jia2.26424","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;There is a need to synthesize recent evidence on the effectiveness of psychosocial interventions to improve mental health, quality of life and wellbeing in adults living with HIV in high-income countries. A systematic review and meta-analysis was conducted to address this research gap.&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;Medline, Embase, Psychinfo and Web of science were searched (from 2008 to December 2023). In total, 67 randomized controlled trials (RCTs) of psychosocial intervention among adults living with HIV in high-income countries were eligible.&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;In the meta-analysis, there was an overall positive effect of interventions on reducing depression (&lt;i&gt;N&lt;/i&gt; = 40; standardized mean difference [SMD] −0.19 [95% CI: −0.29, −0.10]), anxiety (&lt;i&gt;N&lt;/i&gt; = 15; SMD −0.12 [−0.23, −0.02]), stress (&lt;i&gt;N&lt;/i&gt; = 13; SMD −0.22 [−0.41, −0.04]), and other measures of poor wellbeing (&lt;i&gt;N&lt;/i&gt; = 19; SMD −0.18 [−0.35, −0.02]) and increasing levels of coping/self-efficacy (&lt;i&gt;N&lt;/i&gt; = 8; SMD 0.17 [0.04, 0.31]). For depression, interventions that used symptom screening above a threshold score to identify eligible individuals were more effective than those without such an eligibility criterion (SMD −0.29 vs. -0.10, &lt;i&gt;p&lt;/i&gt; = 0.023). Interventions compared to standard care controls had a greater effect on depression versus interventions compared to not standard care controls, when the latter category included standard care controls that received intentional support (SMD -0.28 vs. -0.11, &lt;i&gt;p&lt;/i&gt; = 0.035). There was also weak evidence of an overall positive effect on: reducing stigma (&lt;i&gt;N&lt;/i&gt; = 7; SMD −0.17 [−0.35, 0.02]), and improving social support/participation (&lt;i&gt;N&lt;/i&gt; = 6; SMD 0.17 [−0.02, 0.35]), mental health quality of life (&lt;i&gt;N&lt;/i&gt; = 12; SMD 0.09 [−0.01, 0.19]), physical health quality of life (&lt;i&gt;N&lt;/i&gt; = 11; SMD 0.07 [−0.02, 0.16]) and quality of social life (&lt;i&gt;N&lt;/i&gt; = 6; SMD 0.10 [−0.04, 0.24]). There was no evidence found for an effect on loneliness, although data were limited.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Pooled effect estimates were small or small tomoderate. In line with previous literature, there was no evidence of differential effects on depression according to the intervention type (psychotherapeutic vs. other).&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;Evidence from RCTs suggest that psychosocial interventions are effective ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707542","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}