Journal of the International AIDS Society最新文献

{"title":"Put rights at the centre of person- and people-centred HIV prevention","authors":"Megan McLemore,&nbsp;Joseph J. Amon","doi":"10.1002/jia2.70028","DOIUrl":"https://doi.org/10.1002/jia2.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>“Person-centred” and “people-centred” HIV prevention programmes both seek to scale up access to HIV prevention services. A “person-centred” approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A “people-centred” approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In 2017, the Global Fund's <i>Breaking Down Barriers</i> initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019–2021 and 2022–2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237104","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":"Oral pre-exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review","authors":"Anke Rotsaert,&nbsp;Zaynab Essack,&nbsp;Shannon Bosman,&nbsp;Dvora Joseph Davey,&nbsp;Bernadette Hensen","doi":"10.1002/jia2.70035","DOIUrl":"https://doi.org/10.1002/jia2.70035","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;In 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long-acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person-centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC.&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 systematically searched three databases for English-language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self-reported use), continuation (persistent use over time) and/or adherence (self-reported and/or objective).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow-up time) precluded meta-analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow-up periods from 1 month post-enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self-reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk-based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two-way SMS communication (Kenya) and real-time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard-of-care.&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;Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237232","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":"Laser hair removal to antiretrovirals: findings from a person-centred care model for transgender people in India","authors":"Simran Shaikh,&nbsp;Parthasarathy Mugundu Ramien,&nbsp;Jade Bell,&nbsp;Kanchan Pawar,&nbsp;Allison M. McFall,&nbsp;Saya Okram,&nbsp;Ajay Enugu,&nbsp;Lakshmi Ganapathi,&nbsp;Maria Salvat Ballester,&nbsp;Viswanathan Arumugam,&nbsp;Rose Pollard Kaptchuk,&nbsp;Aditya Singh,&nbsp;Shantanu Kumar Purohit,&nbsp;Alex Keuroghlian,&nbsp;Kevin Ard,&nbsp;Shruti H. Mehta,&nbsp;Sukhvinder Kaur,&nbsp;Kenneth H. Mayer,&nbsp;Sunil Suhas Solomon","doi":"10.1002/jia2.70041","DOIUrl":"https://doi.org/10.1002/jia2.70041","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;Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Since 2021, we established three “&lt;i&gt;Mitr&lt;/i&gt;” (meaning: friend) clinics in Hyderabad, Pune and Thane, India, for transgender people with staffing primarily from the community. &lt;i&gt;Mitr&lt;/i&gt; clinics provide free HIV testing and pre-exposure prophylaxis (PrEP) on site with linkage to government antiretroviral therapy (ART) centres. They also provide free consultation for gender-affirming hormone therapy (GAHT), subsidized laser hair removal and legal assistance. Client service utilization data were analysed using summary statistics to evaluate uptake of HIV and gender-affirming services; correlates of HIV testing were examined using logistic regression. Semi-structured interviews conducted at one site were used to understand barriers/facilitators of HIV testing.&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;A total of 5223 unique clients registered between March 2021 and September 2024; median age was 26 years. Most (86%) self-identified as TGW, and 35% reported transactional sex. Most clients (70%) had not previously accessed public sector HIV services. The majority (75%) accessed &lt;i&gt;Mitr&lt;/i&gt; clinics for gender-affirming care, including laser hair removal (53%), GAHT consultations (34%) and surgical referral (26%). Over half (62%) of clients eligible for HIV testing underwent screening, of whom 6% were newly diagnosed. Accessing &lt;i&gt;Mitr&lt;/i&gt; clinics for gender-affirming surgical services was significantly associated with HIV testing receipt (aOR: 1.51; 95% CI: 1.02, 2.25). Services provided by staff from the community were a prominent facilitator for HIV testing, while stigma and disclosure concerns were notable barriers. Among 585 clients interested in and eligible for PrEP, 576 (98%) initiated PrEP, and 378 (66%) were PrEP persistent at 3 months. Of 454 clients with HIV (newly diagnosed or previously known), 392 (86%) initiated ART. As of 30 September 2024, 233 (59%) were still receiving &lt;i&gt;Mitr&lt;/i&gt; clinic services and retained in HIV care; viral suppression was 98% among the 156 clients with data.&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;The &lt;i&gt;Mitr&lt;/i&gt; model highlights the importance of aligning programme and community priorities. The provision of gender-affirming care attracted many clients who might not otherwise have accessed HIV services; indeed, laser hair removal served as the ke","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237233","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":"Sustaining HIV prevention success in Australia through person-centred approaches","authors":"Benjamin R. Bavinton,&nbsp;James Gray,&nbsp;Andrew E. Grulich","doi":"10.1002/jia2.70007","DOIUrl":"https://doi.org/10.1002/jia2.70007","url":null,"abstract":"&lt;p&gt;Person-centred care is a critical element of HIV care. Global and country-level consensus statements, including from Australia, have emphasized holistic, rights-based approaches centring the autonomy, dignity, experiences, diverse needs, preferences and wellbeing of people living with HIV (PLHIV) [&lt;span&gt;1&lt;/span&gt;]. However, the focus has been on HIV care with less focus on person-centred prevention, despite its recent integration into the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal that 95% of individuals at risk of HIV will utilize “appropriate, person-centred, prioritised, and effective combination prevention options” by 2025 [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Drawing on the concept of person-centred care, person-centred HIV prevention [&lt;span&gt;3&lt;/span&gt;] prioritizes individuals – their autonomy, dignity, rights, decisions and experiences – over interventions or risk categories. It recognizes that individuals are best placed to determine suitable prevention methods, respecting their personal choice and agency. This approach acknowledges the dynamic nature of needs and choices, shaped by personal, contextual and structural factors, such as stigma, discrimination, criminalization and socio-economic conditions. It requires services to be appropriate, responsive and accessible, particularly for marginalized communities facing barriers to care.&lt;/p&gt;&lt;p&gt;Australia has achieved considerable success in HIV prevention, and has an ambitious goal to virtually eliminate HIV transmission by 2030 [&lt;span&gt;4&lt;/span&gt;]. In gay, bisexual and other men who have sex with men (GBMSM) in certain urban areas, reductions in HIV diagnoses are approaching the UNAIDS 2030 goal of a 90% reduction from a 2010 baseline [&lt;span&gt;5&lt;/span&gt;]. Nonetheless, disparities are evident, particularly among overseas-born GBMSM and those residing outside inner-city suburbs. While nationwide HIV diagnoses decreased by 54% in Australian-born GBMSM between 2010 and 2023, there was a 55% increase in migrant GBMSM, and by 2023, 59% of all GBMSM diagnoses were in migrants [&lt;span&gt;6&lt;/span&gt;]. Diagnoses among sex workers and people who use drugs are very low, and HIV rates are also very low among heterosexuals, though those born overseas are at higher risk [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Community and community-based organizations (CBOs) have long been integral to HIV prevention, and play an essential role in understanding, articulating and advocating for the needs and preferences of communities affected by HIV [&lt;span&gt;7&lt;/span&gt;]. Referred to in Australia as the “partnership approach” [&lt;span&gt;8&lt;/span&gt;], collaboration between community, government, policymakers, clinicians and researchers has ensured that communities affected by HIV are key players in decision-making. Despite occasional fluctuations, there has been sustained investment in Australia's HIV-focused CBOs, including support to diversify their remit to encompass broader elements of LGBTQ+ health, other blood-borne viruses and/or sexually transmitted infec","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237384","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":"“From an HCV and HIV point of view, it's been remarkable”: A qualitative study about using prescribed safer supply to support people who use drugs along the HIV and HCV prevention and treatment cascades in Ontario, Canada","authors":"Adrian Guta,&nbsp;Katherine Rudzinski,&nbsp;Marilou Gagnon,&nbsp;Rose A. Schmidt,&nbsp;Gillian Kolla,&nbsp;Danielle German,&nbsp;David Kryszajtys,&nbsp;Melissa Perri,&nbsp;Andrea Sereda,&nbsp;Christopher Sterling-Murphy,&nbsp;Carol Strike","doi":"10.1002/jia2.70038","DOIUrl":"https://doi.org/10.1002/jia2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SSPs supported HIV/HCV care by first addressing patients’ substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237105","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":"Person-centred HIV prevention in an era of innovation and uncertainties","authors":"Andrew Mujugira,&nbsp;Iskandar Azwa,&nbsp;Marie-Claude Lavoie","doi":"10.1002/jia2.70043","DOIUrl":"https://doi.org/10.1002/jia2.70043","url":null,"abstract":"&lt;p&gt;Person-centred care (PCC) is a healthcare approach that focuses on understanding and respecting clients’ preferences, values and beliefs. It aims to empower clients by actively involving them in their own care and highlighting the importance of effective communication and relationships between providers and clients [&lt;span&gt;1-3&lt;/span&gt;]. Person-centred health systems are widely endorsed in political and policy statements as essential for addressing health system challenges, promoting equity in access, delivering quality and effective care, and ensuring that no one is left behind [&lt;span&gt;4&lt;/span&gt;]. Despite widespread recognition of these PCC principles, current healthcare delivery models often fall short of these ideals because they tend to be disease-focused, fragmented and siloed, emphasising specific programmatic outputs, putting pressure on health workers and jeopardising client-centred care delivery [&lt;span&gt;5&lt;/span&gt;]. There is an urgent need to transition from disease-focused health systems to those centred on individuals because nearly half of the global population lacks equitable access to essential healthcare services.&lt;/p&gt;&lt;p&gt;This transformation requires innovative solutions that meet client needs while maintaining accessibility and continuity of care. Recent advances in HIV prevention, including long-acting injectables for pre-exposure prophylaxis (LAI-PrEP), create unprecedented opportunities for PCC. In 2024, the ground-breaking PURPOSE 1 trial reported 100% efficacy among young women receiving twice-yearly lenacapavir​ [&lt;span&gt;6&lt;/span&gt;]. Similarly, the PURPOSE 2 trial demonstrated that HIV incidence was 96% lower with lenacapavir compared to the background incidence [&lt;span&gt;7&lt;/span&gt;]. For the first time, individuals can choose from multiple PrEP options—pills, rings or injectables—that align with their sexual behaviours, needs, preferences and life circumstances. Health providers need to educate and counsel individuals about these options, providing evidence-based information about their effectiveness, side effects and requirements (such as adherence to daily dosing or injection schedule) to facilitate autonomous and informed decision-making.&lt;/p&gt;&lt;p&gt;HIV self-testing (HIVST) utilisation can be improved through PCC approaches and complement PrEP. A meta-analysis of 33 studies from around the globe found that HIVST kit distribution by sexual partners, peers or through online platforms achieved higher testing rates than facility-based testing [&lt;span&gt;8&lt;/span&gt;]. Significantly, it expanded testing coverage in key populations without reducing test accuracy or safety. Recent evidence suggests that HIVST streamlines HIV screening for people on PrEP and promotes PrEP uptake by individuals not accessing care. It can be leveraged to support PrEP initiation, continuation and re-engagement in care [&lt;span&gt;9&lt;/span&gt;]. Technological innovations, such as LAI-PrEP and HIVST, represent only one component of effective prevention. To maximise their effectiveness, i","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237235","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":"Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services","authors":"Jacob Busang,&nbsp;Nqobile Ngoma,&nbsp;Thembelihle Zuma,&nbsp;Carina Herbst,&nbsp;Nonhlanhla Okesola,&nbsp;Natsayi Chimbindi,&nbsp;Jaco Dreyer,&nbsp;Theresa Smit,&nbsp;Kristien Bird,&nbsp;Lucky Mtolo,&nbsp;Osee Behuhuma,&nbsp;Willem Hanekom,&nbsp;Kobus Herbst,&nbsp;Limakatso Lebina,&nbsp;Janet Seeley,&nbsp;Andrew Copas,&nbsp;Kathy Baisley,&nbsp;Maryam Shahmanesh","doi":"10.1002/jia2.70032","DOIUrl":"https://doi.org/10.1002/jia2.70032","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.&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;&lt;i&gt;Thetha Nami ngithethe nawe&lt;/i&gt; is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).&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;Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.&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;Community-based and person-centred approaches delivered thr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237385","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":"Harnessing digital health data for person-centred HIV prevention monitoring: a survey of national health information systems","authors":"Shona Dalal,&nbsp;Bradley Mathers,&nbsp;Dominik Stelzle,&nbsp;Lilly M. Nyagah,&nbsp;Francis Agbo,&nbsp;Dennis Annang,&nbsp;Saiprasad Prabhakar Bhavsar,&nbsp;Stone Mbiriyawanda,&nbsp;Bongiwe Mhlanga,&nbsp;Tshepo Molapo,&nbsp;Lowrence Moro,&nbsp;Peter Mudiope,&nbsp;Linea Ngwali,&nbsp;Mwiche Siame Nyirenda,&nbsp;Isabel Sathane,&nbsp;Rajatashuvra Adhikary,&nbsp;Monica Alonso Gonzalez,&nbsp;Polin Chan,&nbsp;Annette Gerritsen,&nbsp;Kiyohiko Izumi,&nbsp;Giorgi Kuchukhidze,&nbsp;Antons Mozalevskis,&nbsp;Georges Perrin,&nbsp;Ahmed S. Alaama,&nbsp;Madidimalo Tebogo,&nbsp;Annette Verster,&nbsp;Daniel Low-Beer","doi":"10.1002/jia2.70039","DOIUrl":"https://doi.org/10.1002/jia2.70039","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;Measuring HIV prevention impact is challenging because prevention is started and stopped as needed, and individual-level data availability has been suboptimal or not collected. WHO's 2022 &lt;i&gt;Consolidated guidelines on person-centred HIV strategic information&lt;/i&gt; aim to bridge this gap by recommending a minimum dataset for HIV prevention monitoring.&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 surveyed the availability of 42 HIV prevention data elements collected on an individual from WHO's recommended minimum dataset in 21 countries’ national health information systems during a Prevention Outcome Monitoring Workshop held in September 2024 in Gaborone, Botswana. Over 150 participants representing ministries of health and programme implementers from 21 countries in Africa and Asia, as well as representatives from global organizations, attended. National HIV prevention managers completed the survey covering: registration (client demographics, use of unique identification, key population status), HIV testing, HIV prevention and vertical transmission. Data element availability determined which prevention indicators each country could calculate. Additionally, we describe global data on the use of unique identification for key populations.&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 21 attending countries, 18 completed the survey. Fifteen countries (83%) used unique identification in their national health information systems. All 18 countries collected HIV testing data elements, while 14–18 countries (78–100%) collected those for vertical transmission. However, prevention data availability varied widely. Different data elements on pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) were collected by 13–17 (72–94%) countries, condoms by 15 (83%) and voluntary medical male circumcision by 11 (61%) countries. Data elements on harm reduction were available in 4–6 countries among 8–10 countries providing services. While all countries could calculate HIV testing indicators, around 90% could for vertical transmission, 50–94% for PrEP/PEP and 40–75% for harm reduction. Only two countries could calculate linkage to prevention, which incorporates all prevention interventions. Kenya was the only country that collected all recommended person-centred data elements. Overall, up to 37 of 105 reporting countries had a nationally harmonized personal unique identification method for key populations.&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;Data building blocks for HIV prevention exist in most n","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237237","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":"Empowering at-risk Thai adolescents and young adults: an observational study of “Stand By You” – a person-centred online service model for HIV self-screening, text-based counselling and linkage to care","authors":"Kantarida Sripanidkulchai,&nbsp;Supattra Rungmaitree,&nbsp;Yuitiang Durier,&nbsp;Theppharit Thiamprasert,&nbsp;Vitharon Boon-Yasidhi,&nbsp;Peerawong Werarak,&nbsp;Yenjit Somphoh,&nbsp;Pornvilai Urujchutchairut,&nbsp;Pichapun Pongsakul,&nbsp;Benjawan Khumcha,&nbsp;Alan Maleesatharn,&nbsp;Kulkanya Chokephaibulkit","doi":"10.1002/jia2.70040","DOIUrl":"https://doi.org/10.1002/jia2.70040","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;Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of Stand By You, a mobile application, in delivering HIV-related services to at-risk Thai AYAs.&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;Deidentified data from clients who accessed Stand By You services between August 2022 and February 2024 were analysed. HIV self-testing (HIVST) services were promoted through TikTok influencers to target AYAs vulnerable to HIV. An automated chatbot provided real-time responses to client inquiries, and trained counsellors provided confidential, text-based counselling daily. Clients who completed risk assessments received personalized recommendations for HIVST based on their risk profile. Clients who submitted their HIVST results received post-test counselling and linkage to care and prophylactic treatment. Multivariable logistic regression was used to assess risk factors for reactive HIVST kit results. The per unit direct cost of the programme's performance metrics were assessed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 8863 clients provided 11,536 risk assessments. The majority were male (76.3%), under the age of 30 (76.0%), identified as members of key populations (60.4%) and first-time testers (56.1%). Additionally, 27.8% had a history of sexually transmitted infections (3,202/11,536), 16.5% reported receiving money or incentives for sex (1908/11,536) and clients indicated an average of 2.6 sexual partners in the past month (SD 3.4). Out of 7585 submitted HIVST results, 3.6% were reactive (&lt;i&gt;n&lt;/i&gt; = 274); 60.2% were linked to care (&lt;i&gt;n&lt;/i&gt; = 165/274) and 10.4% are in the process of linkage (&lt;i&gt;n&lt;/i&gt; = 23/274). Of the 5.3% invalid results reported (&lt;i&gt;n&lt;/i&gt; = 401/7585), nearly all were non-reactive by the second HIVST (117/187). A history of testing HIV negative (adjusted odds ratio [aOR] 0.54 [95% CI 0.40–0.72], &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and receiving pre-exposure prophylaxis (aOR 0.20 [95% CI 0.06–0.64], &lt;i&gt;p&lt;/i&gt; = 0.007) were independently associated with reduced odds of a reactive result. Average direct cost was $18.7, $40.3 and $1100 USD per distributed HIVST kit, first-time tester and new client linked to care, respectively.&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;AYA populations at risk for HIV can be effectively reached through mobile phone applications that provide services anonymously. Online strategies for HIVST delivery and supportiv","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237236","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":"Enhancing PrEP adherence through person-centred mobile app interventions: a real-world data and machine learning approach using UPrEPU among gay, bisexual and other men who have sex with men in Taiwan","authors":"Jay Chiehen Liao,&nbsp;Huei-Jiuan Wu,&nbsp;Tsan-Tse Chuang,&nbsp;Tsai-Wei Chen,&nbsp;Carol Strong","doi":"10.1002/jia2.70033","DOIUrl":"https://doi.org/10.1002/jia2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that relies on good adherence in high-risk scenarios. To understand the factors that predict adherence, technology such as mobile applications like UPrEPU—allowing for logging users’ daily behaviours at close to the time they have sex or PrEP intake—can be used as a person-centred, self-care intervention. This study aims to develop a machine learning model using logs of sexual activities and user attributes recorded in the UPrEPU mobile application in Taiwan to predict whether a sexual event was protected by oral PrEP among gay, bisexual and other men who have sex with men (GBMSM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the UPrEPU app collected between January 2022 and May 2023 in Taiwan. The dataset included information on users’ sex events, such as the timing and users’ sex roles (e.g. versatile, receptive or insertive partner), and the dynamic user-based attributes related to sexual behaviours and PrEP use. Various subsets of these features were employed in CatBoost models to predict whether the sex events were associated with correct PrEP use. We evaluated the models’ performance using five-fold cross-validation. The influential features were identified through feature importance analysis and Shapley Additive Explanations (SHAP) values to explain the models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 198 users recorded 2356 anal sex events on UPrEPU. The model with dynamic user-based attributes outperformed those without them. The most parsimonious model had a good prediction performance (accuracy = 75%, precision = 78%, recall = 90%, F1-score = 83%) and identified the key features of PrEP protection. The model with five dynamic user-based attributes—age, cumulative PrEP use, condom use and the proportion of anal sex events with HIV-negative partners not on PrEP—significantly outperformed the model based on event-level attributes alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Behavioural patterns significantly influence PrEP adherence among GBMSM. Person-centred mobile applications such as UPrEPU provide valuable data for tailored, just-in-time interventions, enhancing adherence. Recognizing these patterns can guide person-centred interventions. Incorporating these insights into clinical care or digital tools may improve consultations and support timely, informed HIV prevention decisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237103","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}